Does informed consent alter elderly patients' preferences for colorectal cancer screening? Results of a randomized trial.
OBJECTIVE
To assess the impact of informed consent on elderly patients' colorectal cancer (CRC) screening preferences.


METHODS
Randomized, controlled trial.


METHODS
Four general internal medicine practices.


METHODS
We studied 399 elderly patients visiting their primary care provider for routine office visits.


METHODS
Patients were randomized to receive either a scripted control message briefly describing CRC screening methods or one of two informational interventions simulating an informed consent presentation about CRC screening. One intervention described CRC mortality risk reduction in relative terms; the other, in absolute terms.


RESULTS
The main outcome measure was intent to begin or continue fecal occult blood testing (FOBT), flexible sigmoidoscopy, or both. There was no difference in screening interest between the control group and the two information groups (p =.8). The majority (63%) of patients intended to begin or continue CRC screening. Informed patients were able to gauge more accurately the positive predictive value of screening (p =.0009). Control patients rated the efficacy of screening higher than did patients receiving relative risk reduction information, who rated it higher than did patients receiving absolute risk reduction information (p =.0002).


CONCLUSIONS
Elderly patients appeared to understand CRC screening information and use it to gauge the efficacy of screening, but provision of information had no impact on their preferences for screening. In view of the large proportion who preferred not to be screened, we conclude that elderly patients should be involved in the screening decision. However, factors other than provision of information must determine their CRC screening preferences.
Wolf
A M
AM
Department of Medicine, University of Virginia School of Medicine, Charlottesville, VA 22908, USA. aw6a@virginia.edu
Schorling
J B
JB
D000368:Aged; D015179:Colorectal Neoplasms / Q000517:prevention & control*; D003657:Decision Making; D005260:Female; D006801:Humans; D007258:Informed Consent; D008297:Male; D009780:Occult Blood; D011237:Predictive Value of Tests; D012812:Sigmoidoscopy