Top

BMC Medical Informatics and Decision Making

Published in:

Open Access 01-12-2019 | Care | Research article

Effectiveness of a decision aid for promoting colorectal cancer screening in Spain: a randomized trial

Authors: Lilisbeth Perestelo-Perez, Amado Rivero-Santana, Alezandra Torres-Castaño, Vanesa Ramos-Garcia, Yolanda Alvarez-Perez, Nerea Gonzalez-Hernandez, Andrea Buron, Michael Pignone, Pedro Serrano-Aguilar

Published in: BMC Medical Informatics and Decision Making | Issue 1/2019

Abstract

Background

Colorectal cancer (CRC) screening has shown to reduce incidence and mortality rates, and therefore is widely recommended for people above 50 years-old. However, despite the implementation of population-based screening programs in several countries, uptake rates are still low. Decision aids (DAs) may help patients to make informed decisions about CRC screening.

Methods

We performed a randomized controlled trial to assess the effectiveness of a DA developed to promote CRC screening, with patients from two primary care centers in Spain who never had underwent CRC screening. Contrary to center B (n = 24), Center A (n = 83) attended patients from an area where the population-based screening program was not implemented at that moment. Outcome measures were decisional conflict, knowledge of the disease and available screening options, intention to uptake the test, and concordance between patients’ goals/concerns and intention.

Results

In center A, there were significant differences favoring the DA in decisional conflict (p < 0.001) and knowledge (p < 0.001). The absolute differences favoring DA group in intention to undergo fecal occult blood test (10.5%) and colonoscopy (13.7%) were significant only before correction for attenuation. In center B the differences were significant only for knowledge (p < 0.001). Patients’ goals and concerns regarding the screening did not significantly predict their intention, and therefore we could not calculate a measure of concordance between the two constructs.

Conclusions

A DA improved the decisional process of participants who had never been invited to participate in the Spanish public CRC screening program, replicating previous results in this field. Future research is needed to identify subgroups that could benefit more from these interventions.

Trial registration

International Standard Registered Clinical/social Study Number: ISRCTN98108615 (Retrospectively registered on 27 December 2018).

GLOBOCAN. Colorectal Cancer: Estimated incidence, mortality and prevalence worldwide in 2012. International Agency for Research on Cancer. 2012. http://globocan.iarc.fr/Default.aspx.

Browse the SEER Cancer Statistics Review (CSR) 1975-2013. https://seer.cancer.gov/archive/csr/1975_2013/browse_csr.php?sectionSEL=6&pageSEL=sect_06_table.09.html. Accessed 13 Jun 2017.

Torre LA, Bray F, Siegel RL, Ferlay J, Lortet-Tieulent J, Jemal A. Global cancer statistics, 2012. CA Cancer J Clin. 2015;65:87–108. https://doi.org/10.3322/caac.21262.CrossRefPubMed

Ait Ouakrim D, Pizot C, Boniol M, Malvezzi M, Boniol M, Negri E, et al. Trends in colorectal cancer mortality in Europe: retrospective analysis of the WHO mortality database. BMJ. 2015;351:h4970. https://doi.org/10.1136/bmj.h4970.CrossRefPubMedPubMedCentral

Verma M, Sarfaty M, Brooks D, Wender RC. Population-based programs for increasing colorectal cancer screening in the United States. CA Cancer J Clin. 2015;65:496–510. https://doi.org/10.3322/caac.21295.CrossRef

Cancer Screening in the European Union. Report on the implementation of the council recommendation on cancer Screening. 2017.

Schreuders EH, Ruco A, Rabeneck L, Schoen RE, Sung JJY, Young GP, et al. Colorectal cancer screening: a global overview of existing programmes. Gut. 2015;64:1637–49. https://doi.org/10.1136/gutjnl-2014-309086.CrossRefPubMed

Beydoun HA, Beydoun MA. Predictors of colorectal cancer screening behaviors among average-risk older adults in the United States. Cancer Causes Control. 2008;19:339–59. https://doi.org/10.1007/s10552-007-9100-y.CrossRefPubMed

Deding U, Henig AS, Salling A, Torp-Pedersen C, Bøggild H. Sociodemographic predictors of participation in colorectal cancer screening. Int J Color Dis. 2017;32(8):1117–24. https://doi.org/10.1007/s00384-017-2832-6.CrossRef

10.

