Ian Zajac, Ingrid Flight, Carlene Wilson, Tess Gregory, Deborah Turnbull, Steve Cole, Graeme Young Testing the efficacy of internet-based personalised decision support for colorectal cancer screening

Impact of Colorectal Cancer Colorectal Cancer is the second most commonly diagnosed cancer and is the second leading cause of cancer-related death in Australia. In 2005, 7,181 males and 5,895 females were diagnosed with CRC.

Personalised Decision Support Trial So –Why use the web?? Rapidly increasing usage of Internet amongst the ‘Silver Surfers’ Users can interact with information in ways that have no precedents in paper documents Print is static in nature; while they may contain both text, graphics and images, they may not contain video, animation or sound, which may reinforce the educational message Ability to avoid procrastination

So –Why tailor?? Catch attention Be read and remembered Be saved for later reference Be discussed with others Be perceived as interesting By perceived as personally relevant By perceived as having been written especially for the reader Personalised Decision Support Trial

Preventive Health Model (PHM) Constructs* Salience and Coherence (4 items) “Colorectal cancer screening makes sense to me” Cancer Worries (2 items) “I am afraid of having an abnormal colorectal cancer screening result” Response Efficacy (2 items) “When colorectal cancer is found early, it can be cured” Social Influence (4 items) “My doctor/family thinks I should have colorectal cancer screening” Perceived susceptibility (4 items) “Compared with other persons my age, I am at lower risk for colorectal cancer” *Tiro et al (2005), Cancer Epidemiol Biomarkers Prev 14: Personalised Decision Support Trial

Creating a library of tailored messages FACTORRESPONSE EFFICACY Stage significanc e Not considering; Decided to do Statemen t When colorectal polyps are found, colorectal cancer can be prevented. Strongly agree [Name], you’ve told us that colon cancer screening is effective. You’re absolutely right. That is why the Australian Cancer Council recommends yearly screening for people over 50 who are of average risk. It’s an important step to take to protect your health for the future, and could save your life. Agree[Name], you’ve told us that you believe colon cancer screening is effective. You’re right. That is why the Australian Cancer Council recommends yearly screening for people over 50 who are of average risk. It’s an important step to take to protect your health for the future, and could save your life. Not sure[Name], you’re not sure that colon cancer screening is effective. It’s very effective—that’s why the Australian Cancer Council recommends yearly screening for people over 50 who are of average risk. As you are [age], It’s an important step to take to protect your health for the future, and could save your life. Disagree[Name], you don’t think that colon cancer screening is effective. In fact it’s very effective—that’s why the Australian Cancer Council recommends yearly screening for people over 50 who are of average risk. As you are [age], screening could save your life by finding early, curable cancer. Strongly Disagree [Name], you really don’t believe that colon cancer screening is effective. In fact it’s very effective—that’s why the Australian Cancer Council recommends yearly screening for people over 50 who are of average risk. As you are [age], screening could save your life by finding early, curable cancer. Reinforcing Motivating

Web based, tailored decision aid for CRC screening

Primary Hypotheses: 1)Access to Tailored PDS improves participation in CRC screening relative to Non-tailored and Control conditions 2)Access to PDS moves people to a higher decision-stage for screening when compared to non-tailored PDS and control groups. Personalised Decision Support Trial

Eligibility Criteria: 1Access to the Internet at some location (i.e., home, library etc) 2Absence of FOBT screening in preceding 12 months 3Absence of Colonoscopy in preceding 5 years 4No clinical diagnosis of Bowel Cancer Personalised Decision Support Trial

RECRUITMENT N=25,000 invitational surveys sent out (N=25,500 in Total) Current Stats N=10,464 returned surveys (41%) N=8,762 completed the ES (84%) N=3421 Eligible... About 40% Males: 49% Females: 51% Aged <60: 56.5% Aged 60 – 70: 36% Aged 70+: 11.5% Personalised Decision Support Trial

RANDOMISATION Tailored PDS: N=1,137 Non-Tailored: N=1,136 Control: N=1135 FOBT INVITATIONS Tailored PDS: N=720 Non-Tailored: N=712 Control: N=815 Personalised Decision Support Trial *Stratification levels; State, Sex, Age

Preliminary Results Current Participation Rates Tailored x Control, p=.02; Non-Tailored x Control, p=.002

Personalised Decision Support Trial X 2 (8) = 3.63, p=.88 X 2 (2) = 0.85, p=.65

Why does PDS result in improved screening uptake? The answer is unknown at the moment: Follow up behavioural measurements still underway In-depth qualitative interviews yet to be undertaken Complex website user data yet to be analysed Possibilities? PDS provides instant access to relevant, well organised information prior to receipt of the FOBT kit. Does this help participants move through decision stages easier/faster than otherwise? Personalised Decision Support Trial

Questions?