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Miles A, Paschalidi A, Sharma N. The effect of numeric information about the likelihood of receiving a false negative or false positive result on people's attitudes towards colorectal cancer screening using faecal immunochemical testing (FIT). PATIENT EDUCATION AND COUNSELING 2023; 114:107857. [PMID: 37348310 DOI: 10.1016/j.pec.2023.107857] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/14/2023] [Revised: 05/25/2023] [Accepted: 06/14/2023] [Indexed: 06/24/2023]
Abstract
OBJECTIVE To examine the impact of numeric risk information about false negative (FN) and false positive (FP) rates in fecal immunochemical testing (FIT) on attitudes towards screening. METHODS 102 people aged 45-55, living in the UK, read 6 hypothetical vignettes presented online about the use of FIT kits to detect colorectal cancer, in which information about FN and FP rates was systematically varied. RESULTS Numeric FN risk information reduced people's interest in screening, perception of screening effectiveness and lowered trust in screening compared to verbal FN information. Verbal FN information reduced perceptions of screening effectiveness and trust compared to no FN information. People with high subjective numeracy reported lower trust in screening following the provision of numeric FN information but numeracy did not moderate any other associations. FP information did not affect attitudes towards FIT testing. CONCLUSION Numeric FN risk information decreased people's perceptions of screening effectiveness and trust in the results of screening. While it influenced people's interest in screening, the effect was small. PRACTICE IMPLICATIONS Numeric FN information has a small effect on interest in screening and could promote informed decision making without affecting screening uptake.
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Affiliation(s)
- Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK.
| | - Alexandra Paschalidi
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
| | - Navya Sharma
- Department of Psychological Sciences, Birkbeck, University of London, London, UK
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2
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Fisher KA, Tan ASL, Matlock DD, Saver B, Mazor KM, Pieterse AH. Keeping the patient in the center: Common challenges in the practice of shared decision making. PATIENT EDUCATION AND COUNSELING 2018; 101:2195-2201. [PMID: 30144968 PMCID: PMC6376968 DOI: 10.1016/j.pec.2018.08.007] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/01/2018] [Revised: 08/03/2018] [Accepted: 08/05/2018] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To examine situations where shared decision making (SDM) in practice does not achieve the goal of a patient-centered decision. METHODS We explore circumstances in which elements necessary to realize SDM - patient readiness to participate and understanding of the decision - are not present. We consider the influence of contextual factors on decision making. RESULTS Patients' preference and readiness for participation in SDM are influenced by multiple interacting factors including the patient's comprehension of the decision, their emotional state, the strength of their relationship with the clinician, and the nature of the decision. Uncertainty often inherent in information can lead to misconceptions and ill-formed opinions that impair patients' understanding. In combination with cognitive biases, these factors may result in decisions that are incongruent with patients' preferences. The impact of suboptimal understanding on decision making may be augmented by the context. CONCLUSIONS There are circumstances in which basic elements required for SDM are not present and therefore the clinician may not achieve the goal of a patient-centered decision. PRACTICE IMPLICATIONS A flexible and tailored approach that draws on the full continuum of decision making models and communication strategies is required to achieve the goal of a patient-centered decision.
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Affiliation(s)
- Kimberly A Fisher
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; Meyers Primary Care Institute, A joint Endeavor Between the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA.
| | - Andy S L Tan
- Division of Population Sciences, Dana-Farber Cancer Institute, Boston, MA, USA; Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Daniel D Matlock
- Division of Geriatric Medicine, Department of Medicine, University of Colorado School of Medicine, Aurora, CO, USA; VA Eastern Colorado Geriatric Research Education and Clinical Center, Denver, CO, USA
| | - Barry Saver
- Swedish Family Medicine Residency Cherry Hill, Seattle, WA, USA; Department of Family and Community Medicine, University of Massachusetts, Worcester, MA, USA
| | - Kathleen M Mazor
- Department of Medicine, University of Massachusetts Medical School, Worcester, MA, USA; Meyers Primary Care Institute, A joint Endeavor Between the University of Massachusetts Medical School, Reliant Medical Group, and Fallon Health, Worcester, MA, USA
| | - Arwen H Pieterse
- Department of Biomedical Data Sciences, Leiden University Medical Center, Leiden, The Netherlands
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Brandhof SD, Fagerlin A, Hawley S, Toes-Zoutendijk E, Trevena L, McCaffery K, Korfage IJ. Colorectal cancer screening: Associations between information provision, attitudes and intended participation. PATIENT EDUCATION AND COUNSELING 2018; 101:546-550. [PMID: 28899711 DOI: 10.1016/j.pec.2017.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/31/2017] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Properly informing target audiences is crucial in population-based screening programs. We aimed to evaluate the impact of information about CRC screening on attitudes and intended participation in a screening-naive population. METHODS 614 persons (aged 55-75 years) received a survey. Information on CRC and screening was provided piece by piece, and per piece its impact on attitudes and intended participation was assessed. All persons received the same information content, but the sequence of information differed per condition: information on the high mortality rate of colorectal cancer was presented in the first or the second piece. Educational levels, the extent people considered future consequences, and value concordance between attitudes and intentions were assessed. RESULTS 436 persons (response 71%) completed the survey. Overall most respondents reported positive attitudes towards CRC screening (78%) and intentions to participate in CRC screening (83%), independent of sequence of information provision. Intentions about participation were value concordant in the majority (88%). Results were similar in low educated groups. CONCLUSION Providing balanced information about CRC screening (also addressing negative effects) did not impede value concordance and high rates of intended participation. PRACTICE IMPLICATIONS High rates of screening intentions are possible without omitting threatening health information in communication materials.