Pornet C, Denis B, Perrin P, Gendre I, Launoy G. Predictors of adherence to repeat fecal occult blood test in a population-based colorectal cancer screening program. Br J Cancer. 2014;111:2152–5. https://doi.org/10.1038/bjc.2014.507.CrossRefPubMedPubMedCentral

11.

Gale CR, Deary IJ, Wardle J, Zaninotto P, Batty GD. Cognitive ability and personality as predictors of participation in a national colorectal cancer screening programme: the English longitudinal study of ageing. J Epidemiol Community Health. 2015;69:530–5. https://doi.org/10.1136/jech-2014-204888.CrossRefPubMed

12.

Brouwers MC, De Vito C, Bahirathan L, Carol A, Carroll JC, Cotterchio M, et al. Effective interventions to facilitate the uptake of breast, cervical and colorectal cancer screening: an implementation guideline. Implement Sci. 2011;6:112. https://doi.org/10.1186/1748-5908-6-112.CrossRefPubMedPubMedCentral

13.

Sabatino SA, Lawrence B, Elder R, Mercer SL, Wilson KM, DeVinney B, et al. Effectiveness of interventions to increase screening for breast, cervical, and Colorectal cancers. Am J Prev Med. 2012;43:97–118. https://doi.org/10.1016/j.amepre.2012.04.009.CrossRefPubMed

14.

Rawl SM, Menon U, Burness A, Breslau ES. Interventions to promote colorectal cancer screening: an integrative review. Nurs Outlook. 2012;60:172–81.e13. https://doi.org/10.1016/j.outlook.2011.11.003.CrossRefPubMedPubMedCentral

15.

Elwyn G, O’Connor A, Stacey D, Volk R, Edwards A, Coulter A, et al. Developing a quality criteria framework for patient decision aids: online international Delphi consensus process. BMJ. 2006;333:417. https://doi.org/10.1136/bmj.38926.629329.AE.CrossRefPubMedPubMedCentral

16.

Coulter A, Stilwell D, Kryworuchko J, Mullen P, Ng C, van der Weijden T. A systematic development process for patient decision aids. BMC Med Inform Decis Mak. 2013;13(Suppl 2):S2. https://doi.org/10.1186/1472-6947-13-S2-S2.CrossRefPubMedPubMedCentral

17.

Stacey D, Légaré F, Lewis K, Barry MJ, Bennett CL, Eden KB, et al. Decision aids for people facing health treatment or screening decisions. Cochrane Database Syst Rev. 2017;4:CD001431.PubMed

18.

Volk RJ, Linder SK, Lopez-Olivo MA, Kamath GR, Reuland DS, Saraykar SS, et al. Patient decision aids for Colorectal Cancer screening. Am J Prev Med. 2016;51:779–91. https://doi.org/10.1016/j.amepre.2016.06.022.CrossRefPubMedPubMedCentral

19.

Binefa G, Garcia M, Milá N, Fernández E, Rodríguez-Moranta F, Gonzalo N, et al. Colorectal Cancer screening Programme in Spain: results of key performance indicators after five rounds (2000-2012). Sci Rep. 2016;6:19532. https://doi.org/10.1038/srep19532.CrossRefPubMedPubMedCentral

20.

Portillo-Villares I, Arana-Arri E, Idigoras-Rubio I, Espinás-Piñol JA, Pérez-Riquelme F, de la Vega Prieto M, et al. Lesions detected in six Spanish Colorectal Cancer screening population based Programmes. CRIBEA Project Spain. Rev Esp Salud Publica. 2017;91:e201701021 http://www.ncbi.nlm.nih.gov/pubmed/28218734.PubMed

21.

Pignone M, Winquist A, Schild LA, Lewis C, Scott T, Hawley J, et al. Effectiveness of a patient and practice-level colorectal cancer screening intervention in health plan members. Cancer. 2011;117:3352–62. https://doi.org/10.1002/cncr.25924. CrossRefPubMed

22.

