Project Overview +

This study aims to increase the number of insured, primary care patients who complete a colorectal cancer (CRC) screening. This study integrates an innovative preference elicitation methodology, conjoint analysis, into a decision tool to help primary care patients clarify their preferences for CRC screening tests. The two sites participating in this study also allow for a more racially/ethnically diverse audience than other Decider Guider studies.

Aims +

Aim 1. To evaluate the effectiveness of a preference-tailored intervention vs. standard information delivered via computer for increasing patient adherence to CRC screening guidelines in a randomized controlled trial in two racially/ethnically diverse geographic locations.

Aim 2. To assess the impact of the intervention on patient perceptions of informed decision-making, knowledge about CRC screening, decisional conflict and satisfaction, and intention to get screened 3 days after a primary care visit.

Aim 3. To conduct a cost effectiveness analysis of a preference-tailored strategy for increasing CRC screening utilization within a primary care setting.

Participants +

The study will recruit 325 people per site: 1) members of the Health Alliance Plan (HAP) within Henry Ford Health System (HFHS) in Detroit, MI, and 2) members of the San Francisco Community Health Network (SFCHN) affiliated with San Francisco General Hospital in California.

Intervention +

New to this version of Decider Guider, participants have one of two choices:

  1. Arrive at the physician office 40 minutes before their scheduled physician appointment to complete the program.
  2. Complete the program at home on their own computer and bring their results with them to their physician visit.

Participants are randomly assigned to receive the intervention or standard CRC screening information.

Control participants review information about colon cancer, the screening tests available, and are asked to choose a test they prefer. They receive a copy of the CDC Screen For Life Fact Sheet on Colorectal Cancer Screening to take to their visit. This includes a brief overview of all screening options, but does not list the participant's final test preference.

Intervention participants read an overview about CRC, descriptions of four screening tests available to them, and definitions of key screening test terms used in the study's conjoint analysis exercise. Each intervention participant then sees 20 screens, each with a hypothetical screening test scenario. Each screen shows participants two choices with different characteristics. For example:

  • Option 1: test every 5 to 10 years, follow-up tests needed.
  • Option 2: yearly testing, no follow-up tests.

Option 1 words and images are on the left side of the screen, while Option 2 is on the right. Participants choose one point on a 9-point scale ("I strongly prefer Option 1" to "I strongly prefer Option 2") and their responses are stored for later conjoint analysis.

After completing the scenarios, participants review a page that lists their "Top 3 test attributes" (e.g., frequency, accuracy, preparation). They also see the screening test that is most consistent with their top attributes (e.g., FOBT) and basic information about this test. They may view more information if they choose. Additionally, they see a list of other test options and may view more information about each one. Finally, they choose the test they would prefer from a list of all four test options. A final screen lists their preference-matched test, determined by the conjoint analysis exercise, their preferences and their final choice. A printout of this screen is provided to the participant, with a brief description of each of the screening options included on the back of the printout.

Participants are encouraged to share the handout with their physician during their visit. Participants receive a follow-up telephone call approximately 3 days after their visit to complete a 30-minute telephone interview. A medical chart audit 12 months later assesses use of services.

Decider Guider - Primary Care

06/09/2008 - 04/30/2012

Sponsor(s)

National Cancer Institute

Principal Investigator:

Sarah T. Hawley, PhD, MPH