Assignment: Colorectal Cancer Screening

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Assignment: Colorectal Cancer Screening

Assignment: Colorectal Cancer Screening


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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

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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