This study will develop and test the efficacy of a multimedia decision aid that addresses the facts and myths about colorectal cancer, identifies the risk factors for colorectal cancer, and reviews the options for colorectal screening. Work for the development on this web-based decision aid is based on results from the coloWeb (Katz) project.

cancer prevention, colorectal cancer, screening, informed decision making, risk assessment, decision aid, preference tool, Internet, web

1. Describe the range of methods or messages people who have not been screened would find useful in changing their behavior related to screening for colorectal cancer.
2. Develop web-based messages related to promoting colorectal cancer screening.
3. Describe the range of responses to these messages received from the target audience with respect to ease of use, understanding, change in knowledge, change in behavior, and perceived impact on the population.

174 rural/urban, Caucasians/African Americans over 50 and who have not completed CRC screening.

Participants are randomly assigned to receive either a standard website on colorectal cancer screening or the intervention (coloWeb). The intervention website contains the following information and interactive tools:

1) What is Colorectal Cancer? This section provides an overview of colorectal cancer, defines key terms, contains a graphic illustration of the digestive tract, and explains that screening tests are available to detect the disease. It contains a section on risk factors for colorectal cancer as well as a Personal Risk Assessment, which provides tailored feedback of a patient's risk for the disease based on the pre-test data provided.

2) How Can I Check For It? This section explains that several screening tests are available to detect colorectal cancer and contains detailed information about fecal occult blood testing (FOBT), colonoscopy, flexible sigmoidoscopy, and double contrast barium enema (DCBE). We used the latest screening recommendations from the American Cancer Society. Each test description includes a list of advantages and considerations, such as the test’s frequency, accuracy, cost, and type of preparation required.

3) Should I Get Tested? This section provides factual information about some common myths about colorectal cancer, including prevention, symptoms, perceived risk, and survival. It also addresses a number of common barriers or fears that may keep people from getting screened, such as pain or embarrassment.

4) Choosing a Test. This section contains an interactive tool that allows patients to choose the best test(s) for them based on a set of factors that include accuracy, convenience, cost, discomfort, embarrassment, frequency, need for additional tests, preparation, risk, and sedation. Patients can select the three most important factors and learn which test is most suitable based on those factors. They can repeat this exercise, choosing new factors as often as they like. Patients who arrive at this section already knowing which test they prefer can bypass the interactive component and select their preferred test. Regardless of the path they follow to select a test (either choosing directly or having a test recommended based on their top 3 factors), all patients view a brief video on the next screen that depicts a University of Michigan physician reinforcing their choice and encouraging them to proceed with getting screened. The text of the doctor’s message is also displayed on the screen next to the video window.

5) Other Resources. This section contains brief descriptions, links, and contact information for national and state organizations that users can contact for more information about colorectal cancer.

The intervention site also contains links in multiple places to a glossary and table that summarizes helpful information about each of the four recommended screening tests. Users can print this table and use it for a side-by-side comparison of the tests.

All participants will complete an immediate post-intervention survey to evaluate whether or not they have chosen a preferred method for completing CRC screening. All participant medical records will be reviewed at 24 weeks to determine if CRC screening has been completed.

174 eligible adults were randomized and participated. Immediately post-intervention, Colorectal Web participants were significantly more likely to have a preferred colorectal cancer screening method, but this difference did not persist at subsequent follow-up. Eighty-nine participants had been screened for colorectal cancer by 24 weeks post-intervention. The probability of being screened for the Colorectal Web intervention study arm compared to the control is OR=3.23 (2.73-3.50 95% Confidence Interval).

Colorectal Web is more effective than a standard colorectal cancer Web site at prompting previously unscreened individuals to choose a preferred colorectal cancer screening test and to be screened for colorectal cancer.

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Jimbo M, Ruffin M, Nease D, Fetters, MD, Strecher V, Saunders E. Cancer screening adherence through technology-enhanced shared decision making. Family Medicine Digital Resources Library. Available at: http://www.fmdrl.org/index.cfm?event=c.beginBrowseD#740

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