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Fransen MP, Damman OC, Bas S, Uiters E, Timmermans DR. Decision-making in breast cancer screening: A qualitative exploration of the match between women's beliefs and screening information in the Netherlands. PATIENT EDUCATION AND COUNSELING 2024; 122:108155. [PMID: 38325207 DOI: 10.1016/j.pec.2024.108155] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Decision-making about breast cancer screening requires balanced and understandable information that takes prior beliefs of screening invitees into account. METHODS In qualitative interviews with 22 Dutch women who were invited for screening for the first time (49-52 years of age, varying health literacy levels), we gained insight in their beliefs on breast cancer and breast cancer screening, and explored how the current screening information matched these beliefs. RESULTS Breast cancer was perceived as an unpredictable, severe, and uncontrollable disease. Women considered screening as self-evident and an important mean to gain some control over breast cancer. Information on benefits of screening was in line with women's prior beliefs and confirmed women's main reasons to participate. Information about false-positive outcomes, overtreatment, and false negative outcomes did not correspond to women's prior beliefs and this information was generally not considered relevant for decision-making. Preferences for additional information merely concerned practical information on the screening procedure. CONCLUSION Complex information on the harms of screening does not match women's beliefs and is not taken into account in their decision-making. PRACTICE IMPLICATIONS Information regarding breast cancer screening could be further aligned to prior beliefs by taking into account values, filling knowledge gaps and correct misconceptions.
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Affiliation(s)
- Mirjam P Fransen
- National Institute for Public Health and the Environment, Centre for Prevention, Lifestyle and Health, Bilthoven, the Netherlands; Amsterdam UMC, Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Public Health Research institute, Quality of Care, Amsterdam, the Netherlands.
| | - Olga C Damman
- Amsterdam Public Health Research institute, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Public and Occupational Health, Van der Boechorststraat 7 1081 Amsterdam, the Netherlands
| | - Sharell Bas
- National Institute for Public Health and the Environment, Centre for Prevention, Lifestyle and Health, Bilthoven, the Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment, Centre for Prevention, Lifestyle and Health, Bilthoven, the Netherlands
| | - Daniëlle Rm Timmermans
- Amsterdam Public Health Research institute, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Public and Occupational Health, Van der Boechorststraat 7 1081 Amsterdam, the Netherlands
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Gadd N, Lee S, Sharman MJ, Obamiro K. Educational interventions to improve bowel cancer awareness and screening in Organisation for Economic Co-operation and Development countries: A scoping review. Prev Med Rep 2024; 39:102653. [PMID: 38384964 PMCID: PMC10879007 DOI: 10.1016/j.pmedr.2024.102653] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 01/29/2024] [Accepted: 02/07/2024] [Indexed: 02/23/2024] Open
Abstract
Objectives Summarise theory informed educational interventions for improving bowel cancer awareness and screening. Methods A search was conducted in PubMed, EMBASE, Web of Science and CINAHL. English studies from 2016 to 2022 which implemented community-based bowel cancer awareness and/or screening education interventions for adults in Organisation for Economic Co-operation and Development countries were included. Results Sixty-two studies were included, 32 measured both screening and awareness (24 measured screening only, 6 measured awareness only). Education interventions were grouped and summarised in five education types: lay community health education/counselling (n = 28), education material (n = 5), health professional education/counselling (n = 10), mass media (n = 5) and other (n = 19). Other included education interventions which did not fit into the four types previously mentioned. Six studies tested more than one education type. Each type within these studies were reported/summarised separately within the appropriate education type. Lay educators resulted in improved awareness and screening. Brochures were effective education materials for screening and combined with lay educators resulted in increased awareness. State-wide mass media campaigns significantly improved screening uptake for up to 2-months post-campaign. Fear and loss-framed messaging improved screening intentions compared to humour or gain-based messaging. Decision aids had limited improvements in awareness. Facebook campaign and telephone counselling had limited improvements in screening. Conclusions Lay community health educators, brochures, and mass media campaigns occurring multiple times a year may be effective interventions in improving screening and/or awareness. Such approaches should be considered when developing community education. Education interventions should include multiple components suggested above to maximise improvements of awareness and screening.
