Colorectal Cancer Screening in Vulnerable Patients

Abstract

Introduction Low-income, low-literacy, limited English–proficient populations have low colorectal cancer (CRC) screening rates and experience poor patient–provider communication and decision-making processes around screening. The purpose of this study was to test the effect of a CRC screening decision aid on screening-related communication and decision making in primary care visits. Study design RCT with data collected from patients at baseline and immediately after the provider encounter. Setting/participants Patients aged 50–75 years, due for CRC screening, were recruited from two safety net clinics in North Carolina and New Mexico (data collection, January 2014–September 2015; analysis, 2015). Intervention Participants viewed a CRC screening decision aid or a food safety (control) video immediately before their provider encounter. Main outcome measures CRC screening–related knowledge, discussion, intent, test preferences, and test ordering. Results The study population (N=262) had a mean age of 58.3 years and was 66% female, 61% Latino, 17% non-Latino black, and 16% non-Latino white. Among Latino participants, 71% preferred Spanish. Compared with controls, intervention participants had greater screening-related knowledge (on average 4.6 vs 2.8 of six knowledge items correct, adjusted difference [AD]=1.8, 95% CI=1.5, 2.1) and were more likely to report screening discussion (71.0% vs 45.0%, AD=26.1%, 95% CI=14.3%, 38.0%) and high screening intent (93.1% vs 84.7%, AD=9.0%, 95% CI=2.0%, 16.0%). Intervention participants were more likely to indicate a specific screening test preference (93.1% vs 68.0%, AD=26.5%, 95% CI=17.2%, 35.8%) and to report having a test ordered (56.5% vs 32.1%, AD=25.8%, 95% CI=14.4%, 37.2%). Conclusions Viewing a CRC screening decision aid before a primary care encounter improves knowledge and shared decision making around screening in a racially, ethnically, and linguistically diverse safety net clinic population. Trial registration This study is registered at www.clinicaltrials.gov NCT02054598.

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

“…Twenty-seven articles reported CRC screening preferences for a single or multiple racial/ethnic minority groups ( Table 2 ). 42 – 68 Out of these studies, nine were conducted among African Americans,42,44,48,49,54,57–59,61 five among Hispanics/Latinos, 47 , 53 , 55 , 62 , 68 eight among both African Americans and Hispanics/Latinos, 43 , 45 , 50 , 51 , 63 – 66 four among non-whites, 46 , 56 , 60 , 67 and one among Korean Americans. 52 Race was self-reported in nearly all of these articles, except for a study in which recruitment was conducted at a community-based organization serving Korean Americans, 52 a study that used health insurance claims data with enrollment database-reported race/ethnicity, 59 and a study that did not clearly specify how race/ethnicity was obtained.…”

Testing a Culturally Adapted Colorectal Cancer Screening Decision Aid Among American Indians: Results from a Pre–Post Trial

“…We used a measure of screening preferences from prior studies. 24 Participants were asked, ''If you had to choose a colon cancer screening test, which test would you prefer?'' with multiple choice response options of the different tests (i.e., FOBT/FIT and colonoscopy) and options to indicate they had no preference or did not have enough information to decide.…”

The LEAD trial - the effectiveness of a decision aid on decision making among citizens with lower educational attainment who have not participated in FIT-based colorectal cancer screening in Denmark: study protocol for a randomized controlled trial

“…and they may encourage readers to reflect on the information in a structured way, for example by the means of “values clarification exercises” [ 8 ]. Studies have shown that decision aids can increase CRC knowledge and the proportion of citizens making an informed decision about screening uptake when used by citizens and healthcare professionals together [ 9 , 10 ]. Furthermore, they can increase screening uptake [ 11 – 15 ].…”

“…Tailoring a decision aid to this group could be advantageous, but their information needs are diverse, ranging from a desire for a clear recommendation to the need to know all the details [ 25 ]. Decision aids tailored to this group do exist [ 9 , 10 , 13 ], but are not self-administered [ 19 ], and none of them embrace diverse information and support needs. Hence, this research group has developed a decision aid tailored for lower educational attainment citizens [ 26 ].…”