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Affiliation(s)
- Stephanie D Brandhof
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Angela Fagerlin
- Department of Population Health Services, University of Utah, Salt Lake City, UT, USA; Veterans Affairs Center Salt Lake City Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, UT, USA
| | - Sarah Hawley
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA; Cancer Surveillance & Outcomes Research Team (CanSORT), University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lyndal Trevena
- Discipline of General Practice, Sydney Public Health, University of Sydney, Australia
| | - Kirsten McCaffery
- Screening & Test Evaluation Program (STEP), The University of Sydney, Sydney, NSW 2006, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, Australia
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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4
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Saver BG, Mazor KM, Luckmann R, Cutrona SL, Hayes M, Gorodetsky T, Esparza N, Bacigalupe G. Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions. Ann Fam Med 2017; 15:48-55. [PMID: 28376460 PMCID: PMC5217843 DOI: 10.1370/afm.1996] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2016] [Revised: 07/19/2016] [Accepted: 08/09/2016] [Indexed: 11/09/2022] Open
Abstract
PURPOSE We wanted to evaluate novel decision aids designed to help patients trust and accept the controversial, evidence-based, US Preventive Services Task Force recommendations about prostate cancer screening (from 2012) and mammography screening for women aged 40 to 49 years (from 2009). METHODS We created recorded vignettes of physician-patient discussions about prostate cancer screening and mammography, accompanied by illustrative slides, based on principles derived from preceding qualitative work and behavioral science literature. We conducted a randomized crossover study with repeated measures with 27 men aged 50 to 74 years and 35 women aged 40 to 49 years. All participants saw a video intervention and a more traditional, paper-based decision aid intervention in random order. At entry and after seeing each intervention, they were surveyed about screening intentions, perceptions of benefits and harm, and decisional conflict. RESULTS Changes in screening intentions were analyzed without regard to order of intervention after an initial analyses showed no evidence of an order effect. At baseline, 69% of men and 86% of women reported wanting screening, with 31% and 6%, respectively, unsure. Mean change on a 3-point, yes, unsure, no scale was -0.93 (P = <.001) for men and -0.50 (P = <.001) for women after seeing the video interventions vs 0.0 and -0.06 (P = .75) after seeing the print interventions. At the study end, 33% of men and 49% of women wanted screening, and 11% and 20%, respectively, were unsure. CONCLUSIONS Our novel, persuasive video interventions significantly changed the screening intentions of substantial proportions of viewers. Our approach needs further testing but may provide a model for helping patients to consider and accept evidence-based, counterintuitive recommendations.
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Affiliation(s)
- Barry G Saver
- University of Massachusetts Medical School, Worcester, Massachusetts
- Meyers Primary Care Research Institute, Worcester, Massachusetts
- Swedish Family Medicine Residency Cherry Hill, Seattle, Washington
| | - Kathleen M Mazor
- University of Massachusetts Medical School, Worcester, Massachusetts
- Meyers Primary Care Research Institute, Worcester, Massachusetts
| | - Roger Luckmann
- University of Massachusetts Medical School, Worcester, Massachusetts
| | - Sarah L Cutrona
- University of Massachusetts Medical School, Worcester, Massachusetts
- Meyers Primary Care Research Institute, Worcester, Massachusetts
- Veterans Health Administration, HSRD COIN Edith Nourse Rogers Memorial Hospitalo, Bedford, Massachusetts
| | - Marcela Hayes
- University of Massachusetts Medical School, Worcester, Massachusetts
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Wu CA, Mulder AL, Zai AH, Hu Y, Costa M, Tishler LW, Saltzman JR, Ellner AL, Bitton A. A population management system for improving colorectal cancer screening in a primary care setting. J Eval Clin Pract 2016; 22:319-28. [PMID: 26259696 DOI: 10.1111/jep.12427] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 06/24/2015] [Indexed: 11/30/2022]
Abstract
RATIONALE Provision of colorectal cancer (CRC) screening in primary care is suboptimal; failure to observe screening guidelines poses unnecessary risks to patients and doctors. AIMS AND OBJECTIVES Implement a population management system for CRC screening; evaluate impact on compliance with evidence-based guidelines. DESIGN A quasi-experimental, prospective quality improvement study design using pre-post-analyses with concurrent controls. SETTING Six suites within an academic primary care practice. PARTICIPANTS 5320 adults eligible for CRC screening treated by 70 doctors. INTERVENTION In three intervention suites, doctors reviewed real-time rosters of patients due for CRC screening and chose practice delegate outreach or default reminder letter. Delegates tracked overdue patients, made outreach calls, facilitated test ordering, obtained records and documented patient deferral, exclusion or decline. In three control suites, doctors followed usual preventive care practices. MAIN OUTCOME MEASURES CRC screening compliance (including documented decline, deferral or exclusion) and CRC screening completion rates over 5 months. RESULTS At baseline, there was no significant difference in CRC screening compliance (I: 80.4% and C: 79.6%, P = 0.439) and CRC screening completion rates (I: 78.3% and C: 77.3%, P = 0.398) between intervention and control groups. Post-intervention, compliance rates (I: 88.1% and C: 80.5%, P < 0.01) and completion rates (I: 81.0% and C: 78.1%, P < 0.05) were significantly higher in the intervention group. CONCLUSIONS A population management system using closed-loop communication may improve CRC screening compliance and completion rates within academic primary care practices. Team-based care using well-designed IT systems can enable sharing of patient care responsibilities and improve patient outcomes.
