title: Factors Associated with Informed Decisions and Participation in Bowel Cancer Screening among Adults with Lower Education and Literacy.
abstract: Making informed decisions about cancer screening involves understanding the benefits and harms in conjunction with personal values. There is little research examining factors associated with informed decision making or participation in screening in the context of a decision aid trial.
  
  
  
  To identify factors associated with informed choice and participation in fecal occult blood testing (FOBT) among lower education populations.
  
  
  
  Randomized controlled trial of an FOBT decision aid conducted between July and November 2008.
  
  
  
  Socioeconomically disadvantaged areas in New South Wales, Australia.
  
  
  
  Included 572 adults aged 55 to 64 years with lower education.
  
  
  
  Sociodemographic variables, perceived health literacy, and involvement preferences in decision making were examined to identify predictors of informed choice (knowledge, attitudes, and behavior).
  
  
  
  Multivariate analysis identified independent predictors of making an informed choice as having higher education (relative risk [RR], 1.49; 95% confidence interval [CI], 1.13-1.95; P = 0.001), receiving the decision aid (RR, 2.88; 95% CI, 1.87-4.44; P < 0.001), and being male (RR, 1.48; 95% CI, 1.11-1.97; P = 0.009). Participants with no confidence in completing forms and poorer self-reported health were less likely to make an informed choice (RR, 0.74; 95% CI, 0.53-1.03; P = 0.05 and RR, 0.57; 95% CI, 0.36-0.89; P = 0.007, respectively). Independent predictors of completing the FOBT were positive screening attitudes, receiving the standard information, preference for making the decision alone, and knowing that screening may lead to false-positive/negative results.
  
  
  
  We did not objectively measure health literacy.
  
  
  
  Participants with the lowest levels of education had greater difficulties making an informed choice about participation in bowel screening. Alternative methods are needed to support informed decision making among lower education populations.
authors.affiliation: Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine University of New South Wales, NSW, Australia (SKS)
authors.forename: Sian K
authors.initials: SK
authors.lastname: Smith
authors.affiliation: Sydney School of Public Health, University of Sydney, NSW, Australia (JMS)
authors.forename: Judy M
authors.initials: JM
authors.lastname: Simpson
authors.affiliation: Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, NSW, Australia (LJT, KJM)|Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, NSW, Australia (LJT, KJM).
authors.forename: Lyndal J
authors.initials: LJ
authors.lastname: Trevena
authors.affiliation: Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, NSW, Australia (LJT, KJM)|Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, NSW, Australia (LJT, KJM).
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 / Q000523:psychology*; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D057220:Health Literacy; D006304:Health Status; D006801:Humans; D008297:Male; D008875:Middle Aged; D009517:New South Wales; D009780:Occult Blood; D010358:Patient Participation / Q000379:methods*; D012737:Sex Factors
keywords: cancer screening; decision aids; decision-making; education; fecal occult blood test; health literacy; informed choice; predictors; randomized controlled trials