JMIR Publications

ABSTRACT

Background:

Identifying inherited colorectal cancer syndromes patients has many potential benefits. However, individuals usually have decisional conflicts about genetic testing of colorectal cancer (CRC) and the rate of genetic testing uptake is low. Given the popularity of genetic testing and increasing demands on genetic service providers, strategies to promote informed decision-making, the uptake of genetic testing for at-risk individuals and rational use of genetic service resources are needed.

Objective:

To determine whether a decision aid (DA) tool could promote informed decision-making for family member regarding the genetic testing of patient with CRC.

Methods:

A single-center, parallel-group, randomized controlled trial was conducted. We randomized 82 family members of patients with CRC who make major decisions about the patient's medical activities to DA versus usual care (UC). The primary outcome was the informed decision-making measured by knowledge, decision conflicts, decision self-efficacy and preparation for decision making. Secondary outcomes were patients’ genetic counselling and testing uptake, the rate of CRC screening, healthy lifestyle scores, anxiety and depression, quality of life, and intervention satisfaction. Data obtained at baseline (T0), postintervention (T1), and 3-month after the baseline survey (T2). The implementation of DA intervention and outcomes assessment (T1 and T2) was carried out via WeChat. The effects of the intervention were estimated using generalized estimating equation models.

Results:

Statistically significant improvements in knowledge (T1: β=2.049, P<.001; T2: β=3.317, P<.001), decision conflicts (T1: β=−11.660, P<.001; T2: β=−17.587, P<.001), and decision self-efficacy (T1: β=15.353, P<.001; T2: β=22.337, P<.001) for DA compared with UC at T1 and T2. And the DA had significantly greater improvements in processed and red meat intake (β=−1.494, P<.001) only at T1 and healthy lifestyle scores (β=1.073, P=.03) only at T2. The groups did not differ on other outcomes.

Conclusions:

A DA tool may be a safe, effective, and resource-efficient approach to facilitate informed decision-making about genetic testing. The current DA tool needs to be optimized and further tested, such as using smarter technology than WeChat to develop a more simple and intelligent DA system. Clinical Trial: Clinical Trial Registration Number: Chinese Clinical Trial Registry (ChiCTR2100048051). Registration date: June 28, 2021. Date of first recruitment: July 1, 2021.