Informed decision-making in colorectal cancer screening using colonoscopy or CT-colonography

• Published in: Patient education and counseling 2013-06, Vol.91 (3), p.318-325
• Main Authors: de Haan, Margriet C, de Wijkerslooth, Thomas R, Stoop, Esther, Bossuyt, Patrick, Fockens, Paul, Thomeer, Maarten, Kuipers, Ernst J, Essink-Bot, Marie-Louise, van Leerdam, Monique E, Dekker, Evelien, Stoker, Jaap
• Format: Article
• Language: English
• Subjects: Aged; Attitudes; Colonography, Computed Tomographic - methods; Colonography, Computed Tomographic - utilization; Colonoscopy; Colonoscopy - methods; Colonoscopy - utilization; Colorectal cancer; Colorectal Neoplasms - diagnosis; CT Colonography; Decision Making; Early Detection of Cancer; Health Knowledge, Attitudes, Practice; Humans; Information Dissemination; Informed decision making; Internal Medicine; Mass Screening - psychology; Middle Aged; Netherlands; Nursing; Patient Education as Topic; Positive thought; Registries; Screening; Socioeconomic Factors; Surveys and Questionnaires
• ISSN: 0738-3991; 1873-5134
• DOI: 10.1016/j.pec.2013.01.004

Abstract Objective To evaluate the level of informed decision making in a randomized controlled trial comparing colonoscopy and CT-colonography for colorectal cancer screening. Methods 8844 citizens aged 50–75 were randomly invited to colonoscopy ( n = 5924) or CT-colonography ( n = 2920) screening. All invitees received an information leaflet. Screenees received a questionnaire within 4 weeks before the planned examination, non-screenees 4 weeks after the invitation. A decision was categorized as informed when characterized by sufficient decision-relevant knowledge and consistent with personal attitudes toward participation in screening. Results Knowledge and attitude items were completed by 1032/1276 colonoscopy screenees (81%), by 698/4648 colonoscopy non-screenees (15%), by 824/982 CT-colonography screenees (84%) and by 192/1938 CT-colonography non-screenees (10%). 1027 colonoscopy screenees (>99%) and 815 CT-colonography screenees (99%) had adequate knowledge; 915 (89%) and 742 (90%) had a positive attitude. 675 non-screenees invited to colonoscopy (97%) and 182 invited to CT-colonography (95%) had adequate knowledge; 344 (49%) and 94 (49%) expressed a negative attitude. Conclusion A large majority of screenees made an informed decision on participation. Almost half of responding non-screenees, made an uninformed decision, suggesting additional barriers to participation. Practice implications Efforts to understand the additional barriers will create opportunities to facilitate informed participation to colorectal cancer screening.