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

https://doi.org/10.1016/j.pec.2013.01.004Get rights and content
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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.

Keywords

Colorectal cancer
Screening
Colonoscopy
CT Colonography
Informed decision making

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