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Affiliation(s)
- Nicola Gadd
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Simone Lee
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Matthew J Sharman
- School of Health Sciences, University of Tasmania, Launceston 7250, Australia
| | - Kehinde Obamiro
- Centre for Rural Health, School of Health Sciences, University of Tasmania, Launceston 7250, Australia
- Central Queensland Centre for Rural and Remote Health, James Cook University, Emerald, Queensland, Australia
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Ong C, Li AD, Marino JL, Peate M. Interventions to improve oncofertility knowledge and decision-making in patients with low health literacy: A systematic review. PATIENT EDUCATION AND COUNSELING 2024; 119:108096. [PMID: 38070299 DOI: 10.1016/j.pec.2023.108096] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/29/2023] [Revised: 11/19/2023] [Accepted: 11/29/2023] [Indexed: 01/02/2024]
Abstract
OBJECTIVE To conduct a systematic review of interventions that improve knowledge, health and decision-related outcomes in cancer, fertility or the intersection of both among low health literacy (LHL) patients. METHODS Articles published from 2000 to March 2022 in English were identified through searching MEDLINE, PsycInfo, and Embase databases on 29/03/2022. Studies were independently screened against eligibility criteria and appraised for quality. A narrative synthesis of data was presented. RESULTS Of 235 citations, 11 studies (2585 participants) investigating three categories were included: decision-support tools (n = 8), mobile health applications (n = 2) and communication tools (n = 1). No eligible study was identified for fertility or oncofertility. All interventions integrated multimedia or interactivity to supplement plain-language text. Decision aids and mobile health applications improved knowledge, reduced decisional conflict and increased clarity around cancer-related choices. Overall, findings favoured the use of online interventions tailored for LHL patients. CONCLUSION There is a lack of data on LHL interventions in fertility and oncofertility. In cancer, LHL interventions improved knowledge and decision-making outcomes. The ideal intervention remains inconclusive. PRACTICE IMPLICATIONS Lack of engagement with LHL needs in oncofertility and fertility settings have implications for informed treatment decision-making. In cancer, further research is required to ascertain most effective intervention format.
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Affiliation(s)
- Cassandra Ong
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, VIC 3052, Australia
| | - Anna D Li
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, VIC 3052, Australia
| | - Jennifer L Marino
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, VIC 3052, Australia; Centre for Adolescent Health, Murdoch Children's Research Institute, Parkville, VIC, Australia; Department of Paediatrics, University of Melbourne, Parkville, VIC, Australia; Centre for Epidemiology and Biostatistics, University of Melbourne, Parkville, VIC, Australia; Specialty of Child and Adolescent Health, Faculty of Medicine and Health, University of Sydney, Westmead, NSW, Australia
| | - Michelle Peate
- Department of Obstetrics and Gynaecology, Royal Women's Hospital, University of Melbourne, Parkville, VIC 3052, Australia.