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Affiliation(s)
- Charlotte A Wu
- General Internal Medicine Primary Care, Boston Medical Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Amara L Mulder
- South Shore Medical Center, Brigham and Women's Hospital, Boston, MA, USA
| | - Adrian H Zai
- Laboratory of Computer Science, Massachusetts General Hospital, Boston, MA, USA
| | - Yuanshan Hu
- Population Health, Brigham and Women's Hospital, Boston, MA, USA
| | | | | | - John R Saltzman
- Division of Gastroenterology, Hepatology, and Endoscopy, Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA
| | - Andrew L Ellner
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School Center for Primary Care, Boston, MA, USA
| | - Asaf Bitton
- Department of Medicine, Brigham and Women's Hospital, Boston, MA, USA.,Harvard Medical School, Boston, MA, USA
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Seale H, Kaur R, Lajoie K, Dixon J, Gallard J. Examining the role of a decision aid in reducing decisional conflict amongst hospital healthcare workers towards receiving the influenza vaccine. BMC Health Serv Res 2016; 16:84. [PMID: 26961353 PMCID: PMC4785629 DOI: 10.1186/s12913-016-1339-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2015] [Accepted: 03/07/2016] [Indexed: 11/14/2022] Open
Abstract
Background Currently the uptake of the influenza vaccine amongst Australian hospital staff remains low. While some staff members choose not to receive the vaccine, others may feel decisional conflict around whether to receive the vaccine or not. Having access to information that is personalized to the staff members’ concerns may alleviate this conflict. Our study aimed to explore the attitudes of hospital staff towards an online decision aid (DA), which focuses on influenza and the vaccine. We were also interested to examine whether they accepted the new tool and whether they had any suggestions for improvements. Methods Forty-one semi-structured interviews were undertaken with a range of hospital staff from two major public hospitals in Sydney and Melbourne, Australia in 2013. Emails and posters were used to inform staff members about the study. Thematic analysis was performed to explore the attitudes of hospital staff towards the DA. Results Our participants were well aware of the time/location of the staff vaccination clinics, however very few reported attending or receiving any educational material about the disease or the vaccine. Amongst those who did receive material, they felt that the messages were “dumbed down”. There was a mostly positive response to the DA from participants, however they felt that unless it was included as part of mandatory training or orientation, it would be difficult to get staff to use the tool. Conclusions Previous studies have established that education is an important component of an influenza vaccination program. We believe that the decision aid offers an alternative approach to delivering balanced information to staff members, which may reduce workload burdens on administrators and drive up rates.
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Affiliation(s)
- Holly Seale
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia.
| | - Rajneesh Kaur
- School of Public Health and Community Medicine, UNSW Medicine, University of New South Wales, Sydney, Australia
| | - Kerryn Lajoie
- Immunisation Services, Melbourne, Victoria, Australia
| | - Julie Dixon
- Planning and Population Health, South Eastern Sydney Local Health District, Sydney, Australia
| | - Julie Gallard
- Centre for Hospital Epidemiology and Staff Services, Prince of Wales Hospital, Sydney, Australia
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7
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Lee S, Lee YY, Yoon HJ, Choi E, Suh M, Park B, Jun JK, Kim Y, Choi KS. Responses to Overdiagnosis in Thyroid Cancer Screening among Korean Women. Cancer Res Treat 2015; 48:883-91. [PMID: 26727718 PMCID: PMC4946348 DOI: 10.4143/crt.2015.218] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 12/11/2015] [Indexed: 01/17/2023] Open
Abstract
Purpose Communicating the harms and benefits of thyroid screening is necessary to help individuals decide on whether or not to undergo thyroid cancer screening. This study was conducted to assess changes in thyroid cancer screening intention in response to receiving information about overdiagnosis and to determine factors with the greatest influence thereon. Materials and Methods Data were acquired from subjects included in the 2013 Korean National Cancer Screening Survey (KNCSS), a nationwide, population-based, cross-sectional survey. Of the 4,100 respondents in the 2013 KNCSS, women were randomly subsampled and an additional face-to-face interview was conducted. Finally, a total of 586 female subjects were included in this study. Intention to undergo thyroid cancer screening was assessed before and after receiving information on overdiagnosis. Results Prior awareness of overdiagnosis in thyroid cancer screening was 27.8%. The majority of subjects intended to undergo thyroid cancer screening before and after receiving information on overdiagnosis (87% and 74%, respectively). Only a small number of subjects changed their intention to undergo thyroid cancer screening from positive to negative after receiving information on overdiagnosis. Women of higher education level and Medical Aid Program recipients reported being significantly more likely to change their intention to undergo thyroid cancer screening afterreceiving information on overdiagnosis,whilewomen with stronger beliefs on the efficacy of cancer screening were less likely to change their intention. Conclusion Women in Korea appeared to be less concerned about overdiagnosis when deciding whether or not to undergo thyroid cancer screening.
