Are patient education materials about cancer screening more effective when co-created with patients? A qualitative interview study and randomized controlled trial.

N.Y Bashir,N.R Bell,J.E Moore,M Tonelli,B.D Thombs,W Isaranuwatchai,D Buckland,M Rodrigues,S.E Straus,D.M Shilman,T Peng

doi:10.3747/co.26.4621

N.Y Bashir, N.R Bell + Show 9 more

Open Access

https://doi.org/10.3747/co.26.4621

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Abstract

Patient education materials (pems) are frequently used to help patients make cancer screening decisions. However, because pems are typically developed by experts, they might inadequately address patient barriers to screening. We co-created, with patients, a prostate cancer (pca) screening pem, and we compared how the co-created pem and a pem developed by experts affected decisional conflict and screening intention in patients. We identified and used patient barriers to pca screening to co-create a pca screening pem with patients, clinicians, and researchers. We then conducted a parallel-group randomized controlled trial with men 40 years of age and older in Ontario to compare decisional conflict and intention about pca screening after those men had viewed the co-created pem (intervention) or an expert-created pem (control). Participants were randomized using dynamic block randomization, and the study team was blinded to the allocation. Of 287 participants randomized to exposure to the co-created pem, 230 were analyzed, and of 287 randomized to exposure to the expert-created pem, 223 were analyzed. After pem exposure, intervention and control participants did not differ significantly in Decisional Conflict Scale scores [mean difference: 0.37 ± 1.23; 95% confidence interval (ci): -2.05 to 2.79]; in sure (Sure of myself, Understand information, Risk-benefit ratio, or Encouragement) scores (odds ratio: 0.75; 95% ci: 0.52 to 1.08); or in screening intention (mean difference: 0.09 ± 0.08; 95% ci: -0.06 to 0.24]). The effectiveness of the co-created pem did not differ from that of the pem developed by experts. Thus, pem developers should choose the method that best fits their goals and resources.

Highlights

Patient education materials are frequently used to help patients make cancer screening decisions
The effectiveness of the co-created pem did not differ from that of the pem developed by experts
Shared decision-making can involve the use of decision aids and other knowledge products such as printed patient education materials[3,4]

Summary

Introduction

Patient education materials (pems) are frequently used to help patients make cancer screening decisions. Because pems are typically developed by experts, they might inadequately address patient barriers to screening. Many cancer screening guidelines highlight evidencebased shared decision-making involving patients and clinicians[1,2]. Patients are regularly engaged in developing decision aids[6,7,8], pems are typically developed by experts (for example, clinicians and researchers) with minimal patient input[9,10]. Pems might not optimally address underlying patient barriers and facilitators to cancer screening. Pems that are co-created with patients using established participatory design methods might enhance a patient’s understanding about the harms and benefits of prostate cancer (pca) screening[13,14,15]. By facilitating collaboration[14], structured participatory design activities could help clinicians, researchers, and patients co-create pems that meet patient needs

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