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Lewis JA, Klein DE, Eberth JM, Carter-Bawa L, Studts JL, Tong BC, Smith RA, Kazerooni EA, Houston TP. The American Cancer Society National Lung Cancer Roundtable strategic plan: Provider engagement and outreach. Cancer 2024. [PMID: 39302232 DOI: 10.1002/cncr.34555] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/22/2024]
Abstract
The American Cancer Society National Lung Cancer Roundtable strategic plan for provider engagement and outreach addresses barriers to the uptake of lung cancer screening, including lack of provider awareness and guideline knowledge about screening, concerns about potential harms from false-positive examinations, lack of time to implement workflows within busy primary care practices, insufficient infrastructure and administrative support to manage a screening program and patient follow-up, and implicit bias based on sex, race/ethnicity, social class, and smoking status. Strategies to facilitate screening include educational programming, clinical reminder systems within the electronic medical record, decision support aids, and tools to track nodules that can be implemented across a diversity of practices and health care organizational structures. PLAIN LANGUAGE SUMMARY: The American Cancer Society National Lung Cancer Roundtable strategic plan to reduce deaths from lung cancer includes strategies designed to support health care professionals, to better understand lung cancer screening, and to support adults who are eligible for lung cancer screening by providing counseling, referral, and follow-up.
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Affiliation(s)
- Jennifer A Lewis
- Veterans Health Administration-Tennessee Valley Healthcare System Geriatric Research, Education and Clinical Center, Nashville, Tennessee, USA
- Division of Hematology/Oncology, Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Vanderbilt Ingram Cancer Center, Nashville, Tennessee, USA
| | - Deborah E Klein
- Swedish Primary Care, Swedish Medical Center, Seattle, Washington, USA
| | - Jan M Eberth
- Dornsife School of Public Health, Drexel University, Philadelphia, Pennsylvania, USA
| | - Lisa Carter-Bawa
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| | - Jamie L Studts
- Department of Medicine, Division of Medical Oncology, University of Colorado School of Medicine, Aurora, Colorado, USA
| | - Betty C Tong
- Division of Cardiovascular and Thoracic Surgery, Department of Surgery, Duke University Medical Center, Durham, North Carolina, USA
| | - Robert A Smith
- Center for Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| | - Ella A Kazerooni
- Division of Cardiothoracic Radiology, Department of Radiology, University of Michigan, Ann Arbor, Michigan, USA
- Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Thomas P Houston
- Department of Family Medicine, The Ohio State University College of Medicine, Columbus, Ohio, USA
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Rose DE, Farmer MM, Oishi SM, Klap RS, Bean-Mayberry BA, Canelo I, Washington DL, Yano EM. Does a Welcoming Environment Influence Women Veterans' Primary Care Experiences? Womens Health Issues 2024; 34:540-548. [PMID: 39198050 DOI: 10.1016/j.whi.2024.07.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2023] [Revised: 07/05/2024] [Accepted: 07/18/2024] [Indexed: 09/01/2024]
Abstract
BACKGROUND A welcoming environment may influence patient care experiences, and it may be particularly relevant for underrepresented groups, such as women veterans at Veterans Health Administration (VA) facilities where they represent only 8-10% of patients. Challenges to ensuring a welcoming environment for women veterans may include unwelcome comments from male veterans and staff or volunteers and feeling unsafe inside or outside VA facilities. We assessed associations between reports of gender-related environment of care problems and patient-reported outcomes. PROCEDURES We merged national patient-reported outcomes from women veterans (n = 4,961) using Consumer Assessment of Health Plans & Systems Patient Centered Medical Home (CAHPS-PCMH) survey composite measures with Women Veteran Program Managers' reports of gender-related environment of care problems (n = 127, 2016-2017) at VA facilities. We performed multilevel bivariate logistic regressions to assess associations between Women Veteran Program Managers' reports of large/extreme problems and likelihood of women veterans' optimal ratings of primary care experiences (access, coordination, comprehensiveness, provider communication, and overall rating of primary care provider). We adjusted for patient-, site-, and area-level characteristics, and clustering of patients within VA facilities, and we applied design weights to address nonresponse bias in the patient data. Response rates were 40% for women veterans and 90% for Women Veteran Program Managers. MAIN FINDINGS Few (<15%) Women Veteran Program Managers reported large/extreme environment of care problems. Women veterans obtaining care at those sites were less likely to rate provider communication and comprehensiveness (psychosocial health assessed) as optimal. PRINCIPAL CONCLUSIONS Ensuring a welcoming environment may improve women veterans' primary care experiences.
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Affiliation(s)
- Danielle E Rose
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California.
| | - Melissa M Farmer
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Sabine M Oishi
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Ruth S Klap
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Bevanne A Bean-Mayberry
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California; Division of General Internal Medicine and Health Services Research, David Geffen School of Medicine at University of California Los Angeles, Los Angeles, California; UCLA Fielding School of Public Health, Los Angeles, California
| | - Ismelda Canelo
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Donna L Washington
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
| | - Elizabeth M Yano
- VA HSR Center for the Study of Healthcare Innovation, Implementation & Policy, VA Greater Los Angeles Healthcare System, Los Angeles, California
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Petrik AF, Johnson ES, Mummadi R, Slaughter M, Coronado GD, Lin SC, Savitz L, Wallace N. The use of individual and multilevel data in the development of a risk prediction model to predict patients' likelihood of completing colorectal cancer screening. Prev Med Rep 2023; 36:102366. [PMID: 37732019 PMCID: PMC10507149 DOI: 10.1016/j.pmedr.2023.102366] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2023] [Revised: 08/07/2023] [Accepted: 08/08/2023] [Indexed: 09/22/2023] Open
Abstract
Promotion of colorectal cancer (CRC) screening can be expensive and unnecessary for many patients. The use of predictive analytics promises to help health systems target the right services to the right patients at the right time while improving population health. Multilevel data at the interpersonal, organizational, community, and policy levels, is rarely considered in clinical decision making but may be used to improve CRC screening risk prediction. We compared the effectiveness of a CRC screening risk prediction model that uses multilevel data with a more conventional model that uses only individual patient data. We used a retrospective cohort to ascertain the one-year occurrence of CRC screening. The cohort was determined from a Health Maintenance Organization, in Oregon. Eligible patients were 50-75 years old, health plan members for at least one year before their birthday in 2018 and were due for screening. We created a risk model using logistic regression first with data available in the electronic health record (EHR), and then added multilevel data. In a cohort of 59,249 patients, 36.1% completed CRC screening. The individual level model included 14 demographic, clinical and encounter based characteristics, had a bootstrap-corrected C-statistic of 0.722 and sufficient calibration. The multilevel model added 9 variables from clinical setting and community characteristics, and the bootstrap-corrected C-statistic remained the same with continued sufficient calibration. The predictive power of the CRC screening model did not improve after adding multilevel data. Our findings suggest that multilevel data added no improvement to the prediction of the likelihood of CRC screening.
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Affiliation(s)
- Amanda F. Petrik
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- Northwest Permanente, Portland, OR, USA
| | - Eric S. Johnson
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- Northwest Permanente, Portland, OR, USA
| | - Rajasekhara Mummadi
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- Northwest Permanente, Portland, OR, USA
| | | | | | - Sunny C. Lin
- Oregon Health & Science University/Portland State University School of Public Health, Portland, OR, USA
- Washington University, St. Louis, MO, USA
| | - Lucy Savitz
- Kaiser Permanente Center for Health Research, Portland, OR, USA
- University of Pittsburgh, Pittsburgh, PA, USA
| | - Neal Wallace
- Oregon Health & Science University/Portland State University School of Public Health, Portland, OR, USA
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Timmermans L, Boeykens D, Sirimsi MM, Decat P, Foulon V, Van Hecke A, Vermandere M, Schoenmakers B, Remmen R, Verté E, Sirimsi MM, Van Bogaert P, De Loof H, Van den Broeck K, Anthierens S, Huybrechts I, Raeymaeckers P, Buffel V, Devroey D, Aertgeerts B, Schoenmakers B, Timmermans L, Foulon V, Declerq A, Van de Velde D, Boeckxstaens P, De Sutter A, De Vriendt P, Lahousse L, Pype P, Boeykens D, Van Hecke A, Decat P, Roose R, Martin S, Rutten E, Pless S, Tuinstra A, Gauwe V, Reynaert D, Van Landschoot L, Hartmann ML, Claeys T, Vandenhoudt H, De Vliegher K, Op de Beeck S. Self-management support in flemish primary care practice: the development of a preliminary conceptual model using a qualitative approach. BMC PRIMARY CARE 2022; 23:63. [PMID: 35361118 PMCID: PMC8968094 DOI: 10.1186/s12875-022-01652-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/21/2021] [Accepted: 02/25/2022] [Indexed: 12/05/2022]
Abstract
Background Coping with a chronic disease can be really challenging. Self-management represents a promising strategy to improve daily life experiences. The role of primary healthcare professionals cannot be underestimated in supporting self-management. Due to a shortage of theory, implementation of self-management support is hindered in primary care practice. The aim of this study is to create a conceptual model for self-management support by analysing patients’ care experiences towards self-management support. Methods An explorative-descriptive qualitative study was conducted in Flanders, Belgium. Semi-structured interviews were performed with 16 patients and their informal caregiver (dyads) using a purposive sampling strategy and processed by an inductive content analysis, according to Graneheim and Lundman. Results Interviews revealed in-depth insights into patients’ care experiences. A conceptual model was developed for primary care practice, including five fundamental tasks for healthcare professionals - Supporting, Involving, Listening, Coordinating and Questioning (SILCQ) – contributing to the support of self-management of chronic patients. Conclusions This qualitative paper emphasises the use of the SILCQ-model to develop optimal roadmaps and hands-on toolkits for healthcare professionals to support self-management. The model needs to be further explored by all stakeholders to support the development of self-management interventions in primary care practice. Supplementary Information The online version contains supplementary material available at 10.1186/s12875-022-01652-8.
