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2019 HSR&D/QUERI National Conference Abstract

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4106 — Promoting Appropriate Use of Cancer Screening in Older Adults: Influence of a Decision Aid on Patient-Provider Colorectal Cancer Screening Discussions

Lead/Presenter: Darcy Saffar,  COIN - Ann Arbor
All Authors: Saffar D (Center for Clinical Management Research, Ann Arbor), Forman, JH (Center for Clinical Management Research, Ann Arbor, University of Michigan), Lewis, CL (University of Colorado School of Medicine) Hawley, ST (Center for Clinical Management Research, Ann Arbor, University of Michigan School of Medicine) Myers, AD (Center for Clinical Management Research, Ann Arbor) Zikmund-Fisher, BJ (University of Michigan School of Public Health) Vijan, S (Center for Clinical Management Research, Ann Arbor) Lipson, R (Center for Clinical Management Research, Ann Arbor) Kerr, EA (Center for Clinical Management Research, Ann Arbor; University of Michigan Health System) Saini, SD (Center for Clinical Management Research, Ann Arbor; University of Michigan Medical School)

Objectives:
Decision aids can improve decision satisfaction and reduce decisional conflict. But the impact of these tools on the duration and content of patient-provider discussions remains uncertain. We sought to assess the influence of a personalized colorectal cancer (CRC) screening decision aid (DA) on visit duration and informed decision making (IDM) during patient-provider discussions in primary care in the context of a cluster randomized controlled trial (RCT) [NCT02027545].

Methods:
We recruited Veterans aged 70-75 who were due for average-risk CRC screening and had an upcoming visit with their primary care provider (PCP). Before the visit, Veterans in the intervention group received a DA with personalized information about CRC screening benefits/harms, and those in the control group received a generic booklet encouraging them to discuss screening with their PCP. A subset of subjects hand-carried an audio-recorder into their visit. We quantified time spent discussing CRC screening and coded the content of the discussion for elements of IDM.

Results:
53 PCP visits were recorded, 35 (66%) in the DA arm and 18 (34%) in the control arm. Discussions in the DA arm scored higher than control in 7 of 8 IDM elements and had more total IDM elements on average: 4.18 DA vs 3.32 control (p = 0.07). Discussion of cons of screening was significantly more common in the intervention arm: 61% DA vs 33% control (p = 0.04). Confirmation of patient understanding was low in both groups, though PCPs in the DA arm were more likely to assess understanding: 18% DA vs 0% control (p = 0.07). Average time discussing CRC screening was 2.07 minutes in the control arm and 4.47 minutes in the DA arm (p < 0.0001).

Implications:
A DA with personalized information about CRC benefits and harms encouraged more balanced discussions of screening compared to a control condition, but it also modestly increased the amount of time spent discussing screening.

Impacts:
Decisions about screening cessation in older adults are challenging and potentially time consuming. DAs have the potential to enhance discussions and encourage IDM in such patients with a modest increase in clinic time.