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Fritzell K, Hedberg B, Woudstra A, Forsberg A, Sventelius M, Kottorp A, Jervaeus A. Making the BEST decision-the BESTa project development, implementation and evaluation of a digital Decision Aid in Swedish cancer screening programmes- a description of a research project. PLoS One 2023; 18:e0294332. [PMID: 38085710 PMCID: PMC10715660 DOI: 10.1371/journal.pone.0294332] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2023] [Accepted: 10/18/2023] [Indexed: 12/18/2023] Open
Abstract
BACKGROUND Sweden has a long tradition of organized national population-based screening programmes. Participation rates differ between programmes and regions, being relatively high in some groups, but lower in others. To ensure an equity perspective on screening, it is desirable that individuals make an informed decision based on knowledge rather than ignorance, misconceptions, or fear. Decision Aids (DAs) are set to deliver information about different healthcare options and help individuals to visualize the values associated with each available option. DAs are not intended to guide individuals to choose one option over another. The advantage of an individual Decision Aid (iDA) is that individuals gain knowledge about cancer and screening by accessing one webpage with the possibility to communicate with health professionals and thereafter make their decision regarding participation. The objective is therefore to develop, implement and evaluate a digital iDA for individuals invited to cancer screening in Sweden. METHODS This study encompasses a process-, implementation-, and outcome evaluation. Multiple methods will be applied including focus group discussions, individual interviews and the usage of the think aloud technique and self-reported questionnaire data. The project is based on The International Patient Decision Aid Standards (IPDAS) framework and the proposed model development process for DAs. Individuals aged 23-74, including women (the cervical-, breast- and CRC screening module) and men (the CRC screening module), will be included in the developmental process. Efforts will be made to recruit participants with self-reported physical and mental limitations, individuals without a permanent residence and ethnic minorities. DISCUSSION To the best of our knowledge, the present study is the first attempt aimed at developing an iDA for use in the Swedish context. The iDA is intended to facilitate shared decision making about participation in screening. Furthermore, the iDA is expected to increase knowledge and raise awareness about cancer and cancer screening. PATIENT OR PUBLIC CONTRIBUTION Lay people are involved throughout the whole development and implementation process of the digital DA. TRIAL REGISTRATION NCT05512260.
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Affiliation(s)
- Kaisa Fritzell
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
- Hereditary Cancer Clinic, Theme Cancer, Karolinska University Hospital, Stockholm, Sweden
| | - Berith Hedberg
- School of Health Sciences, Jönköping University, Jönköping, Sweden
| | - Anke Woudstra
- Team Advies en Onderzoek, Municipal Health Service (GGD) Kennemerland, Haarlem, the Netherlands
| | - Anna Forsberg
- Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden
| | | | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Anna Jervaeus
- Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, Huddinge, Sweden
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Chan DNS, Choi KC, Wong CL, So WKW, Fan N. Use of a Linguistically Appropriate Decision Aid for Cervical Cancer Screening of South Asian Ethnic Minority Women in Hong Kong: A Pilot Randomised Controlled Trial. Int J Behav Med 2023; 30:878-890. [PMID: 36482142 DOI: 10.1007/s12529-022-10143-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/28/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Decision aids have been shown to be effective in assisting the decision-making process in healthcare settings. This study aimed to examine the feasibility and acceptability of a linguistically appropriate printed decision aid for cervical cancer screening in South Asian women and to preliminarily estimate its effects on decisional conflicts, clarity of values, risk perception, the screening decision and screening uptake. METHODS This was a pilot randomised controlled trial. Forty-eight South Asian women aged 25 to 64 years were recruited and allocated to either the intervention group or control group. The participants in the intervention group read a linguistically appropriate printed decision aid. RESULTS All of the participants in the intervention group agreed that the decision aid was useful in aiding their decision-making. These participants showed significantly greater improvement in decisional conflicts, clarity of values and risk perceptions than those in the control group (all p < 0.05). The screening uptake rate was significantly higher in the intervention group than in the control group (p < 0.001). CONCLUSIONS The decision aid was feasible and acceptable among South Asian women, and it resulted in reduced decisional conflict and increased screening uptake compared with usual care. To improve the convenience of using decision aids, they could be developed in various forms, such as printed and mobile application forms, to meet individual requirements. TRIAL REGISTRATION The trial was registered at the Chinese Clinical Trial Registry on 23 October 2021 (ChiCTR2100052225).
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Affiliation(s)
- Dorothy N S Chan
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, NT, Hong Kong SAR, China.
