Development and evaluation of a new survey instrument to measure the quality of colorectal cancer screening decisions

BackgroundGuidelines for colorectal cancer screening recommend that patients be informed about options and be able to select preferred method of screening; however, there are no existing measures available to assess whether this happens.MethodsColorectal Cancer Screening Decision Quality Instrument (CRC-DQI) includes knowledge items and patients' goals and concerns. Items were generated through literature review and qualitative work with patients and providers. Hypotheses relating to the acceptability, feasibility, discriminant validity and retest reliability of the survey were examined using data from three studies: (1) 2X2 randomized study of participants recruited online, (2) cross-sectional sample of patients recruited in community health clinics, and (3) cross-sectional sample of providers recruited from American Medical Association Master file.Results338 participants were recruited online, 94 participants were recruited from community health centers, and 115 physicians were recruited. The CRC-DQI was feasible and acceptable with low missing data and high response rates for both online and paper-based administrations. The knowledge score was able to discriminate between those who had seen a decision aid or not (84% vs. 64%, p < 0.001) and between providers, online patients and clinic patients (89% vs. 74% vs. 41%, p < 0.001 for all comparisons). The knowledge score and most of the goals had adequate retest reliability. About half of the participants received a test that matched their goals (47% and 51% in online and clinic samples respectively). Many respondents who had never been screened had goals that indicated a preference for colonoscopy. A minority of respondents in the online (21%) and in clinic (2%) samples were both well informed and received a test that matched their goals.ConclusionsThe CRC-DQI demonstrated good psychometric properties in diverse samples, and across different modes of administration. Few respondents made high quality decisions about colon cancer screening.

[1]  Karen R. Sepucha,et al.  Measuring decision quality: psychometric evaluation of a new instrument for breast cancer surgery , 2012, BMC Medical Informatics and Decision Making.

[2]  Karen R. Sepucha,et al.  Policy support for patient-centered care: the need for measurable improvements in decision quality. , 2004, Health affairs.

[3]  E W Steyerberg,et al.  What determines individuals' preferences for colorectal cancer screening programmes? A discrete choice experiment. , 2010, European journal of cancer.

[4]  G. Harewood,et al.  A Videotape-Based Decision Aid for Colon Cancer Screening , 2000, Annals of Internal Medicine.

[5]  J. Nunnally Psychometric Theory (2nd ed), New York: McGraw-Hill. , 1978 .

[6]  R. Thomson,et al.  Decision aids for people facing health treatment or screening decisions. , 2003, The Cochrane database of systematic reviews.

[7]  Dachao Liu,et al.  Colorectal cancer screening knowledge, attitudes, and beliefs among veterans: does literacy make a difference? , 2004, Journal of clinical oncology : official journal of the American Society of Clinical Oncology.

[8]  Robert F. DeVellis,et al.  Scale Development: Theory and Applications. , 1992 .

[9]  S. Weller,et al.  Cancer and colorectal cancer: knowledge, beliefs, and screening preferences of a diverse patient population. , 2005, Family medicine.

[10]  Floyd J. Fowler,et al.  Survey Research Methods , 1984 .

[11]  Angela Fagerlin,et al.  Adherence to colorectal cancer screening: a randomized clinical trial of competing strategies. , 2012, Archives of internal medicine.

[12]  T. Heeren,et al.  Patient preferences for colorectal cancer screening: how does stool DNA testing fare? , 2007, The American journal of managed care.

[13]  Karen R. Sepucha,et al.  Psychometric Evaluation of a Decision Quality Instrument for Treatment of Lumbar Herniated Disc , 2012, Spine.

[14]  L. Eby Book Review: Survey Research Methods, 3rd ed., by Floyd J. Fowler Jr. (2002). Thousand Oaks, Ca: Sage. , 2003 .

[15]  M J Buxton,et al.  Evaluating patient-based outcome measures for use in clinical trials. , 1998, Health technology assessment.

[16]  Karen R. Sepucha,et al.  Decision quality instrument for treatment of hip and knee osteoarthritis: a psychometric evaluation , 2011, BMC musculoskeletal disorders.

[17]  Carmen L. Lewis,et al.  Decision-Making Processes for Breast, Colorectal, and Prostate Cancer Screening: The DECISIONS Survey , 2010, Medical decision making : an international journal of the Society for Medical Decision Making.

[18]  Navkiran K. Shokar,et al.  Informed Decision Making Changes Test Preferences for Colorectal Cancer Screening in a Diverse Population , 2010, The Annals of Family Medicine.

[19]  H. Pollard,et al.  Retraction: The effect of a sports chiropractic manual therapy intervention on the prevention of back pain, hamstring and lower limb injuries in semi-elite Australian Rules footballers: A randomized controlled trial , 2011, BMC musculoskeletal disorders.

[20]  David P. Miller,et al.  The effect of health literacy on knowledge and receipt of colorectal cancer screening: a survey study , 2007, BMC family practice.

[21]  F DeVellis.Robert,et al.  SCALE DEVELOPMENT Theory and Applications Third Edition , 2012 .

[22]  David P. Miller,et al.  Effectiveness of a web-based colorectal cancer screening patient decision aid: a randomized controlled trial in a mixed-literacy population. , 2011, American journal of preventive medicine.