Risk Stratification and Shared Decision Making for XXXX : A Randomized Controlled Trial.

@entity1 @entity14
BACKGROUND: Eliciting @entity1 preferences within the context of shared decision making has been advocated for @entity14 ( @entity14 ) screening, yet providers often fail to comply with @entity1 preferences that differ from their own. PURPOSE: To determine whether risk stratification for @entity14 ( @entity14 ) influences provider willingness to comply with @entity1 preferences when selecting a desired @entity14 screening option. DESIGN: Randomized controlled trial. SETTING/ @entity1 : Asymptomatic, average-risk @entity1 due for @entity14 screening in an urban safety net health care setting. INTERVENTION: @entity1 were randomized 1:1 to a decision aid alone (n= 168) or decision aid plus risk assessment (n= 173) arm between September 2012 and September 2014. OUTCOMES: The primary outcome was concordance between @entity1 preference and test ordered; secondary outcomes included @entity1 satisfaction with the decision-making process, screening intentions, test completion rates, and provider satisfaction. RESULTS: Although providers perceived risk stratification to be useful in selecting an appropriate screening test for their average-risk @entity1 , no significant differences in concordance were observed between the decision aid alone and decision aid plus risk assessment groups (88.1% v. 85.0%,P= 0.40) or high- and low-risk groups (84.5% v. 87.1%,P= 0.51). Concordance was highest for colonoscopy and relatively low for tests other than colonoscopy, regardless of study arm or risk group. Failure to comply with @entity1 preferences was negatively associated with satisfaction with the decision-making process, screening intentions, and test completion rates. LIMITATIONS: Single-institution setting; lack of provider education about the utility of risk stratification into their decision making. CONCLUSIONS: Providers perceived risk stratification to be useful in their decision making but often failed to comply with @entity1 preferences for tests other than colonoscopy, even among those deemed to be at low risk of @entity14 .