| | - Kai Chow Choi
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, NT, Hong Kong SAR, China
| | - Cho Lee Wong
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, NT, Hong Kong SAR, China
| | - Winnie K W So
- The Nethersole School of Nursing, The Chinese University of Hong Kong, 6-8/F, Esther Lee Building, Shatin, NT, Hong Kong SAR, China
| | - Ning Fan
- Yan Chai Hospital, Hospital Authority, Hong Kong SAR, China
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Pluymen LPM, Yebyo HG, Stegeman I, Fransen MP, Dekker E, Brabers AEM, Leeflang MMG. Perceived Importance of the Benefits and Harms of Colorectal Cancer Screening: A Best-Worst Scaling Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:918-924. [PMID: 36646279 DOI: 10.1016/j.jval.2022.12.015] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/25/2022] [Revised: 12/16/2022] [Accepted: 12/30/2022] [Indexed: 06/04/2023]
Abstract
OBJECTIVES To elicit the relative importance of the benefits and harms of colorectal cancer (CRC) screening among potential screening participants in the Dutch population. METHODS In a consensus meeting with 11 experts, risk reduction of CRC and CRC deaths (benefits) and complications from colonoscopy, stress of receiving positive fecal immunological test (FIT) results, as well as false-positive and false-negative FIT results (harms) were selected as determinant end points to consider during decision making. We conducted an online best-worst scaling survey among adults aged 55 to 75 years from the Dutch Health Care Consumer Panel of The Netherlands Institute for Health Services Research to elicit preference values for these outcomes. The preference values were estimated using conditional logit regression. RESULTS Of 265 participants, 234 (89%) had ever participated in CRC screening. Compared with the stress of receiving a positive FIT result, the outcome perceived most important was the risk of CRC death (odds ratio [OR] 4.5; 95% confidence interval [CI] 3.9-5.1), followed by risk of CRC (OR 4.1; 95% CI 3.6-4.7), a false-negative FIT result (OR 3.1; 95% CI 2.7-3.5), colonoscopy complications (OR 1.6; 95% CI 1.4-1.8), and a false-positive FIT result (OR 1.4; 95% CI 1.3-1.6). The magnitude of these differences in perceived importance varied according to age, educational level, ethnic background, and whether the individual had previously participated in CRC screening. CONCLUSION Dutch men and women eligible for FIT-based CRC screening perceive the benefits of screening to be more important than the harms.
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Affiliation(s)
- Linda P M Pluymen
- Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands.
| | - Henock G Yebyo
- Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland
| | - Inge Stegeman
- Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Mirjam P Fransen
- Public and Occupational Health, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Quality of Care, Amsterdam Public Health, Amsterdam, The Netherlands
| | - Evelien Dekker
- Gastroenterology and Hepatology, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Gastroenterology Endocrinology Metabolism, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands
| | - Anne E M Brabers
- Nivel, The Netherlands Institute for Health Services Research, Utrecht, The Netherlands
| | - Mariska M G Leeflang
- Epidemiology and Data Science, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
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Golden SE, Disher N, Dieckmann NF, Eden KB, Matlock D, Vranas KC, Slatore CG, Sullivan DR. Show me the roads and give me a road map: Development of a patient conversation tool to improve lung cancer treatment decision-making. PEC INNOVATION 2022; 1:100094. [PMID: 37213736 PMCID: PMC10194168 DOI: 10.1016/j.pecinn.2022.100094] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 10/13/2022] [Accepted: 10/19/2022] [Indexed: 05/23/2023]
Abstract
Objective Evidence-based decision support resources do not exist for persons with lung cancer. We sought to develop and refine a treatment decision support, or conversation tool, to improve shared decision-making (SDM). Methods We conducted a multi-site study among patients with stage I-IV non-small cell lung cancer (NSCLC) who completed or had ongoing lung cancer treatment using semi-structured, cognitive qualitative interviews to assess participant understanding of content. We used an integrated approach of deductive and inductive thematic analysis. Results Twenty-seven patients with NSCLC participated. Participants with prior cancer experiences or those with family members with prior cancer experiences reported better preparedness for cancer treatment decision-making. All participants agreed the conversation tool would be helpful to clarify their thinking about values, comparisons, and goals of treatment, and to help patients communicate more effectively with their clinicians. Conclusion Participants reported that the tool may empower them with confidence and agency to actively participate in cancer treatment SDM. The conversation tool was acceptable, comprehensible, and usable. Next steps will test effectiveness on patient-centered and decisional outcomes. Innovation A personalized conversation tool using consequence tables and core SDM components is novel in that it can encourage a tailored, conversational dynamic and includes patient-centered values along with traditional decisional outcomes.
