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Health Care Decisionmaking

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Decision aids minimize conflict for patients regarding colorectal cancer screening decisions

Individuals who use a decision aid to help them choose among currently recommended colorectal cancer screening programs have less conflict about their screening decisions than those who don't use a decision aid. That's the conclusion of a pilot study supported by the Agency for Healthcare Research and Quality (HS10728) and conducted by James G. Dolan, M.D., F.A.C.P., and Susan Frisina, R.N., of the University of Rochester.

The researchers randomized 96 patients at average risk for colorectal cancer seen in an internal medicine practice in Rochester, NY, to a control or experimental group. The control group had a standardized interview and educational briefing on five recommended screening programs for patients at average risk for colorectal cancer: annual fecal occult blood test; flexible sigmoidoscopy (examining the last one-third of the colon looking through a short flexible tube) every 5 years; combination of yearly fecal occult blood test and flexible sigmoidoscopy once every 5 years; double contrast barium enema every 5 years; and colonoscopy every 10 years. The experimental group additionally received a detailed analysis of the options that integrated quantitative data with patient values and preferences.

The decision aid asked patients to define the relative importance of factors that can influence decisions about colorectal cancer screening, including avoiding colorectal cancer, avoiding major side effects from screening tests, avoiding false-positive screening test results, the nature of the test procedure, preparations required, and the frequency of screening. Patients were then asked to judge how well the alternatives satisfied each of these considerations. The two sets of information were then combined to rank the screening options according to how well they matched each patient's preferences.

Patients who used this decision aid had fewer conflicts about their colorectal cancer screening decisions on the decisional conflict scale than patients who didn't use the aid. This was due to increased knowledge, better clarity of values, and higher ratings of the quality of the decisions they made, conclude the researchers. About half of both groups completed planned screening tests.

Details are in "Randomized controlled trial of a patient decision aid for colorectal cancer screening," by Dr. Dolan and Ms. Frisina, in the March 2002 Medical Decision Making 22, pp. 122-136.

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