Skip to main content
PMC home page
Journal of Epidemiology and Community Health logoLink to Journal of Epidemiology and Community Health
. 2003 Aug;57(8):589–593. doi: 10.1136/jech.57.8.589

Randomised controlled trial of the effect of evidence based information on women's willingness to participate in cervical cancer screening

P Adab 1, T Marshall 1, A Rouse 1, B Randhawa 1, H Sangha 1, N Bhangoo 1
PMCID: PMC1732533  PMID: 12883063

Abstract

Study objectives: To assess whether providing women with additional information on the pros and cons of screening, compared with information currently offered by the NHS, affects their intention to attend for screening.

Design: Randomised controlled trial. Participants were randomly assigned to receive either the control, (based on an NHS Cervical Screening Programme leaflet currently used), or the intervention leaflet (containing additional information on risks and uncertainties).

Setting: Three general practices in Birmingham.

Participants: 300 women aged 20 to 64 attending the practices during a one month period.

Main outcome measures: Intention to attend for screening.

Main results: 283 women (94.3%) completed the study. Fewer women in the intervention (79%) than the control group (88%) expressed intention to have screening after reading the information leaflet (difference between groups 9.2%, 95% confidence intervals (CI) 3.2% to 21.7%). The crude odds ratio (OR) and 95% CI was 0.50 (0.26 to 0.97). After adjusting for other factors, the trend persisted (OR 0.60, 95% CI 0.28 to 1.29). Having a previous Pap smear was the only significant predictor of intention to have screening (adjusted OR 2.54, 95% CI 1.03 to 6.21). Subgroup analysis showed no intervention effect in intended uptake between women at higher and lower risk of cervical cancer (p=0.59).

Conclusions: Providing women with evidence based information on the risks, uncertainties, and the benefits of screening, is likely to deter some, but not differentially those at higher risk.

Full Text

The Full Text of this article is available as a PDF (158.8 KB).

