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Pivac I, Markić J, Poklepović Peričić T, Aranza D, Marušić A. Evaluating health claim assessment skills of parents with preschool children: A cross-sectional study using Informed Health Choices Claim Evaluation Tool. J Glob Health 2023; 13:04156. [PMID: 37917876 PMCID: PMC10622117 DOI: 10.7189/jogh.13.04156] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2023] Open
Abstract
Background Health literacy is a global problem and is particularly relevant when making health care decisions about small children. We analysed how parents of preschool children assess health claims and explored the predictors of their assessment skill. Methods We conducted a survey with questions from the Claim Evaluation Tools (CET) database, part of the Informed Health Choices (IHC) project, in ten paediatric primary care practices of the Split-Dalmatia County Health Center, Split, Croatia, from 1 February to 31 March 2023. Eligible participants were parents accompanying preschool-aged children for check-ups. We also collected data on parents' and children's demographic and health characteristics (including the presence of any chronic illness in the child), visits to paediatric emergency service, hospitalisations, vaccination status, the presence of chronic illness of parents or relatives, and whether parents had to made treatment decisions for themselves and/or their family member. Results Overall, 402 parents of preschool children (median age 35 years (interquartile range (IQR) = 31.0-38.3)) had a median IHC CET test score of 10.0 (IQR = 8.0-11.0) out of 12 questions. The multiple regression analysis showed that female gender, higher level of education, being employed, and having a history of a visit to paediatric emergency service were significant predictors of the test score, explaining 21.9% of the variance. Conclusions Parents of preschool children have a very good ability for critical assessment of health-related statements in a complex health care system and an environment of generally unsatisfactory health literacy. Further studies should explore how parents understand health claims in different geographical, socio-economic and cultural setting, and explore educational interventions to increase critical thinking abilities and informed decision-making, especially among fathers, unemployed parents and those with lower levels of education.
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Affiliation(s)
- Ivan Pivac
- University of Split School of Medicine, Split, Croatia
| | - Joško Markić
- University of Split School of Medicine, Split, Croatia
- Department of Pediatrics, University Hospital of Split, Split, Croatia
| | | | - Diana Aranza
- University Department of Health Studies, University of Split, Split, Croatia
| | - Ana Marušić
- University of Split School of Medicine, Split, Croatia
- Center for Evidence-based Medicine, University of Split School of Medicine, Split, Croatia
- Department for Research in Biomedicine and Health, University of Split School of Medicine, Split, Croatia
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AlFaifi JJ, Alrehaili RA, Alshammari SD, Alqurashi JHM, Alasmari HMA, Alhallafi AFS. Levels of Surgical Patients' Education Related to Surgical Interventions Among Patients in Saudi Arabia. Cureus 2023; 15:e42715. [PMID: 37654936 PMCID: PMC10466169 DOI: 10.7759/cureus.42715] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/30/2023] [Indexed: 09/02/2023] Open
Abstract
BACKGROUND Patient education and counseling should simplify and clarify the condition, surgery, postoperative care, and potential complications. This study aimed to determine the levels of surgical patients' education regarding surgical interventions among patients in Saudi Arabia. METHOD This was an online survey study that was conducted between January and May 2023 to determine the levels of surgical patients' education regarding surgical interventions among patients in Saudi Arabia. The study population was patients who underwent surgeries (elective and emergency) living in Saudi Arabia. The questionnaire tool used in this study was developed based on an extensive literature review in the field of patients' education regarding surgical interventions. Binary logistic regression analysis was used to identify predictors of satisfaction with the callouts and the surgeon-consultant's communication quality. RESULTS A total of 1360 participants were involved in this study. Around 40.5% of the participants reported that they met the surgeon after diagnosing and recommending the issue. Almost 70.0% of research participants reported that the consultant surgeon personally explained a diagnosis or strategy to attain it and the surgical technique, method, and purpose before signing the informed consent. The majority of study participants reported that the consulting surgeon or a member of his surgical team explained the stages of reaching a diagnosis and the steps he/she will take to diagnose their condition (83.2%), discussed the diagnosis with them and how certain they are of the diagnosis (88.1%), described the surgery clearly and simply (85.5%), informed them of alternatives to surgical intervention (63.1%), and discussed the entire postoperative treatment plan (81.8%), informed them of possible postoperative complications (79.6%), used additional callout during the discussion (81.3%), and spoke to them after the surgery and before they left the hospital (69.2%). After a conversation with their doctors, 36.3% of study participants said they did not require an outside source to understand the diagnosis, operation, probable problems, treatment plan, and follow-up. Discussion "Just talk," sketching, and pictograms were the most popular callouts during patient education, with 78.3%, 22.3%, and 17.9%, respectively. Saudi participants were more likely to be satisfied with the quality of communication by the surgeon-consultant (p<0.05). At the same time, participants who live in the Southern area were less likely to be satisfied with the quality of communication by the surgeon-consultant (p<0.05). CONCLUSION This study highlights the crucial role of surgeons in preoperative patient education as well as the significance of surgical team participation in this process. In order to increase patient knowledge, facilitate treatment decisions, and assure informed consent, it is necessary to establish guidelines and roles to improve surgeon-patient communication, increase patient and surgeon awareness, nurture patient concern expression, and encourage non-medical patient participation.
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Affiliation(s)
- Jubran Jaber AlFaifi
- Department of Surgery, College of Medicine, Imam Mohammad Ibn Saud Islamic University, Riyadh, SAU
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Tyldesley-Marshall N, Grove A, Ghosh I, Kudrna L, Ayorinde A, Singh M, Mehaan E, Clarke A, Taylor-Phillips S, Al-Khudairy L. Investigating informed choice in screening programmes: a mixed methods analysis. BMC Public Health 2022; 22:2319. [PMID: 36510247 PMCID: PMC9743591 DOI: 10.1186/s12889-022-14685-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 11/21/2022] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Screening programmes aim to identify individuals at higher risk of developing a disease or condition. While globally, there is agreement that people who attend screening should be fully informed, there is no consensus about how this should be achieved. We conducted a mixed methods study across eight different countries to understand how countries address informed choice across two screening programmes: breast cancer and fetal trisomy anomaly screening. METHODS Fourteen senior level employees from organisations who produce and deliver decision aids to assist informed choice were interviewed, and their decision aids (n = 15) were evaluated using documentary analysis. RESULTS We discovered that attempts to achieve informed choice via decision aids generate two key tensions (i) between improving informed choice and increasing uptake and (ii) between improving informed choice and comprehensibility of the information presented. Comprehensibility is fundamentally at tension with an aim of being fully informed. These tensions emerged in both the interviews and documentary analysis. CONCLUSION We conclude that organisations need to decide whether their overarching aim is ensuring high levels of uptake or maximising informed choice to participate in screening programmes. Consideration must then be given to all levels of development and distribution of information produced to reflect each organisation's aim. The comprehensibility of the DA must also be considered, as this may be reduced when informed choice is prioritised.
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Affiliation(s)
- Natalie Tyldesley-Marshall
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Amy Grove
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK ,grid.7372.10000 0000 8809 1613Public Health and Health Technology Assessment and Implementation Science, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Iman Ghosh
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Laura Kudrna
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK ,grid.6572.60000 0004 1936 7486Present address : Institute of Applied Health Research, University of Birmingham, B15 2TT Edgbaston, UK
| | - Abimbola Ayorinde
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Megha Singh
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Edward Mehaan
- grid.1002.30000 0004 1936 7857Monash University, Wellington Road, VIC 3800 Clayton, Melbourne, Australia
| | - Aileen Clarke
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Sian Taylor-Phillips
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
| | - Lena Al-Khudairy
- grid.7372.10000 0000 8809 1613Applied Research Collaboration West Midlands, Warwick Medical School, University of Warwick, CV4 7AL Coventry, UK
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Jones E, Poyade M, Varsou O. Developing and evaluating a prototype public health mobile app on the UK NHS Abdominal Aortic Aneurysm Screening Programme. J Vis Commun Med 2022; 45:160-168. [DOI: 10.1080/17453054.2022.2037409] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Affiliation(s)
- Ella Jones
- University of Glasgow, Glasgow, UK
- Glasgow School of Art, Glasgow, UK
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5
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Lie HC, Juvet LK, Street RL, Gulbrandsen P, Mellblom AV, Brembo EA, Eide H, Heyn L, Saltveit KH, Strømme H, Sundling V, Turk E, Menichetti J. Effects of Physicians' Information Giving on Patient Outcomes: a Systematic Review. J Gen Intern Med 2022; 37:651-663. [PMID: 34355348 PMCID: PMC8858343 DOI: 10.1007/s11606-021-07044-5] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2021] [Accepted: 07/14/2021] [Indexed: 11/18/2022]
Abstract
BACKGROUND Providing diagnostic and treatment information to patients is a core clinical skill, but evidence for the effectiveness of different information-giving strategies is inconsistent. This systematic review aimed to investigate the reported effects of empirically tested communication strategies for providing information on patient-related outcomes: information recall and (health-related) behaviors. METHODS The databases MEDLINE, Embase, PsycINFO (Ovid), Cochrane Central Register of Controlled Trials, and relevant bibliographies were systematically searched from the inception to April 24, 2020, without restrictions, for articles testing information-giving strategies for physicians (PROSPERO ID: CRD42019115791). Pairs of independent reviewers identified randomized controlled studies with a low risk of selection bias as from the Cochrane risk of bias 2 tool. Main outcomes were grouped into patient information recall and behavioral outcomes (e.g., alcohol consumption, weight loss, participation in screening). Due to high heterogeneity in the data on effects of interventions, these outcomes were descriptively reported, together with studies', interventions', and information-giving strategies' characteristics. PRISMA guidelines were followed. RESULTS Seventeen of 9423 articles were included. Eight studies, reporting 10 interventions, assessed patient information recall: mostly conducted in experimental settings and testing a single information-giving strategy. Four of the ten interventions reported significant increase in recall. Nine studies assessed behavioral outcomes, mostly in real-life clinical settings and testing multiple information-giving strategies simultaneously. The heterogeneity in this group of studies was high. Eight of the nine interventions reported a significant positive effect on objectively and subjectively measured patients' behavioral outcomes. DISCUSSION Using specific framing strategies for achieving specific communication goals when providing information to patients appears to have positive effects on information recall and patient health-related behaviors. The heterogeneity observed in this group of studies testifies the need for a more consistent methodological and conceptual agenda when testing medical information-giving strategies. TRIAL REGISTRATION PROSPERO registration number: CRD42019115791.
