College of Public Health, The Ohio State University, College of Public Health, Columbus, OH 43201, USA.
J Gen Intern Med. 2012 Sep;27(9):1135-41. doi: 10.1007/s11606-012-2045-1. Epub 2012 Apr 5.
Colorectal cancer (CRC) screening rates remain low among low-income minority populations.
To evaluate informed decision making (IDM) elements about CRC screening among low-income minority patients.
Observational data were collected as part of a patient-level randomized controlled trial to improve CRC screening rates. Medical visits (November 2007 to May 2010) were audio-taped and coded for IDM elements about CRC screening. Near the end of the study one provider refused recording of patients' visits (33 of 270 patients). Among all patients in the trial, agreement to be audio taped was 43.5 % (103/237). Evaluable patient (n = 100) visits were assessed for CRC screening discussion occurrence, IDM elements, and who initiated discussion of each IDM element.
Patients were African American (72.2 %), female (63.7 %), with annual household incomes <$20,000 (60.7 %), without health insurance (57.0 %), and limited health literacy (53.7 %).
Although CRC screening was mentioned during 48 (48 %) visits, no further discussion about screening occurred in 23 visits (19 times mentioned by the participant with no response from providers). During any visit, the maximum number of IDM elements was five; however, only two visits included five elements. The most common IDM element discussed in addition to the nature of the decision was the assessment of the patient's understanding in 16 (33.3 %) of the visits that included a CRC discussion.
A patient activation intervention initiated CRC screening discussions with health care providers; however, limited IDM occurred about CRC screening during medical visits of minority and low-income patients.
结直肠癌（CRC）筛查率在低收入少数民族人群中仍然较低。
评估低收入少数民族患者 CRC 筛查的知情决策（IDM）要素。
观察性数据是作为提高 CRC 筛查率的患者水平随机对照试验的一部分收集的。医疗访问（2007 年 11 月至 2010 年 5 月）被录音并对 CRC 筛查的 IDM 要素进行编码。在研究接近尾声时，一名医生拒绝记录患者的就诊（270 名患者中的 33 名）。在试验中的所有患者中，同意录音的比例为 43.5%（237 名中的 103 名）。评估了试验中可评估患者（n=100）就诊时 CRC 筛查讨论的发生情况、IDM 要素以及每个 IDM 要素的讨论发起者。
患者为非裔美国人（72.2%）、女性（63.7%），年收入<20000 美元（60.7%），没有健康保险（57.0%），健康素养有限（53.7%）。
尽管在 48 次就诊中提到了 CRC 筛查，但在 23 次就诊中没有进一步讨论筛查（23 次是由参与者提出的，没有得到提供者的回应）。在任何一次就诊中，IDM 要素的最大数量为五个；然而，只有两次就诊包含五个要素。除了决策的性质外，在包括 CRC 讨论的 16 次就诊中（占 33.3%），讨论最多的 IDM 要素是评估患者的理解能力。
患者激活干预措施启动了与医疗保健提供者的 CRC 筛查讨论；然而，在少数民族和低收入患者的医疗就诊中，关于 CRC 筛查的 IDM 内容有限。
