Assignment: CRC Screening Literature

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Assignment: CRC Screening Literature

Assignment: CRC Screening Literature

One of the most commonly cited barriers to

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implementation of SDM is the time requirement.

Although studies to date have provided con-

flicting data regarding the impact of decision

aids on consultation time for other condi-

tions,17–22 we postulated that by educating

patients about the risks and benefits of the dif-

ferent screening options and facilitating IDM

prior to the provider–patient encounter, our

decision aid would have the potential of

improving the efficiency of SDM and thus save

time, as noted by Green et al. and Brackett

et al.17,18 We found that although a majority of

providers agreed or strongly agreed that pre-visit

use of the tool saved time, 21% were neutral on

the issue and 14% disagreed or strongly dis-

agreed. It is conceivable that this diversity of

opinion might be a reflection of the extent to

which provider and patient preferences agreed or

disagreed. In instances where there was concor-

dance between preferences, as was often the case

that since colonoscopy was preferred by major-

ity of both patients and providers,16 one would

expect that the time required for deliberation

and negotiation would be substantially shorter

than in situations where there was discordance.

Alternatively, these differences might reflect

differences in case mix with respect to patient

factors, such as literacy level or desired level of

participation in the decision-making process.

A secondary objective of our study was to

elicit provider feedback regarding content and

format preferences to gain insight into potential

modifications that might enhance future uptake.

Because of an ongoing debate in the CRC

screening literature,23–27 we focused on content

issues related to cost information and number of

screening options to include in the decision aid.

Both questions elicited a divergence of opinions.

Whereas nearly 50% of respondents felt that

cost information should be included, the

remainder was either neutral or opposed to its

inclusion. Similarly, when asked about the

number of screening options to include, �50% preferred the full menu of options and �40% preferred a more limited menu. This diversity of

opinion highlights some of the key challenges in

designing tools with broad dissemination


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