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Affiliation(s)
- Sangeun Lee
- Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Yoon Young Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Hyo Joong Yoon
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eunji Choi
- Graduate School of Cancer Science and Policy, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- Graduate School of Cancer Science and Policy, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, Goyang, Korea.,National Cancer Control Institute, National Cancer Center, Goyang, Korea
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8
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Kirkegaard P, Mortensen GL, Mortensen SL, Larsen MB, Gabel P, Andersen B. Making decisions about colorectal cancer screening. A qualitative study among citizens with lower educational attainment. Eur J Public Health 2015; 26:176-81. [PMID: 26541860 DOI: 10.1093/eurpub/ckv207] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Few decision aids (DAs) have been developed to support an informed choice to citizens with lower educational attainment about colorectal cancer screening. The aim of this study was to identify information needs and preferences for formats and content in a DA for this group of citizens. METHODS Four focus groups were conducted among Danish men and women aged 50-74 years with lower educational attainment. A semi-structured interview guide was developed to explore participants' perceptions about colorectal cancer screening and wishes for a DA. The interviews were transcribed and analysed using an ethnographic approach. RESULTS The participants appreciated information about the causes, symptoms, incidence and mortality of colorectal cancer compared with other common cancers. The majority preferred the information to be presented in a clear and simple way with numbers and figures kept to a minimum. Values clarification exercises were not found useful. Receiving a screening kit to collect a sample of faeces along with the invitation letter was seen by the participants as a clear request from the health authorities to get screened. However, the overall message in the DA was perceived as ambiguous by the participants as it both recommended screening and seemed to disclaim responsibility for it. CONCLUSION The results are relevant to a discussion of the delicate balance between participants' call for a clear recommendation, and the purpose of a DA to present options in a neutral and balanced way. This discussion is relevant beyond the group of citizens with lower educational attainment.
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Affiliation(s)
- Pia Kirkegaard
- 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark 2 Research Unit for General Practice, School of Public Health, Aarhus University, Denmark
| | | | | | - Mette Bach Larsen
- 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Pernille Gabel
- 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark
| | - Berit Andersen
- 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark
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Cost effectiveness of a web-based decision aid for parents deciding about MMR vaccination: a three-arm cluster randomised controlled trial in primary care. Br J Gen Pract 2015; 64:e493-9. [PMID: 25071062 DOI: 10.3399/bjgp14x680977] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
BACKGROUND Levels of measles in England and Wales are at their highest for 18 years, and strategies targeting the different groups of parents who do not vaccinate their children continue to be needed. Decision aids for decisions regarding childhood immunisation appear to be effective in achieving an increase in vaccine uptake but their cost effectiveness is unknown. AIM To assess the cost effectiveness of a web-based decision aid to increase uptake of the MMR vaccine. DESIGN AND SETTING Economic evaluation conducted alongside a cluster randomised controlled trial using urban GP practices in the north of England. METHOD Fifty GP practices in the north of England were randomised to one of three trial arms: decision aid, leaflet, usual practice. A total of 220 first-time parents (child aged 3-12 months) were recruited. Parents self-reported their contacts with the NHS and other previous/expected resource utilisation; associated costs were calculated. Vaccine-uptake data were collected from GP practices. A cost-effectiveness analysis was undertaken and provided the incremental cost per first-vaccine uptake. Multiple imputation was used to account for missing data and findings were adjusted for baseline differences in parents' levels of decisional conflict regarding MMR vaccination. RESULTS Of the 220 first-time parents recruited to the study, 179 completed the baseline and post-intervention questionnaires. MMR uptake was highest for those receiving the decision aid (42 out of 42, 100%) versus usual practice (61 out of 62, 98%) and leaflet arm (69 out of 75, 92%), and was associated with lower cost (-£9.20 versus usual practice and -£7.17 versus leaflet). CONCLUSION The decision aid has a high chance of being cost effective, regardless of the value placed on obtaining additional vaccinations. It also appears to offer an efficient means of decision support for parents.
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10
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Wong IOL, Lam WWT, Wong CN, Cowling BJ, Leung GM, Fielding R. Towards informed decisions on breast cancer screening: Development and pilot testing of a decision aid for Chinese women. PATIENT EDUCATION AND COUNSELING 2015; 98:961-969. [PMID: 25959986 DOI: 10.1016/j.pec.2015.04.014] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/31/2014] [Revised: 04/08/2015] [Accepted: 04/18/2015] [Indexed: 06/04/2023]
Abstract
OBJECTIVE To pilot-test a novel, self-use breast cancer (BC) screening decision aid (DA) targeting Hong Kong (HK) Chinese women at average risk of BC. METHODS Women were recruited through a population-based telephone survey using random digit dialling between October 2013 and January 2014. Eligible participants completed our baseline survey and then received the DA by post. Participants (n=90) completed follow-up telephone interviews one month later. RESULTS Most participants thought that all/most DA content was presented clearly (86.7%), and was useful in helping women make screening-related decisions (88.9%). It also achieved its expected impact of improving informed decision-making and increasing shared-participation preference without increasing participants' anxiety levels. Participants showed a modest non-statistical increase in their screening knowledge scores. Older women rated the perceived severity of a BC diagnosis as significantly lower, and more educated women reported significantly lower perceived anxiety about the disease. CONCLUSION Our DA appears acceptable and feasible for self-use by HK Chinese women who need to make an informed decision about BC screening without increasing overall anxiety levels. PRACTICE IMPLICATIONS This study supports the potential of self-use DAs for cancer screening-related decision support in a Chinese population.