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Sedani AE, Davis OC, Clifton SC, Campbell JE, Chou AF. Facilitators and Barriers to Implementation of Lung Cancer Screening: A Framework-Driven Systematic Review. J Natl Cancer Inst 2022; 114:1449-1467. [PMID: 35993616 PMCID: PMC9664175 DOI: 10.1093/jnci/djac154] [Citation(s) in RCA: 10] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The purpose of this study is to undertake a comprehensive systematic review to describe multilevel factors (barriers and facilitators) that may influence the implementation of low-dose chest computed tomography for lung cancer screening in the United States. METHODS Systematic literature searches were performed using 6 online databases and citation indexes for peer-reviewed studies, for articles published from 2013 to 2021. Studies were classified into 3 perspectives, based on the study's unit of analysis: system, health-care provider, and patient. Barriers and facilitators identified for each study included in our final review were then coded and categorized using the Consolidate Framework for Implementation Research domains. RESULTS At the system level, the 2 most common constructs were external policy and incentives and executing the implementation process. At the provider level, the most common constructs were evidence strength and quality of the intervention characteristics, patient needs and resources, implementation climate, and an individual's knowledge and beliefs about the intervention. At the patient level, the most common constructs were patient needs and resources, individual's knowledge and beliefs about the intervention, and engaging in the implementation process. These constructs can act as facilitators or barriers to lung cancer screening implementation. CONCLUSIONS Applying the Consolidate Framework for Implementation Research domains and constructs to understand and specify factors facilitating uptake of lung cancer screening as well as cataloging the lessons learned from previous efforts helps inform the development and implementation processes of lung cancer screening programs in the community setting. REGISTRATION PROSPERO, CRD42021247677.
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Affiliation(s)
- Ami E Sedani
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Olivia C Davis
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shari C Clifton
- Robert M. Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ann F Chou
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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Rose DE, Oishi SM, Farmer MM, Bean-Mayberry B, Canelo I, Washington DL, Yano EM. Association Between Availability of Women's Health Services and Women Veterans' Care Experiences. Womens Health Issues 2022; 32:623-632. [PMID: 36115812 DOI: 10.1016/j.whi.2022.07.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2021] [Revised: 07/11/2022] [Accepted: 07/26/2022] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Few studies have focused on determinants of women's ratings of care experiences in primary care. We assessed associations between availability of women's health services and women veterans' ratings of care experiences. METHODS In a cross-sectional analysis, we linked Fiscal Year 2017 (October 1, 2016, to September 30, 2017) survey data from 126 Veterans Health Administration (VA) primary care leaders to 4,254 women veterans' ratings of care from VA's Survey of Health care Experiences of Patients-Patient Centered Medical Home (2017). The dependent variables were ratings of optimal access (appointments, information), care coordination, comprehensiveness (behavioral health assessment), patient-provider communication, and primary care provider. Key independent variables were number of women's health services 1) routinely available all weekday hours (compared with some hours or not available) and 2) available in VA general primary care vs. other arrangements. In multilevel logistic regression models, we adjusted for patient-, facility-, and area-level characteristics. RESULTS A greater number of women's health services routinely available in VA primary care was associated with a higher likelihood of optimal ratings of care coordination (adjusted odds ratio [AOR], 1.06; 95% confidence interval [CI], 1.01-1.10), provider communication (AOR, 1.08; 95% CI, 1.002-1.16), and primary care provider (AOR, 1.07; 95% CI, 1.02-1.13). A greater number of services available in VA primary care was associated with a lower likelihood of optimal ratings for access (AOR, 0.94; 95% CI, 0.88-0.99). CONCLUSION For the most part, routine availability of women's health services in VA primary care clinics enhanced women's health care experiences. These empirical findings offer health care leaders evidence-based approaches for improving women's care experiences.
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Affiliation(s)
- Danielle E Rose
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California.
| | - Sabine M Oishi
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - Melissa M Farmer
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - Bevanne Bean-Mayberry
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Ismelda Canelo
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California
| | - Donna L Washington
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California
| | - Elizabeth M Yano
- VA Health Services Research & Development (HSR&D) Center for the Study of Healthcare Innovation, Implementation & Policy, Los Angeles, California; Department of Medicine, UCLA Geffen School of Medicine, Los Angeles, California; Department of Health Policy & Management, UCLA Fielding School of Public Health, Los Angeles, California
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Samimi G, Douglas J, Heckman-Stoddard BM, Ford LG, Szabo E, Minasian LM. Report from an NCI Roundtable: Cancer Prevention in Primary Care. Cancer Prev Res (Phila) 2022; 15:273-278. [PMID: 35502552 PMCID: PMC9306398 DOI: 10.1158/1940-6207.capr-21-0599] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2021] [Revised: 01/07/2022] [Accepted: 01/26/2022] [Indexed: 01/07/2023]
Abstract
The Division of Cancer Prevention in the NCI sponsored a Roundtable with primary care providers (PCP) to determine barriers for integrating cancer prevention within primary care and discuss potential opportunities to overcome these barriers. The goals were to: (i) assess the cancer risk assessment tools available to PCPs; (ii) gather information on use of cancer prevention resources; and (iii) understand the needs of PCPs to facilitate the implementation of cancer prevention interventions beyond routine screening and interventions. The Roundtable discussion focused on challenges and potential research opportunities related to: (i) cancer risk assessment and management of high-risk individuals; (ii) cancer prevention interventions for risk reduction; (iii) electronic health records/electronic medical records; and (iv) patient engagement and information dissemination. Time constraints and inconsistent/evolving clinical guidelines are major barriers to effective implementation of cancer prevention within primary care. Social determinants of health are important factors that influence patients' adoption of recommended preventive interventions. Research is needed to determine the best means for implementation of cancer prevention across various communities and clinical settings. Additional studies are needed to develop tools that can help providers collect clinical data that can enable them to assess patients' cancer risk and implement appropriate preventive interventions.
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Affiliation(s)
- Goli Samimi
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland.,Corresponding Author: Goli Samimi, Division of Cancer Prevention, National Cancer Institute, 9609 Medical Center Drive, Rockville, MD 20850. Phone: 240-276-6582; E-mail:
| | | | | | - Leslie G. Ford
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
| | - Lori M. Minasian
- Division of Cancer Prevention, National Cancer Institute, Rockville, Maryland
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Kasting ML, Rathwell J, Gabhart KM, Garcia J, Roetzheim RG, Carrasquillo O, Giuliano AR, Vadaparampil ST. There's just not enough time: a mixed methods pilot study of hepatitis C virus screening among baby boomers in primary care. BMC FAMILY PRACTICE 2020; 21:248. [PMID: 33267799 PMCID: PMC7713319 DOI: 10.1186/s12875-020-01327-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Liver cancer rates are rising and hepatitis C virus (HCV) is the primary cause. The CDC recommends a one-time HCV screening for all persons born 1945-1965 (baby boomers). However, 14% of baby boomers have been screened. Few studies have examined primary care providers' (PCP) perspectives on barriers to HCV screening. This study examines current HCV screening practices, knowledge, barriers, and facilitators to HCV screening recommendation for baby boomers among PCPs. METHODS We conducted a mixed methods pilot study of PCPs. Quantitative: We surveyed PCPs from 3 large academic health systems assessing screening practices, knowledge (range:0-9), self-efficacy to identify and treat HCV (range:0-32), and barriers (range:0-10). Qualitative: We conducted interviews assessing patient, provider, and clinic-level barriers to HCV screening for baby boomers in primary care. Interviews were audio recorded, transcribed, and analyzed with content analysis. RESULTS The study sample consisted of 31 PCPs (22 survey participants and nine interview participants). All PCPs were aware of the birth cohort screening recommendation and survey participants reported high HCV testing recommendation, but qualitative interviews indicated other priorities may supersede recommending HCV testing. Provider knowledge of viral transmission was high, but lower for infection prevalence. While survey participants reported very few barriers to HCV screening in primary care, interview participants provided a more nuanced description of barriers such as lack of time. CONCLUSIONS There is a need for provider education on both HCV treatment as well as how to effectively recommend HCV screening for their patients. As HCV screening guidelines continue to expand to a larger segment of the primary care population, it is important to understand ways to improve HCV screening in primary care.
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Affiliation(s)
- Monica L Kasting
- Department of Public Health, Purdue University, 812 W. State Street, West Lafayette, IN, 47907, USA
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Julie Rathwell
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Kaitlyn M Gabhart
- Department of Public Health, Purdue University, 812 W. State Street, West Lafayette, IN, 47907, USA
| | - Jennifer Garcia
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive MRC-COEE, Tampa, FL, 33612, USA
| | - Richard G Roetzheim
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive MRC-COEE, Tampa, FL, 33612, USA
- Department of Family Medicine, University of South Florida, Tampa, USA
| | - Olveen Carrasquillo
- Division of General Internal Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Susan T Vadaparampil
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive MRC-COEE, Tampa, FL, 33612, USA.
