title: Colorectal Cancer Screening in Vulnerable Patients: Promoting Informed and Shared Decisions.
abstract: Low-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.
  
  
  
  RCT with data collected from patients at baseline and immediately after the provider encounter.
  
  
  
  Patients 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).
  
  
  
  Participants viewed a CRC screening decision aid or a food safety (control) video immediately before their provider encounter.
  
  
  
  CRC screening-related knowledge, discussion, intent, test preferences, and test ordering.
  
  
  
  The 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%).
  
  
  
  Viewing 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.
  
  
  
  This study is registered at www.clinicaltrials.gov NCT02054598.
authors.affiliation: 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.
authors.forename: Alison T
authors.initials: AT
authors.lastname: Brenner
authors.affiliation: Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa.
authors.forename: Richard
authors.initials: R
authors.lastname: Hoffman
authors.affiliation: Department of Family Medicine, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Andrew
authors.initials: A
authors.lastname: McWilliams
authors.affiliation: 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.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Pignone
authors.affiliation: Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico; University of New Mexico Cancer Center, Albuquerque, New Mexico;
authors.forename: Robert L
authors.initials: RL
authors.lastname: Rhyne
authors.affiliation: Department of Family Medicine, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Hazel
authors.initials: H
authors.lastname: Tapp
authors.affiliation: Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Mark A
authors.initials: MA
authors.lastname: Weaver
authors.affiliation: University of New Mexico Cancer Center, Albuquerque, New Mexico;
authors.forename: Danelle
authors.initials: D
authors.lastname: Callan
authors.affiliation: Department of Family Medicine, Carolinas HealthCare System, Charlotte, North Carolina.
authors.forename: Brisa Urquieta
authors.initials: BU
authors.lastname: de Hernandez
authors.affiliation: Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina.
authors.forename: Khalil
authors.initials: K
authors.lastname: Harbi
authors.affiliation: 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. Electronic address: dreuland@med.unc.edu.
authors.forename: Daniel S
authors.initials: DS
authors.lastname: Reuland
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003657:Decision Making; D003661:Decision Support Techniques; D005260:Female; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000523:psychology*; D008875:Middle Aged; D035862:Vulnerable Populations / Q000208:ethnology / Q000523:psychology*