Colorectal Cancer Screening in Vulnerable Patients: Promoting Informed and Shared Decisions

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• 作者：Alison T. Brenner ; PhD¹ ; ² ; ³ ; Richard Hoffman ; MD ; MPH⁴ ; ⁵ ; Andrew McWilliams ; MD ; MPH⁶ ; Michael P. Pignone ; MD ; MPH¹ ; ² ; ³ ; Robert L. Rhyne ; MD ; MPH⁷ ; ⁸ ; Hazel Tapp ; PhD⁶ ; Mark A. Weaver ; PhD² ; ⁹ ; Danelle Callan ; MA⁸ ; Brisa Urquieta de Hernandez ; BUS⁶ ; Khalil Harbi ; MSPH¹ ; Daniel S. Reuland ; MD ; MPH¹ ; ² ; ³ ; ^{dreuland@med.unc.edu" class="auth_mail" title="E-mail the corresponding author}
• 刊名：American Journal of Preventive Medicine
• 出版年：2016
• 出版时间：October 2016
• 年：2016
• 卷：51
• 期：4
• 页码：454-462
• 全文大小：322 K

文摘

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.