O’Connor AM. Validation of a decisional conflict scale. Med Decis Mak. 1995;15:25–30. https://doi.org/10.1177/0272989X9501500105.CrossRef

23.

Urrutia M, Campos S, O’Connor A. Validación de una versión en español de la Escala de Conflicto Decisional. Rev Med Chil. 2008;136. https://doi.org/10.4067/S0034-98872008001100010.

24.

Perestelo-Pérez L, Rivero-Santana A, Boronat M, Sánchez-Afonso JA, Pérez-Ramos J, Montori VM, et al. Effect of the statin choice encounter decision aid in Spanish patients with type 2 diabetes: a randomized trial. Patient Educ Couns. 2016;99:295–9. https://doi.org/10.1016/j.pec.2015.08.032.CrossRefPubMed

25.

Perestelo-Perez L, Rivero-Santana A, Sanchez-Afonso JA, Perez-Ramos J, Castellano-Fuentes CL, Sepucha K, et al. Effectiveness of a decision aid for patients with depression: a randomized controlled trial. Health Expect. 2017. https://doi.org/10.1111/hex.12553.

26.

Reuland DS, Ko LK, Fernández A, Braswell LC, Pignone M. Testing a Spanish-language colorectal cancer screening decision aid in Latinos with limited English proficiency: results from a pre-post trial and four month follow-up survey. BMC Med Inform Decis Mak. 2012;12:53. https://doi.org/10.1186/1472-6947-12-53.CrossRefPubMedPubMedCentral

27.

Schroy PC, Emmons KM, Peters E, Glick JT, Robinson PA, Lydotes MA, et al. Aid-assisted decision making and Colorectal Cancer screening. Am J Prev Med. 2012;43:573–83. https://doi.org/10.1016/j.amepre.2012.08.018.CrossRefPubMedPubMedCentral

28.

Kim J, Whitney A, Hayter S, Lewis C, Campbell M, Sutherland L, et al. Development and initial testing of a computer-based patient decision aid to promote colorectal cancer screening for primary care practice. BMC Med Inform Decis Mak. 2005;5:36. https://doi.org/10.1186/1472-6947-5-36.CrossRefPubMedPubMedCentral

29.

Sepucha KR, Feibelmann S, Cosenza C, Levin CA, Pignone M. Development and evaluation of a new survey instrument to measure the quality of colorectal cancer screening decisions. BMC Med Inform Decis Mak. 2014;14:72. https://doi.org/10.1186/1472-6947-14-72.CrossRefPubMedPubMedCentral

30.

Man-Son-Hing M, Laupacis A. A patient decision aid regarding antithrombotic therapy for stroke prevention in atrial fibrillation: a randomized controlled trial. JAMA. 1999;282:737–43. https://doi.org/10.1001/jama.282.8.737.CrossRefPubMed

31.

O’Connor AM, Tugwell P, Wells GA, Elmslie T, Jolly E, Hollingworth G, et al. Randomized trial of a portable, self-administered decision aid for postmenopausal women considering long-term preventive hormone therapy. Med Decis Mak. 1998;18:295–303. https://doi.org/10.1177/0272989X9801800307.CrossRef

32.

Laupacis A, O’Connor AM, Drake ER, Rubens FD, Robblee JA, Grant FC, et al. A decision aid for autologous pre-donation in cardiac surgery?A randomized trial. Patient Educ Couns. 2006;61:458–66. https://doi.org/10.1016/j.pec.2005.05.014.CrossRefPubMed

33.

Miller DP, Spangler JG, Case LD, Goff DC, Singh S, Pignone MP. Effectiveness of a web-based Colorectal Cancer screening patient decision aid. Am J Prev Med. 2011;40:608–15. https://doi.org/10.1016/j.amepre.2011.02.019.CrossRefPubMedPubMedCentral

34.

Pignone M, Harris R, Kinsinger L. Videotape-based decision aid for colon cancer screening. A randomized, controlled trial. Ann Intern Med. 2000;133:761–9.CrossRefPubMed

35.

