Assignment: Colorectal Cancer Screening
Assignment: Colorectal Cancer Screening
Introduction
Engaging patients to participate in the decision-
making process when confronted with prefer-
ence-sensitive choices related to cancer screening
or treatment is fundamental to the concept of
patient-centred care endorsed by the Institute of
Medicine, US Preventive Services Task Force
and the Centers for Disease Control and Pre-
vention.1–3 Ideally, this process should occur
within the context of shared decision making
(SDM), whereby patients and their health-care
providers form a partnership to exchange
information, clarify values and negotiate a
mutually agreeable medical decision.4,5 SDM,
however, has been difficult to implement into
routine clinical practice in part owing to lack of
time, resources, clinician expertise and suitabil-
ity for certain patients or clinical situations.6,7
The use of patient-oriented decision aids outside
of the context of the provider–patient interac-
tion has been proposed as a potentially effective
strategy for circumventing several of these bar-
riers.3,8 Decision aids are distinct from patient
education programmes in that they serve as
tools to enable patients to make an informed,
value-concordant choice about a particular
course of action based on an understanding of
potential benefits, risks, probabilities and sci-
entific uncertainty.9–11 Besides facilitating
informed decision making (IDM), decision aids
also have the potential to facilitate SDM by
improving the quality and efficiency of the
patient–provider encounter and by empowering
users to participate in the decision-making
process.11 Studies to date have demonstrated
that while decision aids enhance knowledge,
at either the Boston Medical Center or the
South Boston Community Health Center. After
completing the computer session, patients met
with their providers to discuss screening and
Colorectal cancer screening decision aid, P C Schroy, S Mylvaganam and P Davidson
� 2011 John Wiley & Sons Ltd Health Expectations, 17, pp.27–35
28
identify a preferred screening strategy. Although
providers were blinded to their patients� ran- domization status, they received written notifi-
cation in the form of a hand-delivered flyer from
all study patients acknowledging that they were
participating in the �CRC decision aid study� to ensure that screening was discussed. Outcomes
of interest were assessed using pre ⁄post-tests, electronic medical record and administrative
databases. The study to date has found that the
tool enables users to identify a preferred
screening option based on the relative values
they place on individual test features, increases
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