Assignment: CRC Screening Literature
One of the most commonly cited barriers to
implementation of SDM is the time requirement.
Although studies to date have provided con-
flicting data regarding the impact of decision
aids on consultation time for other condi-
tions,17–22 we postulated that by educating
patients about the risks and benefits of the dif-
ferent screening options and facilitating IDM
prior to the provider–patient encounter, our
decision aid would have the potential of
improving the efficiency of SDM and thus save
time, as noted by Green et al. and Brackett
et al.17,18 We found that although a majority of
providers agreed or strongly agreed that pre-visit
use of the tool saved time, 21% were neutral on
the issue and 14% disagreed or strongly dis-
agreed. It is conceivable that this diversity of
opinion might be a reflection of the extent to
which provider and patient preferences agreed or
disagreed. In instances where there was concor-
dance between preferences, as was often the case
that since colonoscopy was preferred by major-
ity of both patients and providers,16 one would
expect that the time required for deliberation
and negotiation would be substantially shorter
than in situations where there was discordance.
Alternatively, these differences might reflect
differences in case mix with respect to patient
factors, such as literacy level or desired level of
participation in the decision-making process.
A secondary objective of our study was to
elicit provider feedback regarding content and
format preferences to gain insight into potential
modifications that might enhance future uptake.
Because of an ongoing debate in the CRC
screening literature,23–27 we focused on content
issues related to cost information and number of
screening options to include in the decision aid.
Both questions elicited a divergence of opinions.
Whereas nearly 50% of respondents felt that
cost information should be included, the
remainder was either neutral or opposed to its
inclusion. Similarly, when asked about the
number of screening options to include, �50% preferred the full menu of options and �40% preferred a more limited menu. This diversity of
opinion highlights some of the key challenges in
designing tools with broad dissemination
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