• Carmen L Lewis, Christine E Kistler, Alexandra F Dalton, Carolyn Morris, Renée Ferrari, Colleen Barclay, Noel T Brewer, Rowena Dolor, Russell Harris, Maihan Vu, and Carol E Golin.
• Division of General Internal Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA.
• Med Decis Making. 2018 Jul 1; 38 (5): 614-624.

BackgroundConcerns have been raised about both over- and underutilization of colorectal cancer (CRC) screening in older patients and the need to align screening behavior with likelihood of net benefit.ObjectiveThe purpose of this study was to test a novel use of a patient decision aid (PtDA) to promote appropriate CRC screening in older adults.MethodsA total of 424 patients ages 70 to 84 y who were not up to date with CRC screening participated in a double-blinded randomized controlled trial of a PtDA targeted to older adults making decisions about whether to undergo CRC screening from March 2012 to February 2015.InterventionPatients were randomized to a targeted PtDA or an attention control. The PtDA was designed to facilitate individualized decision making-helping patients understand the potential risks, benefits, and uncertainties of CRC screening given advanced age, health state, preferences, and values.OutcomesTwo composite outcomes, appropriate CRC screening behavior 6 mo after the index visit and appropriate screening intent immediately after the visit, were defined as completed screening or intent for patients in good health, discussion about screening with their provider for patients in intermediate health, and no screening or intent for patients in poor health. Health state was determined by age and Charlson Comorbidity Index.ResultsFour hundred twelve (97%) and 421 (99%) patients were analyzed for the primary and secondary outcomes, respectively. Appropriate screening behavior at 6 mo was higher in the intervention group (55% v. 45%, P = 0.023) as was appropriate screening intent following the provider visit (61% v. 47%, P = 0.003).LimitationsThe study took place in a single geographic region. The appropriate CRC screening classification system used in this study has not been formally validated.ConclusionsA PtDA for older adults promoted appropriate CRC screening behavior and intent.Trial RegistrationClinicaltrials.gov, registration number NCT01575990. https://clinicaltrials.gov/ct2/show/NCT01575990?term=epic-d&rank=1.

25 keywords...

hide…