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. Anderson C. M., Nottingham J. Bridging the knowledge gap and communicating uncertainties for informed consent in cervical cytology screening; we need unbiased information and a culture change. Cytopathology. 1999 Aug;10(4):221–228. doi: 10.1046/j.1365-2303.1999.00198.x. [DOI] [PubMed] [Google Scholar]
  2. Austoker J. Cancer prevention in primary care. Screening for cervical cancer. BMJ. 1994 Jul 23;309(6949):241–248. doi: 10.1136/bmj.309.6949.241. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. Cannistra S. A., Niloff J. M. Cancer of the uterine cervix. N Engl J Med. 1996 Apr 18;334(16):1030–1038. doi: 10.1056/NEJM199604183341606. [DOI] [PubMed] [Google Scholar]
  4. Cockburn J., Redman S., Hill D., Henry E. Public understanding of medical screening. J Med Screen. 1995;2(4):224–227. doi: 10.1177/096914139500200410. [DOI] [PubMed] [Google Scholar]
  5. Coulter A. Evidence based patient information. is important, so there needs to be a national strategy to ensure it. BMJ. 1998 Jul 25;317(7153):225–226. doi: 10.1136/bmj.317.7153.225. [DOI] [PMC free article] [PubMed] [Google Scholar]
  6. Domenighetti Gianfranco, Grilli Roberto, Maggi Jenny Rose. Does provision of an evidence-based information change public willingness to accept screening tests? Health Expect. 2000 Jun;3(2):145–150. doi: 10.1046/j.1369-6513.2000.00081.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  7. Edwards Adrian, Elwyn Glyn, Mulley Al. Explaining risks: turning numerical data into meaningful pictures. BMJ. 2002 Apr 6;324(7341):827–830. doi: 10.1136/bmj.324.7341.827. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Flood A. B., Wennberg J. E., Nease R. F., Jr, Fowler F. J., Jr, Ding J., Hynes L. M. The importance of patient preference in the decision to screen for prostate cancer. Prostate Patient Outcomes Research Team. J Gen Intern Med. 1996 Jun;11(6):342–349. doi: 10.1007/BF02600045. [DOI] [PubMed] [Google Scholar]
  9. Foster P., Anderson C. M. Reaching targets in the national cervical screening programme: are current practices unethical? J Med Ethics. 1998 Jun;24(3):151–157. doi: 10.1136/jme.24.3.151. [DOI] [PMC free article] [PubMed] [Google Scholar]
  10. Jepson R. G., Forbes C. A., Sowden A. J., Lewis R. A. Increasing informed uptake and non-uptake of screening: evidence from a systematic review. Health Expect. 2001 Jun;4(2):116–126. doi: 10.1046/j.1369-6513.2001.00143.x. [DOI] [PMC free article] [PubMed] [Google Scholar]
  11. Kreuter M. W. Dealing with competing and conflicting risks in cancer communication. J Natl Cancer Inst Monogr. 1999;(25):27–35. doi: 10.1093/oxfordjournals.jncimonographs.a024203. [DOI] [PubMed] [Google Scholar]
  12. Lerman C., Biesecker B., Benkendorf J. L., Kerner J., Gomez-Caminero A., Hughes C., Reed M. M. Controlled trial of pretest education approaches to enhance informed decision-making for BRCA1 gene testing. J Natl Cancer Inst. 1997 Jan 15;89(2):148–157. doi: 10.1093/jnci/89.2.148. [DOI] [PubMed] [Google Scholar]
  13. Nottingham J. Women must be given fully informed information about cervical screening. BMJ. 1999 Jun 5;318(7197):1555–1556. doi: 10.1136/bmj.318.7197.1555a. [DOI] [PMC free article] [PubMed] [Google Scholar]
  14. O'Connor A. M., Rostom A., Fiset V., Tetroe J., Entwistle V., Llewellyn-Thomas H., Holmes-Rovner M., Barry M., Jones J. Decision aids for patients facing health treatment or screening decisions: systematic review. BMJ. 1999 Sep 18;319(7212):731–734. doi: 10.1136/bmj.319.7212.731. [DOI] [PMC free article] [PubMed] [Google Scholar]
  15. Quinn M., Babb P., Jones J., Allen E. Effect of screening on incidence of and mortality from cancer of cervix in England: evaluation based on routinely collected statistics. BMJ. 1999 Apr 3;318(7188):904–908. doi: 10.1136/bmj.318.7188.904. [DOI] [PMC free article] [PubMed] [Google Scholar]
  16. Raffle A. E., Alden B., Mackenzie E. F. Detection rates for abnormal cervical smears: what are we screening for? Lancet. 1995 Jun 10;345(8963):1469–1473. doi: 10.1016/s0140-6736(95)91036-0. [DOI] [PubMed] [Google Scholar]
  17. Raffle A. E. Screening for the 21st century: learning from the past. Cytopathology. 2000 Feb;11(1):4–7. doi: 10.1046/j.1365-2303.2000.00226.x. [DOI] [PubMed] [Google Scholar]
  18. Sasieni P., Adams J. Effect of screening on cervical cancer mortality in England and Wales: analysis of trends with an age period cohort model. BMJ. 1999 May 8;318(7193):1244–1245. doi: 10.1136/bmj.318.7193.1244. [DOI] [PMC free article] [PubMed] [Google Scholar]
  19. Wolf A. M., Nasser J. F., Wolf A. M., Schorling J. B. The impact of informed consent on patient interest in prostate-specific antigen screening. Arch Intern Med. 1996 Jun 24;156(12):1333–1336. [PubMed] [Google Scholar]
  20. Wolf A. M., Philbrick J. T., Schorling J. B. Predictors of interest in prostate-specific antigen screening and the impact of informed consent: what should we tell our patients? Am J Med. 1997 Oct;103(4):308–314. doi: 10.1016/s0002-9343(97)00155-1. [DOI] [PubMed] [Google Scholar]

Associated Data

This section collects any data citations, data availability statements, or supplementary materials included in this article.

Supplementary Materials

[Web-only Appendix]
jepicomh_57_8_589__index.html (1.2KB, html)
jepicomh_57_8_589__1.pdf (100KB, pdf)

Articles from Journal of Epidemiology and Community Health are provided here courtesy of BMJ Publishing Group

RESOURCES