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Affiliation(s)
- Sara E. Golden
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Corresponding author at: 3710 SW US Veterans Hospital Rd. R&D 66, Portland, OR 97239, USA.
| | - Natalie Disher
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
| | - Nathan F. Dieckmann
- School of Nursing, Oregon Health and Science University (OHSU), Portland, OR, USA
- Division of Psychology, School of Medicine, OHSU, Portland, OR, USA
| | - Karen B. Eden
- Department of Medical Informatics and Clinic Epidemiology, OHSU, Portland, OR, USA
| | - Daniel Matlock
- Division of Geriatric Medicine, University of Colorado School of Medicine, Aurora, CO, USA
- Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Kelly C. Vranas
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Section of Pulmonary and Critical Care Medicine, VAPORHCS, Portland, OR, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, OHSU, Portland, OR, USA
| | - Christopher G. Slatore
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Section of Pulmonary and Critical Care Medicine, VAPORHCS, Portland, OR, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, OHSU, Portland, OR, USA
| | - Donald R. Sullivan
- Center to Improve Veteran Involvement in Care, VA Portland Health Care System (VAPORHCS), Portland, OR, USA
- Division of Pulmonary, Allergy, and Critical Care Medicine, OHSU, Portland, OR, USA
- Cancer Prevention and Control Program, Knight Cancer Institute, OHSU, Portland, OR, USA
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Fritzell K, Kottorp A, Jervaeus A. Different information needs-The major reasons for calling the helpline when invited to colorectal cancer screening. Health Expect 2022; 25:1548-1554. [PMID: 35393757 PMCID: PMC9327847 DOI: 10.1111/hex.13496] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2021] [Revised: 03/27/2022] [Accepted: 03/29/2022] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION This study pertains to the design of a decision aid (DA) to shed light on information and support needs in colorectal cancer screening, with the aim to explore the calling patterns to the Screening of Swedish Colons (SCREESCO) study's helpline. METHODS A cross-sectional study was conducted with data from documented telephone calls to the SCREESCO study, including individuals, 59-60 years, randomized to colonoscopy or high sensitive faecal immunochemical test (FIT). RESULTS More than 2000 calls (women 58.5%; colonoscopy 59%) were analysed. Calling patterns: unsubscribing from screening, confirmation of participation, logistical concerns about the screening procedure, counselling, and FIT screening difficulties or in need of a new FIT test. Comorbidity was the most frequent reason for unsubscribing and most of the counselling calls included questions about the FIT test or the colonoscopy. CONCLUSION Most of the calls to the helpline seemed to be related to individuals' lack of understanding about the organization of the screening programme and the screening procedure. Therefore, we find it important to further stress the tailoring part in our DA developing process, that is, provide limited information initially, with the possibility of access to more, if desired by the individual, still with respect to the individual's needs, health and digital literacy. PATIENT AND PUBLIC CONTRIBUTION Individuals representing the public and invited to SCREESCO participated since we analysed their calls to the helpline. The findings will contribute to our continued work with the DA where the public will contribute and participate.
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Affiliation(s)
- Kaisa Fritzell
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
| | - Anders Kottorp
- Faculty of Health and Society, Malmö University, Malmö, Sweden
| | - Anna Jervaeus
- Department of Neurobiology, Care Sciences and Society, Karolinska Institutet, Stockholm, Sweden
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Larsen MB, Stokholm R, Kirkegaard P, Laursen HS, Gabel P, Andersen B. Making decisions on your own: Self-administered decision aids about colorectal cancer screening - A systematic review and meta-analyses. PATIENT EDUCATION AND COUNSELING 2022; 105:534-546. [PMID: 34376303 DOI: 10.1016/j.pec.2021.07.035] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 06/15/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE To provide a systematic review of self-administered decision aids (DAs) for citizens invited to participate in colorectal cancer screening synthesizing the effectiveness of self-administered DAs on informed choice or the components hereof; knowledge, attitudes, and participation. METHODS The literature search was undertaken in PubMed, CINAHL, PsycINFO, Embase and Scopus and last updated 19 March 2021. Results were presented by narrative synthesis, meta-analyses and vote counting based on direction of effect. RESULTS Fourteen studies of fair methodological quality were included. One study reported on informed choice and 13 studies reported on the components. Self-administered DAs increased participation and knowledge whereas it was inconclusive with regard to attitudes towards screening. The studies were very heterogeneous with different comparators, outcomes and means of measurement. CONCLUSION This systematic review showed a potential for self-administered DAs to support informed choice in colorectal cancer screening, especially by increasing knowledge. PRACTICE IMPLICATIONS It seems reasonable to consider informed choice to be one of the main outcomes of self-administered DAs. Yet there is a need for consensus on how to measure informed choice in cancer screening, especially a validated measurement of knowledge defining what constitutes 'adequate knowledge'.
