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ARTICLE

Videotape-Based Decision Aid for Colon Cancer Screening

A Randomized, Controlled Trial

Michael Pignone, MD, MPH; Russell Harris, MD, MPH; and Linda Kinsinger, MD, MPH

21 November 2000 | Volume 133 Issue 10 | Pages 761-769

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.

Author and Article Information

From University of North Carolina and University of North Carolina–Lineberger Comprehensive Cancer Center, Chapel Hill, North Carolina.

Acknowledgments: The authors thank the Making Prevention Work staff, including Jennifer Karnitschnig, Shelby Dunivant, June Hall, Larissa Ruuskanen, Rachel Carr, Keri Chatham, and Ann Chamberlin, for their help, and the University of North Carolina Educational Technology Group for their work in filming and editing the video. They also thank the staff of the Cecil G. Sheps Center for Health Services Research for computer and data entry support, Joanne Garrett for statistical advice, and Gary Barnas for providing the findings from his previous unpublished trial.

Grant Support: By the National Cancer Institute, Robert Wood Johnson Foundation Clinical Scholars Program, and University of North Carolina–Lineberger Comprehensive Cancer Center.

Requests for Single Reprints: Michael Pignone, MD, MPH, Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina, CB 7110, 5039 Old Clinic Building, University of North Carolina Hospital, Chapel Hill, NC 27599-7110.

Current Author Addresses: Drs. Pignone, Harris, and Kinsinger: Division of General Internal Medicine and Clinical Epidemiology, University of North Carolina, CB 7110, 5039 Old Clinic Building, University of North Carolina Hospital, Chapel Hill, NC 27599-7110.

Author Contributions: Conception and design: M. Pignone, R. Harris, L. Kinsinger.

Analysis and interpretation of the data: M. Pignone, R. Harris, L. Kinsinger.

Drafting of the article: M. Pignone, R. Harris.

Critical revision of the article for important intellectual content: M. Pignone, L. Kinsinger.

Final approval of the article: M. Pignone, R. Harris, L. Kinsinger.

Provision of study materials or patients: R. Harris, L. Kinsinger.

Obtaining of funding: R. Harris, L. Kinsinger.

Administrative, technical, or logistic support: R. Harris, L. Kinsinger.

Related articles in Annals:

Summaries for Patients
A Videotape-Based Decision Aid for Colon Cancer Screening

Annals 2000 133: S-50. [Full Text]  

Letters
Videotape-Based Decision Aid for Colon Cancer Screening
Gavin Harewood

Annals 2001 135: 634. [Full Text]  

Letters
Videotape-Based Decision Aid for Colon Cancer Screening
Pignone Michael, Harris Russell, AND Kinsinger Linda

Annals 2001 135: 634-635. [Full Text]  

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