Med Decis Making - The impact of a novel computer-based decision aid on shared decision making for colorectal cancer screening: a randomized trial.

Tópicos

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Resumo

CKGROUND: Eliciting patients' preferences within a framework of shared decision making (SDM) has been advocated as a strategy for increasing colorectal cancer (CRC) screening adherence. Our objective was to assess the effectiveness of a novel decision aid on SDM in the primary care setting.METHODS: An interactive, computer-based decision aid for CRC screening was developed and evaluated within the context of a randomized controlled trial. A total of 665 average-risk patients (mean age, 57 years; 60% female; 63% black, 6% Hispanic) were allocated to 1 of 2 intervention arms (decision aid alone, decision aid plus personalized risk assessment) or a control arm. The interventions were delivered just prior to a scheduled primary care visit. Outcome measures (patient preferences, knowledge, satisfaction with the decision-making process [SDMP], concordance between patient preference and test ordered, and intentions) were evaluated using prestudy/poststudy visit questionnaires and electronic scheduling.RESULTS: Overall, 95% of patients in the intervention arms identified a preferred screening option based on values placed on individual test features. Mean cumulative knowledge, SDMP, and intention scores were significantly higher for both intervention groups compared with the control group. Concordance between patient preference and test ordered was 59%. Patients who preferred colonoscopy were more likely to have a test ordered than those who preferred an alternative option (83% v. 70%; P < 0.01). Intention scores were significantly higher when the test ordered reflected patient preferences.CONCLUSIONS: Our interactive computer-based decision aid facilitates SDM, but overall effectiveness is determined by the extent to which providers comply with patient preferences.

Resumo Limpo

ckground elicit patient prefer within framework share decis make sdm advoc strategi increas colorect cancer crc screen adher object assess effect novel decis aid sdm primari care settingmethod interact computerbas decis aid crc screen develop evalu within context random control trial total averagerisk patient mean age year femal black hispan alloc intervent arm decis aid alon decis aid plus person risk assess control arm intervent deliv just prior schedul primari care visit outcom measur patient prefer knowledg satisfact decisionmak process sdmp concord patient prefer test order intent evalu use prestudypoststudi visit questionnair electron schedulingresult overal patient intervent arm identifi prefer screen option base valu place individu test featur mean cumul knowledg sdmp intent score signific higher intervent group compar control group concord patient prefer test order patient prefer colonoscopi like test order prefer altern option v p intent score signific higher test order reflect patient preferencesconclus interact computerbas decis aid facilit sdm overal effect determin extent provid compli patient prefer

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