Aid-Assisted Decision Making and Colorectal Cancer Screening

Schroy, Paul C.; Emmons, Karen M.; Peters, Ellen; Glick, Julie T.; Robinson, Patricia A.; Lydotes, Maria A.; Mylvaganam, Shamini R.; Coe, Alison; Chen, Clara A.; Chaisson, Christine E.; Pignone, Michael; Prout, Marianne N.; Davidson, Peter; Heeren, Timothy

doi:10.1016/j.amepre.2012.08.018

Cited by 66 publications

(82 citation statements)

References 44 publications

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“…[18][19][20][21][22][23][24][25][26][27][28][29][30][31][32][33][34][35][36] Two of the articles described different outcomes from one RCT. 31,32 Thus, we considered these two papers one intervention, resulting in a total of 18 interventions with data. The results describe select studies from our review that highlight the types of health conditions, populations studied, DA type and delivery mode, and cultural tailoring used.…”

Section: Resultsmentioning

confidence: 99%

Use of Decision Aids with Minority Patients: a Systematic Review

et al. 2016

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BACKGROUND:One potential approach to reducing health disparities among minorities is through the promotion of shared decision making (SDM). The most commonly studied SDM intervention is the decision aid (DA). While DAs have been extensively studied, we know relatively little about their use in minority populations. We conducted a systematic review to characterize the application and effectiveness of DAs in racial, ethnic, sexual, and gender minorities. METHODS: We searched PubMed for randomized controlled trials (RCTs) evaluating DAs between 2004 and 2013. We included trials that enrolled adults (> 18 years of age) with > 50 % representation by minority patients. Four reviewers independently assessed 597 initially identified articles, and those with inconclusive results were discussed to consensus. We abstracted decision quality, patient-doctor communication, and clinical treatment decision outcomes. Results were considered significantly modified by the DA if the study reported p < 0.05. RESULTS: We reviewed 18 RCTs of DA interventions in minority populations. The majority of interventions (78 %) addressed cancer screening. The most common mode of delivery for the DAs was personal counseling (46 %), followed by multi-media (29 %), and print materials (25 %). Most of the trials studied racial (78 %) or ethnic (17 %) minorities with only one trial focused on sexual minorities and none on gender minorities. Ten studies tailored their interventions for their minority populations. Comparing intervention vs. control, decision quality outcomes improved in six out of eight studies and patient-doctor communication improved in six out of seven studies. Of the 15 studies that reported on clinical decisions, eight demonstrated significant changes in decisions with DAs. DISCUSSION: DAs have been effective in improving patient-doctor communication and decision quality outcomes in minority populations and could help address health disparities. However, the existing literature is almost non-existent for sexual and gender minorities and has not included the full breadth of clinical decisions that affect minority populations.KEY WORDS: shared decision making; disparities; race and ethnicity; minority health; systematic reviews; medical decision making.

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Section: Resultsmentioning

confidence: 99%

Use of Decision Aids with Minority Patients: a Systematic Review

et al. 2016

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“…21,29 Pre-visit patient-level interventions in patients of lower socioeconomic status, which have been effective in increasing CRC screening discussions/recommendations, include activation counseling, 31,32 computer-delivered tailored intervention 33 and decision aids. 34 Modest increases (7-27 %) in CRC discussions and/or recommendations with these interventions have been reported. [31][32][33][34] Our current study is unique in targeting both physicians and patients; few prior studies have done so.…”

Section: Discussionmentioning

confidence: 99%

“…34 Modest increases (7-27 %) in CRC discussions and/or recommendations with these interventions have been reported. [31][32][33][34] Our current study is unique in targeting both physicians and patients; few prior studies have done so. 21,35,36 Aragones et al recently showed that a CRC educational video and brochure in Spanish and a patient-delivered physician reminder was associated with a trend toward an increase in physician CRC recommendation rate and a significant increase in CRC test completion.…”

