The effect of a supplementary ('Gist-based') information leaflet on colorectal cancer knowledge and screening intention: a randomized controlled trial.

Samuel G Smith,Christian Von Wagner,Rosalind Raine,Michael S Wolf,Austin Obichere,Jane Wardle

doi:10.1007/s10865-014-9596-z

Abstract

Guided by Fuzzy Trace Theory, this study examined the impact of a ‘Gist-based’ leaflet on colorectal cancer screening knowledge and intentions; and tested the interaction with participants’ numerical ability. Adults aged 45–59 years from four UK general practices were randomly assigned to receive standard information (‘The Facts’, n = 2,216) versus standard information plus ‘The Gist’ leaflet (Gist + Facts, n = 2,236). Questionnaires were returned by 964/4,452 individuals (22 %). 82 % of respondents reported having read the information, but those with poor numeracy were less likely (74 vs. 88 %, p < .001). The ‘Gist + Facts’ group were more likely to reach the criterion for adequate knowledge (95 vs. 91 %; p < .01), but this was not moderated by numeracy. Most respondents (98 %) intended to participate in screening, with no group differences and no interaction with numeracy. The improved levels of knowledge and self-reported reading suggest ‘The Gist’ leaflet may increase engagement with colorectal cancer screening, but ceiling effects reduced the likelihood that screening intentions would be affected.Electronic supplementary materialThe online version of this article (doi:10.1007/s10865-014-9596-z) contains supplementary material, which is available to authorized users.

Highlights

Colorectal cancer is the third most common cancer and fourth most common cause of cancer death worldwide (International Agency for Research on Cancer 2014)
Guided by Fuzzy Trace Theory, this study examined the impact of a ‘Gist-based’ leaflet on colorectal cancer screening knowledge and intentions; and tested the interaction with participants’ numerical ability
The ‘Gist + Facts’ group were more likely to reach the criterion for adequate knowledge (95 vs. 91 %; p \ .01), but this was not moderated by numeracy

Summary

Introduction

Colorectal cancer is the third most common cancer and fourth most common cause of cancer death worldwide (International Agency for Research on Cancer 2014). It was projected that there would be over 142,000 new cases of colorectal cancer and more than 50,000 deaths in the United States in 2013 (U.S Cancer Statistics Working Group 2013). Colorectal cancer is a leading cause of mortality in the United Kingdom (UK), with over 15,000 deaths recorded in 2011 (General Register Office for Scotland 2012; Northern Ireland Statistics Research Agency 2012; Office for National Statistics 2013). Colorectal cancer screening recommendations vary between countries, but there is evidence for a reduction in cancer-specific mortality with colonoscopy, flexible sigmoidoscopy and the Fecal Occult Blood (FOB) test (Atkin et al, 2010; Hewitson et al, 2007; Whitlock et al, 2008). Up-to-date colorectal cancer screening prevalence (using any screening modality) for 50–75 year olds was estimated to be 63 % in 2008 (Centers for Disease Control and Prevention 2010b), which is lower than for pap smears in 2010 (18–30 years, up-to-date; 67 %) and considerably

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