Jennifer M. Griffith

The effect of offering different numbers of colorectal cancer screening test options in a decision aid: a pilot randomized trial

BackgroundDecision aids can improve decision making processes, but the amount and type of information that they should attempt to communicate is controversial. We sought to compare, in a pilot randomized trial, two colorectal cancer (CRC) screening decision aids that differed in the number of screening options presented.MethodsAdults ages 48–75 not currently up to date with screening were recruited from the community and randomized to view one of two versions of our previously tested CRC screening decision aid. The first version included five screening options: fecal occult blood test (FOBT), sigmoidoscopy, a combination of FOBT and sigmoidoscopy, colonoscopy, and barium enema. The second discussed only the two most frequently selected screening options, FOBT and colonoscopy. Main outcomes were differences in screening interest and test preferences between groups after decision aid viewing. Patient test preference was elicited first without any associated out-of-pocket costs (OPC), and then with the following costs: FOBT-

The uptake and effect of a mailed multi-modal colon cancer screening intervention: a pilot controlled trial.

10, sigmoidoscopy-

Effect of Adding a Values Clarification Exercise to a Decision Aid on Heart Disease Prevention: A Randomized Trial

50, barium enema-

Physicians' decisions about continuing or stopping colon cancer screening in the elderly: A qualitative study

50, and colonoscopy-

Individuals’ responses to global CHD risk: A focus group study

200.Results62 adults participated: 25 viewed the 5-option decision aid, and 37 viewed the 2-option version. Mean age was 54 (range 48–72), 58% were women, 71% were White, 24% African-American; 58% had completed at least a 4-year college degree. Comparing participants that viewed the 5-option version with participants who viewed the 2-option version, there were no differences in screening interest after viewing (1.8 vs. 1.9, t-test p = 0.76). Those viewing the 2-option version were somewhat more likely to choose colonoscopy than those viewing the 5-option version when no out of pocket costs were assumed (68% vs. 46%, p = 0.11), but not when such costs were imposed (41% vs. 42%, p = 1.00).ConclusionThe number of screening options available does not appear to have a large effect on interest in colorectal cancer screening. The effect of offering differing numbers of options may affect test choice when out-of-pocket costs are not considered.

Assessment of an Interactive Computer-Based Patient Prenatal Genetic Screening and Testing Education Tool

BackgroundWe sought to determine whether a multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing direct access to scheduling screening tests through standing orders, would be an effective and efficient means of promoting colon cancer screening in primary care practice.MethodsWe conducted a controlled trial comparing the proportion of intervention patients who received colon cancer screening with wait list controls at one practice site. The intervention was a mailed package that included a letter from their primary care physician, a colon cancer screening decision aid, and instructions for obtaining each screening test without an office visit so that patients could access screening tests directly. Major outcomes were screening test completion and cost per additional patient screened.ResultsIn the intervention group, 15% (20/137) were screened versus 4% (4/100) in the control group (difference 11%; (95%; CI 3%;18% p = 0.01). The cost per additional patient screened was estimated to be

Should a colon cancer screening decision aid include the option of no testing? A comparative trial of two decision aids

94.ConclusionA multi-modal intervention, which included mailing a patient reminder with a colon cancer decision aid to patients and system changes allowing patients direct access to schedule screening tests, increased colon cancer screening test completion in a subset of patients within a single academic practice. Although the uptake of the decision aid was low, the cost was also modest, suggesting that this method could be a viable approach to colon cancer screening.