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Affiliation(s)
- Hanne C Lie
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Lene K Juvet
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.,Norvegian Institute of Public Health, Oslo, Norway
| | - Richard L Street
- Department of Communication, Texas A&M University, College Station, TX, USA
| | - Pål Gulbrandsen
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Health Services Research (HØKH) Centre, Akershus University Hospital, Lørenskog, Norway
| | - Anneli V Mellblom
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway.,Regional Centre for Child and Adolescent Mental Health, Eastern and Southern Norway (RBUP), Oslo, Norway
| | - Espen Andreas Brembo
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Hilde Eide
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Lena Heyn
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway
| | - Kristina H Saltveit
- Department of Behavioral Medicine, Institute of Basic Medical Sciences, Faculty of Medicine, University of Oslo, Oslo, Norway
| | - Hilde Strømme
- Library of Medicine and Science, University of Oslo, Oslo, Norway
| | - Vibeke Sundling
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.,Department of Optometry, Radiography and Lighting Design, University of South-Eastern Norway, Kongsberg, Norway
| | - Eva Turk
- Centre for Health and Technology, Faculty of Health and Social Sciences, University of South-Eastern Norway, Drammen, Norway.,Medical Faculty, University of Maribor, Maribor, Slovenia
| | - Julia Menichetti
- Institute of Clinical Medicine, University of Oslo, Oslo, Norway. .,Health Services Research (HØKH) Centre, Akershus University Hospital, Lørenskog, Norway.
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Gold N, Durlik C, Sanders JG, Thompson K, Chadborn T. Applying behavioural science to increase uptake of the NHS Health Check: a randomised controlled trial of gain- and loss-framed messaging in the national patient information leaflet. BMC Public Health 2019; 19:1519. [PMID: 31727030 PMCID: PMC6854644 DOI: 10.1186/s12889-019-7754-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2019] [Accepted: 10/04/2019] [Indexed: 12/21/2022] Open
Abstract
BACKGROUND The NHS Health Check (NHSHC) is a national programme for the prevention of non-communicable diseases. Patients aged 40-74 without an existing cardiovascular-related condition should be invited quinquennially. Uptake is lower than anticipated. We assessed the impact on uptake of two new behaviourally-enhanced leaflets (with the current national leaflet as a control), enclosed with the invitation letter: the first trial on the leaflet. METHODS A double-blind three-armed randomized controlled trial was conducted. The new leaflets were shorter (two pages, instead of four); one was loss-framed ('don't miss out') and the other was gain-framed ('make the most of life'). The participants were patients from 39 practices in Lewisham and 17 practices in NE Lincolnshire, who were allocated to interventions using a random-number generator and received one of the leaflets with their invitation letter from April-September 2018. The outcome measure was uptake of an NHSHC by November 2018. The trial was powered to detect a 2% effect. RESULTS Uptake was 17.6% in the control condition (n = 3677), 17.4% in the loss-framed condition (n = 3664), and 18.2% in the gain-framed condition (n = 3697). Leaflet type was not a significant predictor of NHSHC uptake in a logistic regression that controlled for demographic variables, with GP practice as a random effect. Statistically significant predictors of uptake included location (higher uptake in Lewisham), age (increased age was associated with increased attendance) and sex (higher uptake in females). The Bayes Factor comparing the null to a hypothesis of differences between conditions was 416, which is extreme evidence in favour of the null hypothesis. CONCLUSION There was no evidence for a meaningful effect of either a loss-framed or gain-framed behaviourally-informed leaflet type on uptake, which is surprising, given that behaviourally informed letters have improved uptake of NHSHCs. It is possible that people do not pay attention to leaflets that are enclosed with letters, or that the leaflet continues to support informed decision-making but this does not affect uptake. TRIAL REGISTRATION Clinicaltrials.gov, NCT03524131. Registered May 14, 2018. Retrospectively registered.
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Affiliation(s)
- Natalie Gold
- Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London, SE1 8UG, UK.
- Radcliffe Humanities, University of Oxford, Woodstock Road, Oxford, OX2 6GG, UK.
| | - Caroline Durlik
- Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London, SE1 8UG, UK
| | - Jet G Sanders
- Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London, SE1 8UG, UK
- Department of Psychological and Behavioural Science, London School of Economics and Political Science, Houghton St, Holborn, London, WC2A 2AE, UK
| | - Katherine Thompson
- Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London, SE1 8UG, UK
| | - Tim Chadborn
- Public Health England, Wellington House, 133-155 Waterloo Rd, Lambeth, London, SE1 8UG, UK
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Bikker AP, Macdonald S, Robb KA, Conway E, Browne S, Campbell C, Weller D, Steele R, Macleod U. Perceived colorectal cancer candidacy and the role of candidacy in colorectal cancer screening. HEALTH RISK & SOCIETY 2019. [DOI: 10.1080/13698575.2019.1680816] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Affiliation(s)
| | | | | | | | | | | | - David Weller
- The Usher Institute, The University of Edinburgh, Edinburgh, UK
| | - Robert Steele
- Medical Research Institute, University of Dundee, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
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Dierks T, Heijnsdijk EAM, Korfage IJ, Roobol MJ, de Koning HJ. Informed decision-making based on a leaflet in the context of prostate cancer screening. PATIENT EDUCATION AND COUNSELING 2019; 102:1483-1489. [PMID: 31014933 PMCID: PMC6800081 DOI: 10.1016/j.pec.2019.03.009] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/10/2018] [Revised: 03/08/2019] [Accepted: 03/16/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE We aimed to assess to what extent men make informed choices in the context of prostate cancer screening and how written material contributes to that process. METHODS We developed a leaflet describing prostate cancer screening, and a questionnaire consisting of knowledge, attitude, and intended screening uptake components to assess informed decision-making. The leaflet and questionnaire were pilot-tested among men of the target population, adapted accordingly, and sent to 761 members of an online research panel. We operationalized whether the leaflet was read as spending one minute on the leaflet page and by a self-reported answer of respondents. RESULTS The response rate was 66% (501/761). The group who read the leaflet (n = 342) correctly answered a knowledge item significantly more often (10.9 versus 8.8; p < 0.001) than those who did not read the leaflet (n = 159), and made more informed choices (73% versus 56%; p = 0.001). There were no significant differences in attitude and intended screening uptake between both groups. CONCLUSION Having read the leaflet could be one of the factors associated with increased levels of knowledge and informed decision-making. PRACTICAL IMPLICATIONS The results of this study showed that increasing knowledge and supporting informed decision-making with written material are feasible in prostate cancer screening.
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Affiliation(s)
- Tessa Dierks
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands.
| | - Eveline A M Heijnsdijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Monique J Roobol
- Department of Urology, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
| | - Harry J de Koning
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 2040, 3000 CA Rotterdam, The Netherlands
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Reder M, Thygesen LC. Crowd-figure-pictograms improve women's knowledge about mammography screening: results from a randomised controlled trial. BMC Res Notes 2018; 11:332. [PMID: 29784009 PMCID: PMC5963070 DOI: 10.1186/s13104-018-3437-z] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2018] [Accepted: 05/11/2018] [Indexed: 11/20/2022] Open
Abstract
Objective To evaluate the effect of crowd-figure-pictograms on women’s numeric knowledge about mammography screening in a three-armed parallel randomised controlled trial. Results 552 women were randomised to receive (1) non-numeric information (n = 192), (2) non-numeric and numeric information (n = 186), or (3) non-numeric and numeric information complemented by crowd-figure-pictograms (n = 174). Baseline numeric knowledge was low (control 0.61, numeric 0.66, and pictogram 0.51 on a scale ranging from 0 to 5). Women in the crowd-figure-pictogram group had a larger knowledge increase than women in the numeric group (2.42 vs 2.06, p = .03). Both groups had significant increases in knowledge compared to the control (0.20, p < .001). Providing numeric information in absolute numbers improves knowledge; even more so when crowd-figure-pictograms are added. Trial registration German Clinical Trials Register DRKS00014736, retrospectively registered 11 May 2018 Electronic supplementary material The online version of this article (10.1186/s13104-018-3437-z) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Maren Reder
- School of Public Health, Bielefeld University, Universitätsstraße 25, 33615, Bielefeld, Germany. .,Institute of Psychology, University of Hildesheim, Universitätsplatz 1, 31141, Hildesheim, Germany.
| | - Lau Caspar Thygesen
- National Institute of Public Health, University of Southern Denmark, Studiestræde 6, 1455, Copenhagen K, Denmark
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Caetano IRCES, Santiago LM, Marques M. Impact of written information on control and adherence in type 2 diabetes. ACTA ACUST UNITED AC 2018; 64:140-147. [PMID: 29641669 DOI: 10.1590/1806-9282.64.02.140] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2017] [Accepted: 07/16/2017] [Indexed: 01/21/2023]
Abstract
INTRODUCTION Diabetes therapeutic education and information by leaflets is important. This study aimed to understand the effectiveness of written information to diabetic patients, after six months, in the control of diabetes and medication adherence. METHOD Non-pharmacological clinical trial. Randomized sample of diabetic patients of 65 volunteer doctors, distributed among the five health regions in Portugal. At the first appointment, patients were randomized in four groups (three intervention with validated leaflets and one control), leaflet reading being reinforced at the follow-up appointments in a 6-months period. Variables collected: HbA1c, home blood glucose, weight, waist circumference, blood pressure, cigarettes smoked, physical activity level, adherence to medication, medication, height, diabetes progression, age, sex and educational background. Descriptive and inferential statistics. RESULTS From the 709 patients recruited, 702 were studied in this 6-months period with no statistical differences in the baseline variables studied. After six months of intervention, the adherence to medication improved in the leaflet group (p=0.034). This was noticed in those under 65 years of age (p=0.027), with diabetes for ≤ 5 years (p=0.010), with educational background up to 4 years (p=0.030) and 9 years (p=0.006) and with HbA1c ≥ 7% at the beginning of the study. CONCLUSION Interventions with leaflets handed in primary healthcare to people with diabetes type 2 can bring benefits in what concerns adherence to therapeutics, namely in younger people with a less studies.