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Samimi G, Heckman-Stoddard BM, Holmberg C, Tennant B, Sheppard BB, Coa KI, Kay SS, Ford LG, Szabo E, Minasian LM. Assessment of and Interventions for Women at High Risk for Breast or Ovarian Cancer: A Survey of Primary Care Physicians. Cancer Prev Res (Phila) 2020; 14:205-214. [PMID: 33023915 DOI: 10.1158/1940-6207.capr-20-0407] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2020] [Revised: 09/16/2020] [Accepted: 10/02/2020] [Indexed: 01/10/2023]
Abstract
As clinical guidelines for cancer prevention refer individuals to primary care physicians (PCP) for risk assessment and clinical management, PCPs may be expected to play an increasing role in cancer prevention. It is crucial that PCPs are adequately supported to assess an individual's cancer risk and make appropriate recommendations. The objective of this study is to assess use, familiarity, attitude, and behaviors of PCPs regarding breast and ovarian cancer risk and prevention, to better understand the factors that influence their prescribing behaviors. We conducted a cross-sectional, web-based survey of PCPs in the United States, recruited from an opt-in healthcare provider panel. Invitations were sent in batches until the target sample size of 750 respondents (250 each for obstetrics/gynecology, internal medicine, and family medicine) was met. Self-reported use of breast/ovarian cancer risk assessments was low (34.7%-59.2%) compared with discussion of cancer family history (96.9%), breast exams (87.1%), and mammograms (92.8%). Although most respondents (48.0%-66.8%) were familiar with cancer prevention interventions, respondents who reported to be less familiar were more likely to report cautious attitudes. When presented with hypothetical cases depicting patients at different breast/ovarian cancer risks, up to 34.0% of respondents did not select any of the clinically recommended course(s) of action. This survey suggests that PCP use of breast/ovarian cancer risk assessment tools and ability to translate the perceived risks to clinical actions is variable. Improving implementation of cancer risk assessment and clinical management guidelines within primary care may be necessary to improve the appropriate prescribing of cancer prevention interventions.Prevention Relevance: Primary care physicians are becoming more involved in cancer prevention management, so it is important that cancer risk assessment and medical society guideline recommendations for cancer prevention are better integrated into primary care to improve appropriate prescribing of cancer prevention interventions and help reduce cancer risk.
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Affiliation(s)
- Goli Samimi
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland.
| | | | - Christine Holmberg
- Institute of Social Medicine and Epidemiology, Brandenburg Medical School Theodor Fontane, Brandenburg, Havel, Germany
| | | | | | | | | | - Leslie G Ford
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Eva Szabo
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
| | - Lori M Minasian
- Division of Cancer Prevention, National Cancer Institute, Bethesda, Maryland
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Lewis JA, Chen H, Weaver KE, Spalluto LB, Sandler KL, Horn L, Dittus RS, Massion PP, Roumie CL, Tindle HA. Low Provider Knowledge Is Associated With Less Evidence-Based Lung Cancer Screening. J Natl Compr Canc Netw 2020; 17:339-346. [PMID: 30959463 DOI: 10.6004/jnccn.2018.7101] [Citation(s) in RCA: 31] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2018] [Accepted: 10/22/2018] [Indexed: 11/17/2022]
Abstract
BACKGROUND Despite widespread recommendation and supportive policies, screening with low-dose CT (LDCT) is incompletely implemented in the US healthcare system. Low provider knowledge of the lung cancer screening (LCS) guidelines represents a potential barrier to implementation. Therefore, we tested the hypothesis that low provider knowledge of guidelines is associated with less provider-reported screening with LDCT. PATIENTS AND METHODS A cross-sectional survey was performed in a large academic medical center and affiliated Veterans Health Administration in the Mid-South United States that comprises hospital and community-based practices. Participants included general medicine providers and specialists who treat patients aged >50 years. The primary exposure was LCS guideline knowledge (US Preventive Services Task Force/Centers for Medicare & Medicaid Services). High knowledge was defined as identifying 3 major screening eligibility criteria (55 years as initial age of screening eligibility, smoking status as current or former smoker, and smoking history of ≥30 pack-years), and low knowledge was defined as not identifying these 3 criteria. The primary outcome was self-reported LDCT order/referral within the past year, and the secondary outcome was screening chest radiograph. Multivariable logistic regression evaluated the adjusted odds ratio (aOR) of screening by knowledge. RESULTS Of 625 providers recruited, 407 (65%) responded, and 378 (60.5%) were analyzed. Overall, 233 providers (62%) demonstrated low LCS knowledge, and 224 (59%) reported ordering/referring for LDCT. The aOR of ordering/referring LDCT was less among providers with low knowledge (0.41; 95% CI, 0.24-0.71) than among those with high knowledge. More providers with low knowledge reported ordering screening chest radiographs (aOR, 2.7; 95% CI, 1.4-5.0) within the past year. CONCLUSIONS Referring provider knowledge of LCS guidelines is low and directly proportional to the ordering rate for LDCT in an at-risk US population. Strategies to advance evidence-based LCS should incorporate provider education and system-level interventions to address gaps in provider knowledge.
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Affiliation(s)
- Jennifer A Lewis
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,bDivision of Hematology/Oncology, Department of Medicine, and
| | - Heidi Chen
- cDepartment of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Kathryn E Weaver
- dDepartment of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Lucy B Spalluto
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,eDepartment of Radiology
| | | | - Leora Horn
- bDivision of Hematology/Oncology, Department of Medicine, and
| | - Robert S Dittus
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,fDivision of General Internal Medicine and Public Health, Department of Medicine, and
| | - Pierre P Massion
- gDivision of Allergy, Pulmonary, and Critical Care Medicine, Vanderbilt University Medical Center, Nashville, Tennessee; and.,hDepartment of Medicine, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee
| | - Christianne L Roumie
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,fDivision of General Internal Medicine and Public Health, Department of Medicine, and
| | - Hilary A Tindle
- aGeriatric Research, Education and Clinical Center, Veterans Health Administration - Tennessee Valley Healthcare System, Nashville, Tennessee.,fDivision of General Internal Medicine and Public Health, Department of Medicine, and
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11
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Coughlin JM, Zang Y, Terranella S, Alex G, Karush J, Geissen N, Chmielewski GW, Arndt AT, Liptay MJ, Zimmermann LJ, Dowling L, Levitan A, Seder CW. Understanding barriers to lung cancer screening in primary care. J Thorac Dis 2020; 12:2536-2544. [PMID: 32642161 PMCID: PMC7330370 DOI: 10.21037/jtd.2020.03.66] [Citation(s) in RCA: 44] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
Background Low-dose computed tomography (LDCT) scan for lung cancer screening is underutilized. Studies suggest that up to one-third of providers do not know the current lung cancer screening guidelines. Thus, identifying the barriers to utilization of LDCT scan is essential. Methods Primary care providers in three different healthcare settings in the United States were surveyed to assess provider knowledge of LDCT scan screening criteria, lung cancer screening practices, and barriers to the utilization of LDCT scan screening. Fisher’s Exact, Chi-Squared, and Kruskal-Wallis tests were used to compare provider responses. Multivariable logistic regression was used to test the association between provider characteristics and the likelihood of utilizing LDCT scan for lung cancer screening. Results The survey was sent to 614 providers, with a 15.7% response rate. Overall, 29.2% of providers report never ordering LDCT scans for eligible patients. Providers practicing at a community or academic hospital more frequently order LDCT scans than those practicing at a safety net hospital. Academic- and community-based providers received a significantly higher mean knowledge score than safety net-based providers [academic 6.84 (SD 1.33), community 6.72 (SD 1.46), safety net 5.85 (SD 1.38); P<0.01]. Overall, only 6.2% of respondents correctly identified all six Centers for Medicare and Medicaid Services eligibility criteria when challenged with three incorrect criteria. Common barriers to utilization of LDCT scan included failure of the electronic medical record (EMR) to notify providers of eligible patients (54.7%), patient refusal (37%), perceived high false-positive rate leading to unnecessary procedures (18.9%), provider time constraints (16.8%), and lack of insurance coverage (13.7%). Conclusions Provider knowledge of lung cancer screening guidelines varies, perhaps contributing to underutilization of LDCT scan for lung cancer screening. Improved provider education at safety net hospitals and improving EMR-based best practice alerts may improve the rate of lung cancer screening.
