• Alison T Brenner, Richard Hoffman, Andrew McWilliams, Michael P Pignone, Robert L Rhyne, Hazel Tapp, Mark A Weaver, Danelle Callan, Brisa Urquieta de Hernandez, Khalil Harbi, and Daniel S Reuland.
• Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina; Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina.
• Am J Prev Med. 2016 Oct 1; 51 (4): 454-62.

IntroductionLow-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 DesignRCT with data collected from patients at baseline and immediately after the provider encounter.Setting/ParticipantsPatients 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).InterventionParticipants viewed a CRC screening decision aid or a food safety (control) video immediately before their provider encounter.Main Outcome MeasuresCRC screening-related knowledge, discussion, intent, test preferences, and test ordering.ResultsThe 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%).ConclusionsViewing 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 RegistrationThis study is registered at www.clinicaltrials.gov NCT02054598.Copyright © 2016 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

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