基于受教育程度的大肠癌筛查决策辅助工具对知情选择各要素效果的随机对照试验。
Effectiveness of a decision aid for colorectal cancer screening on components of informed choice according to educational attainment: A randomised controlled trial.
机构信息
Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark.
Division of Population Medicine, School of Medicine, Cardiff University, Cardiff, United Kingdom.
出版信息
PLoS One. 2020 Nov 10;15(11):e0241703. doi: 10.1371/journal.pone.0241703. eCollection 2020.
BACKGROUND
The decision to take up colorectal cancer screening has to be made on informed grounds balancing benefits and harms. Self-administered decision aids can support citizens in making an informed choice. A self-administered web-based decision aid targeting citizens with lower educational attainment has been evaluated within the target population. However, the effectiveness in the general screening population remains unexplored. The aim of this study was to evaluate the effectiveness of a web-based decision aid for colorectal cancer screening on components of informed choice among previous non-participants in colorectal cancer screening.
METHODS AND FINDINGS
The study was designed as a parallel randomised controlled trial among non-participants in colorectal cancer screening in Central Denmark Region (men and women aged 53-74 years). Respondents to baseline and follow-up questionnaires comprised the study population (n = 1,723). The intervention group received the decision aid electronically along with the second reminder. The control group received only the second reminder. The main outcomes (knowledge, attitudes, uptake and decisional conflict) were obtained through questionnaires data and from the Danish Colorectal Cancer Screening Database. The decision aid increased the uptake rate by 8 percentage points (95% CI: 3.4;12.6) but had no effect on either knowledge (scale score differences: 0.09; 95% CI: -0.05;0.24) or attitudes (0.45; 95% CI: -0.00;0.91). Decisional conflict decreased by 1.69 scale points (95% CI: -3.18;-0.20). The effect was similar across educational attainment levels.
CONCLUSIONS
The web-based decision aid offers a feasible way to provide individualised screening information in a "one size fits all" approach that may hold the potential to increase informed CRC screening uptake.
TRIAL REGISTRATION
ClinicalTrials.gov registration number: NCT03253888.
背景
在权衡收益和危害的基础上，做出接受结直肠癌筛查的决定必须基于充分知情。自我管理的决策辅助工具可以帮助公民做出明智的选择。一种针对受教育程度较低的公民的自我管理式网络决策辅助工具已经在目标人群中进行了评估。然而，其在一般筛查人群中的效果仍有待探索。本研究旨在评估一种针对结直肠癌筛查的网络决策辅助工具在结直肠癌筛查的既往非参与者中对知情选择各组成部分的有效性。
方法和发现
该研究是在丹麦中部地区（年龄在 53-74 岁的男性和女性）的结直肠癌筛查既往非参与者中设计的一项平行随机对照试验。基线和随访问卷调查的应答者构成了研究人群（n=1723）。干预组通过电子方式收到决策辅助工具和第二次提醒。对照组仅收到第二次提醒。主要结局（知识、态度、参与率和决策冲突）通过问卷调查数据和丹麦结直肠癌筛查数据库获得。决策辅助工具使参与率提高了 8 个百分点（95%CI：3.4；12.6），但对知识（量表评分差异：0.09；95%CI：-0.05；0.24）或态度（0.45；95%CI：-0.00；0.91）均无影响。决策冲突减少了 1.69 个量表点（95%CI：-3.18；-0.20）。这种效果在不同的教育程度水平中是相似的。
结论
该网络决策辅助工具提供了一种可行的方法，可以在“一刀切”的方法中提供个体化的筛查信息，这可能有潜力提高结直肠癌筛查的知情参与率。
临床试验注册号
NCT03253888。
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