Assignment: Internet-based Tools

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Assignment: Internet-based Tools

Assignment: Internet-based Tools

ORDER NOW FOR AN ORIGINAL PAPER:Assignment: Internet-based Tools

In the light of recent evidence sug-

gesting that the number of screening options

may influence test choice but not interest in

screening and that the importance of out-of-

pocket costs declines as the number of screening

options discussed increases,26 one approach

would be to develop one tool that presents the

full menu of screening options without cost

information and a second that includes a more

limited set of options with cost information. A

more appealing approach would be to develop a

more comprehensive tool that includes both the

full menu of options and cost information in a

format that permits navigation so that patients

could tailor their use to fit their own informa-

tional needs and ⁄or recommendations of their provider. Internet-based tools are ideally suited

for this purpose but, as noted by several par-

ticipants in our study, access remains a potential

barrier for a sizeable, albeit declining, propor-

tion of the target population. Providers in our

study felt that both Internet- and DVD-for-

matted tools were viable options for dissemina-

tion, even though the DVD-formatted tool

offers less navigation potential.

Our study has several notable limitations.

First, the survey was conducted among primary

care providers at only two institutions, and

hence, the findings may not be generalizable to

providers in other health care settings. It is

noteworthy, however, that the study was con-

ducted among a diverse patient population with

respect to both race ⁄ ethnicity and educational status.16 Second, as participating providers

never formally reviewed the decision aid, we

Colorectal cancer screening decision aid, P C Schroy, S Mylvaganam and P Davidson

� 2011 John Wiley & Sons Ltd Health Expectations, 17, pp.27–35


were unable to assess their opinions with respect

to actual content or format.

Third, the content

of our survey instrument did not allow us to

tease out the extent to which use of the decision

aid impacted on individual steps of the SDM

process.4,5 Even though satisfaction with the

decision-making process was universally high

among patients participating in the clinical

trial,16 especially those in the intervention

groups, only a relative minority of providers felt

that use of the tool helped them tailor their

counselling about CRC screening to their

patients� needs or increased patient satisfaction with their care. Fourth, the anonymous nature

of our survey precluded any attempt to correlate

response data with exposure rates. It is con-

ceivable that the perceptions of providers

exposed to multiple patients in the intervention

arms might differ from those exposed to only a

few patients. Lastly, we cannot rule out the

possibility of social response bias, whereby

respondents may have felt compelled to offer

more positive responses than they actually



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