Effectiveness of a decision aid for promoting colorectal cancer screening in Spain: a randomized trial

Alezandra Torres-Castaño,Vanesa Ramos-Garcia,Michael Pignone,Yolanda Alvarez-Perez,Nerea Gonzalez-Hernandez,Pedro Serrano-Aguilar,Amado Rivero-Santana,Lilisbeth Perestelo-Perez,Andrea Buron

doi:10.1186/s12911-019-0739-6

Abstract

BackgroundColorectal cancer (CRC) screening has shown to reduce incidence and mortality rates, and therefore is widely recommended for people above 50 years-old. However, despite the implementation of population-based screening programs in several countries, uptake rates are still low. Decision aids (DAs) may help patients to make informed decisions about CRC screening.MethodsWe performed a randomized controlled trial to assess the effectiveness of a DA developed to promote CRC screening, with patients from two primary care centers in Spain who never had underwent CRC screening. Contrary to center B (n = 24), Center A (n = 83) attended patients from an area where the population-based screening program was not implemented at that moment. Outcome measures were decisional conflict, knowledge of the disease and available screening options, intention to uptake the test, and concordance between patients’ goals/concerns and intention.ResultsIn center A, there were significant differences favoring the DA in decisional conflict (p < 0.001) and knowledge (p < 0.001). The absolute differences favoring DA group in intention to undergo fecal occult blood test (10.5%) and colonoscopy (13.7%) were significant only before correction for attenuation. In center B the differences were significant only for knowledge (p < 0.001). Patients’ goals and concerns regarding the screening did not significantly predict their intention, and therefore we could not calculate a measure of concordance between the two constructs.ConclusionsA DA improved the decisional process of participants who had never been invited to participate in the Spanish public CRC screening program, replicating previous results in this field. Future research is needed to identify subgroups that could benefit more from these interventions.Trial registrationInternational Standard Registered Clinical/social Study Number: ISRCTN98108615 (Retrospectively registered on 27 December 2018).

Highlights

Colorectal cancer (CRC) screening has shown to reduce incidence and mortality rates, and is widely recommended for people above 50 years-old
To assess differences between the decision aids (DA) and control groups in the intention to undergo Fecal occult blood test (FOBT) and/or colonoscopy, respectively, we performed χ2 analyses for the whole sample and separately by center; since several of these analyses yielded expected frequencies < 5 in the “no screening” cells, we report the results corrected for continuity (Yates’ correction)
24 from center B, and 53 and 54 patients were randomized to intervention (DA) and control groups, respectively

Summary

Introduction

Colorectal cancer (CRC) screening has shown to reduce incidence and mortality rates, and is widely recommended for people above 50 years-old. Colorectal cancer (CRC) is the third most common type of cancer in the world and one of the main causes of death by cancer, showing a wide geographical variation in incidence and mortality [1] In western countries, these rates have declined from several decades ago due to the introduction of screening techniques (e.g., fecal occult blood test -FOBT-, colonoscopy, sigmoidoscopy), and the improvement in treatment [2,3,4]. Proposed interventions to increase and improve recruitment for CRC screening have included reminders by health professionals, informational material in different formats (printed, videos, interactive computer programs), mailed FOBT kits, group education, counseling or provider or practice-directed interventions [12,13,14] One of these practice-based interventions is the application of decision aids (DA). These tools include explanations of the available treatment or screening/diagnostic procedures, evidence-based quantitative information about their benefits and risks, and promote implicit or explicit clarification of patients’ preferences about testing and its potential consequences [15, 16]

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