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Affiliation(s)
| | | | - Margarida Marques
- Biostatistics Laboratory, Faculdade de Medicina, Universidade de Coimbra, Coimbra, Portugal
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11
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Participants, Physicians or Programmes: Participants' educational level and initiative in cancer screening. Health Policy 2018; 122:422-430. [PMID: 29454541 DOI: 10.1016/j.healthpol.2018.02.001] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2017] [Revised: 01/31/2018] [Accepted: 02/01/2018] [Indexed: 01/26/2023]
Abstract
This study is an in-depth examination of at whose initiative (participant, physician or screening programme) individuals participate in cervical, breast and colorectal cancer screening across the EU-28. Special attention is paid to (1) the association with educational attainment and (2) the country's cancer screening strategy (organised, pilot/regional or opportunistic) for each type of cancer screened. Data were obtained from Eurobarometer 66.2 'Health in the European Union' (2006). Final samples consisted of 10,186; 5443 and 9851 individuals for cervical, breast, and colorectal cancer, respectively. Multinomial logistic regressions were performed. Surprisingly, even in countries with organised screening programmes, participation in screenings for cervical, breast and colorectal cancer was most likely to be initiated by the general practitioner (GP) or the participant. In general, GPs were found to play a crucial role in making referrals to screenings, regardless of the country's screening strategy. The results also revealed differences between educational groups with regard to their incentive to participate in cervical and breast cancer screening and, to a lesser extent, in colorectal cancer screening. People with high education are more likely to participate in cancer screening at their own initiative, while people with less education are more likely to participate at the initiative of a physician or a screening programme. Albeit, the results varied according to type of cancer screening and national screening strategy.
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12
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Sustersic M, Gauchet A, Foote A, Bosson J. How best to use and evaluate Patient Information Leaflets given during a consultation: a systematic review of literature reviews. Health Expect 2017; 20:531-542. [PMID: 27669682 PMCID: PMC5512995 DOI: 10.1111/hex.12487] [Citation(s) in RCA: 95] [Impact Index Per Article: 13.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/02/2016] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND In the past, several authors have attempted to review randomized clinical trials (RCT) evaluating the impact of Patient Information Leaflets (PILs) used during a consultation and draw some general conclusions. However, this proved difficult because the clinical situations, size and quality of RCTs were too heterogeneous to pool relevant data. OBJECTIVE To overcome this 30-year stalemate, we performed a review of reviews and propose general recommendations and suggestions for improving the quality of PILs, how to use them and methods for evaluating them. METHODOLOGY We searched five databases for reviews, systematic reviews and meta-analyses describing PILs. We drew general and condition-linked conclusions concerning the impact of PILs. Checklists summarize criteria for quality PILs, and ways of using and evaluating them. RESULTS Of 986 articles found, 24 reviews were pertinent; the five oldest considered the impact of PILs irrespective of the condition the patient consulted for; the 19 more recent ones mostly addressed precise clinical situations. DISCUSSION Whatever the clinical situation, PILs improve patients' knowledge and satisfaction. For acute conditions, in the short-term PILs also improve adherence to treatment. For chronic diseases, invasive procedures or screening situations, their impact on adherence varies depending on the context, how the PILs are given and the invasiveness of the intervention. CONCLUSION PILs are considered to be very useful, especially for acute conditions where the patient is the first to suffer from lack of information. We propose checklists for writing, designing, using and evaluating PILs in RCTs to enable comparisons between different studies.
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Affiliation(s)
- Mélanie Sustersic
- TIMC‐IMAGUniversity of Grenoble AlpesGrenobleFrance
- Groupe Hospitalier Mutualiste de Grenoble (GHM)GrenobleFrance
| | - Aurélie Gauchet
- LIP/LPC2S, EA 4145University of Grenoble AlpesGrenobleFrance
| | - Alison Foote
- Inserm CIC 1406Grenoble Alpes University HospitalGrenobleFrance
| | - Jean‐Luc Bosson
- TIMC‐IMAGUniversity of Grenoble AlpesGrenobleFrance
- Inserm CIC 1406Grenoble Alpes University HospitalGrenobleFrance
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Ghanouni A, Renzi C, Meisel SF, Waller J. Common methods of measuring 'informed choice' in screening participation: Challenges and future directions. Prev Med Rep 2016; 4:601-607. [PMID: 27843761 PMCID: PMC5107638 DOI: 10.1016/j.pmedr.2016.10.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/09/2016] [Accepted: 10/27/2016] [Indexed: 02/06/2023] Open
Abstract
There is general agreement among public health practitioners, academics, and policymakers that people offered health screening tests should be able to make informed choices about whether to accept. Robust measures are necessary in order to gauge the extent to which informed choice is achieved in practice and whether efforts to improve it have succeeded. This review aims to add to the literature on how to improve methods of measuring informed choice. We discuss and critique commonly-used approaches and outline possible alternative methods that might address the issues identified. We explore the challenges of defining what information should be provided about screening and hence understood by service users, appraise the use of 'thresholds' to define e.g. positive attitudes towards screening, and describe problems inherent in conceptualising 'informed choice' as a single dichotomous outcome that either does or does not occur. Suggestions for future research include providing greater detail on why particular aspects of screening information were considered important, analysing knowledge and attitude measures at an ordinal or continuous level (avoiding problematic decisions about dichotomising data in order to set thresholds), and reconceptualising informed choice as a multifactorial set of outcomes, rather than a unitary one.
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Affiliation(s)
| | | | | | - Jo Waller
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, United Kingdom
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Chinn D, Homeyard C. Easy read and accessible information for people with intellectual disabilities: Is it worth it? A meta-narrative literature review. Health Expect 2016; 20:1189-1200. [PMID: 27862757 PMCID: PMC5689240 DOI: 10.1111/hex.12520] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/21/2016] [Indexed: 11/28/2022] Open
Abstract
Background The proliferation of “accessible information” for people with intellectual disabilities in UK health care has accelerated in recent years, underpinned by policy guidance alongside the recent introduction of mandatory standards. However, questions have been raised as to the impact of such resources as a means of enhancing involvement in health care and addressing health inequalities. Objective To review and synthesize the evidence from different approaches used to evaluate the impact of accessible information for people with intellectual disabilities using a meta‐narrative approach. Search strategy Literature searches were iterative and incorporated formal databases, grey literature and hand searches alongside more intuitive and opportunistic methods. Inclusion criteria Included English language papers published before December 2015 described the design and evaluation of written information adapted for adults with intellectual disabilities. Data extraction and synthesis We organized the papers into five groups according to similarity in authors’ writing styles and presentation, epistemology and theoretical foundations, aims and methodologies, professional and organizational identities. Main results The 42 included papers in the five groupings occupied diverse positions on (i) public communication vs individualized materials, (ii) literacy as decontextualized skills vs social practices and (iii) the expertise of patients vs professionals. There was limited evidence for the impact of accessible health information, notwithstanding the potential benefits associated with their creation. Conclusions Individually tailored information is more likely to meet personalized health information needs for people with intellectual disabilities. The emergence of different social formations in the creation of accessible information has potential for advancing engagement of diverse groups.
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Affiliation(s)
- Deborah Chinn
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
| | - Claire Homeyard
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, London, UK
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Etchegary H, Nicholls SG, Tessier L, Simmonds C, Potter BK, Brehaut JC, Pullman D, Hayeems R, Zelenietz S, Lamoureux M, Milburn J, Turner L, Chakraborty P, Wilson B. Consent for newborn screening: parents' and health-care professionals' experiences of consent in practice. Eur J Hum Genet 2016; 24:1530-1534. [PMID: 27302842 PMCID: PMC5110054 DOI: 10.1038/ejhg.2016.55] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2016] [Revised: 04/21/2016] [Accepted: 05/05/2016] [Indexed: 12/26/2022] Open
Abstract
Consent processes for newborn bloodspot screening (NBS) are variable, with a lack of descriptive research that depicts how the offer of NBS is made to parents. We explored the experience, in practice, of consent for NBS. Semistructured interviews in two Canadian provinces were held with: (1) parents of children offered NBS (n=32); and (2) health-care professionals involved in the NBS process (n=19). Data on recollections of NBS, including consent processes, were utilized to identify emerging themes using the method of constant comparison. Three themes were relevant to NBS consent: (1) The 'offer' of NBS; (2) content and timing of information provision; and (3) the importance of parental experiences for consent decisions. Recollections of consent for NBS were similar between jurisdictions. Excepting midwives and their patients, NBS was viewed as a routine part of giving birth, with little evidence of an informed consent process. Although most parents were satisfied, all respondents suggested information about NBS be provided long before the birth. Accounts of parents who declined screening highlight the influence of parental experiences with the heel prick process in screening decisions. Findings further our understanding of consent in practice and highlight areas for improvement in parent-provider interactions.
