A Novel CRC Screening Decision Aid for Older Adults with Low Health Literacy

  • Clinical Transformation,
  • Health Equity
Project Status: In Progress

This project is developing a decision aid tool to support and inform shared decision making for older adults with low health literacy (LHL) considering colorectal cancer screening.  Findings will empower decision making for LHL older adult populations and improve CRC screening decisions and quality of care.

In the United States, 33% of colorectal cancer (CRC) diagnoses and 46% of CRC deaths occur in adults over the age of 75. While there are benefits to CRC screening including early detection, there is little evidence that screening benefits adults over the age of 75 because few trials included older adults. Patients tend to overestimate the benefits of screening and minimize the risks. Some CRC risks can include perforation, dehydration, and false-positive results. Thus, it is important that for adults over the age of 75, the decision to screen should be individualized to the patient. Shared decision making can be used to guide and inform these individualized decisions. Through this process, patients and their clinicians make joint decisions around treatment, taking into account a patient’s preferences, beliefs, and values.

Decision aids (DAs) are educational tools that can provide information on the benefits and harms of a decision, such as CRC screening, and can help elicit a patient’s preferences and values during the shared decision-making process. DAs can contribute to a patient’s clarity in their decision and decrease decisional conflict, or uncertainty around which course to take. However, there are currently no CRC DAs to help guide decision-making for adults over the age of 75 with low health literacy (LHL).

This project will modify and pilot a DA tailored to the needs of LHL older adults, to ideally guide those who are in good health and at higher risk for CRC towards screening while guiding those in poor health and/or at lower risk away from screening. The DA, leveraging elements of the Ottawa Decision Support Framework, will take into account life expectancy, risk factors for CRC, and CRC screening modalities. The DA will be modified and piloted within community-based settings and will employ an iterative end-user based approach to best tailor the tool to the needs of this particular population. In addition to a feasibility pilot of a CRC DA, the project will identify informational needs and CRC screening perceptions of LHL older adults.

Findings will empower decision making for LHL older adult populations and improve CRC screening decisions and quality of care. This intervention has the potential to be scaled for use in other decision tools for LHL older adults.

National Institute on Aging (NIA) 1K23AG062795 

Project Leads

  • Tamara J. Cadet


    Associate Director, PC3I & Director, Program in Community Engagement Innovation, PC3I

  • Mara A. Schonberg

    MD, MPH

    Associate Professor, General Medicine and Primary Care, Beth Israel Deaconess Medical Center

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