Videotape-based Decision Aid for Colon Cancer Screening. A Randomized, Controlled Trial

Background: Rates of colon cancer screening in the United States are low, in part because of poor communication between patients and providers about the availability of effective screening options.

Objective: To test whether a decision aid consisting of an educational video, targeted brochure, and chart marker increased performance of colon cancer screening in primary care practices.

Design: Randomized, controlled trial.

Setting: Three community primary care practices in central North Carolina.

Patients: 1657 consecutive adult patients 50 to 75 years of age were contacted. Of these, 651 (39%) agreed to participate; 249 of the 651 participants (38%) were eligible. Eligible patients had no personal or family history of colon cancer and had not had fecal occult blood testing in the past year or flexible sigmoidoscopy, colonoscopy, or barium enema in the past 5 years.

Intervention: The 249 participants were randomly assigned to view an 11-minute video about colon cancer screening (intervention group) or a video about automobile safety (control group). After viewing the video, intervention group participants chose a color-coded educational brochure (based on stages of change) to indicate their degree of interest in screening. A chart marker of the same color was attached to their charts. Controls received a generic brochure on automobile safety, and no chart marker was attached.

Measurements: Frequency of screening test ordering as reported by participants and frequency of completion of screening tests as verified by chart review.

Results: Fecal occult blood testing or flexible sigmoidoscopy was ordered for 47.2% of intervention participants and 26.4% of controls (difference, 20.8 percentage points [95% CI, 8.6 to 32.9 percentage points]). Screening tests were completed by 36.8% of the intervention group and 22.6% of the control group (difference, 14.2 percentage points [CI, 3.0 to 25.4 percentage points]).

Conclusion: A decision aid consisting of an educational video, brochure, and chart marker increased ordering and performance of colon cancer screening tests.