Ling Bruce S, Trauth Jeanette M, Fine Michael J, Mor Maria K, Resnick Abby, Braddock Clarence H, Bereknyei Sylvia, Weissfeld Joel L, Schoen Robert E, Ricci Edmund M, Whittle Jeffrey
VA Pittsburgh Healthcare System, Pittsburgh, Pennsylvania 15213, USA.
Med Care. 2008 Sep;46(9 Suppl 1):S23-9. doi: 10.1097/MLR.0b013e31817dc496.
Current recommendations advise patients to participate in the decision-making for selecting a colorectal cancer (CRC) screening option. The degree to which providers communicate the information necessary to prepare patients for participation in this process is not known.
To assess the level of informed decision-making occurring during actual patient-provider communications on CRC screening and test for the association between informed decision-making and screening behavior.
Observational study of audiotaped clinic visits between patients and their providers in the primary care clinic at a Veterans Administration Medical Center.
Male patients, age 50-74 years, presenting to a primary care visit at the study site.
The Informed Decision-Making (IDM) Model was used to code the audiotapes for 9 elements of communication that should occur to prepare patients for participation in decision-making. The primary outcome is completion of CRC screening during the study period.
The analytic cohort consisted of 91 patients due for CRC screening who had a test ordered at the visit. Six of the 9 IDM elements occurred in < or =20% of the visits with none addressed in > or =50%. CRC screening occurred less frequently for those discussing "pros and cons" (12% vs. 46%, P = 0.01) and "patient preferences" (6% vs. 47%, P = 0.001) compared with those who did not.
We found that a lack of informed decision-making occurred during CRC screening discussions and that particular elements of the process were negatively associated with screening. Further research is needed to better understand the effects of informed decision-making on screening behavior.
当前的建议是让患者参与选择结直肠癌（CRC）筛查方案的决策过程。但医生就患者参与该过程所需信息的沟通程度尚不清楚。
评估在实际的医患关于CRC筛查的沟通中知情决策的水平，并测试知情决策与筛查行为之间的关联。
对退伍军人管理局医疗中心初级保健诊所中患者与其医生之间的门诊就诊录音进行观察性研究。
年龄在50 - 74岁之间、到研究地点进行初级保健就诊的男性患者。
采用知情决策（IDM）模型对录音进行编码，以确定为使患者参与决策所需发生的9个沟通要素。主要结局是在研究期间完成CRC筛查。
分析队列包括91名应进行CRC筛查且在就诊时已开具检查单的患者。9个IDM要素中有6个在不到或等于20%的就诊中出现，没有一个要素在超过或等于50%的就诊中被提及。与未讨论“利弊”（12%对46%，P = 0.01）和“患者偏好”（6%对47%，P = 0.001）的患者相比，讨论这些内容的患者进行CRC筛查的频率较低。
我们发现，在CRC筛查讨论中存在缺乏知情决策的情况，并且该过程的特定要素与筛查呈负相关。需要进一步研究以更好地理解知情决策对筛查行为的影响。