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Affiliation(s)
- Irene O L Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China.
| | - Wendy W T Lam
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Cheuk Nam Wong
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Benjamin J Cowling
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Gabriel M Leung
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
| | - Richard Fielding
- School of Public Health, Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
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11
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Smith SK, Kearney P, Trevena L, Barratt A, Nutbeam D, McCaffery KJ. Informed choice in bowel cancer screening: a qualitative study to explore how adults with lower education use decision aids. Health Expect 2014; 17:511-22. [PMID: 22512746 PMCID: PMC5060748 DOI: 10.1111/j.1369-7625.2012.00780.x] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Offering informed choice in screening is increasingly advocated, but little is known about how evidence-based information about the benefits and harms of screening influences understanding and participation in screening. OBJECTIVE We aimed to explore how a bowel cancer screening decision aid influenced decision making and screening behaviour among adults with lower education and literacy. METHODS Twenty-one men and women aged 55-64 years with lower education levels were interviewed about using a decision aid to make their screening decision. Participants were purposively selected to include those who had and had not made an informed choice. RESULTS Understanding the purpose of the decision aid was an important factor in whether participants made an informed choice about screening. Participants varied in how they understood and integrated quantitative risk information about the benefits and harms of screening into their decision making; some read it carefully and used it to justify their screening decision, whereas others dismissed it because they were sceptical of it or lacked confidence in their own numeracy ability. Participants' prior knowledge and beliefs about screening influenced how they made sense of the information. DISCUSSION AND CONCLUSIONS Participants valued information that offered them a choice in a non-directive way, but were concerned that it would deter people from screening. Healthcare providers need to be aware that people respond to screening information in diverse ways involving a range of literacy skills and cognitive processes.
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Affiliation(s)
- Sian K Smith
- Post-Doctoral Research FellowResearch AssistantAssociate Professor Screening and Test Evaluation Program, Centre for Medical Psychology and Evidence Based Decision-Making, Sydney School of Public Health, University of Sydney, NSW, AustraliaProfessor of Epidemiology, Centre for Medical Psychology and Evidence Based Decision-Making, Sydney School of Public Health, University of Sydney, NSW, AustraliaVice-Chancellor, Professor of Public Health, Office of the Vice-Chancellor, University of Southampton, UK
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12
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Hersch J, Barratt A, Jansen J, Houssami N, Irwig L, Jacklyn G, Dhillon H, Thornton H, McGeechan K, Howard K, McCaffery K. The effect of information about overdetection of breast cancer on women's decision-making about mammography screening: study protocol for a randomised controlled trial. BMJ Open 2014; 4:e004990. [PMID: 24833692 PMCID: PMC4025472 DOI: 10.1136/bmjopen-2014-004990] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Women are largely unaware that mammography screening can cause overdetection of inconsequential disease, leading to overdiagnosis and overtreatment of breast cancer. Evidence is lacking about how information on overdetection affects women's breast screening decisions and experiences. This study investigates the consequences of providing information about overdetection of breast cancer to women approaching the age of invitation to mammography screening. METHODS AND ANALYSIS This is a randomised controlled trial with an embedded longitudinal qualitative substudy. Participants are a community sample of women aged 48-50 in New South Wales, Australia, recruited in 2014. Women are randomly allocated to either quantitative only follow-up (n=904) or additional qualitative follow-up (n=66). Women in each stream are then randomised to receive either the intervention (evidence-based information booklet including overdetection, breast cancer mortality reduction and false positives) or a control information booklet (including mortality reduction and false positives only). The primary outcome is informed choice about breast screening (adequate knowledge, and consistency between attitudes and intentions) assessed via telephone interview at 2 weeks postintervention. Secondary outcomes measured at this time include decision process (decisional conflict and confidence) and psychosocial outcomes (anticipated regret, anxiety, breast cancer worry and perceived risk). Women are further followed up at 6 months, 1 and 2 years to assess self-reported screening behaviour and long-term psychosocial outcomes (decision regret, quality of life). Participants in the qualitative stream undergo additional in-depth interviews at each time point to explore the views and experiences of women who do and do not choose to have screening. ETHICS AND DISSEMINATION The study has ethical approval, and results will be published in peer-reviewed journals. This research will help ensure that information about overdetection may be communicated clearly and effectively, using an evidence-based approach, to women considering breast cancer screening. TRIAL REGISTRATION NUMBER Australian New Zealand Clinical Trials Registry ACTRN12613001035718.
