The effect of offering different numbers of colorectal cancer screening test options in a decision aid: a pilot randomized trial

Griffith, Jennifer M.; Lewis, Carmen L.; Brenner, Alison T.; Pignone, Michael

doi:10.1186/1472-6947-8-4

Cited by 48 publications

(68 citation statements)

References 19 publications

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“…Although direct comparisons across studies are diffi cult because of differences in design, methods, and sampling, 25,31,[33][34][35][36][37]53 there are some common themes that emerge. Most studies observe test preferences divided between colonoscopy ,34,37,53 and FOBT.…”

Section: Discussionmentioning

confidence: 99%

“…Although previous studies have examined patient preferences, 25,[31][32][33][34][35][36][37][38] more information is needed about the specifi c attributes of tests that patients prefer. These attributes inform patients choices when a range of options are discussed.…”

Section: Inf or Med Decision M A K Ing A Nd T Es T Pr Efer Enc Esmentioning

confidence: 99%

“…You are given medicine through a needle in your arm to make you sleepy during the test included. 33,34,37 Studies examining subgroup comparisons in test preferences, have confl icting fi ndings: one 37 found that a higher proportion of African Americans were more likely to prefer colonoscopy, whereas another 53 found that African Americans were more likely to prefer FS, and Hispanics were more likely than whites to prefer FOBT and DCBE. These fi ndings taken with ours suggest that preferences cannot be reliably predicted by demographic characteristics and may depend on the setting and type of attributes discussed, and suggest a need for presentation of all options and attributes to each patient.…”

Section: Colonoscopymentioning

confidence: 99%

“…Consistency in preferences for test-specifi c attribute descriptions was strong and clear, but consistency for tests bordered on a meaningful amount of agreement, and consistency for the 13 attributes considered together only approached a meaningful amount of agreement for some subgroups, eg, non-Hispanic whites, with the implication that a single approach for each subgroup may not work. Clearly, further research is needed to systematically examine these possibilities further.Although direct comparisons across studies are diffi cult because of differences in design, methods, and sampling, 25,31,[33][34][35][36][37]53 there are some common themes that emerge. Most studies observe test preferences divided between colonoscopy ,34,37,53 and FOBT.…”

mentioning

confidence: 99%

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Informed Decision Making Changes Test Preferences for Colorectal Cancer Screening in a Diverse Population

Shokar¹,

Carlson²,

Weller

2010

The Annals of Family Medicine

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PURPOSE We wanted to better understand patient preferences and decision making about options for colorectal cancer screening. Consistency in patient preferences could improve patient-clinician communication about tests by simplifying and focusing discussions. METHODSIn a cross-sectional sample of primary care patients, cognitive ranking tasks were used to estimate patient preferences for fecal occult blood testing, fl exible sigmoidoscopy, colonoscopy, and double-contrast barium enema before and after consideration of 13 test attributes, such as accuracy and scientifi c evidence. Patients also ranked the 13 test attributes and attribute descriptions in terms of importance. Friedman's nonparametric test was used to measure overall discrimination among items, and the average Pearson correlation coeffi cient (r ) among participants was used to measure the degree of consistency in choices.RESULTS Participants (n = 168) averaged 62.1 years of age, and 64.3% were of minority racial ethnicity. For test-specifi c attributes, preferences were for high test accuracy (r = 0.63, P <.001), amount of colon examined (r = 0.64, P <.001), strong scientifi c evidence for effi cacy (r = 0.59, P <.001), minimum discomfort (r = 0.50, P <.001), and low risk of complications (r = 0.38, P <.001). When all 13 attributes were considered together, agreement dropped (r = 0.13, P <.001), but attributes considered most important for decision making were test accuracy, scientifi c evidence for effi cacy, amount of colon examined, and need for sedation. Test preferences showed moderate agreement (r = 0.20, P <.001), and choices were fairly consistent before and after exposure to test-specifi c attributes (κ = 0.17, P = .007). Initially the modal choice was fecal occult blood testing (59%); however, after exposure to test specifi c attributes, the modal choice was colonoscopy (54%).CONCLUSION Participants were clear about the attributes that they prefer, but no single test has those attributes. Preferences were varied across participants and were not predictable; clinicians should discuss the full range of recommended tests for colorectal cancer with all patients. 2 Professional organizations have widely endorsed screening for colorectal cancer 3-5 because of evidence of its effectiveness [6][7][8][9][10][11] and because screening could prevent 18,800 deaths per year.12 Screening remains underutilized, [13][14][15][16][17][18] however, with the lowest rates in African Americans and Hispanics. [19][20][21][22] Discussing colorectal cancer screening is challenging because multiple tests are recommended for screening, the tests are quite different and 142 INF OR MED DECISION M A K ING A ND T ES T PR EFER ENC EScomplex, patients lack familiarity with them, physicians have limited time to explain all the tests, and physicians have misconceptions about patient preferences regarding the tests and their attributes. [23][24][25][26] These problems have further been compounded by the continuing evolution of guidelines for colorectal cancer scree...

