Should screening be an offer that is difficult to refuse? A systematic review of decision support interventions for individuals considering bowel cancer screening

Abstract

Objective: To assess the effect on uptake of interventions designed to support individuals making decisions about screening tests for colorectal cancer. Evidence acquisition : We searched for patient decision support interventions, designed to help individuals consider screening tests for colorectal cancer. We identified those that had been evaluated by randomized trials controlled against usual care and conducted a systematic review. Evidence synthesis: Fourteen trials were identified and 7 were excluded. We observed 2 categories of interventions – those that invited participants to choose ‘one from many’ potential screening tests and those that were explicit that not taking the screening test was also an option. These two categories led to different effects in actual uptake: for those interventions that offered the option of not taking part in screening there was either no difference among groups or the patient decision support interventions favoured control. Where the interventions offered the choice of ‘one from many screening tests’, patient decision support interventions favoured uptake. Conclusions: Decision support interventions that offer a menu of screening tests, that is, ‘pick one from many’ lead to different screening test uptake compared to interventions that are explicit about the option of not taking part in screening. Screening programmes for colorectal cancer and other similar programmes, need to consider whether to ‘nudge’ individuals towards participation or to accept that, in some situations, when given information about benefits and potential harms, less individuals decide to take screening tests.