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Affiliation(s)
- Julia M Coughlin
- Department of Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Yanyu Zang
- Bioinformatics and Biostatistics Core, Rush University Medical Center, Chicago, IL, USA
| | | | - Gillian Alex
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Justin Karush
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.,Department of Surgery, Rush Copley Medical Center, Aurora, IL, USA
| | - Nicole Geissen
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.,Department of Cardiothoracic Surgery, John H. Stroger, Jr. Hospital of Cook County, Chicago, IL, USA
| | - Gary W Chmielewski
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA.,Department of Surgery, Northwest Community Hospital, Arlington Heights, IL, USA
| | - Andrew T Arndt
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Michael J Liptay
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Laura J Zimmermann
- Department of Internal Medicine, Rush University Medical Center, Chicago, IL, USA.,Department of Preventive Medicine, Rush University Medical Center, Chicago, IL, USA
| | - Linda Dowling
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Ashley Levitan
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Christopher W Seder
- Department of Cardiovascular and Thoracic Surgery, Rush University Medical Center, Chicago, IL, USA
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12
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Arnold CL, Rademaker AW, Morris JD, Ferguson LA, Wiltz G, Davis TC. Follow-up approaches to a health literacy intervention to increase colorectal cancer screening in rural community clinics: A randomized controlled trial. Cancer 2019; 125:3615-3622. [PMID: 31355924 DOI: 10.1002/cncr.32398] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Revised: 02/28/2019] [Accepted: 04/05/2019] [Indexed: 12/13/2022]
Abstract
BACKGROUND Significant disparities exist in colorectal cancer (CRC) screening rates among those of low socioeconomic status, with fewer years of education, lacking health insurance, or living in rural areas. METHODS A randomized controlled trial was conducted to compare the effectiveness of 2 follow-up approaches to a health literacy intervention to improve CRC screening: automated telephone call or personal call. Patients aged 50 to 75 years residing in 4 rural community clinics in Louisiana were given a structured interview that assessed demographic, health literacy and CRC screening barriers, knowledge, and attitudes. All were given health literacy-informed CRC education, a patient-friendly CRC screening pamphlet, simplified fecal immunochemical test (FIT) instructions, and a FIT kit, and a "teach-back" method was used to confirm understanding. Patients were randomized to 1 of 2 telephone follow-up arms. If they did not mail their FIT kit within 4 weeks, they received a reminder call and were called again at 8 weeks if the test still was not received. RESULTS A total of 620 patients were enrolled. Approximately 55% were female, 66% were African American, and 40% had limited literacy. The overall FIT completion rate was 68%: 69.2% in the automated telephone call arm and 67% in the personal call arm. Greater than one-half of the patients (range, 58%-60%) returned the FIT kit without receiving a telephone call. There was no difference noted with regard to the effectiveness of the follow-up calls; each increased the return rate by 9%. CONCLUSIONS Providing FIT kits and literacy-appropriate education at regularly scheduled clinic visits with a follow-up telephone call when needed was found to increase CRC screening among low-income, rural patients. The lower cost automated call was just as effective as the personal call.
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Affiliation(s)
- Connie L Arnold
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Alfred W Rademaker
- Department of Preventive Medicine, Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois
| | - James D Morris
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
| | - Laurie Anne Ferguson
- College of Nursing and Health, Loyola University New Orleans, New Orleans, Louisiana
| | - Gary Wiltz
- Teche Action Clinic, Franklin, Louisiana
| | - Terry C Davis
- Department of Medicine, Louisiana State University Health Sciences Center-Shreveport, Shreveport, Louisiana
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13
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Brown LJ, Roeger SL, Reed RL. Patient perspectives on colorectal cancer screening and the role of general practice. BMC FAMILY PRACTICE 2019; 20:109. [PMID: 31352897 PMCID: PMC6661764 DOI: 10.1186/s12875-019-0997-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Accepted: 07/16/2019] [Indexed: 11/13/2022]
Abstract
Background Colorectal cancer (CRC) is the second most frequent cause of cancer death in Australia. Early detection can reduce incidence and mortality. General practice-based initiatives have been proposed to improve CRC screening rates but to date have had modest impact. As there is limited research into the patient experience of CRC screening decision making, this study explored patient perspectives on CRC screening and the potential role for general practice. Methods Ten participants, aged between 50 and 74, from a general practice in South Australia were recruited by practice staff. Semi-structured interviews were conducted. Concurrent data collection and analysis were performed, guided by interpretative phenomenological analysis. Results Two key themes were evident: attitudes toward screening and potential roles for general practice. Participants structured the experience of screening in terms of being proactive, ambivalent or avoidant. Roles for general practice centred on tasks as educators, trusted advisors, monitors and screeners. Mixed views on whether general practice involvement was necessary prompted consideration of additional sources of health information and motivation around screening. Conclusions Exploration of the patient experience provides insight into how participants make sense of screening and perceived roles for general practice (or other agents) in screening. There is satisfaction with current Government-driven processes but perceived value in general practice playing a complementary part in increasing screening rates. A multifaceted strategy, accounting for attitudes, is required to improve screening and population health outcomes.
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Affiliation(s)
- Lynsey J Brown
- Torrens University Australia, 88 Wakefield Street, Adelaide, South Australia, 5000, Australia. .,College of Medicine and Public Health, Flinders University of South Australia, GPO Box 2100, Adelaide, South Australia, 5001, Australia.
| | - S Leigh Roeger
- College of Medicine and Public Health, Flinders University of South Australia, GPO Box 2100, Adelaide, South Australia, 5001, Australia
| | - Richard L Reed
- College of Medicine and Public Health, Flinders University of South Australia, GPO Box 2100, Adelaide, South Australia, 5001, Australia
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14
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Kisaakye E, Namakula J, Kihembo C, Kisakye A, Nsubuga P, Babirye JN. Level and factors associated with uptake of human papillomavirus infection vaccine among female adolescents in Lira District, Uganda. Pan Afr Med J 2018; 31:184. [PMID: 31086634 PMCID: PMC6488240 DOI: 10.11604/pamj.2018.31.184.14801] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2018] [Accepted: 11/12/2018] [Indexed: 11/11/2022] Open
Abstract
Introduction the principal burden of human papillomavirus (HPV) infections is cervical cancer. Cervical cancer ranks as the fourth most common malignancy in women affecting 500,000 women each year with an estimated 266,000 deaths. Uganda has one of the highest cervical cancer incidence rates globally with an age-standardised incidence rate per 100,000 of 47.5. This study assessed the level and the factors associated with uptake of HPV vaccine by female adolescents in Lira district, Uganda. Methods a mixed methods approach was employed using a survey among 460 female adolescents. We collected data using an interviewer-administered questionnaire. We interviewed five key informants and conducted ten in-depth interviews. Uptake was defined as completing three doses of the vaccine as per the recommended schedule. Prevalence risk ratios were used as measures of association and were computed using modified poison regression. Content analysis was used for qualitative data. Results the mean age of the respondents was 13.97 (SD=1.24). Uptake was at 17.61% (81/460). The factors associated with uptake of HPV vaccine were: attaining ordinary level of education (aPR 1.48, 95%CI 1.11-1.97), positive attitude towards the vaccine (aPR 3.46, 95%CI 1.70-7.02), receiving vaccine doses from different vaccination sites (aPR 1.59, 95% CI 1.10-2.28) and encouragement from a health worker (aPR 1.55, 95%CI 1.15-2.11) or Village Health Team (aPR 3.47, 95%CI 1.50-8.02) to go for the vaccine. Other factors associated with uptake of HPV vaccine included; the existence of community outreaches (aPR 1.47, 95%CI 1.02-2.12), availability of vaccines at vaccination sites (aPR 4.84, 95%CI 2.90-8.08) and receiving full information about the vaccine at the vaccination site (aPR 1.90, 95%CI 1.26-2.85). Conclusion HPV vaccine uptake was low in Lira district. Efforts to improve uptake of HPV vaccine should focus on ensuring a consistent supply of vaccines at the vaccination sites, health education aimed at creating a positive attitude towards the vaccine, sensitisation of the adolescents about the vaccine and conducting community outreaches.
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Affiliation(s)
- Esther Kisaakye
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Justine Namakula
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Christine Kihembo
- African Field Epidemiology Network, Lugogo House Plot 42, Lugogo Bypass, Kampala, Uganda
| | - Angela Kisakye
- School of Public Health, College of Health Sciences, Makerere University, Kampala, Uganda.,African Field Epidemiology Network, Lugogo House Plot 42, Lugogo Bypass, Kampala, Uganda
| | - Peter Nsubuga
- Global Public Health Solutions, CDC EIS Program, Atlanta, Georgia
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15
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Kasting ML, Giuliano AR, Reich RR, Roetzheim RG, Nelson DR, Shenkman E, Vadaparampil ST. Hepatitis C Virus Screening Trends: Serial Cross-Sectional Analysis of the National Health Interview Survey Population, 2013-2015. Cancer Epidemiol Biomarkers Prev 2018; 27:503-513. [PMID: 29588306 PMCID: PMC5884715 DOI: 10.1158/1055-9965.epi-17-0855] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2017] [Revised: 11/20/2017] [Accepted: 01/31/2018] [Indexed: 12/18/2022] Open
Abstract
Background: Rates of hepatitis C virus (HCV) infection are markedly higher for baby boomers compared with other birth cohorts, and they are now recommended for universal one-time screening. This study examines HCV screening rates and predictors for four birth cohorts [born <1945, born 1945-1965 (baby boomers), born 1966-1985, and born >1985] of a nationally representative sample over time.Methods: We used data from the 2013-2015 National Health Interview Surveys, an annual weighted survey of the U.S. civilian noninstitutionalized population. We assessed HCV screening prevalence stratified birth cohort with bivariate and multivariable logistic regression analyses.Results: There were 15,100 participants born <1945, 28,725 baby boomers, 28,089 born 1966-1985, and 13,296 born >1985 in the final analytic sample. Screening was 11.5%-12.8% for baby boomers. The second youngest birth cohort was similar to baby boomers (13.7%-14.9%), whereas the older birth cohort was screened less. After excluding participants who typically have higher rates of HCV screening than the general population, we developed a multivariable model of the general population. In the final model for baby boomers the odds of HCV screening increased significantly with each subsequent year (OR=1.20; 95% CI=1.05-1.38 and OR=1.31; 95% CI=1.13-1.52). HCV screening was also significantly associated with age, gender, and race/ethnicity in baby boomers.Conclusions: While HCV screening is increasing over time, these increases are minimal and there is substantial room for improvement.Impact: Future research should develop interventions to increase HCV screening with special focus on groups demonstrating significantly lower screening rates, such as Hispanics and females. Cancer Epidemiol Biomarkers Prev; 27(4); 503-13. ©2018 AACR.