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Affiliation(s)
- Holly Etchegary
- Clinical Epidemiology Unit, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Stuart G Nicholls
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
- Children's Hospital of Eastern Ontario (CHEO) Research Institute, Ottawa, Ontario, Canada
| | - Laure Tessier
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Charlene Simmonds
- Health Research Unit, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Beth K Potter
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | | | - Daryl Pullman
- Community Health and Humanities, Faculty of Medicine, Memorial University, St John's, Newfoundland and Labrador, Canada
| | - Robyn Hayeems
- Institute of Health Policy Management and Evaluation, University of Toronto; Program in Child Health Evaluative Sciences, Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Sari Zelenietz
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Monica Lamoureux
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Jennifer Milburn
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
| | - Lesley Turner
- Provincial Medical Genetics Program, Eastern Health, St John's, Newfoundland and Labrador, Canada
| | - Pranesh Chakraborty
- Newborn Screening Ontario, Children's Hospital of Eastern Ontario, Ottawa, Ontario, Canada
- Department of Pediatrics, Faculty of Medicine, University of Ottawa, Ottawa, Ontario, Canada
| | - Brenda Wilson
- School of Epidemiology, Public Health and Preventive Medicine, University of Ottawa, Ottawa, Ontario, Canada
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Reinvitation to screening colonoscopy: a randomized-controlled trial of reminding letter and invitation to educational meeting on attendance in nonresponders to initial invitation to screening colonoscopy (REINVITE). Eur J Gastroenterol Hepatol 2016; 28:538-42. [PMID: 26967693 DOI: 10.1097/meg.0000000000000578] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
OBJECTIVES The response rate to initial invitation to population-based primary screening colonoscopy within the NordICC trial (NCT 00883792) in Poland is around 50%. The aim of this study was to compare the effect of a reinvitation letter and invitation to an educational intervention on participation in screening colonoscopy in nonresponders to initial invitation. METHODS Within the NordICC trial framework, individuals living in the region of Warsaw, who were drawn from Population Registries and assigned randomly to the screening group, received an invitation letter and a reminder with a prespecified screening colonoscopy appointment date. One thousand individuals, aged 55 to 64 years, who did not respond to both the invitation and the reminding letter were assigned randomly in a 1:1 ratio to the reinvitation group (REI) and the educational meeting group (MEET). The REI group was sent a reinvitation letter and reminder 6 and 3 weeks before the new colonoscopy appointment date, respectively. The MEET group was sent an invitation 6 weeks before an educational meeting date. Outcome measures were participation in screening colonoscopy within 6 months and response rate within 3 months from the date of reinvitation or invitation to an educational meeting. RESULTS The response rate and the participation rate in colonoscopy were statistically significantly higher in the REI group compared with the MEET group (16.5 vs. 4.3%; P<0.001 and 5.2 vs. 2.1%; P=0.008, respectively). CONCLUSION A simple reinvitation letter results in a higher response rate and participation rate to screening colonoscopy than invitation to tailored educational meeting in nonresponders to previous invitations. (NCT01183156).
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Doust J, Trevena L, Bastian H, Burgess J, Edwards AGK. Interventions for improving understanding and minimising the psychological impact of screening. Hippokratia 2015. [DOI: 10.1002/14651858.cd001212.pub3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Affiliation(s)
- Jenny Doust
- Bond University; Centre for Research in Evidence Based Practice; Gold Coast Queensland Australia 4229
| | - Lyndal Trevena
- The University of Sydney; Room 322 Edward Ford Building (A27) Sydney NSW Australia 2006
| | - Hilda Bastian
- National Library of Medicine, National Institutes of Health; National Center for Biotechnology Information; 8600 Rockville Pike Bethesda Maryland USA 20894
| | - Jacquii Burgess
- Bond University; Faculty of Health Sciences and Medicine; Gold Coast Queensland Australia 4229
| | - Adrian GK Edwards
- Cardiff University; Cochrane Institute of Primary Care and Public Health, School of Medicine; 2nd Floor, Neuadd Meirionnydd Heath Park Cardiff Wales UK CF14 4YS
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Senore C, Inadomi J, Segnan N, Bellisario C, Hassan C. Optimising colorectal cancer screening acceptance: a review. Gut 2015; 64:1158-77. [PMID: 26059765 DOI: 10.1136/gutjnl-2014-308081] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/09/2015] [Indexed: 12/13/2022]
Abstract
The study aims to review available evidence concerning effective interventions to increase colorectal cancer (CRC) screening acceptance. We performed a literature search of randomised trials designed to increase individuals' use of CRC screening on PubMed, Embase, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects. Small (≤ 100 subjects per arm) studies and those reporting results of interventions implemented before publication of the large faecal occult blood test trials were excluded. Interventions were categorised following the Continuum of Cancer Care and the PRECEDE-PROCEED models and studies were grouped by screening model (opportunistic vs organised). Multifactor interventions targeting multiple levels of care and considering factors outside the individual clinician control, represent the most effective strategy to enhance CRC screening acceptance. Removing financial barriers, implementing methods allowing a systematic contact of the whole target population, using personal invitation letters, preferably signed by the reference care provider, and reminders mailed to all non-attendees are highly effective in enhancing CRC screening acceptance. Physician reminders may support the diffusion of screening, but they can be effective only for individuals who have access to and make use of healthcare services. Educational interventions for patients and providers are effective, but the implementation of organisational measures may be necessary to favour their impact. Available evidence indicates that organised programmes allow to achieve an extensive coverage and to enhance equity of access, while maximising the health impact of screening. They provide at the same time an infrastructure allowing to achieve a more favourable cost-effectiveness profile of potentially effective strategies, which would not be sustainable in opportunistic settings.
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Affiliation(s)
- Carlo Senore
- Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy
| | - John Inadomi
- Digestive Disease Center, University of Washington, Seattle, Washington, USA
| | - Nereo Segnan
- Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy
| | - Cristina Bellisario
- Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy
| | - Cesare Hassan
- Unit of Gastroenterology, Ospedale Nuovo Regina Margherita, Rome, Italy
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Nicholls SG, Southern KW. Considering consent: a structural equation modelling analysis of factors influencing decisional quality when accepting newborn screening. J Inherit Metab Dis 2014; 37:197-205. [PMID: 24043381 DOI: 10.1007/s10545-013-9651-x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2013] [Revised: 08/09/2013] [Accepted: 08/20/2013] [Indexed: 10/26/2022]
Abstract
INTRODUCTION Newborn bloodspot screening (NBS) programs generate an ethical tension between promoting the uptake of effective public health measures and facilitating informed consent from individuals. AIM To explore the factors that affect parental perceptions of decision quality when accepting NBS METHODS: Survey of parents with children screened in 2008 (n = 154, 32% response rate). Questions were based on previous research and existing measures. The primary outcome was decision quality. Predictors were latent constructs of Attitudes to medicine, Perceived knowledge, Attitudes to screening, and Perceived choice. Responses were analysed using structural equation modelling. RESULTS Increases in perceived choice and positive attitudes towards screening improved decision quality. Perceived knowledge had a significant and positive relationship with attitudes to screening (0.375, p < 0.01) as did perceived choice on perceived knowledge (0.806, p < 0.01). Attitudes to screening were also significantly influenced by attitudes to medicine, although less so than the effect of perceived knowledge. The model had good fit on all indices (χ(2) = 61.396, df = 48, p = 0.093; CFI = 0.979; RMSEA = 0.043). CONCLUSIONS Our results implicate the presentation of screening as a key determinant of decision quality both in terms of the immediate information regarding the potential benefits and risks, but also the way in which consent processes are managed. If we want to better understand parent decision-making we need to go beyond analyses of information content, or parental recall of this, but consider the context in which screening is provided.
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Affiliation(s)
- Stuart G Nicholls
- Department of Epidemiology and Community Medicine, University of Ottawa, K1H 8M5, Ottawa, Canada,
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20
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Nicholls SG, Southern KW. Parental decision-making and acceptance of newborn bloodspot screening: an exploratory study. PLoS One 2013; 8:e79441. [PMID: 24265771 PMCID: PMC3827133 DOI: 10.1371/journal.pone.0079441] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2013] [Accepted: 09/23/2013] [Indexed: 01/28/2023] Open
Abstract
Objective Newborn bloodspot screening is an internationally established public health measure. Despite this, there is a paucity of information relating to the decision-making process that parents go through when accepting newborn screening. This is important as screening panels are expanding; potentially leading to an increasing amount of complex information. This study sought to understand the factors that influence parental decisions and roles they play in the decision-making process. Patients and Methods Qualitative thematic evaluation of semi structured interviews with parents whose children had recently undergone newborn screening in the Merseyside and Cheshire region of England, UK. Results Eighteen interviews with first time parents (n = 12) and those with previous children (n = 6). Seven factors were identified as being either explicitly or implicitly related to parental decision-making: Experience, Attitudes to medicine, Information-seeking behaviour, Perceived knowledge, Attitudes to screening, and Perceived choice, all of which ultimately impact on Perceived decisional quality. Conclusions These results indicate that while content is important, other contextual factors such as personal experience, perceived choice, and general attitudes toward medicine, are also highly influential. In particular, relationships with key healthcare professionals are central to information collection, attitudes toward screening, and the level of deliberation that is invested in decisions to accept newborn bloodspot screening.
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Affiliation(s)
- Stuart G. Nicholls
- Department of Epidemiology and Community Medicine, University of Ottawa, Ottawa, Ontario, Canada
- * E-mail:
| | - Kevin W. Southern
- Institute of Child Health, Alder Hey Children's Hospital, Liverpool, Merseyside, United Kingdom
- Department for Women's and Children's Health, University of Liverpool, Liverpool, Merseyside, United Kingdom
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van Agt H, Fracheboud J, van der Steen A, de Koning H. Do women make an informed choice about participating in breast cancer screening? A survey among women invited for a first mammography screening examination. PATIENT EDUCATION AND COUNSELING 2012; 89:353-359. [PMID: 22963769 DOI: 10.1016/j.pec.2012.08.003] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/26/2012] [Revised: 07/19/2012] [Accepted: 08/09/2012] [Indexed: 06/01/2023]
Abstract
OBJECTIVE To determine the level of informed choice in women invited for breast cancer screening for the first time. METHODS To determine the content of decision-relevant knowledge, 16 experts were asked to judge whether each of 51 topics represented essential information to enable informed choices. To assess the level of informed choices, a questionnaire was then sent to all 460 invited women in the south-western part of the Netherlands who turned 50 in August 2008. RESULTS Of all 229 respondents, 95% were deemed to have sufficient knowledge as they answered at least 8 out of 13 items correctly. In 90% there was consistency between intention (not) to participate and attitude. As a result, 88% made an informed choice. Sixty-eight percent of women responded correctly on the item of over-diagnosis. Even if all non-respondents were assumed to have no knowledge, 50% of the total group invited to participate still had sufficient knowledge. CONCLUSIONS Women were deemed to have sufficient relevant knowledge of the benefits and harms if they answered at least half of the items correctly. PRACTICE IMPLICATIONS To further increase informed choices in breast cancer screening, information on some of the possible harms merits further attention.
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Affiliation(s)
- Heleen van Agt
- Department of Public Health, Erasmus MC University Medical Center, Rotterdam, The Netherlands.