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Affiliation(s)
- Jolyn Hersch
- Screening & Test Evaluation Program (STEP) and Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, Australia
| | - Alexandra Barratt
- Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, Australia
| | - Jesse Jansen
- Screening & Test Evaluation Program (STEP) and Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, Australia
| | - Nehmat Houssami
- Screening & Test Evaluation Program (STEP), School of Public Health, University of Sydney, Sydney, Australia
| | - Les Irwig
- Screening & Test Evaluation Program (STEP), School of Public Health, University of Sydney, Sydney, Australia
| | - Gemma Jacklyn
- School of Public Health, University of Sydney, Sydney, Australia
| | - Haryana Dhillon
- Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), Central Clinical School, University of Sydney, Sydney, Australia
| | - Hazel Thornton
- Department of Health Sciences, University of Leicester, Leicester, UK
| | - Kevin McGeechan
- Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, Australia
| | - Kirsten Howard
- Screening & Test Evaluation Program (STEP), School of Public Health, University of Sydney, Sydney, Australia
| | - Kirsten McCaffery
- Screening & Test Evaluation Program (STEP) and Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), School of Public Health, University of Sydney, Sydney, Australia
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Abhyankar P, Volk RJ, Blumenthal-Barby J, Bravo P, Buchholz A, Ozanne E, Vidal DC, Col N, Stalmeier P. Balancing the presentation of information and options in patient decision aids: an updated review. BMC Med Inform Decis Mak 2013; 13 Suppl 2:S6. [PMID: 24625214 PMCID: PMC4044010 DOI: 10.1186/1472-6947-13-s2-s6] [Citation(s) in RCA: 60] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
Background Standards for patient decision aids require that information and options be presented in a balanced manner; this requirement is based on the argument that balanced presentation is essential to foster informed decision making. If information is presented in an incomplete/non-neutral manner, it can stimulate cognitive biases that can unduly affect individuals’ knowledge, perceptions of risks and benefits, and, ultimately, preferences. However, there is little clarity about what constitutes balance, and how it can be determined and enhanced. We conducted a literature review to examine the theoretical and empirical evidence related to balancing the presentation of information and options. Methods A literature search related to patient decision aids and balance was conducted on Medline, using MeSH terms and PubMed; this search supplemented the 2011 Cochrane Collaboration’s review of patient decision aids trials. Only English language articles relevant to patient decision making and addressing the balance of information and options were included. All members of the team independently screened clusters of articles; uncertainties were resolved by seeking review by another member. The team then worked in sub-groups to extract and synthesise data on theory, definitions, and evidence reported in these studies. Results A total of 40 articles met the inclusion criteria. Of these, six explained the rationale for balancing the presentation of information and options. Twelve defined “balance”; the definition of “balance” that emerged is as follows: “The complete and unbiased presentation of the relevant options and the information about those options—in content and in format—in a way that enables individuals to process this information without bias”. Ten of the 40 articles reported assessing the balance of the relevant decision aid. All 10 did so exclusively from the users’ or patients’ perspective, using a five-point Likert-type scale. Presenting information in a side-by-side display form was associated with more respondents (ranging from 70% to 96%) judging the information as “balanced”. Conclusion There is a need for comparative studies investigating different ways to improve and measure balance in the presentation of information and options in patient decision aids.
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Miles A, Rodrigues V, Sevdalis N. The effect of information about false negative and false positive rates on people's attitudes towards colorectal cancer screening using faecal occult blood testing (FOBt). PATIENT EDUCATION AND COUNSELING 2013; 93:342-349. [PMID: 23850021 DOI: 10.1016/j.pec.2013.06.010] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/28/2013] [Revised: 06/13/2013] [Accepted: 06/15/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To examine the impact of numeric risk information about false negative (FN) and false positive (FP) rates in faecal occult blood testing (FOBt) on attitudes towards screening. METHODS 95 people aged 45-59, living in England, read 6 hypothetical vignettes presented online about the use of FOB testing to detect bowel cancer, in which information about FN and FP rates was systematically varied. RESULTS Both verbal and numeric FN risk information reduced people's interest in screening compared with no FN information. Numeric FN risk information reduced people's perceptions of screening effectiveness and lowered perceived trust in the results of screening compared with both verbal FN information and no FN information. FP information did not affect attitudes towards FOB testing. There was limited evidence that FN information reduced interest and perceptions of screening effectiveness more in educated groups. CONCLUSION Numeric FN risk information decreased people's perceptions of screening effectiveness and trust in the results of screening but did not affect people's interest in screening anymore than verbal FN risk information. PRACTICE IMPLICATIONS Numeric FN information could be added to patient information without affecting interest in screening, although this needs to be replicated in a larger, more representative sample.
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Affiliation(s)
- Anne Miles
- Department of Psychological Sciences, Birkbeck, University of London, London, UK.
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Shourie S, Jackson C, Cheater FM, Bekker HL, Edlin R, Tubeuf S, Harrison W, McAleese E, Schweiger M, Bleasby B, Hammond L. A cluster randomised controlled trial of a web based decision aid to support parents' decisions about their child's Measles Mumps and Rubella (MMR) vaccination. Vaccine 2013; 31:6003-10. [PMID: 24148574 PMCID: PMC3898271 DOI: 10.1016/j.vaccine.2013.10.025] [Citation(s) in RCA: 63] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/26/2013] [Revised: 08/22/2013] [Accepted: 10/08/2013] [Indexed: 11/30/2022]
Abstract
The use of decision aids for immunisation decisions is under researched and controversial. Parents receiving a decision aid or a leaflet had reduced decisional conflict for the MMR decision. MMR uptake in the decision aid and control arms achieved levels required for population immunity. Leaflet arm parents were less likely to vaccinate their child. Childhood immunisation decision aids can achieve both informed decision-making and uptake.
Objective To evaluate the effectiveness of a web based decision aid versus a leaflet versus, usual practice in reducing parents’ decisional conflict for the first dose MMR vaccination decision. The, impact on MMR vaccine uptake was also explored. Design Three-arm cluster randomised controlled trial. Setting: Fifty GP practices in the north of, England. Participants: 220 first time parents making a first dose MMR decision. Interventions: Web, based MMR decision aid plus usual practice, MMR leaflet plus usual practice versus usual practice only, (control). Main outcome measures: Decisional conflict was the primary outcome and used as the, measure of parents’ levels of informed decision-making. MMR uptake was a secondary outcome. Results Decisional conflict decreased post-intervention for both intervention arms to a level where, parents could make an informed MMR decision (decision aid: effect estimate = 1.09, 95% CI −1.36 to −0.82; information leaflet: effect estimate = −0.67, 95% CI −0.88 to −0.46). Trial arm was significantly, associated (p < 0.001) with decisional conflict at post-intervention. Vaccination uptake was 100%, 91%, and 99% in the decision aid, leaflet and control arms, respectively (χ2 (1, N = 203) = 8.69; p = 0.017). Post-hoc tests revealed a statistically significant difference in uptake between the information leaflet, and the usual practice arms (p = 0.04), and a near statistically significant difference between the, decision aid and leaflet arms (p = 0.05). Conclusions Parents’ decisional conflict was reduced in both, the decision aid and leaflet arms. The decision aid also prompted parents to act upon that decision and, vaccinate their child. Achieving both outcomes is fundamental to the integration of immunisation, decision aids within routine practice. Trial registration: ISRCTN72521372.
