Wilson Carlene J, Flight Ingrid Hk, Turnbull Deborah, Gregory Tess, Cole Stephen R, Young Graeme P, Zajac Ian T
Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia.
Cancer Council South Australia, Eastwood, South Australia, Australia.
BMC Med Inform Decis Mak. 2015 Apr 9;15:25. doi: 10.1186/s12911-015-0147-5.
In Australia, bowel cancer screening participation using faecal occult blood testing (FOBT) is low. Decision support tailored to psychological predictors of participation may increase screening. The study compared tailored computerised decision support to non-tailored computer or paper information. The primary outcome was FOBT return within 12 weeks. Additional analyses were conducted on movement in decision to screen and change on psychological variables.
A parallel, randomised controlled, trial invited 25,511 people aged 50-74 years to complete an eligibility questionnaire. Eligible respondents (n = 3,408) were assigned to Tailored Personalised Decision Support (TPDS), Non-Tailored PDS (NTPDS), or Control (CG) (intention-to-treat, ITT sample). TPDS and NTPDS groups completed an on-line baseline survey (BS) and accessed generic information. The TPDS group additionally received a tailored intervention. CG participants completed a paper BS only. Those completing the BS (n = 2270) were mailed an FOBT and requested to complete an endpoint survey (ES) that re-measured BS variables (per-protocol, PP sample).
FOBT return: In the ITT sample, there was no significant difference between any group (χ (2)(2) = 2.57, p = .26; TPDS, 32.5%; NTPDS, 33%; and CG, 34.5%). In the PP sample, FOBT return in the internet groups was significantly higher than the paper group (χ (2)(2) = 17.01, p < .001; TPDS, 80%; NTPDS, 83%; and CG, 74%). FOBT completion by TPDS and NTPDS did not differ (χ (2)(1) = 2.23, p = .13). Age was positively associated with kit return. Decision to screen: 2227/2270 of the PP sample provided complete BS data. Participants not wanting to screen at baseline (1083/2227) and allocated to TPDS and NTPDS were significantly more likely to decide to screen and return an FOBT than those assigned to the CG. FOBT return by TPDS and NTPDS did not differ from one another (OR = 1.16, p = .42). Change on psychosocial predictors: Analysis of change indicated that salience and coherence of screening and self-efficacy were improved and faecal aversion decreased by tailored messaging.
Online information resources may have a role in encouraging internet-enabled people who are uncommitted to screening to change their attitudes, perceptions and behaviour.
Australian New Zealand Clinical Trials Registry ACTRN12610000095066.
在澳大利亚，使用粪便潜血检测（FOBT）进行肠癌筛查的参与率较低。针对参与筛查的心理预测因素进行定制的决策支持可能会提高筛查率。本研究将定制的计算机化决策支持与非定制的计算机或纸质信息进行了比较。主要结局是在12周内返回FOBT。对筛查决策的变化以及心理变量的变化进行了额外分析。
一项平行、随机对照试验邀请了25511名年龄在50 - 74岁的人完成一份资格调查问卷。符合条件的受访者（n = 3408）被分配到定制个性化决策支持组（TPDS）、非定制PDS组（NTPDS）或对照组（CG）（意向性分析，ITT样本）。TPDS组和NTPDS组完成了在线基线调查（BS）并获取了一般信息。TPDS组还额外接受了定制干预。CG组参与者仅完成了纸质BS。完成BS的人（n = 2270）收到了一份FOBT，并被要求完成一份终点调查（ES），该调查重新测量了BS变量（符合方案分析，PP样本）。
FOBT返回情况：在ITT样本中，任何组之间均无显著差异（χ(2)(2)=2.57，p = 0.26；TPDS组为32.5%；NTPDS组为33%；CG组为34.5%）。在PP样本中，互联网组的FOBT返回率显著高于纸质组（χ(2)(2)=17.01，p < 0.001；TPDS组为80%；NTPDS组为83%；CG组为74%）。TPDS组和NTPDS组的FOBT完成情况无差异（χ(2)(1)=2.23，p = 0.13）。年龄与试剂盒返回呈正相关。筛查决策：PP样本中的2 / 270提供了完整的BS数据。基线时不想筛查且被分配到TPDS组和NTPDS组的参与者比被分配到CG组的参与者更有可能决定进行筛查并返回FOBT。TPDS组和NTPDS组的FOBT返回情况彼此无差异（OR = 1.16，p = 0.42）。心理社会预测因素的变化：对变化的分析表明，定制信息传递改善了筛查的显著性和连贯性以及自我效能感，并降低了粪便厌恶感。
在线信息资源可能在鼓励未参与筛查的互联网用户改变其态度、观念和行为方面发挥作用。
澳大利亚新西兰临床试验注册中心ACTRN12610000095066 。
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