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Papers by Shamini Mylvaganam
Purpose: Shared decision-making has been advocated as a potentially effective strategy for increa... more Purpose: Shared decision-making has been advocated as a potentially effective strategy for increasing patient adherence to CRC screening recommendations. To facilitate this process, we have developed an interactive, computer-based decision aid to educate patients about the pros and cons of the 5 currently recommended CRC screening options and enable them to identify a preferred option based on personal values. Our decision aid employs videotaped narratives and state-of-the-art graphics to convey key information about CRC and the importance of screening, compare each option using both attribute- and option-based approaches, and elicit patient preferences. The goal of this study was to assess the impact of our decision aid on user knowledge, satisfaction with the decision-making process and intention to complete a screening test. Methods: Asymptomatic, average-risk patients (age, 50-75) without prior screening (except possibly fecal occult blood testing) were randomized to one of two ...
Health Expectations, 2011
Cancer Prevention Research, 2012
Tailoring the use of screening colonoscopy based on the risk of advanced colorectal neoplasia (AC... more Tailoring the use of screening colonoscopy based on the risk of advanced colorectal neoplasia (ACN) could optimize the cost-effectiveness of colorectal cancer (CRC) screening. Our goal was to assess the accuracy of the Your Disease Risk (YDR) CRC risk index for stratifying average risk patients into low- versus intermediate/high-risk categories for ACN. The YDR risk assessment tool was administered to 3,317 asymptomatic average risk patients 50 to 79 years of age just before their screening colonoscopy. Associations between YDR-derived relative risk (RR) scores and ACN prevalence were examined using logistic regression and χ2 analyses. ACN was defined as a tubular adenoma ≥1 cm, tubulovillous or villous adenoma of any size, and the presence of high-grade dysplasia or cancer. The overall prevalence of ACN was 5.6%. Although YDR-derived RR scores were linearly associated with ACN after adjusting for age and gender (P = 0.033), the index was unable to discriminate “below average” from ...
Health Expectations, 2014
Decision aids for colorectal cancer (CRC) screening have been shown to enable patients to identif... more Decision aids for colorectal cancer (CRC) screening have been shown to enable patients to identify a preferred screening option, but the extent to which such tools facilitate shared decision making (SDM) from the perspective of the provider is less well established. Our goal was to elicit provider feedback regarding the impact of a CRC screening decision aid on SDM in the primary care setting. Cross-sectional survey. Primary care providers participating in a clinical trial evaluating the impact of a novel CRC screening decision aid on SDM and adherence. Perceptions of the impact of the tool on decision-making and implementation issues. Twenty-nine of 42 (71%) eligible providers responded, including 27 internists and two nurse practitioners. The majority (>60%) felt that use of the tool complimented their usual approach, increased patient knowledge, helped patients identify a preferred screening option, improved the quality of decision making, saved time and increased patients' desire to get screened. Respondents were more neutral is their assessment of whether the tool improved the overall quality of the patient visit or patient satisfaction. Fewer than 50% felt that the tool would be easy to implement into their practices or that it would be widely used by their colleagues. Decision aids for CRC screening can improve the quality and efficiency of SDM from the provider perspective but future use is likely to depend on the extent to which barriers to implementation can be addressed.
Gastroenterology, 2008
... Comments from the Editors; Gastroenterology and Hepatology News; Imaging and Advanced Technol... more ... Comments from the Editors; Gastroenterology and Hepatology News; Imaging and Advanced Technology; Meeting Summaries; Mini-Reviews and ... Paul C. Schroy ,; Lynne B. Ahn ,; Julie Glick ,; Patricia Robinson ,; Maria Lydotes ,; Shamini Mylvaganam ,; Jacqueline Ashba ,; Michael ...
American Journal of Preventive Medicine, 2012
Shared decision making (SDM) is a widely recommended yet unproven strategy for increasing colorec... more Shared decision making (SDM) is a widely recommended yet unproven strategy for increasing colorectal cancer (CRC) screening uptake. Previous trials of decision aids to increase SDM and CRC screening uptake have yielded mixed results. To assess the impact of decision aid-assisted SDM on CRC screening uptake. RCT. The study was conducted at an urban, academic safety-net hospital and community health center between 2005 and 2010. Participants were asymptomatic, average-risk patients aged 50-75 years due for CRC screening. Study participants (n=825) were randomized to one of two intervention arms (decision aid plus personalized risk assessment or decision aid alone) or control arm. The interventions took place just prior to a routine office visit with their primary care providers. The primary outcome was completion of a CRC screening test within 12 months of the study visit. Logistic regression was used to identify predictors of test completion and mediators of the intervention effect. Analysis was completed in 2011. Patients in the decision-aid group were more likely to complete a screening test than control patients (43.1% vs 34.8%, p=0.046) within 12 months of the study visit; conversely, test uptake for the decision aid and decision aid plus personalized risk assessment arms was similar (43.1% vs 37.1%, p=0.15). Assignment to the decision-aid arm (AOR=1.48, 95% CI=1.04, 2.10), black race (AOR=1.52, 95% CI=1.12, 2.06) and a preference for a patient-dominant decision-making approach (AOR=1.55, 95% CI=1.02, 2.35) were independent determinants of test completion. Activation of the screening discussion and enhanced screening intentions mediated the intervention effect. Decision aid-assisted SDM has a modest impact on CRC screening uptake. A decision aid plus personalized risk assessment tool is no more effective than a decision aid alone. This study is registered at www.clinicaltrials.govNCT00251862.