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Affiliation(s)
- S Shourie
- School of Healthcare, University of Leeds, Leeds LS2 9UT, UK
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Jimbo M, Rana GK, Hawley S, Holmes-Rovner M, Kelly-Blake K, Nease DE, Ruffin MT. What is lacking in current decision aids on cancer screening? CA Cancer J Clin 2013; 63:193-214. [PMID: 23504675 PMCID: PMC3644368 DOI: 10.3322/caac.21180] [Citation(s) in RCA: 47] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Recent guidelines on cancer screening have provided not only more screening options but also conflicting recommendations. Thus, patients, with their clinicians' support, must decide whether to get screened, which modality to use, and how often to undergo screening. Decision aids could potentially lead to better shared decision-making regarding screening between the patient and the clinician. A total of 73 decision aids concerning screening for breast, cervical, colorectal, and prostate cancers were reviewed. The goal of this review was to assess the effectiveness of such decision aids, examine areas in need of more research, and determine how the decision aids can be currently applied in the real-world setting. Most studies used sound study designs. Significant variation existed in the setting, theoretical framework, and measured outcomes. Just over one-third of the decision aids included an explicit values clarification. Other than knowledge, little consistency was noted with regard to which patient attributes were measured as outcomes. Few studies actually measured shared decision-making. Little information was available regarding the feasibility and outcomes of integrating decision aids into practice. In this review, the implications for future research, as well as what clinicians can do now to incorporate decision aids into their practice, are discussed.
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Affiliation(s)
- Masahito Jimbo
- Departments of Family Medicine and Urology, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48109-0708, Phone: (734) 998-7120 Ext 334, Fax: (734) 998-7335
| | - Gurpreet K. Rana
- Taubman Health Sciences Library, University of Michigan, 1135 E. Catherine, Ann Arbor, MI 48109-0726, Phone: (734) 936-1399, Fax: (734) 763-1473
| | - Sarah Hawley
- Departments of Internal Medicine and Health Management and Policy, University of Michigan, NCRC 2800 Plymouth Road Building, 16/406E, Ann Arbor, MI 48109-2800, Phone: (734) 936-8816
| | - Margaret Holmes-Rovner
- Health Services Research, Center for Ethics and Department of Medicine, Michigan State University College of Human Medicine, 965 Fee Road Rm C203, East Lansing, MI, 48824-1316, Phone: (517) 353-5197
| | - Karen Kelly-Blake
- Center for Ethics and Humanities in the Life Sciences, Michigan State University College of Human Medicine, East Fee Hall, 965 Fee Road Room C215, East Lansing, MI 48824, Phone: (517) 353-8582, Fax: (517) 353-3289
| | - Donald E. Nease
- Department of Family Medicine and Colorado Health Outcomes Program, University of Colorado – Denver, 13199 E. Montview Blvd, Suite 300, Mail Stop F443, Aurora, CO 80045, Phone: (303) 724-6270, Fax: (303) 724-1839
| | - Mack T. Ruffin
- Associate Chair for Research Programs, Department of Family Medicine, University of Michigan, 1018 Fuller Street, Ann Arbor, MI 48109-0708, Phone: (734) 998-7120 Ext 310, Fax: (734) 998-7335
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Hersch J, Jansen J, Barratt A, Irwig L, Houssami N, Howard K, Dhillon H, McCaffery K. Women's views on overdiagnosis in breast cancer screening: a qualitative study. BMJ 2013; 346:f158. [PMID: 23344309 PMCID: PMC3552499 DOI: 10.1136/bmj.f158] [Citation(s) in RCA: 119] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVE To elicit women's responses to information about the nature and extent of overdiagnosis in mammography screening (detecting disease that would not present clinically during the woman's lifetime) and explore how awareness of overdiagnosis might influence attitudes and intentions about screening. DESIGN Qualitative study using focus groups that included a presentation explaining overdiagnosis, incorporating different published estimates of its rate (1-10%, 30%, 50%) and information on the mortality benefit of screening, with guided group discussions SETTING Sydney, Australia PARTICIPANTS Fifty women aged 40-79 years with no personal history of breast cancer and with varying levels of education and participation in screening. RESULTS Prior awareness of breast cancer overdiagnosis was minimal. Women generally reacted with surprise, but most came to understand the issue. Responses to overdiagnosis and the different estimates of its magnitude were diverse. The highest estimate (50%) made some women perceive a need for more careful personal decision making about screening. In contrast, the lower and intermediate estimates (1-10% and 30%) had limited impact on attitudes and intentions, with many women remaining committed to screening. For some women, the information raised concerns, not about whether to screen but whether to treat a screen detected cancer or consider alternative approaches (such as watchful waiting). Information preferences varied: many women considered it important to take overdiagnosis into account and make informed choices about whether to have screening, but many wanted to be encouraged to be screened. CONCLUSIONS Women from a range of socioeconomic backgrounds could comprehend the issue of overdiagnosis in mammography screening, and they generally valued information about it. Effects on screening intentions may depend heavily on the rate of overdiagnosis. Overdiagnosis will be new and counterintuitive for many people and may influence screening and treatment decisions in unintended ways, underscoring the need for careful communication.
