title: Aid-assisted decision making and colorectal cancer screening: a randomized controlled trial.
abstract: BACKGROUND
  Shared decision making (SDM) is a widely recommended yet unproven strategy for increasing colorectal cancer (CRC) screening uptake. Previous trials of decision aids to increase SDM and CRC screening uptake have yielded mixed results.
  
  
  OBJECTIVE
  To assess the impact of decision aid-assisted SDM on CRC screening uptake.
  
  
  METHODS
  RCT.
  
  
  METHODS
  The study was conducted at an urban, academic safety-net hospital and community health center between 2005 and 2010. Participants were asymptomatic, average-risk patients aged 50-75 years due for CRC screening.
  
  
  METHODS
  Study participants (n=825) were randomized to one of two intervention arms (decision aid plus personalized risk assessment or decision aid alone) or control arm. The interventions took place just prior to a routine office visit with their primary care providers.
  
  
  METHODS
  The primary outcome was completion of a CRC screening test within 12 months of the study visit. Logistic regression was used to identify predictors of test completion and mediators of the intervention effect. Analysis was completed in 2011.
  
  
  RESULTS
  Patients in the decision-aid group were more likely to complete a screening test than control patients (43.1% vs 34.8%, p=0.046) within 12 months of the study visit; conversely, test uptake for the decision aid and decision aid plus personalized risk assessment arms was similar (43.1% vs 37.1%, p=0.15). Assignment to the decision-aid arm (AOR=1.48, 95% CI=1.04, 2.10), black race (AOR=1.52, 95% CI=1.12, 2.06) and a preference for a patient-dominant decision-making approach (AOR=1.55, 95% CI=1.02, 2.35) were independent determinants of test completion. Activation of the screening discussion and enhanced screening intentions mediated the intervention effect.
  
  
  CONCLUSIONS
  Decision aid-assisted SDM has a modest impact on CRC screening uptake. A decision aid plus personalized risk assessment tool is no more effective than a decision aid alone.
  
  
  BACKGROUND
  This study is registered at www.clinicaltrials.govNCT00251862.
authors.affiliation: Department of Medicine, Boston University, Boston, MA, USA. paul.schroy@bmc.org
authors.forename: Paul C
authors.initials: PC
authors.lastname: Schroy
authors.forename: Karen M
authors.initials: KM
authors.lastname: Emmons
authors.forename: Ellen
authors.initials: E
authors.lastname: Peters
authors.forename: Julie T
authors.initials: JT
authors.lastname: Glick
authors.forename: Patricia A
authors.initials: PA
authors.lastname: Robinson
authors.forename: Maria A
authors.initials: MA
authors.lastname: Lydotes
authors.forename: Shamini R
authors.initials: SR
authors.lastname: Mylvaganam
authors.forename: Alison M
authors.initials: AM
authors.lastname: Coe
authors.forename: Clara A
authors.initials: CA
authors.lastname: Chen
authors.forename: Christine E
authors.initials: CE
authors.lastname: Chaisson
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pignone
authors.forename: Marianne N
authors.initials: MN
authors.lastname: Prout
authors.forename: Peter K
authors.initials: PK
authors.lastname: Davidson
authors.forename: Timothy C
authors.initials: TC
authors.lastname: Heeren
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003151:Community Health Centers; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006786:Hospitals, Urban; D006801:Humans; D016015:Logistic Models; D008297:Male; D008403:Mass Screening / Q000379:methods*; D008875:Middle Aged; D010342:Patient Acceptance of Health Care; D018570:Risk Assessment / Q000379:methods