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Colorectal cancer screening: Associations between information provision, attitudes and intended participation

https://doi.org/10.1016/j.pec.2017.08.021Get rights and content

Highlights

  • Attitudes towards colorectal cancer screening were assessed in a screening-naïve population.

  • Intentions about participation were value-concordant in majority of respondents.

  • Balanced information on negative effects did not impede high rates of intended participation.

Abstract

Objective

Properly informing target audiences is crucial in population-based screening programs. We aimed to evaluate the impact of information about CRC screening on attitudes and intended participation in a screening-naive population.

Methods

614 persons (aged 55–75 years) received a survey. Information on CRC and screening was provided piece by piece, and per piece its impact on attitudes and intended participation was assessed. All persons received the same information content, but the sequence of information differed per condition: information on the high mortality rate of colorectal cancer was presented in the first or the second piece. Educational levels, the extent people considered future consequences, and value concordance between attitudes and intentions were assessed.

Results

436 persons (response 71%) completed the survey. Overall most respondents reported positive attitudes towards CRC screening (78%) and intentions to participate in CRC screening (83%), independent of sequence of information provision. Intentions about participation were value concordant in the majority (88%). Results were similar in low educated groups.

Conclusion

Providing balanced information about CRC screening (also addressing negative effects) did not impede value concordance and high rates of intended participation.

Practice implications

High rates of screening intentions are possible without omitting threatening health information in communication materials.

Introduction

Colorectal cancer (CRC) is the second most common cause of cancer-related deaths in high income countries [1], [2], [3]. CRC screening is effective in reducing disease-specific mortality [4], [5], [6], as survival rates are high if detected early, and fecal immunochemical blood testing (FIT) is highly effective in detecting CRC [7].

Informed decision-making is an important objective in cancer screening [3] [8], [9], [10], [11]. Informed decisions are based on relevant knowledge, concordant with values and behaviorally implemented [12]. Lower levels of informed decisions among non-participants in CRC screening [13], [14] can be related to insufficient knowledge14 [15], e.g. unawareness that CRC may not have symptoms, [14] or to barriers such as embarrassment and worries about risks of the test [14], [15], [16].

Current evidence regarding effective strategies to enhance informed decision-making without impacting CRC screening uptake in vulnerable groups is conflicting. Some decision aids for adults with lower educational levels were found to increase knowledge and informed decision-making [17], but also to reduce participation [17], [18]. This highlights the dilemma between enabling informed decision-making and increasing screening uptake [17], [19]. Alternatively, informed participation could be pursued by framing information so that it facilitates informed decision-making and encourages participation simultaneously. To enhance informed participation, improved understanding is needed on the effect of informing strategies within socioeconomic subpopulations [13], [18], [20].

As no CRC screening program had been introduced in the Netherlands yet, the unique opportunity arose to assess respondents’ initial reactions to screening information. Our objectives were to evaluate how information on various aspects of CRC screening affected attitudes and intended participation in a screening naive population, to assess the impact of the sequence of the information, and to assess whether attitudes and intentions aligned (‘value concordance’) [21], [22], [23].

Section snippets

Methods

In January 2013, a survey was conducted among 620 members of a Dutch online research panel, aged 55–75 years. To provide a sample reflective of the Dutch population panel members were selected according to gender and educational level. Data of respondents who reported a history of CRC (testing) were excluded (Fig. 1).

Based on decision aids guidelines [24] we developed a set of five pieces of information (part 1 to 5, Appendix A), addressing e.g. the high rate of CRC mortality (which may be

Results

A total of 436 panel members (70%) returned completed surveys. Data of 12 respondents was excluded due to a CRC (testing) history. Gender and educational level were reflective of the Dutch population. Global quality of life was comparable to the Dutch population aged 60–69 (Table 1). Most respondents preferred a directive communication in decision-making (Table 1).

Attitude scores indicated positive attitudes (Fig. 3). Only information about colonoscopy led to a significantly less positive

Discussion

The sequence of information provision (mortality start versus neutral start) did not impact either attitudes or intended participation. The proportion of value concordant decisions was high, and reported attitudes and intended participation were positive. This implies that there is no need to be concerned about the sequence in which information on CRC is given.

Surprisingly, educational level did not impact attitudes and intended participation. Individuals with low consideration of future

Acknowledgement

We gratefully acknowledge the funding that one of the authors (Ida J. Korfage) received from the Dutch Cancer Society for this study (EMCR 2003–2775). None of the other authors received funding for the submitted work. Other research activities of one of the authors (Esther Toes-Zoutendijk) were financed by the National Institute of Public Health and the Environment.

The authors were completely independent in the study design, in the collection, analysis and interpretation of data, in the writing

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