title: Effectiveness of a web-based colorectal cancer screening patient decision aid: a randomized controlled trial in a mixed-literacy population.
abstract: BACKGROUND
  Colorectal cancer (CRC) screening reduces mortality yet remains underutilized. Low health literacy may contribute to this underutilization by interfering with patients' ability to understand and receive preventive health services.
  
  
  OBJECTIVE
  To determine if a web-based multimedia CRC screening patient decision aid, developed for a mixed-literacy audience, could increase CRC screening.
  
  
  METHODS
  RCT. Patients aged 50-74 years and overdue for CRC screening were randomized to the web-based decision aid or a control program seen immediately before a scheduled primary care appointment.
  
  
  METHODS
  A large community-based, university-affiliated internal medicine practice serving a socioeconomically disadvantaged population.
  
  
  METHODS
  Patients completed surveys to determine their ability to state a screening test preference and their readiness to receive screening. Charts were abstracted by masked observers to determine if screening tests were ordered and completed.
  
  
  RESULTS
  Between November 2007 and September 2008, a total of 264 patients enrolled in the study. Data collection was completed in 2009, and data analysis was completed in 2010. A majority of participants (mean age=57.8 years) were female (67%), African-American (74%), had annual household incomes of <$20,000 (76%), and had limited health literacy (56%). When compared to control participants, more decision-aid participants had a CRC screening preference (84% vs 55%, p<0.0001) and an increase in readiness to receive screening (52% vs 20%, p=0.0001). More decision-aid participants had CRC screening tests ordered (30% vs 21%) and completed (19% vs 14%), but no statistically significant differences were seen (AOR=1.6, 95% CI=0.97, 2.8, and AOR=1.7, 95% CI=0.88, 3.2, respectively). Similar results were found across literacy levels.
  
  
  CONCLUSIONS
  The web-based decision aid increased patients' ability to form a test preference and their intent to receive screening, regardless of literacy level. Further study should examine ways the decision aid can be combined with additional system changes to increase CRC screening.
authors.affiliation: General Internal Medicine, Wake Forest University School of Medicine, Medical Center Boulevard, Winston-Salem, NC 27157, USA. dmiller@wakehealth.edu
authors.forename: David P
authors.initials: DP
authors.lastname: Miller
authors.forename: John G
authors.initials: JG
authors.lastname: Spangler
authors.forename: L Doug
authors.initials: LD
authors.lastname: Case
authors.forename: David C
authors.initials: DC
authors.lastname: Goff
authors.forename: Sonal
authors.initials: S
authors.lastname: Singh
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pignone
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003661:Decision Support Techniques; D005260:Female; D057220:Health Literacy; D006801:Humans; D020407:Internet; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D057240:Patient Preference; D011320:Primary Health Care / Q000379:methods; D012959:Socioeconomic Factors