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Flight IH, Wilson CJ, Zajac IT, Hart E, McGillivray JA. Decision Support and the Effectiveness of Web-based Delivery and Information Tailoring for Bowel Cancer Screening: An Exploratory Study. JMIR Res Protoc 2012; 1:e12. [PMID: 23611950 PMCID: PMC3626147 DOI: 10.2196/resprot.2135] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 08/13/2012] [Accepted: 08/10/2012] [Indexed: 11/20/2022] Open
Abstract
Background Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females throughout the developed world. Population screening using fecal occult blood tests (FOBTs) facilitates early detection and greater chance of survival, but participation rates are low. We developed a Web-based decision tool to provide information tailored to an individual’s decision stage for CRC screening and attitude toward screening utilizing the Preventive Health Model (PHM) and Precaution Adoption Process Model (PAPM) as theoretical frameworks for screening behavior. We describe the practical steps employed in the tool’s design and the subsequent conduct of an exploratory study. Objective To design a decision tool for CRC screening and conduct an exploratory study among average-risk men and women to (1) test the impact of message type (tailored vs non-tailored) and message delivery modality (Web-based vs paper-based) on attitudes toward screening and screening uptake, and (2) investigate the acceptability of the decision tool and relevance of materials. Methods Participants (n = 100), recruited from a population sample of men and women aged 50-76 residing in urban Adelaide, Australia, were randomly assigned to a control group or one of 4 interventions: (1) Web-based and tailored information, (2) paper-based and tailored information, (3) Web-based and non-tailored (generic) information, or (4) paper-based and non-tailored information. Participation was augmented by snowball recruitment (n = 19). Questionnaires based on PHM variables were administered pre- and post-intervention. Participants were given the opportunity to request an FOBT. Following the intervention, participants discussed the acceptability of the tool. Results Full data were available for 87.4% (104/119) of participants. Post-intervention, perceived susceptibility scores for individuals receiving tailored information increased from mean 10.6 (SD 2.1) to mean 11.8 (SD 2.2). Scores on self-efficacy increased in the tailored group from mean 11.7 (SD 2.0) to mean 12.6 (SD 1.8). There were significant time x modality x message effects for social influence and salience and coherence, reflecting an increase in these scores for tailored Web-based participants only; social influence scores increased from mean 11.7 (SD 2.6) to mean 14.9 (SD 2.3), and salience and coherence scores increased from mean 16.0 (SD 2.2) to mean 17.7 (SD 2.1). There was no greater influence of modality or message type on movement toward a decision to screen or screening uptake, indicating that neither tailored messages nor a Web modality had superior effect. Overall, participants regarded tailored messages positively, but thought that the Web tool lacked “media richness.” Conclusions This exploratory study confirms that tailoring on PHM predictors of CRC screening has the potential to positively address attitudes toward screening. However, tailoring on these variables did not result in significantly increased screening uptake. Future research should consider other possible psychosocial influences. Mode of delivery did not affect outcomes, but as a delivery medium, the Web has economic and logistical advantages over paper.
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Affiliation(s)
- Ingrid H Flight
- Preventative Health Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide BC, Australia.
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Butterworth K, Allam O, Gray A, Butterworth H. Providing confusion: the need for education not information in chronic care. Health Informatics J 2012; 18:111-23. [PMID: 22733679 DOI: 10.1177/1460458212445500] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Patient information is one aspect of meeting the needs of health service users; it is meant to empower patients and their carers in making informed decisions and managing their health needs. Mary Dixon-Woods described two types of discourse in patient education: the first is more concerned with making patients comply with their doctors orders and the second is about empowering patients and rejecting direction. This article looks at the aims of the two and shows that neither is capable of supporting highly successful best practice within medicine. Instead, a hybrid set of strategic aims are proposed for patient education created by merging the two discourses in the same way that John Dewey merged the child-centred and child-led schools of thought in education. These hybrid strategic aims for patient education are then used to develop requirements for an information system to support patient education, using a mixture of system centric and user centric approaches.
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Ahmed S, Bryant LD, Tizro Z, Shickle D. Is advice incompatible with autonomous informed choice? Women's perceptions of advice in the context of antenatal screening: a qualitative study. Health Expect 2012; 17:555-64. [PMID: 22512856 DOI: 10.1111/j.1369-7625.2012.00784.x] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND Patient autonomy in antenatal screening is a high priority for policy developers in many countries. OBJECTIVE This paper presents women's understandings of how health professionals should facilitate informed screening choices with an emphasis on their understandings of autonomy and advice. DESIGN, SETTING AND PARTICIPANTS The study was carried out in 2009 in the UK, using a qualitative approach. Ninety-eight participants of African, British White, Caribbean, Chinese and Pakistani origin had semi-structured interviews, which were analysed using framework analysis. RESULTS Four themes were identified during the analysis: 'Meanings of advice in antenatal screening: the advice continuum', 'Recognition of the role of health professionals in decision making', 'Understandings of advice in the context of autonomous decision making' and 'Reasons given for wanting advice'. Women said they valued advice from health professionals to make decisions about antenatal screening, but their understandings of 'advice' ranged from information giving only to direction about screening choices. CONCLUSION Many women wanted health professionals to support the process of making informed choices by engaging in discussion and did not see advice as incompatible with making autonomous choices. However, some women wanted direction about whether to have a screening test or not, something which policy and guidelines explicitly prohibit. This may cause an ethical dilemma for health professionals who are required to both support women's preference for care and adhere to a policy of non-directiveness. Further clarification is needed on how health professionals should support the process of making informed choices when women ask for clear direction on screening choices.
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Affiliation(s)
- Shenaz Ahmed
- School of Medicine, Leeds Institute of Health Sciences, University of Leeds, LeedsFaculty of Health & Life Sciences, York St John University, Lord Mayor's Walk, York, UK
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Brown K, Dormandy E, Reid E, Gulliford M, Marteau T. Impact on informed choice of offering antenatal sickle cell and thalassaemia screening in primary care: a randomized trial. J Med Screen 2012; 18:65-75. [PMID: 21852698 PMCID: PMC3157892 DOI: 10.1258/jms.2011.010132] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objectives Offering antenatal sickle cell and thalassaemia (SCT) screening early in pregnancy can maximize the range of post-screening choices available, however these benefits should not be obtained at the expense of informed choice. This study examined whether offering this screening in primary care at the time of pregnancy confirmation compromises women making informed choices. Design Partial factorial, cluster randomized controlled trial. Setting 25 general practices in two socially deprived UK areas. Participants 464 pregnant women offered antenatal SCT screening. Intervention Practices were randomly allocated to offer pregnant women screening: i) in primary care at time of pregnancy confirmation, with parallel partner testing (n = 191), ii) in primary care at time of pregnancy confirmation, with sequential partner testing (n = 158), or iii) in secondary care by midwives, with sequential partner testing (standard care, n = 115). Main outcome Informed choice – a classification based on attitudes, knowledge and test uptake. Results 91% of woman underwent screening. About a third (30.6%) made an informed choice to accept or decline screening: 34% in primary care parallel group; 23.4% in primary care sequential and 34.8% in secondary care sequential. Allowing for adjustments, rates of informed choice did not vary by intervention group: secondary care versus primary care with parallel partner testing OR 1.07 (95% CI 0.56 to 2.02); secondary care versus primary care with sequential partner testing OR 0.67 (95% CI 0.36 to 1.25). Uninformed choices were generally attributable to poor knowledge (65%). Conclusion Offering antenatal SCT screening in primary care did not reduce the likelihood that women made informed choices. Rates of informed choice were low and could be increased by improving knowledge.
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Affiliation(s)
- Katrina Brown
- Department of Psychology, King's College London, Health Psychology Section, 5th Floor Bermondsey Wing, Guy's Campus, London SE1 9RT
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Beyond consent—improving understanding in surgical patients. Am J Surg 2012; 203:112-20. [DOI: 10.1016/j.amjsurg.2010.12.010] [Citation(s) in RCA: 109] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2010] [Revised: 12/07/2010] [Accepted: 12/07/2010] [Indexed: 11/15/2022]
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Kellar I, Mann E, Kinmonth A, Prevost A, Sutton S, Marteau T. Can informed choice invitations lead to inequities in intentions to make lifestyle changes among participants in a primary care diabetes screening programme? Evidence from a randomized trial. Public Health 2011; 125:645-52. [DOI: 10.1016/j.puhe.2011.05.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2010] [Revised: 02/28/2011] [Accepted: 05/26/2011] [Indexed: 11/28/2022]
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Giordano L, Stefanini V, Senore C, Frigerio A, Castagno R, Marra V, Dalmasso M, del Turco MR, Paci E, Segnan N. The impact of different communication and organizational strategies on mammography screening uptake in women aged 40-45 years. Eur J Public Health 2011; 22:413-8. [PMID: 21746751 DOI: 10.1093/eurpub/ckr090] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Several factors can influence access to population breast cancer screening. The aim of the study was to evaluate the impact of different information approaches, women's socio-demographic characteristics and organizational factors on mammography screening uptake. METHODS We selected 5744 women aged 40-45 years who were randomly assigned to be given letters with: (i) a pre-fixed appointment plus standard leaflet (Group 1); (ii) a pre-fixed appointment plus a more comprehensive booklet (Group 2); (iii) point (ii) plus the offer of a counselling session (Group 3); and (iv) an invitation to contact the centre to get information and arrange participation (Group 4). RESULTS Ninety-five women were excluded before the invitation and 5649 were randomized. After excluding undelivered letters (n = 41) and women reporting an exclusion criterion following our invitation (n = 248), the final eligible population was 5360 women. Participation rates following the first contact were 36.5, 39.9, 35.8 and 16.5% for Groups 1-4, respectively. The rates increased to 40.9, 43.6, 40.1 and 35.1% after the reminder letters. Women receiving more complete information had a higher uptake (Group 2), although not statistically significant. Differences among the four groups were maintained by controlling the effect of socio-demographic and attendance determinants. Regardless of intervention, participation was higher among married, higher educated, white-collared women, those born in northern Italy, living closer to the screening unit and with a female-collaborative doctor. CONCLUSION Invitation letters with a fixed appointment correlate with a higher attendance rate. Providing women with more information on procedures, risks and benefits of mammography screening does not modify their participation.
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Affiliation(s)
- Livia Giordano
- Unit of Epidemiology - CPO Piemonte, Center for Cancer Prevention, Turin, Italy.
