Promoting Informed Decisions About Colorectal Cancer Screening in Older Adults (PRIMED Study): a Physician Cluster Randomized Trial.

Autor: Sepucha K; Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA. ksepucha@mgh.harvard.edu.; Harvard Medical School, Boston, MA, USA. ksepucha@mgh.harvard.edu., Han PKJ; Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA.; Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, USA., Chang Y; Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Atlas SJ; Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Korsen N; Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA., Leavitt L; Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA., Lee V; Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA., Percac-Lima S; Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Mancini B; Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA., Richter J; Harvard Medical School, Boston, MA, USA.; Division of Gastroenterology, Massachusetts General Hospital, Boston, MA, USA., Scharnetzki E; Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA., Siegel LC; Harvard Medical School, Boston, MA, USA.; Division of General Internal Medicine, Brigham and Women's Hospital, Boston, MA, USA., Valentine KD; Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA., Fairfield KM; Center for Interdisciplinary Population and Health Research, Maine Medical Center, Portland, ME, USA., Simmons LH; Division of General Internal Medicine, Massachusetts General Hospital Health Decision Sciences Center, Boston, MA, USA.; Harvard Medical School, Boston, MA, USA.
Jazyk: angličtina
Zdroj: Journal of general internal medicine [J Gen Intern Med] 2023 Feb; Vol. 38 (2), pp. 406-413. Date of Electronic Publication: 2022 Aug 05.
DOI: 10.1007/s11606-022-07738-4
Abstrakt: Background: For adults aged 76-85, guidelines recommend individualizing decision-making about whether to continue colorectal cancer (CRC) testing. These conversations can be challenging as they need to consider a patient's CRC risk, life expectancy, and preferences.
Objective: To promote shared decision-making (SDM) for CRC testing decisions for older adults.
Design: Two-arm, multi-site cluster randomized trial, assigning physicians to Intervention and Comparator arms. Patients were surveyed shortly after the visit to assess outcomes. Analyses were intention-to-treat.
Participants and Setting: Primary care physicians affiliated with 5 academic and community hospital networks and their patients aged 76-85 who were due for CRC testing and had a visit during the study period.
Interventions: Intervention arm physicians completed a 2-h online course in SDM communication skills and received an electronic reminder of patients eligible for CRC testing shortly before the visit. Comparator arm received reminders only.
Main Measures: The primary outcome was patient-reported SDM Process score (range 0-4 with higher scores indicating more SDM); secondary outcomes included patient-reported discussion of CRC screening, knowledge, intention, and satisfaction with the visit.
Key Results: Sixty-seven physicians (Intervention n=34 and Comparator n=33) enrolled. Patient participants (n=466) were on average 79 years old, 50% with excellent or very good self-rated overall health, and 66% had one or more prior colonoscopies. Patients in the Intervention arm had higher SDM Process scores (adjusted mean difference 0.36 (95%CI (0.08, 0.64), p=0.01) than in the Comparator arm. More patients in the Intervention arm reported discussing CRC screening during the visit (72% vs. 60%, p=0.03) and had higher intention to follow through with their preferred approach (58.0% vs. 47.1, p=0.03). Knowledge scores and visit satisfaction did not differ significantly between arms.
Conclusion: Physician training plus reminders were effective in increasing SDM and frequency of CRC testing discussions in an age group where SDM is essential.
Trial Registration: The trial is registered on clinicaltrials.gov (NCT03959696).
(© 2022. The Author(s).)
Databáze: MEDLINE
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