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Affiliation(s)
- Monica L Kasting
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida
- Center for Infection Research in Cancer, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Anna R Giuliano
- Center for Infection Research in Cancer, H. Lee Moffitt Cancer Center, Tampa, Florida
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Richard R Reich
- Shared Resources, H. Lee Moffitt Cancer Center, Tampa, Florida
| | - Richard G Roetzheim
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida
- Department of Family Medicine, University of South Florida, Tampa, Florida
| | - David R Nelson
- Department of Medicine, University of Florida, Gainesville, Florida
| | - Elizabeth Shenkman
- Department of Health Outcomes and Policy, University of Florida Health, Gainesville, Florida
- Cancer Population Sciences, University of Florida Health, Gainesville, Florida
| | - Susan T Vadaparampil
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, Tampa, Florida.
- Center for Infection Research in Cancer, H. Lee Moffitt Cancer Center, Tampa, Florida
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16
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Hasegawa M, Murakami M, Takebayashi Y, Suzuki S, Ohto H. Social Capital Enhanced Disaster Preparedness and Health Consultations after the 2011 Great East Japan Earthquake and Nuclear Power Station Accident. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018. [PMID: 29538320 PMCID: PMC5877061 DOI: 10.3390/ijerph15030516] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/14/2023]
Abstract
After the Great East Japan Earthquake and the subsequent Fukushima Daiichi Nuclear Power Station accident in 2011, there was a strong demand to promote disaster preparedness approaches and health checkups for the prevention of lifestyle diseases. This study examined the yearly change in the percentage of those who prepared for disasters and who utilized health checkups in Fukushima Prefecture, and identified the factors governing disaster preparedness and utilization of health checkups. We used the public opinion survey from 2011 to 2015 (n = 677–779 each year) on prefectural policies that is conducted every year by the Fukushima Prefecture government Public Consultation Unit. We found that the percentage of those who prepare for disasters decreased, while that for health checkups did not significantly change. With regard to disaster preparedness, experiences of disaster enhance disaster preparedness, while bonds with other local people help to maintain preparedness. For health checkups, familiarity with the welfare service was the most important factor governing such consultations. The findings suggest that social capital should be promoted in order to improve disaster preparedness. The findings also suggest that residents’ accessibility to medical and welfare services is also important in promoting the utilization of health checkups.
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Affiliation(s)
- Makoto Hasegawa
- Department of Health Risk Communication, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan.
| | - Michio Murakami
- Department of Health Risk Communication, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan.
| | - Yoshitake Takebayashi
- Department of Health Risk Communication, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan.
| | - Satoshi Suzuki
- Fukushima Prefectural Centre for Environmental Creation, 2-10 Fukasaku, Miharu-machi, Tamura-gun, Fukushima 963-7700, Japan.
| | - Hitoshi Ohto
- Department of Blood Transfusion and Transplantation Immunology, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan.
- Department of Advanced Cancer Immunotherapy, Fukushima Medical University, 1 Hikarigaoka, Fukushima City, Fukushima 960-1295, Japan.
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17
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Vaisson G, Witteman HO, Bouck Z, Bravo CA, Desveaux L, Llovet D, Presseau J, Saragosa M, Taljaard M, Umar S, Grimshaw JM, Tinmouth J, Ivers NM. Testing Behavior Change Techniques to Encourage Primary Care Physicians to Access Cancer Screening Audit and Feedback Reports: Protocol for a Factorial Randomized Experiment of Email Content. JMIR Res Protoc 2018; 7:e11. [PMID: 29453190 PMCID: PMC5834752 DOI: 10.2196/resprot.9090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/29/2022] Open
Abstract
Background Cancer Care Ontario’s Screening Activity Report (SAR) is an online audit and feedback tool designed to help primary care physicians in Ontario, Canada, identify patients who are overdue for cancer screening or have abnormal results requiring follow-up. Use of the SAR is associated with increased screening rates. To encourage SAR use, Cancer Care Ontario sends monthly emails to registered primary care physicians announcing that updated data are available. However, analytics reveal that 50% of email recipients do not open the email and less than 7% click the embedded link to log in to their report. Objective The goal of the study is to determine whether rewritten emails result in increased log-ins. This manuscript describes how different user- and theory-informed messages intended to improve the impact of the monthly emails will be experimentally tested and how a process evaluation will explore why and how any effects observed were (or were not) achieved. Methods A user-centered approach was used to rewrite the content of the monthly email, including messages operationalizing 3 behavior change techniques: anticipated regret, material incentive (behavior), and problem solving. A pragmatic, 2x2x2 factorial experiment within a multiphase optimization strategy will test the redesigned emails with an embedded qualitative process evaluation to understand how and why the emails may or may not have worked. Trial outcomes will be ascertained using routinely collected administrative data. Physicians will be recruited for semistructured interviews using convenience and snowball sampling. Results As of April 2017, 5576 primary care physicians across the province of Ontario, Canada, had voluntarily registered for the SAR, and in so doing, signed up to receive the monthly email updates. From May to August 2017 participants received the redesigned monthly emails with content specific to their allocated experimental condition prompting use of the SAR. We have not yet begun analyses. Conclusions This study will inform how to communicate effectively with primary care providers by email and identify which behavior change techniques tested are most effective at encouraging engagement with an audit and feedback report. Trial Registration ClinicalTrials.gov NCT03124316; https://clinicaltrials.gov/ct2/show/NCT03124316 (Archived by WebCite at http://www.webcitation.org/6w2MqDWGu)
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Affiliation(s)
- Gratianne Vaisson
- Department of Epidemiology, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Holly O Witteman
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Research Centre of the Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, QC, Canada
| | - Zachary Bouck
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Caroline A Bravo
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Laura Desveaux
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Diego Llovet
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Marianne Saragosa
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Shama Umar
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jill Tinmouth
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
| | - Noah M Ivers
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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18
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Roess AA, Di Peppi R, Kinzoni EA, Molouania M, Kennedy E, Ibata SR, Badinga N, Mabola FS, Moses C. Knowledge Gained and Retained from a Video-Centered, Community-Based Intervention for Ebola Prevention, Congo. JOURNAL OF HEALTH COMMUNICATION 2017; 22:913-922. [PMID: 29125394 DOI: 10.1080/10810730.2017.1377321] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/07/2023]
Abstract
There are few effective communication interventions to respond to Ebola Virus Disease (EVD) outbreaks, and their development is a continuing challenge. The largest outbreak of EVD was first recognized in 2014 and once again highlighted the need for health education communication campaigns. EVD emergence and transmission are associated with behaviors that increase exposure to infected individuals and infected wildlife. In 2008-2009, an educational video-centered intervention consisting of a film followed by a structured discussion was developed to improve EVD knowledge, attitudes, and behaviors (KABs) for prevention of EVD and care of infected people. The film was produced for a Congolese audience in local languages and features doctors and residents from the region. The objective of the study was to assess the effectiveness of this intervention to change KABs related to EVD. The intervention was conducted over 12 months and reached >60,000 people; 220 individuals were sampled before and immediately after the intervention, and a subsample of 53 who had received the intervention 1 year earlier were interviewed to assess changes in KABs related to EVD. Statistically significant improvements in EVD recognition, transmission, and mitigation of risk after the intervention were observed. This study also demonstrates significant retention of knowledge one year after the intervention. Overall, the intervention was effective in improving KABs among a limited literacy population and knowledge was retained for more than one year. The materials and approaches developed were used in 2014 as part of a social mobilization strategy in response to an Ebola outbreak in the Congo Basin.
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Affiliation(s)
- Amira A Roess
- a Department of Global Health , George Washington University , Washington , DC , USA
| | - Rosemarie Di Peppi
- a Department of Global Health , George Washington University , Washington , DC , USA
| | - Eric A Kinzoni
- b International Conservation and Education Fund , Washington , DC , USA
| | | | - Emily Kennedy
- b International Conservation and Education Fund , Washington , DC , USA
| | - Saturnin R Ibata
- b International Conservation and Education Fund , Washington , DC , USA
| | - Nkenda Badinga
- c Medicins D'Afrique , Brazzaville , Republic of the Congo
| | - Fredy S Mabola
- b International Conservation and Education Fund , Washington , DC , USA
| | - Cynthia Moses
- b International Conservation and Education Fund , Washington , DC , USA
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19
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Rajupet S, Doshi D, Wisnivesky JP, Lin JJ. Attitudes About Lung Cancer Screening: Primary Care Providers Versus Specialists. Clin Lung Cancer 2017. [PMID: 28648531 DOI: 10.1016/j.cllc.2017.05.003] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
BACKGROUND On the basis of the results of the National Lung Screening Trial, the US Preventive Services Task Force now recommends yearly low-dose computed tomography (LDCT) for lung cancer screening among high-risk individuals. There is limited information regarding physician attitudes toward LDCT screening and whether these vary according to provider specialty. MATERIALS AND METHODS Primary care providers (PCPs) and specialists were surveyed about their knowledge and attitudes toward lung cancer screening and likelihood to order an LDCT screening. Descriptive and univariate analyses were used to assess differences between PCPs versus specialists. RESULTS Of the 103 respondents 69% were PCPs, 45% were attending-level physicians, 42% were male, and most (51%) worked in mixed outpatient/inpatient practice settings. Compared with specialists, PCPs were less likely to feel confident in their ability to identify appropriate patients for lung cancer screening (63.8% vs. 93.5%; P < .01) or to decide the workup of patients with positive LDCT findings (52.9% vs. 93.5%; P < .01). PCPs were also less likely to believe that the recommended yearly screening interval is feasible (27.5% vs. 86.7%; P < .01), to feel comfortable counseling patients on LDCT (51.4% vs. 82.8%; P = .01) or have sufficient time for counseling (14.3% vs. 50%; P < .01). Despite these differences, PCPs were equally as likely as specialists to recommend LDCT for their high-risk smokers. CONCLUSION Despite feeling less confident and knowledgeable about lung cancer screening, PCPs are as likely as specialists to recommend LDCT screening. However, PCPs need further education to ensure the success of lung cancer screening programs.
