Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice.
BACKGROUND
Although colorectal cancer screening is recommended by major policy-making organizations, rates of screening remain low. Our aim was to develop a patient-directed, computer-based decision aid about colorectal cancer screening and investigate whether it could increase patient interest in screening.


METHODS
We used content from evidence-based literature reviews and our previous decision aid research to develop a prototype. We performed two rounds of usability testing with representative patients to revise the content and format. The final decision aid consisted of an introductory segment, four test-specific segments, and information to allow comparison of the tests across several key parameters. We then conducted a before-after uncontrolled trial of 80 patients 50-75 years old recruited from an academic internal medicine practice.


RESULTS
Mean viewing time was 19 minutes. The decision aid improved patients' intent to ask providers for screening from a mean score of 2.8 (1 = not at all likely to ask, 4 = very likely to ask) before viewing the decision aid to 3.2 afterwards (difference, 0.4; p < 0.0001, paired t-test). Most found the aid useful and reported that it improved their knowledge about screening. Sixty percent said they were ready to be tested, 18% needed more information, and 22% were not ready to be screened. Within 6 months of viewing, 43% of patients had completed screening tests.


CONCLUSIONS
We conclude that a computer-based decision aid can increase patient intent to be screened and increase interest in screening.


CONCLUSIONS
This decision aid can be viewed by patients prior to provider appointments to increase motivation to be screened and to help them decide about which modality to use for screening. Further work is required to integrate the decision aid with other practice change strategies to raise screening rates to target levels.
Kim
Jane
J
Preventive Medicine Residency Program, University of North Carolina, Chapel Hill, NC, USA. kim00057@notes.duke.edu
Whitney
Annie
A
Hayter
Sarah
S
Lewis
Carmen
C
Campbell
Marci
M
Sutherland
Lisa
L
Fowler
Beth
B
Googe
Sue
S
McCoy
Regina
R
Pignone
Michael
M
D000046:Academic Medical Centers; D000368:Aged; D003113:Colonoscopy / Q000379:methods / Q000706:statistics & numerical data; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003194:Computer-Assisted Instruction; D003661:Decision Support Techniques; D005260:Female; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D007388:Internal Medicine; D008297:Male; D008403:Mass Screening / Q000379:methods / Q000706:statistics & numerical data*; D008875:Middle Aged; D009042:Motivation; D009657:North Carolina; D017063:Outcome Assessment, Health Care; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D010353:Patient Education as Topic / Q000379:methods*; D011320:Primary Health Care