Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2011 Jun;40(6):608-15.
doi: 10.1016/j.amepre.2011.02.019.

Effectiveness of a web-based colorectal cancer screening patient decision aid: a randomized controlled trial in a mixed-literacy population

David P Miller Jr  1 , John G Spangler, L Doug Case, David C Goff Jr, Sonal Singh, Michael P Pignone
Affiliations
Randomized Controlled Trial

Effectiveness of a web-based colorectal cancer screening patient decision aid: a randomized controlled trial in a mixed-literacy population

David P Miller Jr et al. Am J Prev Med. 2011 Jun.

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.

Purpose: To determine if a web-based multimedia CRC screening patient decision aid, developed for a mixed-literacy audience, could increase CRC screening.

Design: 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.

Setting/participants: A large community-based, university-affiliated internal medicine practice serving a socioeconomically disadvantaged population.

Main outcome measures: 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.

Trial registration: ClinicalTrials.gov NCT00558233.

PubMed Disclaimer

Figures

Figure 1
Figure 1
Representative screen shot from CHOICE program. All written text is read aloud by a narrator. Patients interact with the program via a touch-screen monitor. The full decision aid may be viewed at http://intmedweb.wfubmc.edu/choice/choice.html.
Figure 2
Figure 2
Patient enrollment and randomization a One patient allocated to CHOICE did not interact with the program due to a computer malfunction. PCP, primary care provider
See this image and copyright information in PMC

References

    1. Jemal A, Siegel R, Xu J, Ward E. Cancer Statistics, 2010. CA Cancer J Clin. 2010;60(5):277–300. - PubMed
    1. Levin B, Lieberman DA, McFarland B, Smith RA, Brooks D, Andrews KS, et al. Screening and surveillance for the early detection of colorectal cancer and adenomatous polyps, 2008: a joint guideline from the American Cancer Society, the U.S. Multi-Society Task Force on Colorectal Cancer, and the American College of Radiology. CA Cancer J Clin. 2008;58(3):130–160. - PubMed
    1. Screening for colorectal cancer: U.S. Preventive Services Task Force recommendation statement. Ann Intern Med. 2008;149(9):627–637. - PubMed
    1. Pignone M, Saha S, Hoerger T, Mandelblatt J. Cost-effectiveness analyses of colorectal cancer screening: a systematic review for the U.S. Preventive Services Task Force. Ann Intern Med. 2002;137(2):96–104. - PubMed
    1. Vital signs: colorectal cancer screening among adults aged 50–75 years—U.S 2008. MMWR Morb Mortal Wkly Rep. 2010;59(26):808–812. - PubMed

Publication types

Associated data