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Section: Discussionmentioning

confidence: 99%

Section: Inf or Med Decision M A K Ing A Nd T Es T Pr Efer Enc Esmentioning

confidence: 99%

Section: Colonoscopymentioning

confidence: 99%

mentioning

confidence: 99%

See 2 more Smart Citations

Informed Decision Making Changes Test Preferences for Colorectal Cancer Screening in a Diverse Population

Shokar¹,

Carlson²,

Weller

2010

The Annals of Family Medicine

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“…The meta-analysis mentioned above found no significant association between the number of options (categorized as 2, 3-5, or 5+) and motivation 16 , and we found only one CRC screening study that evaluated the effect of the number of options presented. This pilot study of 62 patients compared screening intentions of those randomized to a two-option versus a five-option computerbased decision aid and found no significant differences in intention scores across groups 38 . Furthermore, the very small differences in intention scores are unlikely to result in meaningful differences in adherence.…”

Section: Introductionmentioning

confidence: 96%

Bringing an Organizational Perspective to the Optimal Number of Colorectal Cancer Screening Options Debate

et al. 2011

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Improving colorectal cancer (CRC) screening rates represents a challenge for primary care providers. Some have argued that offering a choice of CRC screening modes to patients will improve the currently low adherence rates. Others have raised concerns that offering numerous CRC screening options in practice could overwhelm patients and thus dampen enthusiasm for screening. In this article we assemble evidence to critically evaluate the relative merit of these opposing views. We find little evidence to support the hypothesis that the number of options offered will affect adherence (either positively or negatively), or that expanding the modalities offered beyond FOBT and colonoscopy will improve patient satisfaction. Therefore, we assert future decisions about the number of CRC screening modes to offer would more productively be focused on considerations such as what benefit the health-care organization would derive from offering additional modes, and how this change would affect other critical components of a successful screening program such as timely diagnosis. In light of these organizational level considerations, we agree with the assertion made by others that a screening program limited to FOBT and colonoscopy is likely to be ideal in most settings.KEY WORDS: colorectal neoplasms; mass screening; choice behavior; decision making; organizational decision making.

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Decision aids for people facing health treatment or screening decisions

Stacey¹,

Bennett²,

Barry³

et al. 2011

Cochrane Database of Systematic Reviews

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The effect of offering different numbers of colorectal cancer screening test options in a decision aid: a pilot randomized trial

Cited by 48 publications

References 19 publications

Informed Decision Making Changes Test Preferences for Colorectal Cancer Screening in a Diverse Population

Informed Decision Making Changes Test Preferences for Colorectal Cancer Screening in a Diverse Population

Bringing an Organizational Perspective to the Optimal Number of Colorectal Cancer Screening Options Debate

Decision aids for people facing health treatment or screening decisions

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