DESCRIPTION (provided by applicant): Interventions designed to increase CRC screening have tended to focus on information targeted to either physicians or patients, in relative isolation from the interactive context of physician-patient encounters; studies of these interventions indicate limited improvement in screening rates. In contrast, the Computer-Assisted Counseling Tools (C-ACTs) in the proposed study are situated in the exam room to optimize physician-patient communication and decision-making. We hypothesize that the C-ACTs will increase: (1) the incidence and quality of physician-patient discussions regarding CRC screening; (2) patients' intention to be screened for CRC; (3) adherence to the screening plan. The primary aims of the proposed study are to:
Aim 1 Evaluate primary care physicians' current practices and perceived needs when discussing CRC screening, and identify factors that would enhance acceptance of computer-assisted counseling tools in everyday practice.
Aim 2 Develop and test theory-driven strategies for presenting text and graphics in computer-assisted counseling tools designed to help patients make an informed choice about CRC screening.
Aim 3 Conduct a feasibility study to determine acceptability of the computer-assisted counseling tools in everyday clinical practice, and evaluate the tools' effect on screening discussion, screening intention, and subsequent screening rates.
Aim 1 will be achieved via a survey of primary-care physicians in a local sample. The physician survey will help set parameters (e.g., reasonable length) for the computer-assisted counseling tools to be developed in Aim 2. Aim 2 will be addressed through an iterative process of message design informed by focus groups with adults aged 50-80 including people with low-literacy. Aim 3 will involve analysis of videotaped physician-patient encounters, post-visit patient questionnaires, medical record reviews, and follow-up telephone interviews of patients in the study, as well as debriefing meetings with physicians in the study.
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