Shared decision-making tool development for colorectal cancer screening: A co-creative process with general practitioners and underserved people

Objectives

European guidelines stress the importance of informed decision-making in colorectal cancer (CRC) screening. However, tailored tools that facilitate this process among underserved people and general practitioners (GPs) in Flanders are still lacking. This study aimed to co-create a shared decision-making (SDM) tool for CRC screening with both underserved populations and GPs, capturing their needs and preferences for content, design, and delivery.

Study design

Qualitative study.

Methods

Two rounds of six focus group discussions with underserved people, and five local quality group meetings with GPs were conducted in different areas of Flanders, Belgium. Qualitative data were analyzed using a Modified-Grounded Theory Analytical (M-GTA) approach to identify key themes.

Results

Findings revealed four core themes. The first theme, 'Recognizing the Barriers to Screening', identifies challenges such as a lack of time, staff, and tools to facilitate preventive talks, as well as language and literacy barriers for underserved people in CRC screening. The second theme, 'Learning from Existing Tools', highlights successful elements like visuals and simple language and limitations such as low accessibility and poor navigation. The third theme, 'Determining the Content and Design,' reveals that GPs seek user-friendly tools for at-home viewing, while underserved people value personalised and clear information about CRC risk factors and screening costs. The final theme, 'Identifying Strategies for Integration,' stresses the importance of a structured, personalised, collaborative care approach in using the SDM tool for preventive talks in practice.

Conclusion

Enhancing the accessibility and relevance of SDM tools, particularly in content and design tailored to both underserved people and GPs, is the key to overcoming barriers such as language and health literacy. Nonetheless, further testing is needed to confirm the effectiveness of the SDM tool in supporting SDM in CRC screening.