Gastroenterology, May 31, 2011
Purpose: Shared decision-making has been advocated as a potentially effective strategy for increa... more Purpose: Shared decision-making has been advocated as a potentially effective strategy for increasing patient adherence to CRC screening recommendations. To facilitate this process, we have developed an interactive, computer-based decision aid to educate patients about the pros and cons of the 5 currently recommended CRC screening options and enable them to identify a preferred option based on personal values. Our decision aid employs videotaped narratives and state-of-the-art graphics to convey key information about CRC and the importance of screening, compare each option using both attribute- and option-based approaches, and elicit patient preferences. The goal of this study was to assess the impact of our decision aid on user knowledge, satisfaction with the decision-making process and intention to complete a screening test. Methods: Asymptomatic, average-risk patients (age, 50-75) without prior screening (except possibly fecal occult blood testing) were randomized to one of two ...
Health Expectations, 2011
Cancer Prevention Research, 2012
Tailoring the use of screening colonoscopy based on the risk of advanced colorectal neoplasia (AC... more Tailoring the use of screening colonoscopy based on the risk of advanced colorectal neoplasia (ACN) could optimize the cost-effectiveness of colorectal cancer (CRC) screening. Our goal was to assess the accuracy of the Your Disease Risk (YDR) CRC risk index for stratifying average risk patients into low- versus intermediate/high-risk categories for ACN. The YDR risk assessment tool was administered to 3,317 asymptomatic average risk patients 50 to 79 years of age just before their screening colonoscopy. Associations between YDR-derived relative risk (RR) scores and ACN prevalence were examined using logistic regression and χ2 analyses. ACN was defined as a tubular adenoma ≥1 cm, tubulovillous or villous adenoma of any size, and the presence of high-grade dysplasia or cancer. The overall prevalence of ACN was 5.6%. Although YDR-derived RR scores were linearly associated with ACN after adjusting for age and gender (P = 0.033), the index was unable to discriminate “below average” from ...
Health Expectations, 2014
Decision aids for colorectal cancer (CRC) screening have been shown to enable patients to identif... more Decision aids for colorectal cancer (CRC) screening have been shown to enable patients to identify a preferred screening option, but the extent to which such tools facilitate shared decision making (SDM) from the perspective of the provider is less well established. Our goal was to elicit provider feedback regarding the impact of a CRC screening decision aid on SDM in the primary care setting. Cross-sectional survey. Primary care providers participating in a clinical trial evaluating the impact of a novel CRC screening decision aid on SDM and adherence. Perceptions of the impact of the tool on decision-making and implementation issues. Twenty-nine of 42 (71%) eligible providers responded, including 27 internists and two nurse practitioners. The majority (>60%) felt that use of the tool complimented their usual approach, increased patient knowledge, helped patients identify a preferred screening option, improved the quality of decision making, saved time and increased patients' desire to get screened. Respondents were more neutral is their assessment of whether the tool improved the overall quality of the patient visit or patient satisfaction. Fewer than 50% felt that the tool would be easy to implement into their practices or that it would be widely used by their colleagues. Decision aids for CRC screening can improve the quality and efficiency of SDM from the provider perspective but future use is likely to depend on the extent to which barriers to implementation can be addressed.
Gastroenterology, 2008
... Comments from the Editors; Gastroenterology and Hepatology News; Imaging and Advanced Technol... more ... Comments from the Editors; Gastroenterology and Hepatology News; Imaging and Advanced Technology; Meeting Summaries; Mini-Reviews and ... Paul C. Schroy ,; Lynne B. Ahn ,; Julie Glick ,; Patricia Robinson ,; Maria Lydotes ,; Shamini Mylvaganam ,; Jacqueline Ashba ,; Michael ...
American Journal of Preventive Medicine, 2012
Shared decision making (SDM) is a widely recommended yet unproven strategy for increasing colorec... more Shared decision making (SDM) is a widely recommended yet unproven strategy for increasing colorectal cancer (CRC) screening uptake. Previous trials of decision aids to increase SDM and CRC screening uptake have yielded mixed results. To assess the impact of decision aid-assisted SDM on CRC screening uptake. RCT. The study was conducted at an urban, academic safety-net hospital and community health center between 2005 and 2010. Participants were asymptomatic, average-risk patients aged 50-75 years due for CRC screening. Study participants (n=825) were randomized to one of two intervention arms (decision aid plus personalized risk assessment or decision aid alone) or control arm. The interventions took place just prior to a routine office visit with their primary care providers. The primary outcome was completion of a CRC screening test within 12 months of the study visit. Logistic regression was used to identify predictors of test completion and mediators of the intervention effect. Analysis was completed in 2011. Patients in the decision-aid group were more likely to complete a screening test than control patients (43.1% vs 34.8%, p=0.046) within 12 months of the study visit; conversely, test uptake for the decision aid and decision aid plus personalized risk assessment arms was similar (43.1% vs 37.1%, p=0.15). Assignment to the decision-aid arm (AOR=1.48, 95% CI=1.04, 2.10), black race (AOR=1.52, 95% CI=1.12, 2.06) and a preference for a patient-dominant decision-making approach (AOR=1.55, 95% CI=1.02, 2.35) were independent determinants of test completion. Activation of the screening discussion and enhanced screening intentions mediated the intervention effect. Decision aid-assisted SDM has a modest impact on CRC screening uptake. A decision aid plus personalized risk assessment tool is no more effective than a decision aid alone. This study is registered at www.clinicaltrials.govNCT00251862.
Gastroenterology, May 31, 2011