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

Abstract

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.

More information

Identifiers

Catalogue record

Export record

Altmetrics