Effect of evidence based risk information on "informed choice" in colorectal cancer screening: randomised controlled trial

Abstract

Objective To compare the effect of evidence based information on risk with that of standard information on informed choice in screening for colorectal cancer. Design Randomised controlled trial with 6 months' followup. Setting German statutory health insurance scheme. Participants 1577 insured people who were members of the target group for colorectal cancer screening (age 50-75, no history of colorectal cancer). Interventions Brochure with evidence based risk information on colorectal cancer screening and two optional interactive internet modules on risk and diagnostic tests; official information leaflet of the German colorectal cancer screening programme (control). Main outcome measure The primary end point was "informed choice," comprising "knowledge," "attitude," and "combination of actual and planned uptake." Secondary outcomes were "knowledge" and "combination of actual and planned uptake." Knowledge and attitude were assessed after 6 weeks and combination of actual and planned uptake of screening after 6 months. Results The response rate for return of both questionnaires was 92.4% (n=1457). 345/785 (44.0%) participants in the intervention group made an informed choice, compared with 101/792 (12.8%) in the control group (difference 31.2%, 99% confidence interval 25.7% to 36.7%; P<0.001). More intervention group participants had "good knowledge" (59.6% (n=468) v 16.2% (128); difference 43.5%, 37.8% to 49.1%; P<0.001). A "positive attitude" towards colorectal screening prevailed in both groups but was significantly lower in the intervention group (93.4% (733) v 96.5% (764); difference −3.1%, −5.9% to −0.3%; P<0.01). The intervention had no effect on the combination of actual and planned uptake (72.4% (568) v 72.9% (577); P=0.87). Conclusions Evidence based risk information on colorectal cancer screening increased informed choices and improved knowledge, with little change in attitudes. The intervention did not affect the combination of actual and planned uptake of screening.Trial registration Current Controlled Trials ISRCTN47105521.

Krebsfrüherkennungsuntersuchungen im hohen Alter

“…Eine informierte Entscheidungsfindung ist jedoch nur mög-lich, wenn ausreichend über Risiken und Nutzen von KFU aufgeklärt wird [12,16,18]. Evidenzbasierte Informationsbroschüren können das Wissen über Krebserkrankungen und KFU verbessern und fördern eine informierte Entscheidungsfindung für eine (Nicht-)Teilnahme [16].…”

“…Evidenzbasierte Informationsbroschüren können das Wissen über Krebserkrankungen und KFU verbessern und fördern eine informierte Entscheidungsfindung für eine (Nicht-)Teilnahme [16]. Wichtig ist Aufklärung darüber, dass eine Einstellung der KFU nicht auf ein erhöh-tes Risiko für Krebserkrankungen hindeutet, sondern als Resultat einer Abwä-gung des individuellen Nutzens zu verstehen ist [16].…”

First do no harm: the e-lephant in the consulting room needs firm handling by the doctor

“…They have limited health literacy 5 and have difficulty making sense of the information they get in spoken or written form. 6 Provision of accurate well-presented literature makes patient choices more informed 7 but of the many resources available it is unclear which are useful in which situations, particularly for patients with multimorbidity. 8 Most symptoms, signs, and test results have low predictive value for disease so it's important to have access to data and decision aids to help weigh benefits and risks; 4,9 and this needs information technology.…”

Screening for diabetes in dental settings

“…Though, the amount of detail that each study provided their participants with did all vary, therefore studies and their intervention material varied in the complexity. A total of thirteen studies (Allen et al, 2010;Bodurtha et al, 2009;Bowen & Powers, 2010;Bowen et al, 2011;Glenn et al, 2011;Harari et al, 2008;Helmes, Culver, & Bowen, 2006;Lipkus & Klein, 2006;Rawl et al, 2012;Schroy et al, 2011;Schroy et al, 2012;Steckelberg, Hulfenhaus, Haastert, & Muhlhauser, 2011;Yuksel, Majumdar, Biggs, & Tsuyuki, 2010;Yuksel, Tsuyuki, & Majumdar, 2012) provided participants with some form of educational material regarding a particular disease or condition or screening test. In two studies (Allen et al, 2010;Schroy et al, 2011;Schroy et al, 2012) the main focus was to aid decision making and a decision aid tool was used, where educational information was provided alongside a decision aid tool to assist in the decision making process about attending for screening.…”

“…Two studies provided follow-up/ check-in calls to their participants (Bowen & Powers, 2010;Glanz et al, 2007), whilst six of the total eighteen studies tailored the additional material to the individual, such as incorrect knowledge about disease or screening test (Bowen et al, 2011;Glenn et al, 2011;Lipkus & Klein, 2006;Manne et al, 2009;Rawl et al, 2012;Vernon et al, 2008). In terms of the actual presentation of the individualised risk information, five studies reported presenting a relative risk (Allen et al, 2010;Bowen & Powers, 2010;Helmes et al, 2006;Lipkus & Klein, 2006;Steckelberg et al, 2011), one study (Steckelberg et al, 2011) presented the risk in natural frequencies, and three studies reported presenting lifetime risk (Bloom et al, 2006;Bodurtha et al, 2009;Bowen & Powers, 2010).…”