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Steckelberg A, Hülfenhaus C, Haastert B, Mühlhauser I. Effect of evidence based risk information on "informed choice" in colorectal cancer screening: randomised controlled trial. BMJ 2011; 342:d3193. [PMID: 21636633 PMCID: PMC3106362 DOI: 10.1136/bmj.d3193] [Citation(s) in RCA: 82] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To compare the effect of evidence based information on risk with that of standard information on informed choice in screening for colorectal cancer. DESIGN Randomised controlled trial with 6 months' follow-up. SETTING German statutory health insurance scheme. PARTICIPANTS 1577 insured people who were members of the target group for colorectal cancer screening (age 50-75, no history of colorectal cancer). INTERVENTIONS Brochure with evidence based risk information on colorectal cancer screening and two optional interactive internet modules on risk and diagnostic tests; official information leaflet of the German colorectal cancer screening programme (control). MAIN OUTCOME MEASURE The primary end point was "informed choice," comprising "knowledge," "attitude," and "combination of actual and planned uptake." Secondary outcomes were "knowledge" and "combination of actual and planned uptake." Knowledge and attitude were assessed after 6 weeks and combination of actual and planned uptake of screening after 6 months. RESULTS The response rate for return of both questionnaires was 92.4% (n = 1457). 345/785 (44.0%) participants in the intervention group made an informed choice, compared with 101/792 (12.8%) in the control group (difference 31.2%, 99% confidence interval 25.7% to 36.7%; P < 0.001). More intervention group participants had "good knowledge" (59.6% (n = 468) v 16.2% (128); difference 43.5%, 37.8% to 49.1%; P < 0.001). A "positive attitude" towards colorectal screening prevailed in both groups but was significantly lower in the intervention group (93.4% (733) v 96.5% (764); difference -3.1%, -5.9% to -0.3%; P<0.01). The intervention had no effect on the combination of actual and planned uptake (72.4% (568) v 72.9% (577); P = 0.87). CONCLUSIONS Evidence based risk information on colorectal cancer screening increased informed choices and improved knowledge, with little change in attitudes. The intervention did not affect the combination of actual and planned uptake of screening. Trial registration Current Controlled Trials ISRCTN47105521.
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Affiliation(s)
- Anke Steckelberg
- MIN Faculty, Health Sciences and Education, University Hamburg, Martin-Luther-King Platz 6, D-20146 Hamburg, Germany.
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Perneger TV, Schiesari L, Cullati S, Charvet-Bérard A. Does information about risks and benefits improve the decision-making process in cancer screening - randomized study. Cancer Epidemiol 2011; 35:574-9. [PMID: 21622043 DOI: 10.1016/j.canep.2011.04.004] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2011] [Accepted: 04/13/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND Whether the provision of evidence-based information improves satisfaction with decision-making is unclear. OBJECTIVE To examine whether information about risks and benefits of cancer screening leads to a higher satisfaction with the decision that was made. METHODS Randomized mail survey in the general population, among 2333 adults aged 30-60 years. The survey included a hypothetical cancer screening scenario that included varying amounts of information about benefits and risks of screening (factorial randomized design). The decision process was evaluated by a 6 item scale, with scores between 0 (lowest score) and 100 (highest score). RESULTS Substantial proportions of respondents "completely agreed" that the decision reflected what was most important to them (61.2%), were satisfied with their decision (56.0%), were certain of their decision (54.1%), thought that the best choice for them was obvious (53.5%) and that the decision was easy to make (44.1%). The Cronbach alpha coefficient of the scale was 0.88, the mean score was 82.5, and the standard deviation 17.5. Providing information about benefits increased the decision evaluation score only modestly (+1.1, p=0.11); in contrast, providing information about risks sharply reduced the score (-5.1, p<0.001). Those who refused the screening test had lower scores than those who accepted the screening test (69.2 versus 85.6, p<0.001). CONCLUSIONS Contrary to expectations, informing potential participants about the risks of cancer screening lowered their assessment of the decision process.
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Affiliation(s)
- Thomas V Perneger
- Division of Clinical Epidemiology, University Hospitals of Geneva, Switzerland.
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Korfage IJ, van den Bergh RCN, Essink-Bot ML. Deciding on PSA-screening - Quality of current consumer information on the Internet. Eur J Cancer 2011; 46:3073-81. [PMID: 21047589 DOI: 10.1016/j.ejca.2010.09.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2010] [Revised: 06/28/2010] [Accepted: 09/03/2010] [Indexed: 11/19/2022]
Abstract
PURPOSE OF THE STUDY Given that screening for prostate cancer has the potential to reduce prostate cancer mortality at the expense of considerable overdiagnosis and overtreatment, the availability of core consumer information - correct, balanced and supportive of autonomous decision-making - is a must. We assessed the quality of consumer information available through the Internet per November 2009 and its possible contribution to informed decision-making by potential screenees. METHODS Consumer information on PSA-screening was sought through the Internet in November 2009. Materials had to be targeted at potential consumers, offered by not-for-profit organisations, released in 2005 or after, in English or Dutch. Per material 2 of the authors assessed independently from each other whether standardised pre-defined topics were addressed, whether the content was correct and which approach was taken towards the decision-making process about uptake. RESULTS Twenty-three materials were included, of which 11 were released (shortly) after the results of 2 large randomized-controlled trials (RCTs) that evaluated the effectiveness of screening for prostate cancer had been published in March 2009. That a PSA-test result can be abnormal because of non-cancerous conditions (false positive) and that it may miss prostate cancer (false negative) was not addressed in 2/23 and 8/23 materials, respectively. The risk of overdiagnosis and overtreatment was not mentioned in 6 out of 23. PSA-screening was presented as a usual thing to do in some materials, whereas other materials emphasised the voluntary nature of PSA-screening ('it is your decision'). The content of 19/23 materials was considered sufficiently informative according to the pre-defined criteria, 12/23 materials were considered supportive of informed decision-making by men. CONCLUSIONS Most materials of not-for-profit organizations supplied adequate information about PSA-screening, whilst the degree of persuasion towards uptake reflected variations in opinions on men's autonomy regarding their own health.
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Affiliation(s)
- Ida J Korfage
- Department of Public Health, Erasmus University Medical Center, Rotterdam, The Netherlands.
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Crockett RA, Sutton S, Walter FM, Clinch M, Marteau TM, Benson J. Impact on decisions to start or continue medicines of providing information to patients about possible benefits and/or harms: a systematic review and meta-analysis. Med Decis Making 2011; 31:767-77. [PMID: 21447731 DOI: 10.1177/0272989x11400420] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The impact of providing information about medicines to patients on decisions about starting or continuing them is unknown. PURPOSE To estimate the impact on decisions to start or continue medicines, of providing information to patients about possible benefits and/or harms. DATA SOURCES Electronic searches from 1980 to October 2010; reference and citation searches of included studies. STUDY SELECTION Two investigators assessed studies' eligibility against inclusion criteria: randomized or pseudorandomized trials; participants older than 16 years and deciding for themselves; one group received information about possible benefits and/or harms of a potentially beneficial medicine, compared with another who did not; d) a measure of decision about starting or continuing a medicine. DATA EXTRACTION One investigator extracted all data, checked by a second. DATA SYNTHESIS Eight studies were included, covering a range of medicines. There was no consistent impact of interventions on decisions about whether to start or continue medicines (pooled odds ratio 1.08; 95% confidence interval [CI], 0.69-1.70; P = 0.74). Among those who received more information, knowledge was increased (pooled mean difference 8.47; 95% CI 2.17-14.77; P = 0.008), and decisional conflict was reduced (pooled mean difference -0.15; 95% CI -0.24 to -0.06; P = .001). LIMITATIONS A small number of studies across different clinical contexts, of uncertain heterogeneity, were included. CONCLUSIONS Providing information to patients about possible benefits and/or harms has no consistent effect on the number who decide to start or continue medicines, although it increases patients' knowledge and reduces their decisional conflict.
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Affiliation(s)
- Rachel A Crockett
- Psychology Department (at Guy’s), Health Psychology Section, King’s College London, London, UK (RAC, TMM)
| | - Stephen Sutton
- General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (SS, FMW, MC, JB)
| | - Fiona M Walter
- General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (SS, FMW, MC, JB)
| | - Megan Clinch
- General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (SS, FMW, MC, JB)
| | - Theresa M Marteau
- Psychology Department (at Guy’s), Health Psychology Section, King’s College London, London, UK (RAC, TMM)
| | - John Benson
- General Practice and Primary Care Research Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK (SS, FMW, MC, JB)
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Mann E, Kellar I, Sutton S, Kinmonth AL, Hankins M, Griffin S, Marteau TM. Impact of informed-choice invitations on diabetes screening knowledge, attitude and intentions: an analogue study. BMC Public Health 2010; 10:768. [PMID: 21167033 PMCID: PMC3019193 DOI: 10.1186/1471-2458-10-768] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 12/17/2010] [Indexed: 12/03/2022] Open
Abstract
Background Despite concerns that facilitating informed choice would decrease diabetes screening uptake, 'informed choice' invitations that increased knowledge did not affect attendance (the DICISION trial). We explored possible reasons using data from an experimental analogue study undertaken to develop the invitations. We tested a model of the impact on knowledge, attitude and intentions of a diabetes screening invitation designed to facilitate informed choices. Methods 417 men and women aged 40-69 recruited from town centres in the UK were randomised to receive either an invitation for diabetes screening designed to facilitate informed choice or a standard type of invitation. Knowledge of the invitation, attitude towards diabetes screening, and intention to attend for diabetes screening were assessed two weeks later. Results Attitude was a strong predictor of screening intentions (β = .64, p = .001). Knowledge added to the model but was a weak predictor of intentions (β = .13, p = .005). However, invitation type did not predict attitudes towards screening but did predict knowledge (β = -.45, p = .001), which mediated a small effect of invitation type on intention (indirect β = -.06, p = .017). Conclusions These findings may explain why information about the benefits and harms of screening did not reduce diabetes screening attendance in the DICISION trial.
