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Development, testing, and dissemination of a tool to promote informed decision making about colorectal cancer screening

Development, testing, and dissemination of a tool to promote informed decision making about colorectal cancer screening. Michael Pignone, MD, MPH Associate Professor of Medicine UNC Division of General Internal Medicine Sheps Center for Health Services Research. Acknowledgements.

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Development, testing, and dissemination of a tool to promote informed decision making about colorectal cancer screening

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  1. Development, testing, and dissemination of a tool to promote informed decision making about colorectal cancer screening Michael Pignone, MD, MPHAssociate Professor of Medicine UNC Division of General Internal Medicine Sheps Center for Health Services Research

  2. Acknowledgements • American Cancer Society • Agency for Healthcare Research and Quality • Centers for Disease Control and Prevention • CHAI Core • Foundation for Informed Medical Decisionmaking • Lineberger Cancer Center • National Cancer Institute • Many collaborators and colleagues

  3. Implementation & dissemination research Development of tools to enhance feasibility of performing preventive care Evidence-based systematic reviews of preventive health care

  4. Potential means of promoting informed decision making • Educational training of providers • Educational training of providers • Written decision aids • Audiotape / Videotape decision aids • Computer decision aids • Combinations

  5. Development of decision aid • Chose TTM as theoretical construct • Developed and modified video script • Tested content in pilot study • Revised content • Filmed videotape • Developed stage-targeted brochures

  6. Pilot testing • Uncontrolled trial in UNC Internal Medicine practice • Patients given segments of information • Interest and intent measured before and after each segment

  7. Final decision aid • 11 minute videotape • Patient vignettes discussing screening experiences • Stage-targeted brochures and chart markers • Main themes: • Effective screening tests are available and not that hard • Patients should help decide which test is best for them • Talk with your provider

  8. Randomized Controlled Trial of a Patient Education Video to Improve Colon Cancer Screening Michael Pignone, MD, MPH Russ Harris, MD, MPH Linda Kinsinger, MD, MPH Making Prevention Work National Cancer Institute Lineberger Cancer Center

  9. Methods • site = three primary care practices in Central NC • eligibility criteria: • 50-75 years of age • no personal or family history of colon cancer • no FOBT within 1 year • no flex sig, barium enema, or colonoscopy in 5 years • eligible subjects randomized to intervention (colon cancer video + targeted brochure) or control (auto safety video + standard brochure)

  10. Participants • Mean age = 63 • 61% female • 87% White; 13% African-American • 86% high school graduates or GED • all insured (52% Medicare, 3% Medicaid)

  11. Findings • A patient-directed colon cancer video and targeted brochure significantly increases: • intent to ask for screening (+ 0.6 on 4 pt scale) • Report of a conversation (69% vs. 43%) • proportion of patients having screening tests ordered (47% vs. 26%) • proportion of patients completing screening tests (37% vs. 23%)

  12. Updating and revision • In 2000-2001, Medicare began to cover colonoscopy and barium enema for screening • Computer access skyrocketed • Linear nature of videotapes made revision difficult and forced a “one size fits all” approach • Goal: to revise our decision aid for computer-based use and update its content

  13. Decision Aid - Introductory Screen

  14. Decision Aid - In-Depth Information

  15. Decision Aid- Comparative Information

  16. Pilot trial • 73 patients from UNC Internal Medicine • Mean age 60; 40% female • 69% White, 21% African-American • 64% have HS education or greater • 45% with previous history of screening • 90% preferred to play a major role in deciding how to be screened

  17. Results • Mean viewing time – 19 minutes • Intent increased: 2.8 to 3.2 on 4-point scale • After viewing: • 62% ready to be screened • 17% considering • 16% didn’t want screening at that time • 43% completed screening within 6 months

  18. Informal dissemination • Distributed over 100 copies of original videotape through Sheps Center • Streaming video available on the web: www.med.unc.edu/medicine/edursrc/colon.htm • Managing burden of requests challenging

  19. Current studies • AHRQ-VA pilot implementation trial (Provenzale) • CDC-funded trial of decision aid + academic detailing with Emory (Glanz PI) • Trial of widespread practice-based implementation with FIMDM • Collaboration with other investigators: • Paul Schroy (Boston) • Evelyn Chan (Houston) • David Miller (Wake Forest)

  20. Current studies All studies involve home viewing * Decision aid + academic detailing

  21. Dissemination Issues • Sole intervention vs. combinations • Home viewing vs. office viewing • Multiple test options vs. fewer options • Length • Offer multiple media vs. single type • Outcomes / measures to be collected

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