title: Informed choice in bowel cancer screening: a qualitative study to explore how adults with lower education use decision aids.
abstract: BACKGROUND
  Offering informed choice in screening is increasingly advocated, but little is known about how evidence-based information about the benefits and harms of screening influences understanding and participation in screening.
  
  
  OBJECTIVE
  We aimed to explore how a bowel cancer screening decision aid influenced decision making and screening behaviour among adults with lower education and literacy.
  
  
  METHODS
  Twenty-one men and women aged 55-64 years with lower education levels were interviewed about using a decision aid to make their screening decision. Participants were purposively selected to include those who had and had not made an informed choice.
  
  
  RESULTS
  Understanding the purpose of the decision aid was an important factor in whether participants made an informed choice about screening. Participants varied in how they understood and integrated quantitative risk information about the benefits and harms of screening into their decision making; some read it carefully and used it to justify their screening decision, whereas others dismissed it because they were sceptical of it or lacked confidence in their own numeracy ability. Participants' prior knowledge and beliefs about screening influenced how they made sense of the information.
  
  
  CONCLUSIONS
  Participants valued information that offered them a choice in a non-directive way, but were concerned that it would deter people from screening. Healthcare providers need to be aware that people respond to screening information in diverse ways involving a range of literacy skills and cognitive processes.
authors.affiliation: Post-Doctoral Research FellowResearch AssistantAssociate Professor Screening and Test Evaluation Program, Centre for Medical Psychology and Evidence Based Decision-Making, Sydney School of Public Health, University of Sydney, NSW, AustraliaProfessor of Epidemiology, Centre for Medical Psychology and Evidence Based Decision-Making, Sydney School of Public Health, University of Sydney, NSW, AustraliaVice-Chancellor, Professor of Public Health, Office of the Vice-Chancellor, University of Southampton, UK.
authors.forename: Sian K
authors.initials: SK
authors.lastname: Smith
authors.forename: Paul
authors.initials: P
authors.lastname: Kearney
authors.forename: Lyndal
authors.initials: L
authors.lastname: Trevena
authors.forename: Alexandra
authors.initials: A
authors.lastname: Barratt
authors.forename: Don
authors.initials: D
authors.lastname: Nutbeam
authors.forename: Kirsten J
authors.initials: KJ
authors.lastname: McCaffery
mesh_terms: D002755:Choice Behavior; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003657:Decision Making; D003661:Decision Support Techniques; D055088:Early Detection of Cancer / Q000379:methods*; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006801:Humans; D008297:Male; D008875:Middle Aged; D010358:Patient Participation / Q000379:methods*; D036301:Qualitative Research