Colorectal Cancer Screening in Vulnerable Patients: Promoting Informed and Shared Decisions

Alison T Brenner; Richard Hoffman; Andrew McWilliams; Michael P Pignone; Robert L Rhyne; Hazel Tapp; Mark A Weaver; Danelle Callan; Brisa Urquieta de Hernandez; Khalil Harbi; Daniel S Reuland

doi:10.1016/j.amepre.2016.03.025

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Colorectal Cancer Screening in Vulnerable Patients: Promoting Informed and Shared Decisions

Journal article

Peer reviewed

Colorectal Cancer Screening in Vulnerable Patients: Promoting Informed and Shared Decisions

Alison T Brenner, Richard Hoffman, Andrew McWilliams, Michael P Pignone, Robert L Rhyne, Hazel Tapp, Mark A Weaver, Danelle Callan, Brisa Urquieta de Hernandez, Khalil Harbi, …

American journal of preventive medicine, Vol.51(4), pp.454-462

10/2016

DOI: 10.1016/j.amepre.2016.03.025

PMCID: PMC5501711

PMID: 27242081

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https://www.ncbi.nlm.nih.gov/pmc/articles/5501711View

Open Access

Abstract

Low-income, low-literacy, limited English-proficient populations have low colorectal cancer (CRC) screening rates and experience poor patient-provider communication and decision-making processes around screening. The purpose of this study was to test the effect of a CRC screening decision aid on screening-related communication and decision making in primary care visits. RCT with data collected from patients at baseline and immediately after the provider encounter. Patients aged 50-75 years, due for CRC screening, were recruited from two safety net clinics in North Carolina and New Mexico (data collection, January 2014-September 2015; analysis, 2015). Participants viewed a CRC screening decision aid or a food safety (control) video immediately before their provider encounter. CRC screening-related knowledge, discussion, intent, test preferences, and test ordering. The study population (N=262) had a mean age of 58.3 years and was 66% female, 61% Latino, 17% non-Latino black, and 16% non-Latino white. Among Latino participants, 71% preferred Spanish. Compared with controls, intervention participants had greater screening-related knowledge (on average 4.6 vs 2.8 of six knowledge items correct, adjusted difference [AD]=1.8, 95% CI=1.5, 2.1) and were more likely to report screening discussion (71.0% vs 45.0%, AD=26.1%, 95% CI=14.3%, 38.0%) and high screening intent (93.1% vs 84.7%, AD=9.0%, 95% CI=2.0%, 16.0%). Intervention participants were more likely to indicate a specific screening test preference (93.1% vs 68.0%, AD=26.5%, 95% CI=17.2%, 35.8%) and to report having a test ordered (56.5% vs 32.1%, AD=25.8%, 95% CI=14.4%, 37.2%). Viewing a CRC screening decision aid before a primary care encounter improves knowledge and shared decision making around screening in a racially, ethnically, and linguistically diverse safety net clinic population. This study is registered at www.clinicaltrials.gov NCT02054598.

Decision Making

Vulnerable Populations - psychology

Mass Screening - psychology

Humans

Middle Aged

Decision Support Techniques

Vulnerable Populations - ethnology

Female

Male

Aged

Colorectal Neoplasms - diagnosis

Details

Title: Subtitle: Colorectal Cancer Screening in Vulnerable Patients: Promoting Informed and Shared Decisions
Creators: Alison T Brenner - Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina; Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
Richard Hoffman - Division of General Internal Medicine, University of Iowa Carver College of Medicine, Iowa City, Iowa; Holden Comprehensive Cancer Center, University of Iowa, Iowa City, Iowa
Andrew McWilliams - Department of Family Medicine, Carolinas HealthCare System, Charlotte, North Carolina
Michael P Pignone - Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina; Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina
Robert L Rhyne - Department of Family and Community Medicine, University of New Mexico School of Medicine, Albuquerque, New Mexico; University of New Mexico Cancer Center, Albuquerque, New Mexico
Hazel Tapp - Department of Family Medicine, Carolinas HealthCare System, Charlotte, North Carolina
Mark A Weaver - Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Department of Biostatistics, University of North Carolina, Chapel Hill, North Carolina
Danelle Callan - University of New Mexico Cancer Center, Albuquerque, New Mexico
Brisa Urquieta de Hernandez - Department of Family Medicine, Carolinas HealthCare System, Charlotte, North Carolina
Khalil Harbi - Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina
Daniel S Reuland - Cecil G. Sheps Center for Health Services Research, University of North Carolina, Chapel Hill, North Carolina; Division of General Internal Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina, Chapel Hill, North Carolina. Electronic address: dreuland@med.unc.edu
Resource Type: Journal article
Publication Details: American journal of preventive medicine, Vol.51(4), pp.454-462
DOI: 10.1016/j.amepre.2016.03.025
PMID: 27242081
PMCID: PMC5501711
NLM abbreviation: Am J Prev Med
ISSN: 0749-3797
eISSN: 1873-2607
Grant note: UL1 TR002489 / NCATS NIH HHS UL1 TR001449 / NCATS NIH HHS UL1 TR000041 / NCATS NIH HHS UL1 TR001111 / NCATS NIH HHS
Language: English
Date published: 10/2016
Academic Unit: Epidemiology; General Internal Medicine; Internal Medicine
Record Identifier: 9984094576002771

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