Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands.
National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands.
PLoS One. 2020 May 29;15(5):e0233308. doi: 10.1371/journal.pone.0233308. eCollection 2020.
It is increasingly considered important that people make an autonomous and informed decision concerning colorectal cancer (CRC) screening. However, the realisation of autonomy within the concept of informed decision-making might be interpreted too narrowly. Additionally, relatively little is known about what the eligible population believes to be a 'good' screening decision. Therefore, we aimed to explore how the concepts of autonomous and informed decision-making relate to how the eligible CRC screening population makes their decision and when they believe to have made a 'good' screening decision.
We conducted 27 semi-structured interviews with the eligible CRC screening population (eighteen CRC screening participants and nine non-participants). The general topics discussed concerned how people made their CRC screening decision, how they experienced making this decision and when they considered they had made a 'good' decision.
Most interviewees viewed a 'good' CRC screening decision as one based on both reasoning and feeling/intuition, and that is made freely. However, many CRC screening non-participants experienced a certain social pressure to participate. All CRC screening non-participants viewed making an informed decision as essential. This appeared to be the case to a lesser extent for CRC screening participants. For most, experiences and values were involved in their decision-making.
Our sample of the eligible CRC screening population viewed aspects related to the concepts of autonomous and informed decision-making as important for making a 'good' CRC screening decision. However, in particular the existence of a social norm may be affecting a true autonomous decision-making process. Additionally, the present concept of informed decision-making with its strong emphasis on making a fully informed and well-considered decision does not appear to be entirely reflective of the process in practice. More efforts could be made to attune to the diverse values and factors that are involved in deciding about CRC screening participation.
越来越多的人认为，人们应该自主地、知情地做出关于结直肠癌（CRC）筛查的决定。然而，在知情决策的概念中，对自主性的实现可能被解读得过于狭隘。此外，人们对合格的 CRC 筛查人群认为什么样的筛查决定是“好”的了解相对较少。因此，我们旨在探讨自主和知情决策的概念如何与合格的 CRC 筛查人群做出决定的方式以及他们何时认为自己做出了“好”的筛查决定相关。
我们对合格的 CRC 筛查人群（18 名 CRC 筛查参与者和 9 名非参与者）进行了 27 次半结构化访谈。讨论的主题包括人们如何做出 CRC 筛查决定、他们如何体验做出这一决定以及何时认为自己做出了“好”的筛查决定。
大多数受访者认为，一个“好”的 CRC 筛查决定是基于推理和感觉/直觉的，并且是自由做出的。然而，许多 CRC 筛查非参与者感受到了一定的社会压力来参与。所有 CRC 筛查非参与者都认为知情决策是必不可少的。对于 CRC 筛查参与者来说，这种情况的程度要小一些。对于大多数人来说，经验和价值观都参与了他们的决策过程。
我们的合格 CRC 筛查人群样本认为，与自主和知情决策概念相关的方面对于做出“好”的 CRC 筛查决定很重要。然而，特别是社会规范的存在可能会影响真正的自主决策过程。此外，目前知情决策的概念强调做出充分知情和深思熟虑的决定，这似乎与实践中的决策过程并不完全一致。可以做出更多努力来适应决定参与 CRC 筛查的各种价值观和因素。
