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Health Services Research & Development

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2012 HSR&D/QUERI National Conference Abstract

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2012 National Meeting

3088 — The Effect of a Preference-Tailored Decision Tool on CRC Screening Adherence in the VA

Hawley ST, and Larkin A, Ann Arbor VAMC; Dobroski S, Pittsburgh VAMC; Vernon SW, UT School of Public Health; Partin M, Minnesota VAMC; Ling B, Pittsburgh VAMC;

Objectives:
Although screening rates for colorectal cancer (CRC) exceed 80% in the VA healthcare system (VA), many Veterans remain non-adherent to CRC screening. Incorporating patient preferences into CRC screening decisions has been identified as one method for increasing adherence in these under-screened groups. The purpose of this study was to evaluate a preference-tailored decision tool for increasing CRC screening adherence in Veterans through a multi-site RCT.

Methods:
Eligible subjects (age 50-77, due for CRC screening, with a scheduled primary care visit) were identified at two VAs. Participants arrived 45 minutes early to complete consent and were randomized to view the preference-tailored tool (intervention) or standard information (control) website. Telephone surveys were conducted 3-5 days post-enrollment, and CRC screening adherence was collected from medical charts 6 months later. We evaluated the effect of the tool on adherence with Chi-square tests. We further compared stated preferences for CRC tests to adherence through Chi-square tests and regression.

Results:
468 subjects have been enrolled from two VAs to date (234 per group). CRC screening adherence 6-months post-enrollment was 38.6% and was not significantly different between groups (37.4% intervention, 39.7% control). Of those, most were adherent with fecal occult blood test (22.4%), followed by colonoscopy (16.7%). The most commonly recommended test by physicians was COL (59.2% of tests recommended), though Veterans most commonly stated a preference for FOBT (60.1%). The features of tests most important to Veterans were nature of the test (32.8%), effectiveness (27.1%), and risk of complications (17%). Adherence was significantly (P < 0.001) higher with the test that the patient preferred post-intervention than with the different test (20.2% vs. 6.9% % for FOBT and 32.6% vs. 7.8% for COL).

Implications:
CRC screening adherence in this population of Veterans was low, and the preference-tailored intervention did not significantly improve adherence. Veterans continue to prefer a non-invasive test (FOBT) despite higher rates of recommendation for colonoscopy by physicians.

Impacts:
Improving the match between physician recommendations and patients’ preference may be one method for improving CRC screening adherence in the VA. However, further work is needed to understand other barriers to screening uptake in this population of Veterans.


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