Does informed consent alter elderly patients' preferences for colorectal cancer screening? Results of a randomized trial

OBJECTIVE: To assess the impact of Informed consent on elderly patients' co lorectal cancer (CRC) screening preferences. DESIGN: Randomized, controlled trial, SETTING: Four general internal medicine practices, PATIENTS: We studied 399 elderly patients visiting their primary care provi der for routine office visits. INTERVENTIONS: Patients were randomized to receive either ther a scripted c ontrol message briefly describing CRC screening methods or one of two infor mational interventions simulating an informed consent presentation about CR C screening, One intervention described CRC mortality risk reduction in rel ative terms; the other, in absolute terms, MEASUREMENTS AND MAIN RESULTS: The main outcome measure was intent to begin or continue fecal occult blood testing (FOBT), flexible sigmoidoscopy, or both, There was no difference in screening interest between the control gro up and the two information groups (p = .8). The majority (63%) of patients intended to begin or continue CRC screening, Informed patients were able to gauge more accurately the positive predictive value of screening (p = .000 9). Control patients rated the efficacy of screening higher than did patien ts receiving relative risk reduction information, who rated it higher than did patients receiving absolute risk reduction information (p = .0002). CONCLUSIONS: Elderly patients appeared to understand CRC screening informat ion and use it to gauge the efficacy of screening, but provision of informa tion had no impact on their preferences for screening. In view of the large proportion who preferred not to be screened, we conclude that elderly pati ents should be involved in the screening decision, However, factors other t han provision of information must determine their CRC screening preferences .