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Affiliation(s)
- Eleanor Mann
- Psychology Department at Guy's, Health Psychology Section, 5th Floor Bermondsey Wing, Guy's Campus, London SE1 9RT, UK
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Senore C, Malila N, Minozzi S, Armaroli P. How to enhance physician and public acceptance and utilisation of colon cancer screening recommendations. Best Pract Res Clin Gastroenterol 2010; 24:509-20. [PMID: 20833353 DOI: 10.1016/j.bpg.2010.06.002] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2010] [Revised: 05/17/2010] [Accepted: 06/18/2010] [Indexed: 01/31/2023]
Abstract
Colorectal Cancer (CRC) screening delivery is a multidisciplinary undertaking, aiming at reducing mortality from and incidence of CRC without adversely affecting the health status of participants. The adoption of a public health perspective involves commitment to ensure equity of access and sustainability of the program over time. We reviewed available evidence concerning predictors of CRC screening uptake and the impact of interventions to improve adoption of screening using conceptual frameworks defining the role of determinants of preventive behaviours and the reach and target of interventions. The results of this review indicate that policy measures aimed at supporting screening delivery, as well as organisational changes, influencing the operational features of preventive services, need to be implemented, in order to allow individual's motivation to be eventually realised. To ensure coverage and equity of access and to maximise the impact of the intervention, policies aimed at implementing organised programs should be adopted, ensuring that participation in screening and any follow-up assessment should not be limited by financial barriers. Participants and providers beliefs may determine the response to different screening modalities. To achieve the desired health impact, an active follow-up of people with screening abnormalities should be implemented, supported by the introduction of infrastructural changes and multidisciplinary team work, which can ensure sustainability over time of effective interventions. Continuous monitoring as well as the adoption of plans to evaluate for program effectiveness represent crucial steps in the implementation of a successful program.
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Affiliation(s)
- Carlo Senore
- AOU S Giovanni Battista - CPO Piemonte, SCDO Epidemiologia dei Tumori 2, Via S Francesco da Paola 31, 10123 Torino, Italy.
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Marteau TM, Mann E, Prevost AT, Vasconcelos JC, Kellar I, Sanderson S, Parker M, Griffin S, Sutton S, Kinmonth AL. Impact of an informed choice invitation on uptake of screening for diabetes in primary care (DICISION): randomised trial. BMJ 2010; 340:c2138. [PMID: 20466791 PMCID: PMC2869404 DOI: 10.1136/bmj.c2138] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
OBJECTIVE To compare the effect of an invitation promoting informed choice for screening with a standard invitation on attendance and motivation to engage in preventive action. DESIGN Randomised controlled trial. SETTING Four English general practices. PARTICIPANTS 1272 people aged 40-69 years, at risk for diabetes, identified from practice registers using a validated risk score and invited to attend for screening. INTERVENTION Intervention was a previously validated invitation to inform the decision to attend screening, presenting diabetes as a serious potential problem, and providing details of possible costs and benefits of screening and treatment in text and pie charts. This was compared with a brief, standard invitation simply describing diabetes as a serious potential problem. MAIN OUTCOME MEASURES The primary end point was attendance for screening. The secondary outcome measures were intention to make changes to lifestyle and satisfaction with decisions made among attenders. RESULTS The primary end point was analysed for all 1272 participants. 55.8% (353/633) of those in the informed choice group attended for screening, compared with 57.6% (368/639) in the standard invitation group (mean difference -1.8%, 95% confidence interval -7.3% to 3.6%; P=0.51). Attendance was lower among the more deprived group (most deprived third 47.5% v least deprived third 64.3%; P<0.001). Interaction between deprivation and effect of invitation type on attendance was not significant. Among attenders, intention to change behaviour was strong and unaffected by invitation type. CONCLUSIONS Providing information to support choice did not adversely affect attendance for screening for diabetes. Those from more socially deprived groups were, however, less likely to attend, regardless of the type of invitation received. Further attention to invitation content alone is unlikely to achieve equity in uptake of preventive services. TRIAL REGISTRATION Current Controlled Trials ISRCTN 73125647.
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Affiliation(s)
- Theresa M Marteau
- King's College London, Psychology Department (at Guy's), Health Psychology Section, Psychology and Genetics Research Group, Guy's Campus, London SE1 9RT.
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Perneger TV, Cullati S, Schiesari L, Charvet-Bérard A. Impact of information about risks and benefits of cancer screening on intended participation. Eur J Cancer 2010; 46:2267-74. [PMID: 20466537 DOI: 10.1016/j.ejca.2010.04.011] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/04/2010] [Revised: 04/07/2010] [Accepted: 04/09/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Providing comprehensive information about the risks and benefits of cancer screening is ethically necessary, but information about risks may decrease participation. This study explored the impact of information on intended participation using a randomised factorial design. METHODS We conducted a mail survey of 2333 adults living in Geneva, Switzerland. Each participant was given one randomly chosen version of a scenario that described a hypothetical cancer screening test, and was asked whether he or she would accept to undergo screening. The versions varied in terms of the amount of information about risks and benefits. RESULTS Respondents who received information about risks associated with screening were more likely to refuse participation (odds ratio 2.6 (95% confidence interval (CI) 2.0-3.5)) than those who received minimal information. In contrast, information about benefits had no impact on intended participation (odds ratio 1.0 (95% CI 0.8-1.2)). The impact of information about risks was significantly stronger in women than in men, in respondents who were in poorer health, who have had a doctor visit in the past 6months, those who have had a cancer screening test in the past 3years, and those who reported a high desire for autonomy in medical decisions. CONCLUSIONS Informing potential participants about the risks of screening may reduce participation rates. Enhanced information about the benefits of screening does not counterbalance this effect.
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Affiliation(s)
- Thomas V Perneger
- Division of Clinical Epidemiology, University Hospitals of Geneva, Switzerland; Quality of Care Service, University Hospitals of Geneva, Switzerland.
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Senore C, Armaroli P, Silvani M, Andreoni B, Bisanti L, Marai L, Castiglione G, Grazzini G, Taddei S, Gasperoni S, Giuliani O, Malfitana G, Marutti A, Genta G, Segnan N. Comparing different strategies for colorectal cancer screening in Italy: predictors of patients' participation. Am J Gastroenterol 2010; 105:188-98. [PMID: 19826409 DOI: 10.1038/ajg.2009.583] [Citation(s) in RCA: 56] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
OBJECTIVES The objective of this study was to study predictors of patients' participation in colorectal cancer (CRC) screening. METHODS Men and women, aged 55-64 years, were randomized to the following: (i) biennial fecal occult blood test (FOBT) delivered by mail (n=2,266); (ii) FOBT delivered by a general practitioner (GP)/screening facility (n=5,893); (iii) "once-only" sigmoidoscopy (FS) (n=3,650); (iv) FS followed by FOBT for screenees with negative FS (n=10,867); and (v) patient's choice between FS and FOBT (n=3,579). A stratified (by screening arm) random sample of attenders and nonattenders was contacted by trained interviewers 4 months after the initial invitation. Subjects giving their consent were administered a questionnaire (available online) investigating perceptions of individual CRC risk, attitudes toward prevention, adoption of health protective behaviors, and reasons for attendance/nonattendance. Adjusted prevalence odds ratios (ORs) were computed by multivariable logistic regression. RESULTS The response rate was 71.9% (701 of 975) among nonattenders and 88.9% (773 of 870) among attenders. Adjusting for screening arm, center, gender, age, and education, participation was significantly higher among people who consulted their GP before undergoing screening (OR: 4.24; 95% confidence interval (CI): 3.11-5.78), who mentioned one first-degree relative with CRC (OR: 3.62; 95% CI: 2.02-6.49), who reported regular physical activity (OR: 1.85; 95% CI: 1.33-2.55), and who read the mailed information (letter only: OR: 1.85; 95% CI: 1.23-2.78; letter+leaflet: OR: 3.18; 95% CI: 2.12-4.76). People who considered screening to be ineffective (OR: 0.12; 95% CI: 0.08-0.19), those who considered it to be effective but reported even moderate levels of anxiety (OR: 0.32; 95% CI: 0.23-0.45), and those who mentioned previous knowledge of CRC screening tests were less likely to accept the invitation (OR: 0.49; 95% CI: 0.34-0.70). CONCLUSIONS Adoption of health protective behaviors is associated with a higher attendance rate, whereas anxiety represents a strong barrier, even among people who deemed screening to be effective. Increasing the proportion of people who consult their GP when making a decision regarding screening might enhance participation.
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Affiliation(s)
- Carlo Senore
- Centro Prevenzione Oncologica Regione Piemonte and Azienda Ospedaliero-Universitaria S. Giovanni Battista di Torino, Turin, Italy.
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Mann E, Prevost AT, Griffin S, Kellar I, Sutton S, Parker M, Sanderson S, Kinmonth AL, Marteau TM. Impact of an informed choice invitation on uptake of screening for diabetes in primary care (DICISION): trial protocol. BMC Public Health 2009; 9:63. [PMID: 19232112 PMCID: PMC2666721 DOI: 10.1186/1471-2458-9-63] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2008] [Accepted: 02/20/2009] [Indexed: 11/28/2022] Open
Abstract
Background Screening invitations have traditionally been brief, providing information only about population benefits. Presenting information about the limited individual benefits and potential harms of screening to inform choice may reduce attendance, particularly in the more socially deprived. At the same time, amongst those who attend, it might increase motivation to change behavior to reduce risks. This trial assesses the impact on attendance and motivation to change behavior of an invitation that facilitates informed choices about participating in diabetes screening in general practice. Three hypotheses are tested: 1. Attendance at screening for diabetes is lower following an informed choice compared with a standard invitation. 2. There is an interaction between the type of invitation and social deprivation: attendance following an informed choice compared with a standard invitation is lower in those who are more rather than less socially deprived. 3. Amongst those who attend for screening, intentions to change behavior to reduce risks of complications in those subsequently diagnosed with diabetes are stronger following an informed choice invitation compared with a standard invitation. Method/Design 1500 people aged 40–69 years without known diabetes but at high risk are identified from four general practice registers in the east of England. 1200 participants are randomized by households to receive one of two invitations to attend for diabetes screening at their general practices. The intervention invitation is designed to facilitate informed choices, and comprises detailed information and a decision aid. A comparison invitation is based on those currently in use. Screening involves a finger-prick blood glucose test. The primary outcome is attendance for diabetes screening. The secondary outcome is intention to change health related behaviors in those attenders diagnosed with diabetes. A sample size of 1200 ensures 90% power to detect a 10% difference in attendance between arms, and in an estimated 780 attenders, 80% power to detect a 0.2 sd difference in intention between arms. Discussion The DICISION trial is a rigorous pragmatic denominator based clinical trial of an informed choice invitation to diabetes screening, which addresses some key limitations of previous trials. Trial registration Current Controlled Trials ISRCTN73125647
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Affiliation(s)
- Eleanor Mann
- Psychology Department (at Guy's), Guy's Campus, London, SE1 9RT, UK.