Resident Physicians∍ Life Expectancy Estimates and Colon Cancer Screening Recommendations in Elderly Patients

Background. Experts have called for the inclusion of values clarification (VC) exercises in decision aids (DAs) as a means of improving their effectiveness, but little research has examined the effects of such exercises. Objective. To determine whether adding a VC exercise to a DA on heart disease prevention improves decision-making outcomes. Design. Randomized trial. Setting. UNC Decision Support Laboratory. Patients. Adults ages 40 to 80 with no history of cardiovascular disease. Intervention. A Web-based heart disease prevention DA with or without a VC exercise. Measurements. Pre- and postintervention decisional conflict and intent to reduce coronary heart disease (CHD) risk and postintervention self-efficacy and perceived values concordance. Results. The authors enrolled 137 participants (62 in DA; 75 in DA + VC with moderate decisional conflict (DA 2.4; DA + VC 2.5) and no baseline differences among groups. After the interventions, they found no clinically or statistically significant differences between groups in decisional conflict (DA 1.8; DA + VC 1.9; absolute difference VC—DA 0.1, 95% confidence interval [CI]: —0.1 to 0.3), intent to reduce CHD risk (DA 98%; DA + VC 100%; absolute difference VC—DA: 2%, 95% CI: —0.02% to 5%), perceived values concordance (DA 95%; DA + VC 92%; absolute difference VC—DA —3%, 95% CI: —11% to +5%), or self-efficacy for risk reduction (DA 97%; DA + VC 92%; absolute difference VC—DA —5%, 95% CI: —13% to +3%). However, DA + VC tended to change some decisions about risk reduction strategies. Limitations. Use of a hypothetical scenario; ceiling effects for some outcomes. Conclusions. Adding a VC intervention to a DA did not further improve decision-making outcomes in a population of highly educated and motivated adults responding to scenario-based questions. Work is needed to determine the effects of VC on more diverse populations and more distal outcomes.

Two controlled trials to determine the effectiveness of a mailed intervention to increase colon cancer screening.

ABSTRACTBACKGROUNDExperts suggest an individualized approach to colon cancer screening to take into account variation in older adults’ life expectancies and potential to benefit from screening. However, little is known about how physicians make decisions about colon cancer screening in adults age 75 and older.OBJECTIVETo understand whether physicians employ individualized decision making for colon cancer screening in older adults, and, if so, to determine the individual factors they believed were important to consider in making such decisions.DESIGNQualitative research using focus groups and individual interviewsPARTICIPANTSFifteen primary care physicians practicing in community settings participated in three focus groups and two interviews.APPROACHWe used two clinical vignettes of 78-year-old women in fair and poor health states to stimulate discussions about clinical decision making for CRC screening in older adults.RESULTSPhysicians considered a wide range of factors, including clinical factors, such as age, life expectancy, co-morbidities, and functional status, as well as individual factors, such as personality, previous screening behavior, family support, and the relationship with the patient. Physicians reported difficulty with these decisions because of their complexity and because they involve life expectancy estimates. Their approach and discussion with patients seemed to be dependent on the degree of certainty they perceived regarding their clinical assessment as to whether the patient had the potential to benefit from screening.CONCLUSIONSColorectal cancer screening decision making is complex. Physicians reported using a range of clinical and individual factors to decide about colorectal cancer screening in older adults.

Development of an interactive computer-assisted instruction (ICAI) program for patient prenatal genetic screening and carrier testing for use in clinical settings

OBJECTIVE To explore how individuals respond to global coronary heart disease (CHD) risk and use it in combination with treatment information to make decisions to initiate and maintain risk reducing strategies. METHODS We conducted four focus groups of individuals at risk for CHD (n=29), purposively sampling individuals with each of several risk factors. Two reviewers coded verbatim transcripts and arbitrated differences, using ATLAS.ti 5.2 to facilitate analysis. RESULTS Participants generally regarded the concept of global CHD risk as useful and motivating, although had questions about its precision and comprehensiveness. They identified several additional influential factors in decision-making (e.g. achievable risk, the quickness and self-evidence of results) and generally preferred lifestyle changes to medications (although most would accept medications under certain circumstances). They also noted the importance of participating in decision-making. CONCLUSION Our results underscore the motivating potential of global CHD risk and the importance of patient participation in decision-making. PRACTICE IMPLICATIONS Global CHD risk is a useful adjunct to CHD prevention and can be presented in ways, and with information, that might improve CHD outcomes.