Can cancer risk information raise awareness without increasing anxiety? A randomized trial
Introduction
Promoting public awareness of cancer risk factors was one of the key proposals in the UK NHS Cancer Plan (Department of Health, 2000), and other countries have similarly recognized the need to increase knowledge about cancer (World Health Organisation, 2004). However, because cancer is widely perceived as threatening, there is concern that dissemination of cancer-related information could heighten public anxiety about the disease (Entwistle and Watt, 1998).
Knowledge of colorectal cancer (CRC) is very limited in the UK (McCaffery et al., 2003), but this may be because colorectal screening has not been part of the UK National Screening Program (NSP). Raising public awareness of CRC risk factors is timely because colorectal screening will be included in the NSP for the first time in 2006.
The present study investigated the impact of mailed information on CRC risk factors on knowledge, anxiety, worry, and screening intentions. We hypothesized that risk factor information alone might raise anxiety, but providing information on screening at the same time would allay adverse psychological effects as predicted by the fear–drive model (Hovland et al., 1953).
Section snippets
Participants
Participants were aged 45–66 years (N = 3,365) and registered with one of two general practices in South-West England. None of the participants had been screened before because screening was not part of the UK NSP at the time of data collection. Doctors excluded anyone diagnosed with cancer or awaiting investigation, as well as “vulnerable” participants (e.g., very ill, learning difficulties).
Procedure
Randomization was by household to one of three groups: (1) control group (no information leaflet); (2)
Results
Questionnaires were returned by 61% (Fig. 1). Respondents were slightly older (M = 55.0 years vs. M = 54.4 years; t(3183) = 2.90, P = 0.01), more likely to be female (52.2% vs. 47.8%; χ2(2, N = 3185) = 29.32, P = 0.01), and came from less deprived neighborhoods (Townsend scores M = −1.44 (SD = 2.58) vs. M = 0.97 (SD = 2.73); t(3102) = −4.79, P = 0.01) than non-respondents.
There were no differences in response rates across the groups nor any differences in demographic characteristics (Table 1).
The
Discussion
Respondents receiving the information leaflet had significantly greater knowledge about the risk factors for CRC but were no more anxious or worried about CRC than the control group, contrary to the fears of some health professionals (Entwistle and Watt, 1998). Indeed, levels of anxiety across all three groups were slightly lower than observed in previous studies (Marteau and Bekker, 1992). Presenting cancer risk factor information with or without screening information did not differentially
Acknowledgments
We thank Manjo Doug, Christine Pike, and the doctors, staff, and patients at St. Leonard's Research Practice and Ide Lane Surgery, Exeter. This work was supported by the Medical Research Council and Cancer Research UK, but all work was initiated and analyzed by the investigators.
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