Getting patients back for routine colorectal cancer screening: Randomized controlled trial of a shared decision‐making intervention. (2nd September 2022)

• Record Type: Journal Article
• Authors: Sepucha, Karen R.; Valentine, Kathrene D.; Atlas, Steven J.; Chang, Yuchiao; Fairfield, Kathleen M.; Ha, Jasmine; Leavitt, Lauren; Lee, Vivian; Percac‐Lima, Sanja; Richter, James M.; Simmons, Leigh
• Is Part Of: Cancer medicine. Volume 12:Number 3(2023)
• Page Start: 3555
• Page End: 3566
• Publication Date: 2022-09-02
• Subjects: behavioral science -- cancer education -- colorectal cancer -- screening; 616.994005
• DOI: 10.1002/cam4.5172
• Languages: English
• ISSNs: 2045-7634

Abstract

Abstract: Thousands of colonoscopies were canceled during the initial surge of the COVID‐19 pandemic. As facilities resumed services, some patients were hesitant to reschedule. The purpose of this study was to determine whether a decision aid plus telephone coaching would increase colorectal cancer (CRC) screening and improve patient reports of shared decision making (SDM). A randomized controlled trial assigned adults aged 45–75 without prior history of CRC who had a colonoscopy canceled from March to May 2020 to intervention ( n = 400) or usual care control ( n = 400) arms. The intervention arm received three‐page decision aid and call from decision coach from September 2020 through November 2020. Screening rates were collected at 6 months. A subset ( n = 250) in each arm was surveyed 8 weeks after randomization to assess SDM (scores range 0–4, higher scores indicating more SDM), decisional conflict, and screening preference. The sample was on average, 60 years old, 53% female, 74% White, non‐Hispanic, and 11% Spanish speaking. More intervention arm patients were screened within 6 months (35% intervention vs 23% control, p < 0.001). The intervention respondents reported higher SDM scores (mean difference 0.7 [0.4, 0.9], p < 0.001) and less decisional conflict than controls (−21% [−35%, −7%], p = 0.003). The majority in both arms preferred screening versus delaying (68% intervention vs. 65% control, p = 0.75). An SDM approach that offered alternatives and incorporated patients' preferences resulted in higher screening rates. Patients who are overdue for CRC screening may benefit from proactive outreach with SDM support. Abstract : Many patients who had their colonoscopies cancelled or postponed due to the COVID‐19 pandemic were hesitant to reschedule. This randomized trial found that a brief shared decision making intervention significantly increased colorectal cancer screening uptake and improved the quality of screening decisions over usual care.