Health Dialog Connections

National Cancer Institute Highlights Shared Decision Making in Practice

The National Cancer institute (NCI) has spotlighted a  Journal of General Internal Medicine study that more than doubled the rates of colorectal cancer screening in a high-need, low-income, non-English speaking population. NCI has also developed a corresponding implementation guide and toolkit so that this research can be replicated in practice. We couldn’t be happier that our patient decision aid, “Colon Cancer Screening: Deciding What’s Right for You,” is a key component of this toolkit, and that NCI is promoting the importance and adoption of Shared Decision Making.

The featured study was led by Sanja Percac-Lima, MD, PhD, a primary care physician at Massachusetts General Hospital’s Chelsea HealthCare Center. Dr. Percac-Lima sat down with us to discuss how the decision aid and Shared Decision Making were instrumental to her effort.

Q: Dr. Percac-Lima, could you summarize your study for us?

A: Colorectal cancer (CRC) is the third most commonly diagnosed cancer and second leading cause of cancer death in the US.  Morbidity and mortality can be significantly reduced through early detection and treatment, but almost 2/3 of diagnosed patients present with an advanced stage of the disease. Screening rates for CRC are lower than for other preventable cancers and are particularly low in ethnic minorities, non-English speakers, and low income individuals. I conducted a randomized controlled trial to evaluate a culturally-tailored intervention designed to increase CRC screening among a low-income and non-English speaking population receiving care at the Chelsea HealthCare Center.

Q: What was your intervention? What were the results?

A: My intervention consisted of a letter introducing the program and educational material followed by phone or in-person contact by a language-concordant “patient navigator”. These were community health workers trained, in part using Health Dialog’s Decision Aid,  “Colon Cancer Screening: Deciding What’s Right for You”, to identify and address patient-reported barriers to CRC screening. Individually tailored interventions included patient education, procedure scheduling, translation and explanation of procedure preparation, and help with transportation and insurance coverage. Over a 9 month period, intervention patients were more likely to undergo CRC screening than control patients (27% vs. 12%) and the higher screening rate resulted in the identification of 10.5 CRC polyps per 100 patients in the intervention group vs. 6.8 in the control group.

Q: Can you explain why and how you decided to use the Shared Decision Making® aid as part of your study?

A: Massachusetts General Hospital has been using Health Dialog patient decision aids since 2005 as part of a demonstration funded by the Informed Medical Decisions Foundation that works closely with Health Dialog. I’ve used the aids with my patients and have found them to be very effective. For the study population that did not speak English as a primary language, the CRC Screening decision aid was too sophisticated. However, it proved to be very useful for training the patient navigators who then conveyed the information they learned  to the patients in their native language as part of the navigation process. The decision aid was critical to my study to ensure every aspect of screening was covered, including screening options, risks and benefits, preparation, and what to expect. I am honored that my intervention is now being featured by NCI.  I hope that other community health center physicians can incorporate patient decision aids in this non-traditional way. 

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