Open Access Open Badges Research article

A targeted decision aid for the elderly to decide whether to undergo colorectal cancer screening: development and results of an uncontrolled trial

Carmen L Lewis12*, Carol E Golin12, Chris DeLeon2, Jennifer M Griffith3, Jena Ivey4, Lyndal Trevena5 and Michael Pignone12

Author Affiliations

1 Department of Medicine, University of North Carolina at Chapel Hill - Chapel Hill, NC, USA

2 Cecil G Sheps Center for Health Services Research, University of North Carolina at Chapel Hill - Chapel Hill, NC, USA

3 School of Rural Public Health, Texas A&M Health Science Center, College Station, TX, USA

4 School of Pharmacy, University of North Carolina at Chapel Hill - Chapel Hill, NC, USA

5 School of Public Health, University of Sydney - New South Wales, Australia

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BMC Medical Informatics and Decision Making 2010, 10:54  doi:10.1186/1472-6947-10-54

Published: 17 September 2010



Competing causes of mortality in the elderly decrease the potential net benefit from colorectal cancer screening and increase the likelihood of potential harms. Individualized decision making has been recommended, so that the elderly can decide whether or not to undergo colorectal cancer (CRC) screening. The objective is to develop and test a decision aid designed to promote individualized colorectal cancer screening decision making for adults age 75 and over.


We used formative research and cognitive testing to develop and refine the decision aid. We then tested the decision aid in an uncontrolled trial. The primary outcome was the proportion of patients who were prepared to make an individualized decision, defined a priori as having adequate knowledge (10/15 questions correct) and clear values (25 or less on values clarity subscale of decisional conflict scale). Secondary outcomes included overall score on the decisional conflict scale, and preferences for undergoing screening.


We enrolled 46 adults in the trial. The decision aid increased the proportion of participants with adequate knowledge from 4% to 52% (p < 0.01) and the proportion prepared to make an individualized decision from 4% to 41% (p < 0.01). The proportion that preferred to undergo CRC screening decreased from 67% to 61% (p = 0. 76); 7 participants (15%) changed screening preference (5 against screening, 2 in favor of screening)


In an uncontrolled trial, the elderly participants appeared better prepared to make an individualized decision about whether or not to undergo CRC screening after using the decision aid.