Study shows videotape 'decision aid' boosts colon cancer screening usage

November 20, 2000

CHAPEL HILL -- Watching a videotape that explains the medical procedures involved and their importance in a doctor's office can boost the number of patients who undergo screening for colon cancer, a new University of North Carolina at Chapel Hill study shows. Increasing such testing for the deadly illness could save thousands of lives a year in the United States.

"Colon cancer screening is one of the most underutilized cancer preventive services that has been proven effective," said Dr. Michael P. Pignone, assistant professor of medicine at the UNC-CH School of Medicine. "Depending on the study you look at, only 25 to 40 percent of adults over age 50 who are eligible for such screening are now actually getting it. This new work is important because it shows that we can increase that number by at least 15 percent."

A report on the study appears in the Nov. 21 issue of the Annals of Internal Medicine, a medical journal. Besides Pignone, who led the research, authors are Drs. Russ Harris, associate professor of medicine, and Linda Kinsinger, assistant professor of medicine. All are members of the UNC Lineberger Comprehensive Cancer Center and division of general internal medicine.

Pignone and his colleagues created the 11-minute videotape, along with a color-coded brochure and chart marker, to inform patients about colon cancer screening options and to help them decide how to be tested. The physicians then determined the tape's effectiveness with 250 adults ages 50 to 75 who visited three primary-care practices in Greensboro and Burlington, N.C.

When compared with patients who only watched a video about automobile safety, 15 percent more of those who had seen the colon cancer tape underwent either fecal occult blood or sigmoidoscopy screening. "That's statistically significant as well as clinically important," Pignone said. "It's important because it shows a change in the behavior of both patients and doctors. Too often doctors don't discuss colon cancer screening, and so most patients aren't even aware that they have the option of being screened."

Other efforts already proven effective in increasing screening are office systems that remind doctors to discuss the issue with their patients, the physician said. It may be that coupling patient-directed decision aids like the new videotape and brochure with reminder systems for physicians could boost screening even further.

"Decision aids are a hot topic in medicine right now, and our work is one of the largest trials ever done on their effectiveness in real clinical practices," Pignone said. "We're really excited about it and about doing more work in this area."

Other decision aids include those that help patients decide whether to take anti-coagulation therapy for a heart problem known as atrial fibrillation, for example, and whether to undergo surgery for an enlarged prostate or to manage it medically.

The UNC-CH researchers already have shared their videotape, brochure and chart marker with many other colorectal cancer screening programs throughout the United States, he said. They also are working with the state Medicare review office to learn whether they can increase screening among Medicare enrollees and are also developing a World Wide Web-based version of the decision aid system. The video can be viewed on the UNC-CH School of Medicine Web site at www.med.unc.edu/medicine/edusrc/colon.htm. The study is part of a larger National Cancer Institute-funded study titled "Making Prevention Work" and led by Harris and Kinsinger at UNC-CH. The Robert Wood Johnson Clinical Scholars Program and the Lineberger cancer center also support the effort.

More than 47,000 Americans die from colon cancer each year and another 8,600 die from rectal cancer. Most of those deaths could be prevented if the tumors were caught earlier, doctors agree. Colorectal cancers are the third most common cancers in men and women, and an estimated 140,000 new U.S. cases will be diagnosed this year.
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Note: Pignone can be reached at (919) 966-2276 or 966-1369 or via e-mail at pignone@med.unc.edu.

Lineberger center contact: Dianne Shaw,(919) 966-5905. News Services contact: David Williamson, (919) 962-8596.

University of North Carolina at Chapel Hill

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