Patient Decision Aids for Colorectal Cancer Screening

Abstract

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.

An entertainment‐education colorectal cancer screening decision aid for African American patients: A randomized controlled trial

“…24 A majority of decision aid studies have been successful in significantly improving knowledge, either from baseline to post-intervention or compared to a control group. 24 …”

Colorectal cancer screening for average‐risk adults: 2018 guideline update from the American Cancer Society

“…Intention to screen is also higher if the screening test ordered is consonant with the patient's preference . Decision aids that help patients choose among options have been shown to improve knowledge and interest in screening and lead to increased screening compared with not providing information …”

“…Evidence examining the impact of decision aids on CRC screening adherence is mixed. Several systematic reviews have found that, whereas decision aids increase screening knowledge and modestly increase screening, there were no significant differences in screening interest or behavior among individuals who were exposed to decision aids compared with those who were given general information about CRC screening . A study examining the impact of combining a decision aid with patient navigation in a diverse, vulnerable patient population did demonstrate a strong impact on screening completion but was unable to separate the effects of the decision aid from patient navigation .…”

Effect of a Digital Health Intervention on Receipt of Colorectal Cancer Screening in Vulnerable Patients

“…Decision aids address patient knowledge and attitude barriers well, but fail to address many of the provider and system barriers. (26) In our prior-randomized controlled trial of a web-based decision aid in vulnerable patients, the decision aid increased patients’ desire to receive CRC screening, yet orders for screening tests and completion of screening increased by only 9% and 5% respectively, differences that were not statistically significant. (27) To meaningfully increase receipt of CRC screening, additional efforts are needed that address these multilevel barriers and reach broadly across populations.…”