Research articleEffectiveness of a Web-Based Colorectal Cancer Screening Patient Decision Aid: A Randomized Controlled Trial in a Mixed-Literacy Population
Section snippets
Background
Colorectal cancer (CRC) is the fourth most common noncutaneous cancer in the U.S., and the second-leading cause of cancer death.1 In order to both prevent CRC and reduce its associated mortality, several national organizations recommend routine CRC screening beginning at age 50 years.2, 3 A variety of CRC screening tests are cost effective, giving patients and clinicians a choice of screening options.4
Despite the widespread recommendations for routine screening, CRC screening remains
Methods
The study was conducted at a community-based university-affiliated internal medicine faculty–resident practice serving a primarily socioeconomically disadvantaged patient population. The Wake Forest University IRB approved the study protocol, and all participants provided written informed consent.
Participants were patients aged 50–74 years who were scheduled for a routine (non-urgent care) medical visit and were overdue for CRC screening, defined as not having completed a home fecal occult
Results
Between November 2007 and September 2008, research assistants reached 401 eligible patients by telephone who agreed to participate. Of these 401 patients, 264 arrived to the clinic 45 minutes early as directed, were confirmed eligible, and were enrolled. An equal number were randomized to the CRC decision aid (CHOICE) and the control program (Figure 2). While abstracting charts for the outcomes of interest, study staff discovered that 16 randomized patients met exclusion criteria (15 were up to
Discussion
The web-based decision aid (CHOICE) increased patients' ability to state a test preference and their readiness to receive screening, regardless of literacy level. In addition, more CHOICE patients had CRC screening tests immediately ordered and completed, but these differences were modest and did not reach significance.
Prior studies have examined the use of video or web-based interventions to increase CRC screening. Patient education videos without a decision-aid component have shown mixed
Conclusion
The web-based CRC screening decision aid (CHOICE) increased test preferences and patients' readiness to receive screening, irrespective of literacy level. The decision aid's ability to effectively convey information with little staff involvement may make it a valuable resource for time-strapped clinics. Future research should focus on ways decision aids such as CHOICE can be combined with other system-level interventions to increase CRC screening.
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