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Affiliation(s)
- Jolyn Hersch
- Screening and Test Evaluation Program, School of Public Health, University of Sydney, NSW 2006, Australia
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Hudson B, Zarifeh A, Young L, Wells JE. Patients' expectations of screening and preventive treatments. Ann Fam Med 2012; 10:495-502. [PMID: 23149525 PMCID: PMC3495922 DOI: 10.1370/afm.1407] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
PURPOSE An informed decision to accept a health care intervention requires an understanding of its likely benefit. This study assessed participants' estimates of the benefit, as well as minimum acceptable benefit, of screening for breast and bowel cancer and medication to prevent hip fracture and cardiovascular disease. METHODS Three general practitioners sent questionnaires to all registered patients aged 50 to 70 years. Patients agreeing to participate in the study were asked to estimate the number of events (fractures or deaths) prevented in a group of 5,000 patients undergoing each intervention over a period of 10 years, and to indicate the minimum number of events avoided by the intervention that they considered justified its use. The proportions of participants that overestimated each intervention's benefit were calculated, and univariate and multivariable analyses of predictors of response were performed. RESULTS The participation rate was 36%: 977 patients were invited to participate in the study, and 354 returned a completed questionnaire. Participants overestimated the degree of benefit conferred by all interventions: 90% of participants overestimated the effect of breast cancer screening, 94% overestimated the effect of bowel cancer screening, 82% overestimated the effect of hip fracture preventive medication, and 69% overestimated the effect of preventive medication for cardiovascular disease. Estimates of minimum acceptable benefit were more conservative, but other than for cardiovascular disease mortality prevention, most respondents indicated a minimum benefit greater than these interventions achieve. A lower level of education was associated with higher estimates of minimum acceptable benefit for all interventions. CONCLUSION Patients overestimated the risk reduction achieved with 4 examples of screening and preventive medications. A lower level of education was associated with higher minimum benefit to justify intervention use. This tendency to overestimate benefits may affect patients' decisions to use such interventions, and practitioners should be aware of this tendency when discussing these interventions with patients.
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Affiliation(s)
- Ben Hudson
- Department of Public Health and General Practice, University of Otago, Christchurch, New Zealand.
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Are women ready for the new cervical screening protocol in England? A systematic review and qualitative synthesis of views about human papillomavirus testing. Br J Cancer 2012; 107:243-54. [PMID: 22699825 PMCID: PMC3394982 DOI: 10.1038/bjc.2012.256] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background: A new protocol for human papillomavirus (HPV) testing within the UK cervical screening programme commenced in April 2011, creating new patient experiences. This is the first review to synthesise a substantial body of international evidence of women’s information needs, views and preferences regarding HPV testing. We aimed to inform the development of educational materials to promote informed choice, reduce anxiety and improve disease control. Methods: We searched 12 bibliographic databases. Two reviewers independently screened papers and assessed study quality; disagreements were resolved by discussion. Results were extracted verbatim and authors’ findings treated as primary data. Studies were synthesised collaboratively using framework methods. Results: We synthesised findings from 17 studies. Women had overwhelmingly negative concerns; an HPV diagnosis was daunting, had associated problems of disclosure of a sexually transmitted infection (STI), impacted on relationships and provoked fear of stigmatisation. Nevertheless, many thought HPV testing could be a preferable alternative to repeat cytology. Knowledge was poor; women struggled to interpret limited information in the context of existing knowledge about STIs and cervical cancer. Conclusion: Women are likely to be poorly informed, have limited understanding and many unanswered questions. This could increase anxiety and reduce ability to make informed choices, presenting a substantial challenge for those who design and provide information.
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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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Hersch J, Jansen J, Irwig L, Barratt A, Thornton H, Howard K, McCaffery K. How do we achieve informed choice for women considering breast screening? Prev Med 2011; 53:144-6. [PMID: 21723312 DOI: 10.1016/j.ypmed.2011.06.013] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 06/16/2011] [Accepted: 06/17/2011] [Indexed: 11/18/2022]
Abstract
OBJECTIVE In current medical literature, mammography and other cancer screening programs are subject to controversy because of debate about the magnitude and nature of the benefits and harms. This paper discusses the issues around informed choice for women considering breast screening. METHOD We discuss qualitative and quantitative studies of women's attitudes to breast screening and informed choice. RESULTS Women view breast screening as a way of avoiding potential regret, and reassurance from normal results is highly valued. Screening participants acknowledge anxiety about false positives but awareness regarding potential overdetection of indolent breast cancer is minimal, and research is needed to assess how better understanding of screening downsides may affect women's views. In any case, weighing up screening advantages and disadvantages is sensitive to personal preferences. CONCLUSIONS Communicators have an ethical obligation to make balanced information available to women, which is flexible enough to respond to the level of detail and involvement desired by each individual. Many women want to know more and to participate more actively in screening decisions. Techniques have been developed to present balanced information and support individual decision making in ways that are accessible and empowering for the wider community. Evaluations of breast cancer screening must integrate clinical data with evidence on the perspectives of women themselves.
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Affiliation(s)
- Jolyn Hersch
- Screening and Test Evaluation Program, Sydney School of Public Health, Edward Ford Bldg (A27), University of Sydney, NSW 2006, Australia.
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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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Thornton H. Shared decision-making: Personal, professional and political. Int J Surg 2011; 9:195-7. [DOI: 10.1016/j.ijsu.2010.11.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2010] [Accepted: 11/24/2010] [Indexed: 10/18/2022]
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