Promoting Informed Decisions About Cancer Screening in Older Adults

Not Applicable

Completed

Brief Summary: This project aims to examine the impact of different interventions designed to help individualize colorectal cancer (CRC) screening decisions in adults aged 76-85. Clinicians will be assigned by chance to one of two arms. In the Intervention arm, clinician participants will complete a training course and will also be notified of patients in the target age group who are due for a discussion about CRC screening. In the Comparator arm, clinician participants will be notified of their patients in the target age group with an upcoming visit who are due for a discussion about CRC screening. The investigators expect that patients seen by clinicians in the intervention arm will report more involvement in the decision making process, be more knowledgeable about the risks and benefits of CRC screening, and will have better quality decisions. Further, the investigators expect that the physicians in the intervention arm will have greater confidence in and demonstrate more skills for conducting shared decision making conversations as compared to those in the control arm.

Detailed Description: This study will advance understanding of how to engage and inform older adults in decisions about whether to continue or stop colorectal cancer (CRC) screening. The study will randomly assign about 50 primary care clinicians from 5 different sites to one of two different arms. In the Intervention arm, clinician participants will complete a training course and will also be notified of patients aged 76-85 with an upcoming visit who are due for a discussion about CRC screening. In the Comparator arm, clinician participants will be notified of their patients in the target age group with an upcoming visit who are due for a discussion about CRC screening. The study staff will collect surveys from about 500 eligible patients of participating physicians shortly after their visit to determine the impact of the intervention on patient-reported measures including the amount of shared decision making, knowledge, and preferences for cancer screening. Study staff will follow patients to track colorectal cancer screening tests in the 12 months following the visit and will survey some patients again at 12 months to examine any barriers to follow through with their preferred approach. The study will also assess physician's ability to demonstrate shared decision making skills for cancer screening decisions in simulated patient interactions. Caregivers, if identified by a patient participant, will also complete a short survey evaluating the visit.

Recruitment & Eligibility

Inclusion Criteria

Not provided

Exclusion Criteria

Not provided

Arm && Interventions

Group	Intervention	Description
Training and Notification arm	Notification	Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content.
Training and Notification arm	Training	Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening and will complete a two-hour shared decision making communication skills training course that includes case studies, interactive exercises, and lecture content.
Notification only arm	Notification	Clinician participants will be notified of their patients aged 76-85 with an upcoming visit who are due for colorectal cancer screening.

Primary Outcome Measures

Name	Time	Method
Shared Decision Making Process (SDMP) Scale Score	About 1 week after the physician visit	The SDMP scale is a short, patient-reported scale that asks patients about discussion of options, pros and cons of colonoscopy and discussion of patients' preferences. Total scores range from 0-4, with higher scores indicating more shared decision making.

Secondary Outcome Measures

Name	Time	Method
Percentage of Patients Who Received Preferred Approach to Colorectal Cancer Testing	1 week after physician visit (preference); 12 months after physician visit (testing)	Colorectal Cancer Screening Preference assessed with 1 item adapted from the CRC Decision Quality Instrument will be compared with the screening approach followed (assessed via chart review and patient report) to determine the percentage of patients who received preferred approach to testing.
Physician's Shared Decision Making Skills	Baseline	The transcripts from the simulated patient interactions will be scored by two coders using Braddock's Informed Decision Making framework. Total scores range from 0-9 with higher scores indicating more shared decision making elements in the interaction.
Colorectal Cancer Screening Rates	1 year	The chart review results of cancer screening rates for patients enrolled in the study.
Patients' Colorectal Cancer Screening Knowledge Score	1 week after physician visit	Colorectal Cancer (CRC) Screening Knowledge will be assessed with multiple choice knowledge items adapted from the CRC Decision Quality Instrument. A total score from 0-100% will be calculated based on the number of correct answers, with higher scores indicating higher knowledge.
Clinician Satisfaction With the Visit	1 week post visit	The percentage of study patient visits where the clinicians' reported that they were 'extremely or very satisfied' will be compared across arms.

Locations (5): Brigham and Women's Hospital
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Boston, Massachusetts, United States
Maine Medical Center
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Portland, Maine, United States
North Shore Medical Center
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Danvers, Massachusetts, United States
Massachusetts General Hospital
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Boston, Massachusetts, United States
Newton-Wellesley Hospital
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Newton, Massachusetts, United States