Randomized controlled trial of a patient decision aid for colorectal cancer screening

Abstract

Purpose: To conduct a pilot test of a decision aid designed to help patients choose among currently recommended colorectal cancer screening programs.

Methods: Randomized controlled trial comparing a patient decision aid based on multicriteria decision-making theory with a simple educational intervention.

Patient population: 96 patients at average risk for colorectal cancer seen in an Internal Medicine practice in Rochester, New York.

Outcome measures: The two primary outcome measures were patient decision process and the decision outcome. Patient decision process was assessed using the decisional conflict scale. Decision outcome was defined as the proportion of colorectal cancer screening plans carried out.

Results: After controlling for the effects of the physicians in a factorial analysis of variance, patients who used the decision aid had lower decisional conflict regarding colorectal cancer screening decisions (F ratio 6.47, P = 0.01) due to increased knowledge, better clarity of values, and higher ratings of the quality of the decisions they made. There was no difference between the groups in decision outcomes: 52% of patients in the control group and 49% in the experimental group completed planned screening tests (P = 1.0).

Conclusions: In a pilot study, a multicriteria-based patient decision aid for colorectal cancer screening improved patients' decision-making processes but had no effect on the implementation of screening plans.