A targeted decision aid for the elderly to decide whether to undergo colorectal cancer screening: development and results of an uncontrolled trial

Lewis, Carmen L.; Golin, Carol E.; DeLeon, Chris; Griffith, Jennifer M.; Ivey, Jena L.; Trevena, Lyndal; Pignone, Michael

doi:10.1186/1472-6947-10-54

Cited by 45 publications

(60 citation statements)

References 33 publications

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“…Two of the trials focused on older adults, with one focusing on adults aged ≥65 years 50 and the other on adults aged ≥75 years. 40 Three of the trials focused on specific populations, including individuals with low education, 47 individuals with low SES, 41 and Hispanic or Latino individuals with limited English proficiency. 51 …”

Section: Evidence Synthesismentioning

confidence: 99%

Patient Decision Aids for Colorectal Cancer Screening

Volk

Linder

López-Olivo

et al. 2016

American Journal of Preventive Medicine

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Context Decision aids (DAs) prepare patients to make decisions about healthcare options consistent with their preferences. Helping patients choose among available options for colorectal cancer (CRC) screening is important because rates are lower than screening for other cancers. This systematic review describes studies evaluating patient DAs for CRC screening in average-risk adults and their impact on knowledge, screening intentions, and uptake. Evidence acquisition Sources included Ovid MEDLINE, Elsevier EMBASE, EBSCO CINAHL Plus, Ovid PsycINFO through July 21, 2015, pertinent reference lists, and Cochrane review of patient DAs. Reviewers independently selected studies that quantitatively evaluated a DA compared to one or more conditions or within a pre–post evaluation. Using a standardized form, reviewers independently extracted study characteristics, interventions, comparators, and outcomes. Analysis was conducted in August 2015. Evidence synthesis Twenty-three articles representing 21 trials including 11,900 subjects were eligible. Patients exposed to a DA showed greater knowledge than those exposed to a control condition (mean difference [MD], 18.3 of 100; 95% CI=15.5, 21.1), were more likely to be interested in screening (pooled relative risk [RR], 1.5; 95% CI=1.2, 2.0), and more likely to be screened (pooled RR, 1.3; 95% CI=1.1, 1.4). DA patients had greater knowledge than patients receiving general CRC screening information (pooled MD, 19.3 of 100; 95% CI=14.7, 23.8); however, there were no significant differences in screening interest or behavior. Conclusions DAs improve knowledge and interest in screening, and lead to increased screening over no information, but their impact on screening is similar to general CRC screening information.

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Section: Evidence Synthesismentioning

confidence: 99%

Patient Decision Aids for Colorectal Cancer Screening

Volk

Linder

López-Olivo

et al. 2016

American Journal of Preventive Medicine

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“…A systematic review of decisional role preferences among cancer patients has shown an increasing trend of patients being interested in more participation during TDM (Tariman, Berry, Cochrane, Doorenbos, & Schepp, 2010). In order to meet and facilitate the patient’s preferred level of participation during TDM, interventional studies geared toward increasing a patient’s decisional satisfaction, reducing decisional conflict, and preventing anxiety and depression related to TDM have been steadily increasing in numbers (Allen et al, 2010; Caldon et al, 2010; Evans et al, 2010) with some studies targeting the elderly cancer patient population (Lewis et al, 2010; van Tol-Geerdink et al, 2008). …”

mentioning

confidence: 99%

Older Adults Newly Diagnosed With Symptomatic Myeloma and Treatment Decision Making

