A randomised controlled trial of a bowel cancer screening decision aid for adults with low education and literacy

英联邦已承诺为国家肠癌筛查计划提供资金。这将涉及邮寄肠道检测试剂盒直接到符合条件的消费者在他们的家中。为了最大限度地减少在接受筛查方面的不平等现象，并确保方案的有效性，来自低教育背景和高教育背景的参与者都必须能够获得有关检测的信息和说明。本项目将评估实现这一目标的沟通战略。在医疗保健领域，对书面信息的依赖迅速增加。特别是，使用患者决策辅助工具来支持和告知健康决策的情况正在迅速增加。需要改善信息的筛选程序已特别强调和决策援助提供了一个基于证据的方法来实现这一点。然而，虽然有1级证据表明决策辅助工具可以改善消费者的决策过程，但研究几乎只在受过教育的高识字率参与者中进行。令人关切的是，教育程度低和识字率有限的成年人的需求被忽视。拟议研究分为两个阶段。第一阶段将测试针对教育程度和识字率较低的成年人的最佳量化风险沟通格式。第二阶段将评估一种针对FOBT筛查的低识字率决策辅助工具。该试验将测试决策辅助是否可以增加筛查知识，增加决策参与，提高低教育程度成年人的决策质量，并将研究其对筛查意图和行为的影响。这是一项非常重要的研究。筛查提供者需要更好的方式来告知消费者筛查计划，这些计划可以为不同的受众提供，并在目标人群中公平。这项研究将对国家肠癌筛查计划的使用产生直接影响。

The Commonwealth has committed funds for a national bowel cancer screening program. This will involve mailing bowel testing kits direct to eligible consumers at their homes. To minimise inequalities in accessing screening and to ensure effectiveness of the program, information and instructions for testing will have to be accessible to participants from low as well as high educational backgrounds. This project will evaluate communication strategies to achieve this. Reliance on written information has rapidly increased within healthcare. In particular, the use of patient decision aids to support and inform health decisions is rapidly increasing. The need to improve information in screening programs has been particularly highlighted and decision aids provide an evidence based approach to achieve this. However, whilst there is level 1 evidence that decision aids improve the decision making process for consumers, research has been carried out almost exclusively among educated participants with high literacy. There is concern that the needs of adults with low education and limited literacy have been ignored. The proposed study is 2 phased. Phase I will test optimal quantitative risk communication formats for adults with low education and literacy. Phase 2 will evaluate a tailored low literacy decision aid for FOBT screening. The trial will test whether the decision aid can increase knowledge of screening, increase involvement in decisions and improve the quality of decision making among adults with low education, and will examine its impact on screening intentions and behaviour. This is a highly significant study. Screening providers need better ways to inform consumers of screening programs that are accessible to a diverse audience and equitable across the target population. This study will have direct implications for use in the national bowel cancer screening program.