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Cancer Epidemiol Biomarkers Prev. 2011 Feb;20(2):249-54. doi: 10.1158/1055-9965.EPI-10-0685. Epub 2011 Jan 6.

Effects of a decision support intervention on decisional conflict associated with microsatellite instability testing.

Author information

1
Fox Chase Cancer Center, 333 Cottman Avenue, Philadelphia, PA 19111, USA. michael.hall@fccc.edu

Abstract

BACKGROUND:

Decision support to facilitate informed consent is increasingly important for complicated medical tests. Here, we test a theoretical model of factors influencing decisional conflict in a study examining the effects of a decision support aid that was designed to assist patients at high risk for hereditary nonpolyposis colorectal cancer (CRC) deciding whether to pursue the microsatellite instability (MSI) test.

METHODS:

Participants were 239 CRC patients at high familial risk for a genetic mutation who completed surveys before and after exposure to the intervention. Half of the sample was assigned to the CD-ROM aid and half received a brief description of the test. Structural equation modeling was employed to examine associations among the intervention, knowledge, pros and cons to having MSI testing, self-efficacy, preparedness, and decisional conflict.

RESULTS:

The goodness of fit for the model was acceptable [FIML, full information maximum likelihood, χ(2) (df = 280) = 392.24; P = 0.00]. As expected, the paths to decisional conflict were significant for postintervention pros of MSI testing (t = -2.43; P < 0.05), cons of MSI testing (t = 2.78; P < 0.05), and preparedness (t = -7.27; P < 0.01). The intervention impacted decisional conflict by increasing knowledge about the MSI test and knowledge exerted its effects on decisional conflict by increasing preparedness to make a decision about the test and by increases in perceived benefits of having the test.

CONCLUSION:

Increasing knowledge, preparedness, and perceived benefits of undergoing the MSI test facilitate informed decision making for this test.

IMPACT:

Understanding mechanisms underlying health decisions is critical for improving decisional support. Individuals with Lynch syndrome have an elevated lifetime risk of CRC. Risk of Lynch syndrome may be assessed with a tumor-based screening test (MSI testing or immunohistochemical tissue staining).

PMID:
21212064
PMCID:
PMC3076798
DOI:
10.1158/1055-9965.EPI-10-0685
[Indexed for MEDLINE]
Free PMC Article
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