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Affiliation(s)
- Sritha Rajupet
- Division of Environmental Medicine and Public Health, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Dhvani Doshi
- Division of Hospital Medicine, Johns Hopkins Bayview Medical Center, Baltimore, MD
| | - Juan P Wisnivesky
- Division of Pulmonary, Critical Care and Sleep Medicine, Icahn School of Medicine at Mount Sinai, New York, NY; Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY
| | - Jenny J Lin
- Division of General Internal Medicine, Icahn School of Medicine at Mount Sinai, New York, NY.
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20
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Senore C, Bellisario C, Hassan C. Organization of surveillance in GI practice. Best Pract Res Clin Gastroenterol 2016; 30:855-866. [PMID: 27938781 DOI: 10.1016/j.bpg.2016.08.002] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Accepted: 08/07/2016] [Indexed: 02/08/2023]
Abstract
BACKGROUND Several reports documented an inefficient utilisation of available resources, as well as a suboptimal compliance with surveillance recommendations. Although, evidence suggests that organisational issues can influence the quality of care delivered, surveillance protocols are usually based on non-organized approaches. METHODS We conducted a literature search (publication date: 01/2000-06/2016) on PubMed and Cochrane Database of Systematic Reviews, Database of Abstracts of Reviews of Effects and Cochrane Central Register of Controlled Trials for guidelines, or consensus statements, for surveys of practice, reporting information about patients, or providers attitudes and behaviours, for intervention studies to enhance compliance with guidelines. Related articles were also scrutinised. Based on the clinical relevance and burden on endoscopy services this review was focused on surveillance for Barrett's oesophagus, IBD and post-polypectomy surveillance of colonic adenomas. RESULTS Existing guidelines are generally recognising structure and process requirements influencing delivery of surveillance interventions, while less attention had been devoted to transitions and interfaces in the care process. Available evidence from practice surveys is suggesting the need to design organizational strategies aimed to enable patients to attend and providers to deliver timely and appropriate care. Well designed studies assessing the effectiveness of specific interventions in this setting are however lacking. Indirect evidence from screening settings would suggest that the implementation of automated standardized recall systems, utilisation of clinical registries, removing financial barriers, could improve appropriateness of use and compliance with recommendations. CONCLUSIONS Lack of sound evidence regarding utility and methodology of surveillance can contribute to explain the observed variability in providers and patients attitudes and in compliance with the recommended surveillance.
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Affiliation(s)
- Carlo Senore
- SC Epidemiologia, Screening, Registro Tumori - CPO, AOU Città della Salute e della Scienza, Torino, Italy.
| | - Cristina Bellisario
- SC Epidemiologia, Screening, Registro Tumori - CPO, AOU Città della Salute e della Scienza, Torino, Italy
| | - Cesare Hassan
- Servizio di Gastroenterologia, Ospedale Nuovo Regina Margherita, Roma, Italy
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Sicsic J, Krucien N, Franc C. What are GPs' preferences for financial and non-financial incentives in cancer screening? Evidence for breast, cervical, and colorectal cancers. Soc Sci Med 2016; 167:116-27. [DOI: 10.1016/j.socscimed.2016.08.050] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Revised: 08/26/2016] [Accepted: 08/27/2016] [Indexed: 11/25/2022]
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Murphy CC, Sandler RS, Grubber JM, Johnson MR, Fisher DA. Underuse and Overuse of Colonoscopy for Repeat Screening and Surveillance in the Veterans Health Administration. Clin Gastroenterol Hepatol 2016; 14:436-444.e1. [PMID: 26492843 PMCID: PMC4761454 DOI: 10.1016/j.cgh.2015.10.008] [Citation(s) in RCA: 51] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Revised: 10/05/2015] [Accepted: 10/06/2015] [Indexed: 02/07/2023]
Abstract
BACKGROUND & AIMS Regular screening with colonoscopy lowers colorectal cancer incidence and mortality. We aimed to determine patterns of repeat and surveillance colonoscopy and identify factors associated with overuse and underuse of colonoscopy. METHODS We analyzed data from participants in a previous Veterans Health Administration (VHA) study who underwent outpatient colonoscopy at 25 VHA facilities between October 2007 and September 2008 (n = 1455). The proportion of patients who received a follow-up colonoscopy was calculated for 3 risk groups, which were defined on the basis of the index colonoscopy: no adenoma, low-risk adenoma, or high-risk adenoma. RESULTS Colonoscopy was overused (used more frequently than intervals recommended by guidelines) by 16% of patients with no adenomas, 26% with low-risk adenomas, and 29% with high-risk adenomas. Most patients with high-risk adenomas (54%) underwent colonoscopy after the recommended interval or did not undergo colonoscopy. Patients who received a follow-up recommendation that was discordant with guidelines were more likely to undergo colonoscopy too early (no adenoma odds ratio [OR], 3.80; 95% confidence interval [CI], 2.31-6.25 and low-risk adenoma OR, 5.28; 95% CI, 1.88-14.83). Receipt of colonoscopy at nonacademic facilities was associated with overuse among patients without adenomas (OR, 5.26; 95% CI, 1.96-14.29) or with low-risk adenomas (OR, 3.45; 95% CI, 1.52-7.69). Performance of colonoscopies by general surgeons vs gastroenterologists (OR, 2.08; 95% CI, 1.02-4.23) and female sex of the patient (OR, 3.28; 95% CI, 1.06-10.16) were associated with overuse of colonoscopy for patients with low-risk adenomas. No factors examined were associated with underuse of colonoscopy among patients with high-risk adenomas. CONCLUSIONS In an analysis of patients in the VHA system, more than one fourth of patients with low-risk adenomas received follow-up colonoscopies too early, whereas more than one half of those with high-risk adenomas did not undergo surveillance colonoscopy as recommended. Our findings highlight the need for system-level improvements to facilitate the appropriate delivery of colonoscopy that is based on individual risk.
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Affiliation(s)
- Caitlin C. Murphy
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC
| | - Robert S. Sandler
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC,Center for Gastrointestinal Biology and Disease, University of North Carolina at Chapel Hill
| | - Janet M. Grubber
- Durham VA Health Services Research and Development Center, Durham, NC,Duke University Medical Center, Durham, NC
| | - Marcus R. Johnson
- Durham VA Health Services Research and Development Center, Durham, NC,VA Cooperative Studies Program Epidemiology Center, Durham, NC
| | - Deborah A. Fisher
- Durham VA Health Services Research and Development Center, Durham, NC,Duke University Medical Center, Durham, NC
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Adonis L, Paramanund J, Basu D, Luiz J. Framing preventive care messaging and cervical cancer screening in a health-insured population in South Africa: Implications for population-based communication? J Health Psychol 2016; 22:1365-1375. [DOI: 10.1177/1359105316628735] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
The impact of health message framing on cervical cancer screening uptake is poorly understood. In a prospective randomized control study with 748 females, aged 21–65 years with no Pap smear in the previous 3 years, they randomly received a loss-framed, gain-framed, or neutral health message (control) regarding cervical cancer screening by email. Screening rate in the control group was 9.58 percent (CI: 9.29%–9.87%), 5.71 percent (CI: 5.48%–6.98%) in the gain-framed group, and 8.53 percent (CI: 8.24%–8.81%) in the loss-framed group. Statistically there was no difference between the three screening rates. Framing of health messages may not be a significant consideration when communicating through emails.
