Patient Education and Counseling
Volume 78, Issue 2 , Pages 166-168, February 2010

Strategies for distributing cancer screening decision aids in primary care☆

  • Charles Brackett

      Affiliations

    • Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA
    • Corresponding Author InformationCorresponding author at: Section of General Internal Medicine, Dartmouth Hitchcock Medical Center, One Medical Center Drive, Lebanon, NH 03756, United States. Tel.: +1 603 650 2921.
    • ,
  • Stephen Kearing

      Affiliations

    • Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
    • ,
  • Nan Cochran

      Affiliations

    • White River Junction, VAH, VT, USA
    • ,
  • Anna N.A. Tosteson

      Affiliations

    • Dartmouth Institute for Health Policy and Clinical Practice, Lebanon, NH, USA
    • ,
  • W. Blair Brooks

      Affiliations

    • Dartmouth-Hitchcock Medical Center, Lebanon, NH, USA

Received 31 October 2008; received in revised form 19 June 2009; accepted 29 June 2009. published online 10 August 2009.

Abstract 

Objective

Decision aids (DAs) have been shown to facilitate shared decision making about cancer screening. However, little data exist on optimal strategies for dissemination. Our objective was to compare different decision aid distribution models.

Methods

Eligible patients received video decision aids for prostate cancer (PSA) or colon cancer screening (CRC) through 4 distribution methods. Outcome measures included DA loans (N), % of eligible patients receiving DA, and patient and provider satisfaction.

Results

Automatically mailing DAs to all age/gender appropriate patients led to near universal receipt by screening-eligible patients, but also led to ineligible patients receiving DAs. Three different elective (non-automatic) strategies led to low rates of receipt. Clinician satisfaction was higher when patients viewed the DA before the visit, and this model facilitated implementation of the screening choice. Regardless of timing or distribution method, patient satisfaction was high.

Conclusions

An automatic DA distribution method is more effective than relying on individual initiative. Enabling patients to view the DA before the visit is preferred.

Practice implications

Systematically offering DAs to all eligible patients before their appointments is the ideal strategy, but may be challenging to implement.

Keywords: Shared decision making, Decision aids, Patient education and counseling, Cancer screening

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☆ This research was performed at Dartmouth-Hitchcock Medical Center in Lebanon, NH and White River Junction VA Hospital in White River Junction, VT between June 2006 and May 2008.

PII: S0738-3991(09)00255-9

doi:10.1016/j.pec.2009.06.013

Patient Education and Counseling
Volume 78, Issue 2 , Pages 166-168, February 2010

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