Effectiveness of Colorectal Cancer Screening Promotion Using E-Media Decision-Aids: A Systematic Review and Meta-Analysis (Preprint)

Abstract

BACKGROUND Colorectal cancer (CRC) screening reduces mortality yet remains underutilized. Low health literacy may contribute to this underutilization by interfering with patients' ability to understand and receive preventive health services. E-media decision-aids approach have been shown to improve saliency and foster informed decision making. OBJECTIVE This systematic literature review aims to determine the effectiveness of CRC screening promotion using e-media decision-aids in primary health care (PHC) settings. METHODS Three databases (Medline, Web of Science, and Cochrane Library) were used to search for eligible studies, published from January 2010 until December 2020. Reviewers independently selected studies that quantitatively evaluated e-media decision-aids compared to usual care or other conditions. Cochrane’s tools were applied for quality assessment. Effectiveness of CRC screening e-media decision-aids was primarily measured by CRC screening completion rate. Secondary outcomes were spoiled kit return rate, CRC screening awareness and belief, ability to state screening test preference, readiness to receive and ordered CRC screening test. Meta‐analysis were conducted to calculate pooled estimates of CRC screening completion rate by using RevMan 5.4.1 software. RESULTS Ten studies comprising of 9393 patients were included in this review. Follow-ups were from three to twenty-four months. Most studies focused to improve screening in vulnerable populations that tend to be under-screened. Two types of decision-aid interventions used were video and interactive multimedia program, with duration between six to fifteen minutes. Data from nine feasible studies with low or some risk of bias were synthesized for meta-analysis. Random‐effects model revealed CRC screening promotions using e-media decision aids were almost twice likely to have screening completion than their comparisons (OR 1.62, 95% CI: 1.03‐2.62, p<0.05). All secondary outcomes showed positive effects of CRC screening interventions, despite some were not significant. CONCLUSIONS CRC screening promotion through e-media have great potential to increase screening participation in PHC settings. Development of culturally tailored decision aids aiming for CRC screening completion should be prioritized, and made integrated into existing CRC screening programs. CLINICALTRIAL Prospero (registration ID CRD42020220301)