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

A randomized trial

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

Research output: Contribution to journalArticle

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).

Original languageEnglish (US)
Article number8
JournalBMC Medical Informatics and Decision Making
Volume19
Issue number1
DOIs
StatePublished - Jan 10 2019

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Decision Support Techniques
Early Detection of Cancer
Spain
Colorectal Neoplasms
Occult Blood
Hematologic Tests
Colonoscopy
Population
Primary Health Care
Randomized Controlled Trials
Outcome Assessment (Health Care)
Mortality
Incidence

Keywords

  • Colorectal cancer screening
  • Decision aid
  • Patient involvement
  • Primary care
  • Randomized controlled trial
  • Shared decision-making
  • Spain

ASJC Scopus subject areas

  • Health Policy
  • Health Informatics

Cite this

Perestelo-Perez, L., Rivero-Santana, A., Torres-Castaño, A., Ramos-Garcia, V., Alvarez-Perez, Y., Gonzalez-Hernandez, N., ... Serrano-Aguilar, P. (2019). Effectiveness of a decision aid for promoting colorectal cancer screening in Spain: A randomized trial. BMC Medical Informatics and Decision Making, 19(1), [8]. https://doi.org/10.1186/s12911-019-0739-6

Effectiveness of a decision aid for promoting colorectal cancer screening in Spain : A randomized trial. / Perestelo-Perez, Lilisbeth; Rivero-Santana, Amado; Torres-Castaño, Alezandra; Ramos-Garcia, Vanesa; Alvarez-Perez, Yolanda; Gonzalez-Hernandez, Nerea; Buron, Andrea; Pignone, Michael; Serrano-Aguilar, Pedro.

In: BMC Medical Informatics and Decision Making, Vol. 19, No. 1, 8, 10.01.2019.

Research output: Contribution to journalArticle

Perestelo-Perez, L, Rivero-Santana, A, Torres-Castaño, A, Ramos-Garcia, V, Alvarez-Perez, Y, Gonzalez-Hernandez, N, Buron, A, Pignone, M & Serrano-Aguilar, P 2019, 'Effectiveness of a decision aid for promoting colorectal cancer screening in Spain: A randomized trial', BMC Medical Informatics and Decision Making, vol. 19, no. 1, 8. https://doi.org/10.1186/s12911-019-0739-6
Perestelo-Perez L, Rivero-Santana A, Torres-Castaño A, Ramos-Garcia V, Alvarez-Perez Y, Gonzalez-Hernandez N et al. Effectiveness of a decision aid for promoting colorectal cancer screening in Spain: A randomized trial. BMC Medical Informatics and Decision Making. 2019 Jan 10;19(1). 8. https://doi.org/10.1186/s12911-019-0739-6
Perestelo-Perez, Lilisbeth ; Rivero-Santana, Amado ; Torres-Castaño, Alezandra ; Ramos-Garcia, Vanesa ; Alvarez-Perez, Yolanda ; Gonzalez-Hernandez, Nerea ; Buron, Andrea ; Pignone, Michael ; Serrano-Aguilar, Pedro. / Effectiveness of a decision aid for promoting colorectal cancer screening in Spain : A randomized trial. In: BMC Medical Informatics and Decision Making. 2019 ; Vol. 19, No. 1.
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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).",
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T2 - A randomized trial

AU - Perestelo-Perez, Lilisbeth

AU - Rivero-Santana, Amado

AU - Torres-Castaño, Alezandra

AU - Ramos-Garcia, Vanesa

AU - Alvarez-Perez, Yolanda

AU - Gonzalez-Hernandez, Nerea

AU - Buron, Andrea

AU - Pignone, Michael

AU - Serrano-Aguilar, Pedro

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AB - 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).

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