促进西班牙结直肠癌筛查的决策辅助工具的效果：一项随机试验。
Effectiveness of a decision aid for promoting colorectal cancer screening in Spain: a randomized trial.
机构信息
Evaluation Unit of the Canary Islands Health Service (SESCS), s/n. 38109. El Rosario. S/C de Tenerife, Tenerife, Spain.
Health Services Research on Chronic Patients Network (REDISSEC), Tenerife, Spain.
出版信息
BMC Med Inform Decis Mak. 2019 Jan 10;19(1):8. doi: 10.1186/s12911-019-0739-6.
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).
背景
结直肠癌（CRC）筛查已被证明可降低发病率和死亡率，因此广泛推荐 50 岁以上人群进行筛查。然而，尽管在多个国家实施了基于人群的筛查计划，但其参与率仍然很低。决策辅助工具（DAs）可以帮助患者对 CRC 筛查做出知情决策。
方法
我们进行了一项随机对照试验，评估了一种针对 CRC 筛查的决策辅助工具的有效性，该工具用于西班牙两家初级保健中心从未接受过 CRC 筛查的患者。与中心 B（n=24）不同，中心 A（n=83）的患者来自当时尚未实施基于人群的筛查计划的地区。结局指标包括决策冲突、对疾病和可用筛查选择的了解、接受测试的意愿，以及患者的目标/关注点与意图的一致性。
结果
在中心 A，决策冲突（p<0.001）和知识（p<0.001）方面，DA 组具有显著优势。DA 组在粪便潜血试验（10.5%）和结肠镜检查（13.7%）意愿方面的绝对差异在未经衰减校正时具有显著意义。在中心 B，仅知识方面存在显著差异（p<0.001）。患者对筛查的目标和关注点并未显著预测其意图，因此我们无法计算这两个结构之间的一致性度量。
结论
决策辅助工具改善了从未被邀请参加西班牙公共 CRC 筛查计划的参与者的决策过程，复制了该领域的先前结果。需要进一步研究以确定哪些亚组可能从这些干预措施中获益更多。
试验注册
国际标准随机对照临床试验注册编号：ISRCTN98108615（2018 年 12 月 27 日回顾性注册）。
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