Tariman¹,

Doorenbos²,

Schepp³

et al. 2014

Oncology Nursing Forum

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Purpose/Objectives The purpose of the study was to describe the preferences for participation in decision making of older patients newly diagnosed with symptomatic myeloma and to explore the association between sociodemographic variables and decisional role preferences. Design Descriptive, cross sectional design Setting Subjects’ homes and two large academic cancer centers. Sample The convenience sample consisted of 20 older adults (60 years of age and above) with symptomatic myeloma diagnosed within the past 6 months. Methods The Control Preferences Scale was administered followed by an in-person one-time semi-structured interview. Main Research Variables Role preferences for participation in treatment decision-making, age, gender, race, work status, personal relationship status, education, and income. Findings 55% (n=11) of the subjects had preferred a shared role with the physician and 40% (n=8) had preferred to make the decisions after seriously considering the opinion of their physicians. Only one subject preferred to leave the decision to the doctor as long as the doctor considered the patient’s treatment preferences. Sociodemographic characteristics had no impact on preferences for participation in treatment decision-making. Conclusions The study findings indicate that older adults newly diagnosed with myeloma wanted to participate during treatment decision-making. Oncology nurses must respect the patient's desired role preference and oncology clinicians must listen to the patient and allow them to be autonomous in making treatment decisions if the patient so desire such control in the decision-making process. A culture of equipoise between the patient and the clinician during TDM must be cultivated in order to achieve the patient's desired level of participation. More studies that focus on supporting and involving patients diagnosed with myeloma in the decision-making process are needed in order to influence clinical practice and policy. Practice Implications Nurses and other oncology clinicians can elicit patient’s preferred level of participation in treatment decision-making. Oncology nurses can do the following nursing actions: make sure patients receive disease and treatment-related information; encourage patients to express their decisional role preference to the physician; develop a culture of mutual respect and value the patient's desire for autonomy for treatment decision making; acknowledge that the right to make a treatment choice belongs to the patient; 5) provide psychological support to the patient during treatment decision making throughout the care continuum.

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“…The values clarification exercise was adapted from one developed for use in colorectal cancer screening among elderly people33 to capture the main issues involved in the decision, including features identified as important to patients with colorectal cancer9 (see online supplementary table S1). Patients were asked to complete the questionnaire on the computer, selecting 1 of the 2 options presented for all 10 questions.…”

Section: Methodsmentioning

confidence: 99%

Use of a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer: development and preliminary evaluation

et al. 2017

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ObjectivesTo develop a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer, and examine perceived usefulness, acceptability and areas for improvement of the DA.DesignMixed methods.SettingSingle outpatient oncology department in central London.ParticipantsConsecutive recruitment of 13 patients with stage II colorectal cancer, 12 of whom completed the study. Inclusion criteria were: age >18 years; complete resection for stage II adenocarcinoma of the colon or rectum; patients within 14–56 days after surgery; no contraindication to adjuvant chemotherapy; able to give written informed consent. Exclusion criterion: previous chemotherapy.Primary outcomesPatient perceived usefulness (assessed by the PrepDM questionnaire) and acceptability of the DA.ResultsPrepDM scores, measuring the perceived usefulness of the DA in preparing the patient to communicate with their doctor and make a health decision, were above those reported in other patient groups. Patient acceptability scores were also high; however, interviews showed that there was evidence of a lack of understanding of key information among some patients, in particular their baseline risk of recurrence, the net benefit of combination chemotherapy and the rationale for having chemotherapy when cancer had apparently gone.ConclusionsPatients found the DA acceptable and useful in supporting their decision about whether or not to have adjuvant chemotherapy. Suggested improvements for the DA include: sequential presentation of treatment options (eg, no treatment vs 1 drug, 1 drug vs 2 drugs) to enhance patient understanding of the difference between combination and single therapy, diagrams to help patients understand the rationale for chemotherapy to prevent a recurrence and inbuilt checks on patient understanding of baseline risk of recurrence and net benefit of chemotherapy.

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A targeted decision aid for the elderly to decide whether to undergo colorectal cancer screening: development and results of an uncontrolled trial

Cited by 45 publications

References 33 publications

Patient Decision Aids for Colorectal Cancer Screening

Patient Decision Aids for Colorectal Cancer Screening

Older Adults Newly Diagnosed With Symptomatic Myeloma and Treatment Decision Making

Use of a computerised decision aid (DA) to inform the decision process on adjuvant chemotherapy in patients with stage II colorectal cancer: development and preliminary evaluation

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