Purpose: Colorectal cancer screening (CRCS) remains underutilized. It is unknown if shared decision making (SDM) clarifies patient preference regarding CRCS options and positively affects patient intent to undergo CRCS and CRCS adherence. This study sought to determine if increase in SDM clarifies patient preference regarding CRCS options and positively affects patient intent to undergo CRCS and CRCS adherence. Additionally, effect of SDM on concordance (agreement between patient’s desired CRCS option and clinician’s recommended CRCS option) was assessed.
Methods: Linear regression and change score analyses were performed on patient survey, audio-record, and chart audit data from a 2-armed randomized controlled study (R01CA152413) set in 12 community- and 3 university-based primary care practices in southeastern Michigan. Patients were men and women aged 50 to 75 years not current on CRCS. The 2 arms were interactive vs. non-interactive patient decision aid (DA) on CRCS. All patient web use and data collection were done in the primary care practice immediately prior to the patient/clinician visit. SDM was measured by OPTION-12, a validated instrument that measured clinician performance of SDM during the visit, which was audio-recorded. Main outcomes were change in patient preference and intent as measured by patient survey before and after the visit. Concordance was determined by review of audio-recorded data by two reviewers. CRCS adherence was determined by medical record documentation of CRCS 6 months after the visit.
Results: Among 570 participants, SDM as measured by OPTION-12 was significantly greater among those who clarified their preference [mean (standard deviation) = 12.6 (6.7) vs. 10.5 (6.1), p-value=0.0155] and increased intent [11.6 (6.4) vs. 10.3 (6.1), p-value=0.03] after the visit. SDM was also significantly greater among those with concordance of desired and recommended CRCS option [12.0 (4.9) vs. 10.4 (7.2)]. SDM was not significantly associated with CRCS adherence or study arm.
Conclusion: Increase in SDM clarified patient preference regarding CRCS options and positively affected patient intent to undergo CRCS. Increase in SDM was also correlated with greater concordance. Increase in SDM did not lead to increase in CRCS adherence.