Section: Discussionmentioning

confidence: 99%

The Effectiveness of a Physician-Only and Physician–Patient Intervention on Colorectal Cancer Screening Discussions Between Providers and African American and Latino Patients

et al. 2015

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BACKGROUND: Physician recommendation of colorectal cancer (CRC) screening is a critical facilitator of screening completion. Providing patients a choice of screening options may increase CRC screening completion, particularly among racial and ethnic minorities. OBJECTIVE: Our purpose was to assess the effectiveness of physician-only and physician-patient interventions on increasing rates of CRC screening discussions as compared to usual care. DESIGN: This study was quasi-experimental. Clinics were allocated to intervention or usual care; patients in intervention clinics were randomized to receipt of patient intervention. PARTICIPANTS: Patients aged 50 to 75 years, due for CRC screening, receiving care at either a federally qualified health care center or an academic health center participated in the study. INTERVENTION: Intervention physicians received continuous quality improvement and communication skills training. Intervention patients watched an educational video immediately before their appointment. MAIN MEASURES: Rates of patient-reported 1) CRC screening discussions, and 2) discussions of more than one screening test. KEY RESULTS: The physician-patient intervention (n=167) resulted in higher rates of CRC screening discussions compared to both physician-only intervention (n=183; 61.1 % vs.50.3 %, p=0.008) and usual care (n=153; 61.1 % vs. 34.0 % p=0.03). More discussions of specific CRC screening tests and discussions of more than one test occurred in the intervention arms than in usual care (44.6 % vs. 22.9 %,p=0.03) and (5.1 % vs. 2.0 %, p=0.036), respectively, but discussion of more than one test was uncommon. Across all arms, 143 patients (28.4 %) reported discussion of colonoscopy only; 21 (4.2 %) reported discussion of both colonoscopy and stool tests. CONCLUSIONS:Compared to usual care and a physician-only intervention, a physician-patient intervention increased rates of CRC screening discussions, yet discussions overwhelmingly focused solely on colonoscopy. In underserved patient populations where access to colonoscopy may be limited, interventions encouraging discussions of both stool tests and colonoscopy may be needed.KEY WORDS: colorectal cancer screening; health literacy; randomized trial; physician communication of preventive care.

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Section: Introductionmentioning

confidence: 99%

“…Shared decision-making processes assisted by decision aids increase colorectal screening uptake, reduce decisional conflict by helping patients identify a preferred screening option, and enhance patient knowledge and satisfaction [7,8]. Although these interventions have increased colorectal cancer screening, the overall impact was relatively modest with no effect on further implementation of shared decision-making processes in cancerscreening practices [8,9]. While 70% of patients preferred to engage in shared decision making for preventive health decisions, only 47% indicated that a shared decision-making process occurred during their visit for colorectal cancer screening [9], thus indicating a lack of concordance between patient preferences for shared decision making and the colorectal cancer screening process [9].…”

Section: Introductionmentioning

confidence: 99%

The Impact of Screening, Medical Treatment and Invasive Interventions on Patients' Medical Decision-Making Styles: A Cross-Sectional Study with Inferences to the United States Population

Maldonato¹,

Sperandeo²,

Orco³

et al. 2017

J Psychol Psychother

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Background: Although positive benefits are associated with shared decision making, no previous studies have evaluated the impact of condition on how shared decision making is implemented.Objective: To compare decision-making preferences across three conditions associated with screening, medical treatment, and invasive interventions: Screening tests for colorectal cancer, initiation of prescription medication for hypertension, and surgical treatment for hip or knee osteoarthritis. Methods:We made use of the publicly available National Survey of Medical Decisions (the DECISIONS study) data and our sample comprised of all subjects who completed the following three specific modules of the decisions study: Colorectal cancerscreening tests, high blood-pressure medication, and knee or hip replacement surgery. Our primary outcomes of interest were (1) Who made the final decision? (2) Extent of patients' involvement in the decision, and (3) How confident they were about their decision.Results: When comparing baseline characteristics across the three conditions, the group undergoing screening was youngest with a mean age of 58.7 years compared to the medication group (61.27 years), while the group undergoing surgery was oldest (63.14 years). Females constituted over half of all three groups (greater than 50%). In the invasive interventions, decisions were made mainly by the patients, unlike the other groups where shared decision making was predominant. Most patients in all three groups preferred high levels of participation in decision making. Patients undergoing surgery were significantly more likely to have greater confidence in their decisions, followed by patients with medication for hypertension. Conclusion:Shared decision making is less predominant among invasive interventions. Further research should describe the reasons for the limited use of shared decisions among conditions with invasive interventions, along with its consequences for healthcare quality.

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Aid-Assisted Decision Making and Colorectal Cancer Screening

Cited by 66 publications

References 44 publications

Use of Decision Aids with Minority Patients: a Systematic Review

Use of Decision Aids with Minority Patients: a Systematic Review

The Effectiveness of a Physician-Only and Physician–Patient Intervention on Colorectal Cancer Screening Discussions Between Providers and African American and Latino Patients

The Impact of Screening, Medical Treatment and Invasive Interventions on Patients' Medical Decision-Making Styles: A Cross-Sectional Study with Inferences to the United States Population

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