Making decisions about colorectal cancer screening. A qualitative study among citizens with lower educational attainment

Kirkegaard, Pia; Mortensen, Gitte Lee; Mortensen, Steen Lee; Larsen, Mette Bach; Gabel, Pernille; Andersen, Berit

doi:10.1093/eurpub/ckv207

Cited by 19 publications

(35 citation statements)

References 22 publications

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“…[46] However, in this Danish setting, the paper format of the values clarification exercise was considered inapplicable. [23] In the present study, the The DA was distributed via email, because most citizens are expected to use eHealth solutions, since digital communication is mandatory.…”

Section: Interpretation Of Resultsmentioning

confidence: 99%

“…[22,32] We also used earlier findings about Danish LEA citizens' information needs, which range from preferences to receive a clear recommendation with minimum of information to desires for detailed information and the opportunity to make a personalized decision. [23] We chose to develop a web-based DA, presenting information in steps, and thereby embracing these diverse information preferences. …”

Section: Planning the Developmentmentioning

confidence: 99%

“…According to Coulter et al [29], this step should also evaluate comprehensibility, but since the citizens' information needs, and their preferred figure and chart representations were already described [23], we deferred this evaluation to step 5. For the second alpha testing (step 4b), we conducted email correspondence with citizens and healthcare professionals, exploring usability, acceptability, and design.…”

Section: Alpha and Beta Testingmentioning

confidence: 99%

“…The diverse information needs in LEA citizens as described by Kirkegaard et al [23] prompted the presentation of information in steps. Further, the stepwise development of the DA made it possible to include a wide range of stakeholders and use different ways of communication.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

“…However, regardless of the format, the DA must be developed according to the targeted citizens' information needs. [22] LEA citizens have diverse information needs [23], but few DAs have been specifically tailored to LEA citizens [14,[24][25][26] and none has been developed embracing diverse information needs in CRC screening.…”

mentioning

confidence: 99%

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Developing a Self-Administered Decision Aid for Fecal Immunochemical Test�Based Colorectal Cancer Screening Tailored to Citizens With Lower Educational Attainment: Qualitative Study (Preprint)

Gabel¹,

Kirkegaard²,

Larsen³

et al. 2017

Preprint

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BACKGROUND Citizens with lower educational attainments (EA) take up colorectal cancer screening to a lesser degree, and more seldom read and understand conventional screening information than citizens with average EAs. The information needs of citizens with lower EA are diverse, however, with preferences ranging from wanting clear recommendations to seeking detailed information about screening. Decision aids have been developed to support citizens with lower EA in making informed decisions about colorectal cancer screening participation, but none embrace diverse information needs. OBJECTIVE The aim of this study was to develop a self-administered decision aid for participation in fecal immunochemical test–based colorectal cancer screening. The decision aid should be tailored to citizens with lower EA and should embrace diverse information needs. METHODS The Web-based decision aid was developed according to an international development framework, with specific steps for designing, alpha testing, peer reviewing, and beta testing the decision aid. In the design phase, a prototype of the decision aid was developed based on previous studies about the information needs of lower EA citizens and the International Patient Decision Aid Standards guidelines. Alpha testing was conducted using focus group interviews and email correspondence. Peer review was conducted using email correspondence. Both tests included both lower EA citizens and health care professionals. The beta testing was conducted using telephone interviews with citizens with lower EA. Data were analyzed using thematic analysis. RESULTS The developed decision aid presented information in steps, allowing citizens to read as much or as little as wanted. Values clarification questions were included after each section of information, and answers were summarized in a “choice-indicator” on the last page, guiding the citizens toward a decision about screening participation. Statistics were presented in both natural frequencies, absolute risk formats and graphically. The citizens easily and intuitively navigated around the final version of the decision aid and stated that they felt encouraged to think about the benefits and harms of colorectal cancer screening without being overloaded with information. They found the decision aid easy to understand and the text of suitable length. The health care professionals agreed with the citizens on most parts; however, concerns were raised about the length and readability of the text. CONCLUSIONS We have developed a self-administered decision aid presenting information in steps. We involved both citizens and health care professionals to target the decision aid for citizens with lower EA. This decision aid represents a new way of communicating detailed information and may be able to enhance informed choices about colorectal cancer screening participation among citizens with lower EA.

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Section: Interpretation Of Resultsmentioning

confidence: 99%