Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Randomized Controlled Trial
. 2010 Oct 26:341:c5370.
doi: 10.1136/bmj.c5370.

A decision aid to support informed choices about bowel cancer screening among adults with low education: randomised controlled trial

Sian K Smith  1 , Lyndal Trevena, Judy M Simpson, Alexandra Barratt, Don Nutbeam, Kirsten J McCaffery
Affiliations
Randomized Controlled Trial

A decision aid to support informed choices about bowel cancer screening among adults with low education: randomised controlled trial

Sian K Smith et al. BMJ. .

Abstract

Objective: To determine whether a decision aid designed for adults with low education and literacy can support informed choice and involvement in decisions about screening for bowel cancer.

Design: Randomised controlled trial.

Setting: Areas in New South Wales, Australia identified as socioeconomically disadvantaged (low education attainment, high unemployment, and unskilled occupations).

Participants: 572 adults aged between 55 and 64 with low educational attainment, eligible for bowel cancer screening.

Intervention: Patient decision aid comprising a paper based interactive booklet (with and without a question prompt list) and a DVD, presenting quantitative risk information on the possible outcomes of screening using faecal occult blood testing compared with no testing. The control group received standard information developed for the Australian national bowel screening programme. All materials and a faecal occult blood test kit were posted directly to people's homes.

Main outcome measures: Informed choice (adequate knowledge and consistency between attitudes and screening behaviour) and preferences for involvement in screening decisions.

Results: Participants who received the decision aid showed higher levels of knowledge than the controls; the mean score (maximum score 12) for the decision aid group was 6.50 (95% confidence interval 6.15 to 6.84) and for the control group was 4.10 (3.85 to 4.36; P<0.001). Attitudes towards screening were less positive in the decision aid group, with 51% of the participants expressing favourable attitudes compared with 65% of participants in the control group (14% difference, 95% confidence interval 5% to 23%; P=0.002). The participation rate for screening was reduced in the decision aid group: completion of faecal occult blood testing was 59% v 75% in the control group (16% difference, 8% to 24%; P=0.001). The decision aid increased the proportion of participants who made an informed choice, from 12% in the control group to 34% in the decision aid group (22% difference, 15% to 29%; P<0.001). More participants in the decision aid group had no decisional conflict about the screening decision compared with the controls (51% v 38%; P=0.02). The groups did not differ for general anxiety or worry about bowel cancer.

Conclusions: Tailored decision support information can be effective in supporting informed choices and greater involvement in decisions about faecal occult blood testing among adults with low levels of education, without increasing anxiety or worry about developing bowel cancer. Using a decision aid to make an informed choice may, however, lead to lower uptake of screening. Trial registration ClinicalTrials.gov NCT00765869 and Australian New Zealand Clinical Trials Registry 12608000011381.

PubMed Disclaimer

Conflict of interest statement

Competing interests: All authors have completed the Unified Competing Interest form at www.icmje.org/coi_disclosure.pdf (available on request from the corresponding author) and declare that all authors had: no financial support for the submitted work from anyone other than their employer; no financial relationships with commercial entities that might have an interest in the submitted work; and no non-financial interests that may be relevant to the submitted work.

Figures

None
Flow of participants through trial
See this image and copyright information in PMC

Comment in

References

    1. Australian Commission on Safety and Quality in Health Care. How we work—consumer engagement. 2009. www.safetyandquality.gov.au/internet/safety/publishing.nsf/Content/CES-c....
    1. Agency for Healthcare Research and Quality. Mission statement and budget. 2009. www.ahrq.gov/.
    1. Department of Health (UK). National Health Service constitution. 2009. www.dh.gov.uk/en/Publicationsandstatistics/Publications/PublicationsPoli....
    1. Haynes R, Devereaux P, Guyatt C. Clinical expertise in the era of evidence-based medicine and patient choice. Evid Based Med 2002;7:36-8. - PubMed
    1. Montori VM, Guyatt GH. Progress in evidence-based medicine. JAMA 2008;300:1814-6. - PubMed

Publication types

Associated data