Decision-making by patients is a growing topic of investigation. Previous studies, however, have not assessed whether information about the outcomes of colorectal cancer screening increased informed choice among people from a range of socioeconomic backgrounds nor have they assessed whether this can be administered away from a health-care provider. Trevena and coworkers conducted a randomized controlled trial of a decision aid for colorectal cancer in six primary care locations. Three hundred and fourteen people aged 50-74 years received a self-administered decision aid (DA) booklet about outcomes of biennial fecal occult blood testing (FOBT) screening or government consumer guidelines (G). Significantly more DA recipients (20.9%) were 'informed' compared with G recipients (5.8%); the DA did not affect values clarity (61.9% clear after DA versus 59.1% after G) nor screening decisions overall (87.3% would screen after DA versus 90.5% after G). Test uptake at one month was uniformly low (5.2% DA versus 6.6% G), mostly due to patients claiming to being too busy. DA recipients were more likely to make decisions integrating' knowledge with values (10.4% DA versus 1.5% G). Decisions not to screen were equally uncommon in both groups but more likely to be uninformed in G. More DA recipients from all education levels were informed, particularly in lower education (50.0% DA versus 17.8% G) and university-educated groups (79.4% DA versus 32.1% G).

WHAT THE STUDY MAY MEAN TO YOU AS A HEALTH CARE PROVIDER: Detailed absolute risk and benefit information about FOBT screening can be effectively used at home by people to increase informed choice. The DA was effective in people with lower education levels.

WHAT THE STUDY MAY MEAN TO YOU AS A PATIENT: The nice thing about this study is that level of education was independent of the ability of patients to make informed decisions. The fact that those with lower education levels used the decision making aid effectively is encouraging news to those teaching decision making skills to all patients with a chronic illness. This is particularly important, as decision-making is a basic skill in self-management.

LJ Trevena et al. Randomized trial of a self-administered decision aid for colorectal cancer screening. Journal of Medical Screening, 2008;15:76-82.