Shared Decision-Making for Colorectal Cancer Screening

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DESCRIPTION: Colorectal cancer (CRC) is a leading cause of cancer-related death in the U.S. Screening is a cost-effective strategy for reducing both CRC incidence and mortality but has yet to have a major impact on disease burden partly because of poor patient adherence. Shared decision-making is a potentially effective yet unproven strategy for increasing CRC screening rates. The overall objective of this proposal is to develop an interactive, web-based decision aid and evaluate its impact on shared decision-making and patient adherence to CRC screening recommendations. During Phase 1 (Year 1), an interactive, web-based decision aid will be developed that employs state-of-the-art technology to educate patients about the five recommended CRC screening strategies, heighten risk perception, and empower patients to participate in the decision-making process. Content will be developed using a critical review of relevant literature and existing decision aids, expert opinion, and decision-making theory. A personalized risk assessment tool plus pre-/post-test modules to assess demographics, knowledge, beliefs, desire, barriers, and patient preferences will be incorporated. Tailored feedback will also be provided. Once developed, the aid will be subjected to external review by an outside advisory committee for content validity and pre-tested for usability. During Phase 2 (Year 1), an optimal strategy will be defined for implementation of the decision aid in two ambulatory care settings. The research team will interact with physicians and office staff to identify potential logistical barriers and to conjointly develop a tailored strategy for implementation at the targeted ambulatory care sites. Issues to be addressed include resource needs, space allocation, patient identification and scheduling, and tracking. Physician and staff educational seminars will be conducted before implementation. During Phase 3 (Years 2 to 5), a randomized controlled clinical trial will be conducted to evaluate the impact of the decision aid on shared decision-making and adherence to CRC screening recommendations. Eligible patients will be randomized to review the decision aid, the personalized risk assessment tool alone or a control condition. The primary outcome will be patient adherence to CRC screening recommendations using computerized tracking systems; secondary outcomes will include patient knowledge and patient satisfaction using evaluation components of the decision aid or validated instruments.