Rates of colorectal cancer screening are low despite evidence that screening methods are effective in reducing colorectal cancer-related mortality. Although several effective screening methods are available, only half of eligible Americans have been screened for colorectal cancer. One way to increase colorectal cancer screening is to provide patients with health decision aids. Health decision aids are interventions such as pamphlets, video discs, and computer programs, that act as adjuncts to a healthcare provider's counseling and are designed to help patients make choices among options. Prior research has demonstrated that cancer-related decision aids increase patients'knowledge and involvement in decision-making and may increase rates of cancer screening. The few studies examining colorectal cancer screening decision aids, however, have demonstrated inconsistent impact on screening. The primary objective of the current proposal is to develop a survey instrument (in English and Spanish) to evaluate the effectiveness of colorectal cancer decision aids for patients considering screening. This objective will be achieved by: (1) identifying patients'beliefs and potential misconceptions about colorectal cancer screening via focus groups;(2) developing an evidence-based instrument to measure patients'knowledge, judgments and level of decisional conflict regarding screening;and (3) via a cross-sectional study of primary care patients, validating the instrument and simultaneously assessing patients'baseline levels of knowledge, judgments, and decisional conflict about colorectal cancer screening. The instrument that we will develop during this proposal will help elucidate how colorectal cancer screening decision-aids impact the decision making process by examining potential mediating variables between decision aids and eventual screening behaviors. Thus, the instrument will be an important asset in the process evaluation of current and future colorectal cancer decision aids. The studies contained in this proposal will have important implications for improving colorectal cancer screening rates, and will also provide a framework for future critical assessment of health related decision aids. Furthermore, the above research plan, in conjunction with the career development plan outlined in the proposal, will provide the necessary experience and training needed for Dr. Diaz to pursue his career goal of becoming an independent investigator with an emphasis on cancer control and prevention.
