title: Making decisions about colorectal cancer screening. A qualitative study among citizens with lower educational attainment.
abstract: BACKGROUND
  Few decision aids (DAs) have been developed to support an informed choice to citizens with lower educational attainment about colorectal cancer screening. The aim of this study was to identify information needs and preferences for formats and content in a DA for this group of citizens.
  
  
  METHODS
  Four focus groups were conducted among Danish men and women aged 50-74 years with lower educational attainment. A semi-structured interview guide was developed to explore participants' perceptions about colorectal cancer screening and wishes for a DA. The interviews were transcribed and analysed using an ethnographic approach.
  
  
  RESULTS
  The participants appreciated information about the causes, symptoms, incidence and mortality of colorectal cancer compared with other common cancers. The majority preferred the information to be presented in a clear and simple way with numbers and figures kept to a minimum. Values clarification exercises were not found useful. Receiving a screening kit to collect a sample of faeces along with the invitation letter was seen by the participants as a clear request from the health authorities to get screened. However, the overall message in the DA was perceived as ambiguous by the participants as it both recommended screening and seemed to disclaim responsibility for it.
  
  
  CONCLUSIONS
  The results are relevant to a discussion of the delicate balance between participants' call for a clear recommendation, and the purpose of a DA to present options in a neutral and balanced way. This discussion is relevant beyond the group of citizens with lower educational attainment.
authors.affiliation: 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark 2 Research Unit for General Practice, School of Public Health, Aarhus University, Denmark pia.kirkegaard@rm.dk.
authors.forename: Pia
authors.initials: P
authors.lastname: Kirkegaard
authors.affiliation: 3 AnthroConsult, Fynsgade 24, Aarhus C 8000, Denmark.
authors.forename: Gitte Lee
authors.initials: GL
authors.lastname: Mortensen
authors.affiliation: 3 AnthroConsult, Fynsgade 24, Aarhus C 8000, Denmark.
authors.forename: Steen Lee
authors.initials: SL
authors.lastname: Mortensen
authors.affiliation: 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark.
authors.forename: Mette Bach
authors.initials: MB
authors.lastname: Larsen
authors.affiliation: 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark.
authors.forename: Pernille
authors.initials: P
authors.lastname: Gabel
authors.affiliation: 1 Department of Public Health Programmes, Randers Regional Hospital, Denmark.
authors.forename: Berit
authors.initials: B
authors.lastname: Andersen
mesh_terms: D000368:Aged; D002755:Choice Behavior; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D003657:Decision Making; D003718:Denmark; D055088:Early Detection of Cancer / Q000523:psychology*; D004522:Educational Status; D005260:Female; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008297:Male; D008875:Middle Aged; D010353:Patient Education as Topic / Q000379:methods*; D010358:Patient Participation / Q000379:methods*; D036301:Qualitative Research