An entertainment‐education colorectal cancer screening decision aid for African American patients: A randomized controlled trial

Abstract

BACKGROUND Colorectal cancer screening rates for African American patients remain sub-optimal. Patient decision aids designed with an entertainment-education approach have been shown to improve saliency and foster informed decision making. The purpose of this investigation was to assess whether an entertainment-education decision aid tailored for African American patients improved patients’ decision making, attitudes, intentions, or colorectal cancer screening behavior. METHODS Eighty-nine participants were randomized to view a patient decision aid video containing culturally-tailored information about colorectal cancer screening options and theory-based support in decision making, presented in an entertainment-education format, or an attention-control video about hypertension that contained similarly-detailed information. Participants met with their clinician and then completed follow-up questionnaires assessing their knowledge, decisional conflict, self-advocacy, attitudes, perceived social norms, and intentions. At three months, completion of screening was assessed by chart review. RESULTS Viewing the culturally-tailored decision aid significantly increased African American patients’ knowledge of colorectal cancer screening recommendations and options. It also significantly reduced their decisional conflict and improved their self-advocacy. No significant differences were observed in participants’ attitudes, norms, or intentions. At three months, 23% of all patients had completed a colonoscopy. CONCLUSIONS Designing targeted, engaging patient decision aids for groups that receive sub-optimal screening holds promise for improving patient decision making and self-advocacy, and additional research is warranted to investigate their effectiveness in clinical practices with sub-optimal screening rates, and on downstream behaviors such as repeat testing.

Interventions for increasing colorectal cancer screening uptake among African-American men: A systematic review and meta-analysis

“…Slightly more than half (56%; n = 23) of the studies included only participants aged 50 years and older, while five (12%) included participants starting at age 45 years, three (7%) included participants younger than 45. Twelve of the studies (29.27%) reported demographics specific to African-American men [ 50 , 52 , 56 , 57 , 59 , 60 , 63 , 66 , 71 , 74 , 82 , 84 ]. In the studies aimed at increasing CRC screening uptake among African-American men, the intervention components most frequently employed (among 135 interventions types utilized) were telephone encounters or education (18%; n = 25), mailed or electronically sent educational materials (13%; n = 18), FIT or other CRC stool-based screening kits (mailed or administered in person) (13%; n = 17), patient navigation (10%; n = 13), and printed materials given to individuals in person (12%; n = 16).…”

“…Twenty-nine studies [ 45 , 46 , 48 , 50 – 52 , 54 – 66 , 69 , 71 , 73 – 75 , 77 , 79 – 81 , 83 , 84 ] in the RCT category were largely rated as unclear risk, yet 20 of the studies had low risk on random sequence generation (i.e., description of randomization procedure) [ 50 – 52 , 56 – 63 , 69 , 74 , 75 , 79 – 81 ]. The majority of the studies ( n = 13) did not explain or detail if any blinding of the participants and/or personnel in group allocation occurred, which included 18 studies with an unclear risk on allocation concealment [ 48 , 50 , 52 , 54 , 55 , 57 , 63 – 66 , 71 , 74 , 77 , 79 , 80 , 83 ]. Either listed as a supplement in the manuscript or published elsewhere, only 5 studies [ 50 , 57 , 58 , 61 , 80 ] reported their study protocol.…”

Eliciting vulnerable patients’ preferences regarding colorectal cancer screening: a systematic review

“…This review provides support for the use of decision aids among vulnerable sub-populations as a method of educating patients about their options and allowing patients to clarify their preferences regarding test features and screening modalities. 43 , 87 – 89 …”

Explanation and elaboration of the Standards for UNiversal reporting of patient Decision Aid Evaluations (SUNDAE) guidelines: examples of reporting SUNDAE items from patient decision aid evaluation literature

“… 23 Chart review at three months after the study visit confirmed colorectal cancer screening test orders and completion. 68 …”