Smith SK, Trevena L, Simpson JM, Barratt A, Nutbeam D, KJ MC. A decision aid to support informed choices about bowel cancer screening among adults with low education: randomised controlled trial. BMJ. 2010;341:c5370. https://doi.org/10.1136/bmj.c5370. CrossRefPubMedPubMedCentral

36.

Steckelberg A, Hulfenhaus C, Haastert B, Muhlhauser I. Effect of evidence based risk information on “informed choice” in colorectal cancer screening: randomised controlled trial. BMJ. 2011;342:d3193. https://doi.org/10.1136/bmj.d3193.CrossRefPubMedPubMedCentral

37.

Wolf AM, Schorling JB. Does informed consent alter elderly patients’ preferences for colorectal cancer screening? Results of a randomized trial. J Gen Intern Med. 2000;15:24–30. https://doi.org/10.1046/j.1525-1497.2000.01079.x.CrossRefPubMedPubMedCentral

38.

Griffith JM, Fichter M, Fowler FJ, Lewis C, Pignone MP. Should a colon cancer screening decision aid include the option of no testing? A comparative trial of two decision aids. BMC Med Inform Decis Mak. 2008;8:10. https://doi.org/10.1186/1472-6947-8-10.CrossRefPubMedPubMedCentral

39.

Schroy PC, Duhovic E, Chen CA, Heeren TC, Lopez W, Apodaca DL, et al. Risk stratification and shared decision making for Colorectal Cancer screening. Med Decis Mak. 2016;36:526–35. https://doi.org/10.1177/0272989X15625622.CrossRef

40.

Prochaska JO, Redding CA, Evers K. The Transtheoretical model and stages of change. In: Glanz K, Rimer BK, Lewis FM, editors. Health behavior and health education: theory, research, and practice. 3rd ed. San Francisco: Jossey-Bass, Inc.; 2002.

41.

Durand M-A, Carpenter L, Dolan H, Bravo P, Mann M, Bunn F, et al. Do interventions designed to support shared decision-making reduce health inequalities? A systematic review and meta-analysis. PLoS One. 2014;9:e94670. https://doi.org/10.1371/journal.pone.0094670.CrossRefPubMedPubMedCentral

42.

Gentles SJ, Stacey D, Bennett C, Alshurafa M, Walter SD. Factors explaining the heterogeneity of effects of patient decision aids on knowledge of outcome probabilities: a systematic review sub-analysis. Syst Rev. 2013;2:95. https://doi.org/10.1186/2046-4053-2-95.CrossRefPubMedPubMedCentral

Title: Effectiveness of a decision aid for promoting colorectal cancer screening in Spain: a randomized trial
Authors: Lilisbeth Perestelo-Perez
Amado Rivero-Santana
Alezandra Torres-Castaño
Vanesa Ramos-Garcia
Yolanda Alvarez-Perez
Nerea Gonzalez-Hernandez
Andrea Buron
Michael Pignone
Pedro Serrano-Aguilar
Publication date: 01-12-2019
Publisher: BioMed Central
Keywords: Care
Colonoscopy
Colorectal Cancer
Colorectal Cancer
Published in: BMC Medical Informatics and Decision Making / Issue 1/2019
Electronic ISSN: 1472-6947
DOI: https://doi.org/10.1186/s12911-019-0739-6

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Effectiveness of a decision aid for promoting colorectal cancer screening in Spain: a randomized trial

Abstract

Background

Methods

Results

Conclusions

Trial registration

At a glance: The ONWARDS insulin icodec trials

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

Trial registration

Please log in to get access to this content

Other articles of this Issue 1/2019

Patient centred variables with univariate associations with unplanned ICU admission: a systematic review

Post-acute care referral in United States of America: a multiregional study of factors associated with referral destination in a cohort of patients with coronary artery bypass graft or valve replacement

Correction to: Methods for identifying 30 chronic conditions: application to administrative data

How professional capital and team heterogeneity affect the demands of online team-based medical service

Decision curve analysis apropos of choice of preferable treatment positioning during breast irradiation

A novel hybrid modeling approach for the evaluation of integrated care and economic outcome in heart failure treatment