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Affiliation(s)
| | | | | | - John Luiz
- University of Cape Town, South Africa
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Knobf M, Cooley M, Duffy S, Doorenbos A, Eaton L, Given B, Mayer D, McCorkle R, Miaskowski C, Mitchell S, Sherwood P, Bender C, Cataldo J, Hershey D, Katapodi M, Menon U, Schumacher K, Sun V, Ah D, LoBiondo-Wood G, Mallory G. The 2014–2018 Oncology Nursing Society Research Agenda. Oncol Nurs Forum 2015; 42:450-65. [DOI: 10.1188/15.onf.450-465] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
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Senore C, Inadomi J, Segnan N, Bellisario C, Hassan C. Optimising colorectal cancer screening acceptance: a review. Gut 2015; 64:1158-77. [PMID: 26059765 DOI: 10.1136/gutjnl-2014-308081] [Citation(s) in RCA: 76] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/27/2014] [Accepted: 03/09/2015] [Indexed: 12/13/2022]
Abstract
The study aims to review available evidence concerning effective interventions to increase colorectal cancer (CRC) screening acceptance. We performed a literature search of randomised trials designed to increase individuals' use of CRC screening on PubMed, Embase, Cochrane Database of Systematic Reviews and Database of Abstracts of Reviews of Effects. Small (≤ 100 subjects per arm) studies and those reporting results of interventions implemented before publication of the large faecal occult blood test trials were excluded. Interventions were categorised following the Continuum of Cancer Care and the PRECEDE-PROCEED models and studies were grouped by screening model (opportunistic vs organised). Multifactor interventions targeting multiple levels of care and considering factors outside the individual clinician control, represent the most effective strategy to enhance CRC screening acceptance. Removing financial barriers, implementing methods allowing a systematic contact of the whole target population, using personal invitation letters, preferably signed by the reference care provider, and reminders mailed to all non-attendees are highly effective in enhancing CRC screening acceptance. Physician reminders may support the diffusion of screening, but they can be effective only for individuals who have access to and make use of healthcare services. Educational interventions for patients and providers are effective, but the implementation of organisational measures may be necessary to favour their impact. Available evidence indicates that organised programmes allow to achieve an extensive coverage and to enhance equity of access, while maximising the health impact of screening. They provide at the same time an infrastructure allowing to achieve a more favourable cost-effectiveness profile of potentially effective strategies, which would not be sustainable in opportunistic settings.
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Affiliation(s)
- Carlo Senore
- Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy
| | - John Inadomi
- Digestive Disease Center, University of Washington, Seattle, Washington, USA
| | - Nereo Segnan
- Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy
| | - Cristina Bellisario
- Centro di Prevenzione Oncologica (CPO Piemonte), AOU Città della Salute e della Scienza, Turin, Italy
| | - Cesare Hassan
- Unit of Gastroenterology, Ospedale Nuovo Regina Margherita, Rome, Italy
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Liles EG, Schneider JL, Feldstein AC, Mosen DM, Perrin N, Rosales AG, Smith DH. Implementation challenges and successes of a population-based colorectal cancer screening program: a qualitative study of stakeholder perspectives. Implement Sci 2015; 10:41. [PMID: 25890079 PMCID: PMC4391591 DOI: 10.1186/s13012-015-0227-z] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/06/2014] [Accepted: 03/03/2015] [Indexed: 12/18/2022] Open
Abstract
Background Few studies describe system-level challenges or facilitators to implementing population-based colorectal cancer (CRC) screening outreach programs. Our qualitative study explored viewpoints of multilevel stakeholders before, during, and after implementation of a centralized outreach program. Program implementation was part of a broader quality-improvement initiative. Methods During 2008–2010, we conducted semi-structured, open-ended individual interviews and focus groups at Kaiser Permanente Northwest (KPNW), a not-for-profit group model health maintenance organization using the practical robust implementation and sustainability model to explore external and internal barriers to CRC screening. We interviewed 55 stakeholders: 8 health plan leaders, 20 primary care providers, 4 program managers, and 23 endoscopy specialists (15 gastroenterologists, 8 general surgeons), and analyzed interview transcripts to identify common as well as divergent opinions expressed by stakeholders. Results The majority of stakeholders at various levels consistently reported that an automated telephone-reminder system to contact patients and coordinate mailing fecal tests alleviated organizational constraints on staff’s time and resources. Changing to a single-sample fecal immunochemical test (FIT) lessened patient and provider concerns about feasibility and accuracy of fecal testing. The centralized telephonic outreach program did, however, result in some screening duplication and overuse. Higher rates of FIT completion and a higher proportion of positive results with FIT required more colonoscopies. Conclusions Addressing barriers at multiple levels of a health system by changing the delivery system design to add a centralized outreach program, switching to a more accurate and easier-to-use fecal test, and providing educational and electronic support had both benefits and problematic consequences. Other health care organizations can use our results to understand the complexities of implementing centralized screening programs.
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Affiliation(s)
- Elizabeth G Liles
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA. .,Northwest Permanente, Kaiser Permanente Northwest, 500 NE Multnomah St, Suite 100, Portland, OR, 97232, USA.
| | - Jennifer L Schneider
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - Adrianne C Feldstein
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA. .,Northwest Permanente, Kaiser Permanente Northwest, 500 NE Multnomah St, Suite 100, Portland, OR, 97232, USA.
| | - David M Mosen
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - Nancy Perrin
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - Ana Gabriela Rosales
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
| | - David H Smith
- Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Ave, Portland, OR, 97227, USA.
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Lewis JA, Petty WJ, Tooze JA, Miller DP, Chiles C, Miller AA, Bellinger C, Weaver KE. Low-Dose CT Lung Cancer Screening Practices and Attitudes among Primary Care Providers at an Academic Medical Center. Cancer Epidemiol Biomarkers Prev 2015; 24:664-70. [PMID: 25613118 DOI: 10.1158/1055-9965.epi-14-1241] [Citation(s) in RCA: 120] [Impact Index Per Article: 13.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2014] [Accepted: 01/16/2015] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Low-dose computed tomography (LDCT) screening reduces lung cancer-specific and overall mortality. We sought to assess lung cancer screening practices and attitudes among primary care providers (PCPs) in the era of new LDCT screening guidelines. METHODS In 2013, we surveyed PCPs at an academic medical center (60% response) and assessed: lung cancer screening use, perceived screening effectiveness, knowledge of screening guidelines, perceived barriers to LDCT use, and interest in LDCT screening education. RESULTS Few PCPs (n = 212) reported ordering lung cancer screening: chest X-ray (21%), LDCT (12%), and sputum cytology (3%). Only 47% of providers knew three or more of six guideline components for LDCT screening; 24% did not know any guideline components. In multiple logistic regression analysis, providers who knew three or more guideline components were more likely to order LDCT (OR, 7.1; 95% confidence intervals, 2.0-25.6). Many providers (30%) were unsure of the effectiveness of LDCT. Mammography, colonoscopy, and Pap smear were rated more frequently as effective in reducing cancer mortality compared with LDCT (all P values < 0.0001). Common perceived barriers included patient cost (86.9% major or minor barrier), harm from false positives (82.7%), patients' lack of awareness (81.3%), risk of incidental findings (81.3%), and insurance coverage (80.1%). CONCLUSIONS LDCT lung cancer screening is currently an uncommon practice at an academic medical center. PCPs report ordering chest X-ray, a nonrecommended screening test, more often than LDCT. PCPs had a limited understanding of lung cancer screening guidelines and LDCT effectiveness. Provider educational interventions are needed to facilitate shared decision-making with patients. IMPACT This study describes some of the first data available about PCPs' use of lung cancer screening tests since the publication of multiple professional guidelines endorsing LDCT. Knowledge gaps were identified that may hinder the uptake of evidence-based lung cancer screening guidelines.
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Affiliation(s)
- Jennifer A Lewis
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - W Jeffrey Petty
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Janet A Tooze
- Department of Biostatistical Sciences, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - David P Miller
- Department of Internal Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Caroline Chiles
- Department of Radiology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Antonius A Miller
- Department of Internal Medicine, Section on Hematology and Oncology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Christina Bellinger
- Department of Internal Medicine, Section on Pulmonology, Wake Forest School of Medicine, Winston-Salem, North Carolina
| | - Kathryn E Weaver
- Department of Social Sciences and Health Policy, Wake Forest School of Medicine, Winston-Salem, North Carolina.
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Tarasoff LA, Epstein R, Green DC, Anderson S, Ross LE. Using interactive theatre to help fertility providers better understand sexual and gender minority patients. MEDICAL HUMANITIES 2014; 40:135-41. [PMID: 25005177 DOI: 10.1136/medhum-2014-010516] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/25/2023]
Abstract
OBJECTIVE To determine the effectiveness of interactive theatre as a knowledge translation and exchange (KTE) method to educate assisted human reproduction (AHR) service providers about lesbian, gay, bisexual, trans and queer (LGBTQ) patients. DESIGN We transformed data from the 'Creating Our Families' study, a qualitative, community-based study of LGBTQ peoples' experiences accessing AHR services, into a script for an interactive theatre workshop for AHR service providers. Based on forum theatre principles, our workshop included five scenes illustrating LGBTQ people interacting with service providers, followed by audience interventions to these scenes. Before and after the workshop, service providers completed surveys to assess their knowledge and comfort concerning LGBTQ patients, as well as the modality of the interactive theatre workshop as a KTE strategy. Wilcoxon signed-rank tests were used to determine changes in preworkshop and postworkshop knowledge and comfort scores. RESULTS Thirty AHR service providers attended the workshop. Twenty-three service providers (76.7%) fully completed the preworkshop and postworkshop evaluation forms. Service providers' knowledge scores significantly improved after the workshop, while their comfort scores minimally decreased. Most agreed that the interactive workshop was an effective KTE method. CONCLUSIONS In comparison with traditional forms of KTE, interactive theatre may be particularly effective in engaging service providers and addressing their attitudes towards marginalised patient populations. Although the evaluation results of our interactive workshop were mostly positive, the long-term impact of the workshop is unknown. Long-term evaluations are needed to determine the effectiveness of arts-based KTE efforts. Other considerations for developing effective arts-based KTE strategies include adequate funding, institutional support, attention to power dynamics and thoughtful collaboration with forum theatre experts.
