Strategies for distributing cancer screening decision aids in primary care

Objective: Decision aids (DAs) have been shown to facilitate shared decision making about cancer screening. However, little data exist on optimal strategies for dissemination. Our objective was to compare different decision aid distribution models. Methods: Eligible patients received video decision aids for prostate cancer (PSA) or colon cancer screening (CRC) through 4 distribution methods. Outcome measures included DA loans (N), % of eligible patients receiving DA, and patient and provider satisfaction. Results: Automatically mailing DAs to all age/gender appropriate patients led to near universal receipt by screening-eligible patients, but also led to ineligible patients receiving DAs. Three different elective (non-automatic) strategies led to low rates of receipt. Clinician satisfaction was higher when patients viewed the DA before the visit, and this model facilitated implementation of the screening choice. Regardless of timing or distribution method, patient satisfaction was high. Conclusions: An automatic DA distribution method is more effective than relying on individual initiative. Enabling patients to view the DA before the visit is preferred. Practice implications: Systematically offering DAs to all eligible patients before their appointments is the ideal strategy, but may be challenging to implement. (C) 2009 Elsevier Ireland Ltd. All rights reserved.