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Affiliation(s)
- Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers NO, Denmark.
| | - Rikke Stokholm
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers NO, Denmark.
| | - Pia Kirkegaard
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers NO, Denmark.
| | - Henrik Sehested Laursen
- Medical Library, Regional Hospital Central Jutland, Heibergs Alle 5A, DK-8800 Viborg, Denmark.
| | - Pernille Gabel
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers NO, Denmark.
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, DK-8930 Randers NO, Denmark; Department of Clinical Medicine, Aarhus University, Incuba Skejby, Building 2, Palle Juul-Jensens Boulevard 82, DK-8200 Aarhus N, Denmark.
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Murugesu L, Damman OC, Derksen ME, Timmermans DRM, de Jonge A, Smets EMA, Fransen MP. Women's Participation in Decision-Making in Maternity Care: A Qualitative Exploration of Clients' Health Literacy Skills and Needs for Support. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18031130. [PMID: 33514070 PMCID: PMC7908258 DOI: 10.3390/ijerph18031130] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/22/2021] [Accepted: 01/23/2021] [Indexed: 11/16/2022]
Abstract
Shared decision-making requires adequate functional health literacy (HL) skills from clients to understand information, as well as interactive and critical HL skills to obtain, appraise and apply information about available options. This study aimed to explore women's HL skills and needs for support regarding shared decision-making in maternity care. In-depth interviews were held among women in Dutch maternity care who scored low (n = 10) and high (n = 13) on basic health literacy screening test(s). HL skills and perceived needs for support were identified through thematic analysis. Women appeared to be highly engaged in the decision-making process. They mentioned searching and selecting general information about pregnancy and labor, constructing their preferences based on their own pre-existing knowledge and experiences and by discussions with partners and significant others. However, women with low basic skills and primigravida perceived difficulties in finding reliable information, understanding probabilistic information, constructing preferences based on benefit/harm information and preparing for consultations. Women also emphasized dealing with uncertainties, changing circumstances of pregnancy and labor, and emotions. Maternity care professionals could further support clients by guiding them towards reliable information. To facilitate participation in decision-making, preparing women for consultations (e.g., agenda setting) and supporting them in a timely manner to understand benefit/harm information seem important.
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Affiliation(s)
- Laxsini Murugesu
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (M.E.D.); (M.P.F.)
- Correspondence: ; Tel.: +31-2056-676-33
| | - Olga C. Damman
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (O.C.D.); (D.R.M.T.)
| | - Marloes E. Derksen
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (M.E.D.); (M.P.F.)
| | - Danielle R. M. Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands; (O.C.D.); (D.R.M.T.)
| | - Ank de Jonge
- Department of Midwifery Science, AVAG, Amsterdam Public Health, Amsterdam UMC, Vrije Universiteit Amsterdam, 1081 HV Amsterdam, The Netherlands;
| | - Ellen M. A. Smets
- Department of Medical Psychology, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands;
| | - Mirjam P. Fransen
- Department of Public and Occupational Health, Amsterdam Public Health, Amsterdam UMC, University of Amsterdam, 1105 AZ Amsterdam, The Netherlands; (M.E.D.); (M.P.F.)
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