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Anderberg E, Berntorp K, Crang-Svalenius E. Diabetes and pregnancy: women's opinions about the care provided during the childbearing year. Scand J Caring Sci 2009; 23:161-70. [PMID: 19192239 DOI: 10.1111/j.1471-6712.2008.00614.x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND The extended programmes for pregnant women with diabetes, needed to improve pregnancy outcome, might negatively influence the experience of expecting a baby. AIM To investigate opinions about care during pregnancy, childbirth and the postnatal period among women with diabetes mellitus (DM) and gestational DM (GDM). METHOD A four-part questionnaire was constructed, covering the childbearing year, with a focus on treatment and information. A total of 156 women were asked to participate (53 DM, 103 GDM), three refused. The questionnaire was anonymous. RESULTS The reply frequency was 94%. Of all answers, 95% fell in neutral-satisfied range (Lickert scale 2-5). Three answering patterns deviated positively (care on Specialist Antenatal Clinic, accessibility, and participation-responsibility-respect). Four patterns deviated negatively (information flow, preparation, postpartum care and postpartum check-up). Increased supervision caused problems with time for the family and at work. Comments showed focus on diabetes, forcing the healthy pregnancy aspects into the background. The answers concerning treatment indicated satisfaction (4 + 5 Lickert scale). Women with GDM felt badly prepared before the glucose tolerance test. It was doubtful whether they had been able to make an informed choice about participating. Lack of knowledge among staff was pointed out. Need for more written material was expressed. CONCLUSION Satisfaction with care was shown. A discussion about the implication of informed choice with both staff and mothers are needed. Sharper implementation of the diabetes-care-chain was also an area for improvement.
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Affiliation(s)
- Eva Anderberg
- Department of Obstetrics and Gynecology, Lund University Hospital, Lund, Sweden.
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van Rijn AF, van Rossum LGM, Deutekom M, Laheij RJF, Fockens P, Bossuyt PMM, Dekker E, Jansen JBMJ. Low priority main reason not to participate in a colorectal cancer screening program with a faecal occult blood test. J Public Health (Oxf) 2008; 30:461-5. [DOI: 10.1093/pubmed/fdn063] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
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Promoting patient engagement with self-management support information: a qualitative meta-synthesis of processes influencing uptake. Implement Sci 2008; 3:44. [PMID: 18851743 PMCID: PMC2575203 DOI: 10.1186/1748-5908-3-44] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2008] [Accepted: 10/13/2008] [Indexed: 02/07/2023] Open
Abstract
Background Patient information has been viewed as a key component of self-management. However, little attention has been given to methods of dissemination or implementation of effective information strategies. Previous problems identified with the use and implementation of patient information point to the need to explore the way in which patients engage with and use information to support self-management for chronic conditions. Methods Four published qualitative studies from a programme of research about self-management were analysed as a group; these included studies of the management of inflammatory bowel disease (IBD); self-help in anxiety and depression (SHADE); menorrhagia, treatment, information, and preference (MENTIP) study; and self-help for irritable bowel syndrome (IBS). For the analysis, we used an adapted meta-ethnographic approach to the synthesis of qualitative data in order to develop an evidence base. Results The ontological status and experience of the condition in everyday life was the most dominant theme to emerge from this synthesis. This, coupled with access to and experience of traditional health services responses, shaped the engagement with and use of information to support self-management. Five key elements were found which were likely to influence this: the perception and awareness of alternative self-management possibilities; the prior extent and nature of engagement with information; the extent of and ability to self-manage; opportunities for use of the information and the stage of the illness career; and congruence and synergy with the professional role. Conclusion People with chronic conditions need support from providers in both supply and engagement with information, in a way which gives legitimacy to the person's own self-management strategies and possible alternatives. Thus, a link could usefully be made between information offered, as well as patients' past experiences of self-management and engagement with services for their condition. The timeliness of the information should be considered, both in terms of the illness career and the type of condition (i.e., before depression gets too bad or time to reflect on existing knowledge about a condition and how it is to be managed) and in terms of the pre-existing relationship with services (i.e., options explored and tried). More considered use of information (how it is provided, by whom, and at what point it should be introduced) is key to facilitating patients' engagement with and therefore use of information to support self-management.
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van Rijn AF, van Rossum LGM, Deutekom M, Laheij RJF, Bossuyt PMM, Fockens P, Dekker E, Jansen JBMJ. Getting adequate information across to colorectal cancer screening subjects can be difficult. J Med Screen 2008; 15:149-52. [DOI: 10.1258/jms.2008.008028] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Objectives Participation in screening should be the outcome of an informed decision. We evaluated whether invitees in the first Dutch colorectal cancer (CRC) screening programme were adequately informed after having received a detailed information leaflet. Methods A total of 20,623 subjects aged 50–75 years were invited to the fecal occult blood test (FOBT) screening programme. All received a detailed information leaflet by mail between May 2006 and January 2007. After two weeks, a reminder letter was sent to all invitees, accompanied by a survey on CRC and screening. Results The survey was completed by 9594 invitees (47%). Almost all responders (99%) found the leaflet clear and readable. Almost all indicated that CRC can be treated better if found early (99%). Only 20% of the responders answered all knowledge-related answers correctly. Almost half of the responders (47%) believed that a negative FOBT excludes the presence of CRC. Older age and having a positive family member for CRC were correctly identified as risk factors by 80%. Conclusion This study demonstrates that although an information leaflet was reported as being clear and readable, the information provided in it was not always understood well. This suggests that other educational options should be investigated in order to improve general knowledge of CRC in screening invitees.
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Affiliation(s)
- A F van Rijn
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Biostatistics and Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - L G M van Rossum
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Biostatistics and Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - M Deutekom
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Biostatistics and Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - R J F Laheij
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Biostatistics and Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - P M M Bossuyt
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Biostatistics and Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - P Fockens
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Biostatistics and Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - E Dekker
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Biostatistics and Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
| | - J B M J Jansen
- Department of Gastroenterology and Hepatology, Academic Medical Centre, University of Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Social Medicine, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
- Department of Gastroenterology and Hepatology, Radboud University Nijmegen Medical Centre, Nijmegen, The Netherlands
- Department of Biostatistics and Epidemiology, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands
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Van den Heuvel A, Hollywood A, Hogg J, Dormandy E, Chitty L, Kabra M, Ma R, Masturzo B, Marteau TM. Informed choice to undergo prenatal screening for thalassemia: a description of written information given to pregnant women in Europe and beyond. Prenat Diagn 2008; 28:727-34. [DOI: 10.1002/pd.1995] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
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Kellar I, Sutton S, Griffin S, Prevost AT, Kinmonth AL, Marteau TM. Evaluation of an informed choice invitation for type 2 diabetes screening. PATIENT EDUCATION AND COUNSELING 2008; 72:232-238. [PMID: 18513916 DOI: 10.1016/j.pec.2008.04.005] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/03/2007] [Revised: 04/14/2008] [Accepted: 04/14/2008] [Indexed: 05/26/2023]
Abstract
OBJECTIVE To evaluate an innovative invitation designed to facilitate informed choices for undergoing screening for type 2 diabetes. METHODS Four hundred and seventeen people aged 40-69 years (sex: F 53%/M 47%), without known diabetes, recruited from street locations. Participants were randomised to receive one of two hypothetical invitations for screening for type 2 diabetes; one based on General Medical Council guidelines and combined with a decisional balance sheet, the other a brief traditional invitation. Informed choice was assessed immediately after the invitation and 3 weeks later using measures of knowledge, attitudes and intentions. RESULTS Two weeks after receipt of the invitation, the proportion of informed choices was significantly higher among participants who received the informed choice invitation compared with those who received the traditional invitation (42.9% versus 11.2%; difference=31.7%, 95% CI: 22.5-40.5%; p<0.001). Mean knowledge scores were significantly higher after the receipt of the invitation designed to facilitate informed choices than after the traditional invitation (5.49 versus 3.90; t(405)=10.106, p<0.001). Intentions to participate in screening were unaffected by receipt of the informed choice invitation. CONCLUSION Compared with a traditional invitation, receipt of the invitation designed to facilitate informed choices increased the proportion of informed choices about type 2 diabetes screening attendance. PRACTICE IMPLICATIONS : Although the new invitation was associated with better knowledge of screening it had no differential effect on intention and its effect on attendance still requires evaluation.
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Affiliation(s)
- Ian Kellar
- General Practice & Primary Care Research Unit, Department of Public Health & Primary Care, University of Cambridge, Institute of Public Health, Cambridge, UK.
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van den Heuvel A, Marteau TM. Cultural variation in values attached to informed choice in the context of prenatal diagnosis. Semin Fetal Neonatal Med 2008; 13:99-102. [PMID: 18255366 DOI: 10.1016/j.siny.2007.12.010] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
One of the ethical implications of the widespread introduction of non-invasive prenatal diagnosis (NIPD) is that it might undermine the making of informed choices. There is an almost universal agreement among health professionals and policy makers that prenatal testing decisions should reflect informed choices. It is, however, unclear the extent to which this is a universally held value. We present evidence to suggest that although informed choice is highly valued in Western, individualistically orientated countries, it is less highly valued in non-Western, more collectivist countries. This raises questions as to whether it is beneficial - and indeed appropriate - to recommend facilitating informed choices in countries where this is not a dominant value.
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Affiliation(s)
- Ananda van den Heuvel
- King's College London, Institute of Psychiatry, Department of Psychology at Guy's, Health Psychology Section, 5th Floor, Thomas Guy House, London SE1 9RT, UK
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Acupuncture and fatigue: Current basis for shared communication between breast cancer survivors and providers. J Cancer Surviv 2007; 1:306-12. [DOI: 10.1007/s11764-007-0035-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2007] [Accepted: 10/09/2007] [Indexed: 11/27/2022]
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