Kim J et al. 2005 "Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice."

Reference
Kim J, Whitney A, Hayter S, et al. Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice. BMC Med Inf Decis Making 2005;5:36.
Abstract
"Background: Although colorectal cancer screening is recommended by major policy-making organizations, rates of screening remain low. Our aim was to develop a patient-directed, computer-based decision aid about colorectal cancer screening and investigate whether it could increase patient interest in screening.
Methods: We used content from evidence-based literature reviews and our previous decision aid research to develop a prototype. We performed two rounds of usability testing with representative patients to revise the content and format. The final decision aid consisted of an introductory segment, four test-specific segments, and information to allow comparison of the tests across several key parameters. We then conducted a before-after uncontrolled trial of 80 patients 50-75 years old recruited from an academic internal medicine practice.
Results: Mean viewing time was 19 minutes. The decision aid improved patients' intent to ask providers for screening from a mean score of 2.8 (1 = not at all likely to ask, 4 = very likely to ask) before viewing the decision aid to 3.2 afterwards (difference, 0.4; p < 0.0001, paired t-test). Most found the aid useful and reported that it improved their knowledge about screening. Sixty percent said they were ready to be tested, 18% needed more information, and 22% were not ready to be screened. Within 6 months of viewing, 43% of patients had completed screening tests.
Conclusion: We conclude that a computer-based decision aid can increase patient intent to be screened and increase interest in screening.
Practice Implications: This decision aid can be viewed by patients prior to provider appointments to increase motivation to be screened and to help them decide about which modality to use for screening. Further work is required to integrate the decision aid with other practice change strategies to raise screening rates to target levels."
Objective
"To develop a patient-directed, computer-based decision aid about colorectal cancer screening and investigate whether it could increase patient interest in screening."
Type Clinic
Primary care
Type Specific
Internal medicine
Size
Large
Geography
Urban
Other Information
The study was conducted at the University of North Carolina-Chapel Hill (UNC) general internal medicine practice. The clinic has approximately 12,000 patients (of which roughly 5,000 are within the age limits for the study's sample).
Type of Health IT
Informational resource
Type of Health IT Functions
The educational resource is modular in design and provides a 5-minute introduction followed by five additional sections describing various tests. Through video footage and physician/patient narration, the resource allows patients to review various tests for colorectal cancer and provides information on each test including how the test is performed, preparation required, common patient concerns, risk of adverse effects and the efficacy of each test in its detection of colorectal cancer or polyps. The resource then presents "5-15 second patient vignettes, [consisting] of interviews with white and African-American men and women describing their reasons for choosing a particular screening modality, their experiences with the test, and the benefits and downsides of the test." "Follow-up of abnormal results and comparisons of different screening modalities to one another are explained via text, narration, and graphs." The resource requires that patients watch the introduction and at least one other video segment.
Workflow-Related Findings
Participant feedback on information: 89 percent said the information presented to them increased their knowledge of colon cancer, 78 percent said the information helped their decision about colon cancer screening, and 90 percent said the amount of information presented was appropriate.
"The mean amount of time [the patient] spent viewing the decision aid was 19 minutes."
Study Design
Only postintervention (no control group)
Study Participants
A convenience sample of 80 patients between the ages of 50 and 75 agreed to participate in the study, out of a total of 260 who were asked. "Both patients who were up-to-date with screening and those who were due for screening were allowed to enroll."