PDF(Pubmed)
Abstract：
BACKGROUND: Australian guidelines recommend that people aged 50-70 years consider taking low-dose aspirin to reduce their risk of colorectal cancer (CRC).
OBJECTIVE: To determine the effect of a consultation with a researcher before an appointment in general practice using a decision aid presenting the benefits and harms of taking low-dose aspirin compared with a general CRC prevention brochure on patients\' informed decision making and low-dose aspirin use.
METHODS: Individually randomised controlled trial in six general practices in Victoria, Australia, from October 2020 to March 2021.
METHODS: Participants were recruited from a consecutive sample of patients aged 50-70 years attending a GP. The intervention was a consultation using a decision aid to discuss taking aspirin to reduce CRC risk while control consultations discussed reducing CRC risk generally. Self-reported co-primary outcomes were the proportion of individuals making informed choices about taking aspirin at 1 month and on low-dose aspirin uptake at 6 months, respectively. The intervention effect was estimated using a generalised linear model and reported with Bonferroni-adjusted 95% confidence intervals (CIs) and P-values.
RESULTS: A total of 261 participants (86% of eligible patients) were randomised into trial arms (n = 129 intervention; n = 132 control). Of these participants, 17.7% (n = 20/113) in the intervention group and 7.6% (n = 9/118) in the control group reported making an informed choice about taking aspirin at 1 month, an estimated 9.1% (95% CI = 0.29 to 18.5) between-arm difference in proportions (odds ratio [OR] 2.47, 97.5% CI = 0.94 to 6.52, P = 0.074). The proportions of individuals who reported taking aspirin at 6 months were 10.2% (n = 12/118) of the intervention group versus 13.8% (n = 16/116) of the control group, an estimated between-arm difference of -4.0% (95% CI = -13.5 to 5.5; OR 0.68 [97.5% CI = 0.27 to 1.70, P = 0.692]).
CONCLUSIONS: The decision aid improved informed decision making but this did not translate into long-term regular use of aspirin to reduce CRC risk. In future research, decision aids should be delivered alongside various implementation strategies.
OBJECTIVE: To determine the effect of a consultation with a researcher before an appointment in general practice using a decision aid presenting the benefits and harms of taking low-dose aspirin compared with a general CRC prevention brochure on patients\' informed decision making and low-dose aspirin use.
METHODS: Individually randomised controlled trial in six general practices in Victoria, Australia, from October 2020 to March 2021.
METHODS: Participants were recruited from a consecutive sample of patients aged 50-70 years attending a GP. The intervention was a consultation using a decision aid to discuss taking aspirin to reduce CRC risk while control consultations discussed reducing CRC risk generally. Self-reported co-primary outcomes were the proportion of individuals making informed choices about taking aspirin at 1 month and on low-dose aspirin uptake at 6 months, respectively. The intervention effect was estimated using a generalised linear model and reported with Bonferroni-adjusted 95% confidence intervals (CIs) and P-values.
RESULTS: A total of 261 participants (86% of eligible patients) were randomised into trial arms (n = 129 intervention; n = 132 control). Of these participants, 17.7% (n = 20/113) in the intervention group and 7.6% (n = 9/118) in the control group reported making an informed choice about taking aspirin at 1 month, an estimated 9.1% (95% CI = 0.29 to 18.5) between-arm difference in proportions (odds ratio [OR] 2.47, 97.5% CI = 0.94 to 6.52, P = 0.074). The proportions of individuals who reported taking aspirin at 6 months were 10.2% (n = 12/118) of the intervention group versus 13.8% (n = 16/116) of the control group, an estimated between-arm difference of -4.0% (95% CI = -13.5 to 5.5; OR 0.68 [97.5% CI = 0.27 to 1.70, P = 0.692]).
CONCLUSIONS: The decision aid improved informed decision making but this did not translate into long-term regular use of aspirin to reduce CRC risk. In future research, decision aids should be delivered alongside various implementation strategies.
摘要：
背景：澳大利亚指南建议50-70岁的人考虑服用低剂量阿司匹林以降低其结直肠癌（CRC）的风险。
目的：确定在一般实践中使用决策辅助工具与研究人员进行咨询的效果，该决策辅助工具介绍了与一般CRC预防手册相比，服用低剂量阿司匹林对患者的明智决策和低剂量阿司匹林的使用的益处和危害。
方法：在维多利亚州的六个一般实践中进行的单独随机对照试验，澳大利亚,从2020年10月到2021年3月。
方法：参与者从50-70岁参加GP的患者的连续样本中招募。干预是使用决策援助的咨询，讨论服用阿司匹林以降低CRC风险，而对照咨询则讨论降低CRC风险。自我报告的共同主要结果是在1个月时对服用阿司匹林和6个月时服用低剂量阿司匹林做出知情选择的个体比例。分别。使用广义线性模型估计干预效果，并用Bonferroni调整的95％置信区间（CI）和P值报告。
结果：共有261名参与者（86%的合格患者）被随机分配到试验组（n=129干预；n=132对照）。在这些参与者中,干预组的17.7%（n=20/113）和对照组的7.6%（n=9/118）报告在1个月时对服用阿司匹林做出了明智的选择。估计的9.1%(95%CI=0.29~18.5)的组间比例差异(比值比[OR]2.47,97.5%CI=0.94~6.52,P=0.074).6个月时报告服用阿司匹林的个体比例为干预组的10.2%(n=12/118)，对照组为13.8%(n=16/116)。估计的臂间差异为-4.0%(95%CI=-13.5至5.5;OR0.68[97.5%CI=0.27至1.70,P=0.692])。
结论：决策辅助改善了知情决策，但这并不能转化为长期定期使用阿司匹林来降低CRC风险。在未来的研究中,决策辅助工具应与各种实施策略一起提供。
目的：确定在一般实践中使用决策辅助工具与研究人员进行咨询的效果，该决策辅助工具介绍了与一般CRC预防手册相比，服用低剂量阿司匹林对患者的明智决策和低剂量阿司匹林的使用的益处和危害。
方法：在维多利亚州的六个一般实践中进行的单独随机对照试验，澳大利亚,从2020年10月到2021年3月。
方法：参与者从50-70岁参加GP的患者的连续样本中招募。干预是使用决策援助的咨询，讨论服用阿司匹林以降低CRC风险，而对照咨询则讨论降低CRC风险。自我报告的共同主要结果是在1个月时对服用阿司匹林和6个月时服用低剂量阿司匹林做出知情选择的个体比例。分别。使用广义线性模型估计干预效果，并用Bonferroni调整的95％置信区间（CI）和P值报告。
结果：共有261名参与者（86%的合格患者）被随机分配到试验组（n=129干预；n=132对照）。在这些参与者中,干预组的17.7%（n=20/113）和对照组的7.6%（n=9/118）报告在1个月时对服用阿司匹林做出了明智的选择。估计的9.1%(95%CI=0.29~18.5)的组间比例差异(比值比[OR]2.47,97.5%CI=0.94~6.52,P=0.074).6个月时报告服用阿司匹林的个体比例为干预组的10.2%(n=12/118)，对照组为13.8%(n=16/116)。估计的臂间差异为-4.0%(95%CI=-13.5至5.5;OR0.68[97.5%CI=0.27至1.70,P=0.692])。
结论：决策辅助改善了知情决策，但这并不能转化为长期定期使用阿司匹林来降低CRC风险。在未来的研究中,决策辅助工具应与各种实施策略一起提供。
