Physician training in shared decision-making did not increase the proportion of older adults receiving their preferred CRC screening, Medscape Medical News reported Oct. 3.
New research published in JAMA in August considered recent guidelines recommending that shared decision-making be used when deciding if colonoscopies should be continued in patients over 75.
Here are 10 things to know about the study:
1. The impact of shared decision-making was evaluated in 59 physicians and 466 patients with a mean age of 80 years, sampled from 36 primary care clinics in Massachusetts and Maine.
2. Physicians received shared decision-making training and pre-visit electronic reminders to discuss CRC screening, which functioned as the intervention in the study, or only to give reminders, which functioned as the study's comparator.
3. Shared decision-making training emphasized three options: stopping screening, switching to a less invasive stool-based test or continuing colonoscopy.
4. The primary outcome was consistency between patients' preferred screening method and the screening they actually received, assessed over 12 months through surveys and electronic health records.
5. Thirty-five percent of patients preferred stool-based tests, 25% preferred colonoscopy and 21% opted to stop screening. Another 16% were unsure and 4% did not provide a clear preference and were excluded.
6. One year after the index visit, 39% of patients who received intervention and 29% who received the comparator response completed a CRC screening, a nonsignificant difference, according to the report.
7. About 51% of patients in the intervention group went on to receive their preferred screening method, as did 46% of the comparator group. This was not statistically significant, according to the report.
8. Patients with a strong intent to follow through with their preferred approach and those who had longer discussions with their physicians about the CRC screening were two subgroups within the intervention group that were significantly more likely to receive their desired screening approach.
9. Limitations of the study included the fact that the study may have been underpowered to detect small differences in rates of concordance between preferred screening methods and the screening that patients actually received. The study also had limited racial and ethnic diversity and a high level of education, restricting the generalizability of the results. The COVID-19 pandemic may have also affected the ability of patients to follow through with CRC screenings.
10. The study concluded that in practice, the shared decision-making intervention did not make a "statistically significant improvement in the concordance in this sample," and future work is needed to refine and evaluate clinic decision support as well as shared decision-making skills for primary care physicians.