Different information needs-The major reasons for calling the helpline when invited to colorectal cancer screening

Making the BEST Decision-the BESTa Project: Description of the Design and Alpha Phases as Part of the Development of a Digital Decision Aid for Cancer Screening in Sweden

A digital decision aid for cancer screening can gather balanced information in one place and give individuals the opportunity to elucidate their knowledge, values and engage in shared decision-making. Research shows that ethnic minorities and individuals with various functional limitations participate in cancer screening to a lower extent, hence our ambition to make the decision aid as available and applicable as possible, regardless of end-users' traits. The aim was to describe the design and alpha phases of the development of a digital decision aid for CRC screening and tentative end-users' perceptions. Based on a scientific framework for development of decision aids, participants were recruited through multiple channels. The decision aid was evaluated in two steps, a paper version (design phase) and a website prototype (alpha phase), using the think-aloud approach. Data were rich with detailed suggestions for improvements of the decision aid and how it was perceived. A positive outlook on the decision aid was common. Certain words, wordings or visual features were considered difficult and worry or anxiety, related to the content, were expressed. The variation in the findings illustrates the challenges of decision aid development. Still, our findings emphasise the importance of designing a decision aid in co-creation with its end-users. Developing a digital decision aid is complex, why a well-established framework is essential. With the goal of an equal healthcare system, the inclusion of individuals with diverse backgrounds and functional limitations should not only be a fundamental aspect of all research, but a prerequisite.

Co-construction of an instructional module to improve the understanding of cancer screening by people with intellectual disabilities: Strategic choices

OBJECTIVE

People with intellectual disabilities (ID) have difficulty in accessing oral or written health information presented in a conventional manner what compromises prevention. This study aims to develop accessible information on breast, cervical and colorectal cancer screening for people with ID.

METHOD

The instructional material has been developed collaboratively by a team involving representatives from different scientific disciplines (medical and psychoeducational) and people with ID. Five principles guided its elaboration, i.e. coconstruction, multimodality, phasing, socio-cognitivism and accessibility.

RESULTS

The material created is a 5-component module including a 20-minute easy-toread and understand oral presentation with a slideshow, a workshop that encourages manipulation and discussion, a booklet to take away, a film to consolidate information and a questionnaire.

CONCLUSION

Providing accessible information is considered a key action in reestablishing equality in access to cancer health care and preventing a cascade of consequences. The co-construction of the module ensures its social and ecological validity. An interventional study is underway to verify its efficacy.

PRACTICAL IMPLICATION

The best practices for cancer prevention endorse spending enough time to discuss screening. This accessible module can be used to provide people with ID basic information about screening, increase their adherence, and facilitate the discussion on this issue.

Making the BEST decision-the BESTa project development, implementation and evaluation of a digital Decision Aid in Swedish cancer screening programmes- a description of a research project

BACKGROUND

Sweden has a long tradition of organized national population-based screening programmes. Participation rates differ between programmes and regions, being relatively high in some groups, but lower in others. To ensure an equity perspective on screening, it is desirable that individuals make an informed decision based on knowledge rather than ignorance, misconceptions, or fear. Decision Aids (DAs) are set to deliver information about different healthcare options and help individuals to visualize the values associated with each available option. DAs are not intended to guide individuals to choose one option over another. The advantage of an individual Decision Aid (iDA) is that individuals gain knowledge about cancer and screening by accessing one webpage with the possibility to communicate with health professionals and thereafter make their decision regarding participation. The objective is therefore to develop, implement and evaluate a digital iDA for individuals invited to cancer screening in Sweden.

METHODS

This study encompasses a process-, implementation-, and outcome evaluation. Multiple methods will be applied including focus group discussions, individual interviews and the usage of the think aloud technique and self-reported questionnaire data. The project is based on The International Patient Decision Aid Standards (IPDAS) framework and the proposed model development process for DAs. Individuals aged 23-74, including women (the cervical-, breast- and CRC screening module) and men (the CRC screening module), will be included in the developmental process. Efforts will be made to recruit participants with self-reported physical and mental limitations, individuals without a permanent residence and ethnic minorities.

DISCUSSION

To the best of our knowledge, the present study is the first attempt aimed at developing an iDA for use in the Swedish context. The iDA is intended to facilitate shared decision making about participation in screening. Furthermore, the iDA is expected to increase knowledge and raise awareness about cancer and cancer screening.

PATIENT OR PUBLIC CONTRIBUTION

Lay people are involved throughout the whole development and implementation process of the digital DA.

TRIAL REGISTRATION

NCT05512260.