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Affiliation(s)
- Lesley A Tarasoff
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
| | - Rachel Epstein
- LGBTQ Parenting Network, Sherbourne Health Centre, Toronto, Ontario, Canada
| | | | | | - Lori E Ross
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada Social and Epidemiological Research Department, Centre for Addiction and Mental Health, Toronto, Ontario, Canada
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Nygårdh A, Malm D, Wikby K, Ahlström G. The complexity in the implementation process of empowerment-based chronic kidney care: a case study. BMC Nurs 2014; 13:22. [PMID: 25104917 PMCID: PMC4124497 DOI: 10.1186/1472-6955-13-22] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2013] [Accepted: 07/23/2014] [Indexed: 11/29/2022] Open
Abstract
Background This study is part of an interactive improvement intervention aimed to facilitate empowerment-based chronic kidney care using data from persons with CKD and their family members. There are many challenges to implementing empowerment-based care, and it is therefore necessary to study the implementation process. The aim of this study was to generate knowledge regarding the implementation process of an improvement intervention of empowerment for those who require chronic kidney care. Methods A prospective single qualitative case study was chosen to follow the process of the implementation over a two year period. Twelve health care professionals were selected based on their various role(s) in the implementation of the improvement intervention. Data collection comprised of digitally recorded project group meetings, field notes of the meetings, and individual interviews before and after the improvement project. These multiple data were analyzed using qualitative latent content analysis. Results Two facilitator themes emerged: Moving spirit and Encouragement. The healthcare professionals described a willingness to individualize care and to increase their professional development in the field of chronic kidney care. The implementation process was strongly reinforced by both the researchers working interactively with the staff, and the project group. One theme emerged as a barrier: the Limitations of the organization. Changes in the organization hindered the implementation of the intervention throughout the study period, and the lack of interplay in the organization most impeded the process. Conclusions The findings indicated the complexity of maintaining a sustainable and lasting implementation over a period of two years. Implementing empowerment-based care was found to be facilitated by the cooperation between all involved healthcare professionals. Furthermore, long-term improvement interventions need strong encouragement from all levels of the organization to maintain engagement, even when it is initiated by the health care professionals themselves.
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Affiliation(s)
- Annette Nygårdh
- School of Health Sciences, Jönköping University, P.O. Box 1026, Jönköping SE-551 11, Sweden
| | - Dan Malm
- School of Health Sciences, Jönköping University, P.O. Box 1026, Jönköping SE-551 11, Sweden ; Department of Internal Medicine, County Hospital Ryhov, Jönköping SE-55185, Sweden
| | | | - Gerd Ahlström
- Department of Health Sciences, Faculty of Medicine, Lund University, P.O. Box 187, Lund SE-221 00, Sweden
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Adonis L, Basu D, Luiz J. Predictors of adherence to screening guidelines for chronic diseases of lifestyle, cancers, and HIV in a health-insured population in South Africa. Glob Health Action 2014; 7:23807. [PMID: 24647130 PMCID: PMC3957800 DOI: 10.3402/gha.v7.23807] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2014] [Revised: 02/20/2014] [Accepted: 02/22/2014] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND Adherence to screening guidelines has been widely accepted to reduce morbidity, mortality, and cost outcomes. The aim of this study was to identify predictors of adherence to screening guidelines for chronic diseases of lifestyle (CDL), cancers, and HIV in a health-insured population in South Africa, some of whom voluntarily opt into a wellness program that incentivizes screening. METHOD A cross-sectional study for the period 2007-2011 was conducted using a random sample of 170,471 health insurance members from a single insurer. Adherence to screening guidelines was calculated from medical claims data. RESULTS Adherence to screening guidelines ranged from 1.1% for colorectal cancer to 40.9% for cholesterol screening. Members of the wellness program were up to three times more likely to screen for diseases (odds ratio [OR] = 3.2 for HIV screening, confidence interval [CI] = 2.75-3.73). Plan type (full comprehensive plan) was most strongly associated with cholesterol screening (OR = 3.53, CI = 3.27-3.80), and most negatively associated (hospital-only core plan) with cervical cancer screening (OR = 0.44, CI = 0.28-0.70). Gender was a negative predictor for glucose screening (OR = 0.88, CI = 0.82-0.96). Provincial residence was most strongly associated with cervical cancer screening (OR = 1.89, CI = 0.65-5.54). CONCLUSION Adherence to screening recommendations was <50%. Plan type, gender, provincial residence, and belonging to an incentivized wellness program were associated with disproportionate utilization of screening services, even with equal payment access.
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Affiliation(s)
- Leegale Adonis
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - Debashis Basu
- School of Public Health, University of Witwatersrand, Johannesburg, South Africa
| | - John Luiz
- Graduate School of Business, University of Cape Town, Cape Town, South Africa
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Galor A, Cybulski C, Lubiński J, Narod SA, Gronwald J. Optimizing recruitment to a prostate cancer surveillance program among male BRCA1 mutation carriers: invitation by mail or by telephone. Hered Cancer Clin Pract 2013; 11:17. [PMID: 24325841 PMCID: PMC3904754 DOI: 10.1186/1897-4287-11-17] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2013] [Accepted: 12/02/2013] [Indexed: 11/18/2022] Open
Abstract
The effectiveness of a genetics-based public health screening programs depend on the successful recruitment of subjects who qualify for intensified screening by virtue of a positive genetic test. Herein we compare the effectiveness of a mailed invitation and follow-up phone call for non-responding subjects and an initial invitation by telephone addressed to male BRCA1 mutation carriers for prostate screening. The final participation rate was 75% (42 of 56) for men who were initially contacted by mail (and follow-up phone call) and 81% (30 of 37) for men who were initially contacted by telephone. Among the men who were initially contacted by mail, it was necessary to telephone 54% of these patients (30 of 56). After a calculation of the cost-effectiveness related to these results, we conclude that if the costs of the phone call were to exceed the costs of the letter by 2.5 times or more, then savings would be arranged by initiating contact with a mailed invitation.
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Affiliation(s)
| | | | | | | | - Jacek Gronwald
- Department of Genetics and Pathology, International Hereditary Cancer Center, Pomeranian Medical University, Połabska 4, 70-115 Szczecin, Poland.
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Provincial screening rates for chronic diseases of lifestyle, cancers and HIV in a health-insured population. S Afr Med J 2013; 103:309-12. [PMID: 23971120 DOI: 10.7196/samj.6686] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Screening for asymptomatic diseases can reduce the burden of morbidity and mortality in all population groups. There is widespread geographical variation in the quality of care. Few data are available on national screening rates in South Africa and how these vary across the provinces. OBJECTIVE To examine screening rates for chronic diseases of lifestyle (CDL), HIV and cancer in a privately insured population for a single insurer across all nine provinces in South Africa, and to determine whether or not there are any differences between the provinces. METHOD Screening rates were calculated as the proportion of eligible members who had received screening tests during 2011 in each province. Mean screening rates were compared between Gauteng and the other eight provinces. RESULTS Nationwide screening rates were 20.5% for CDL, 8.2% for HIV and 31.9% for cancer. Despite similar insurance coverage, screening rates ranged from 0.3% to 0.95% lower in other provinces compared with Gauteng. Of all the provinces, Gauteng had the highestannual screening rates for CDL, breast cancer, prostate cancer and HIV (p < 0.001), while the Western Cape had the highest rate for cervical cancer (p < 0.001). CONCLUSION There is much variation in preventive care utilisation across the provinces within this health-insured population. Provinces with more abundant healthcare resources have higher screening rates. Further research is required to understand the reasons for the variation, given equal payment access.
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Rohan EA, Boehm JE, DeGroff A, Glover-Kudon R, Preissle J. Implementing the CDC's Colorectal Cancer Screening Demonstration Program: wisdom from the field. Cancer 2013; 119 Suppl 15:2870-83. [PMID: 23868482 PMCID: PMC5389376 DOI: 10.1002/cncr.28162] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2012] [Revised: 09/24/2012] [Accepted: 10/18/2012] [Indexed: 12/14/2022]
Abstract
BACKGROUND Colorectal cancer, as the second leading cause of cancer-related deaths among men and women in the United States, represents an important area for public health intervention. Although colorectal cancer screening can prevent cancer and detect disease early when treatment is most effective, few organized public health screening programs have been implemented and evaluated. From 2005 to 2009, the Centers for Disease Control and Prevention funded 5 sites to participate in the Colorectal Cancer Screening Demonstration Program (CRCSDP), which was designed to reach medically underserved populations. METHODS The authors conducted a longitudinal, multiple case study to analyze program implementation processes. Qualitative methods included interviews with 100 stakeholders, 125 observations, and review of 19 documents. Data were analyzed within and across cases. RESULTS Several themes related to CRCSDP implementation emerged from the cross-case analysis: the complexity of colorectal cancer screening, the need for teamwork and collaboration, integration of the program into existing systems, the ability of programs to use wisdom at the local level, and the influence of social norms. Although these themes were explored independently from 1 another, interaction across themes was evident. CONCLUSIONS Colorectal cancer screening is clinically complex, and its screening methods are not well accepted by the general public; both of these circumstances have implications for program implementation. Using patient navigation, engaging in transdisciplinary teamwork, assimilating new programs into existing clinical settings, and deferring to local-level wisdom together helped to address complexity and enhance program implementation. In addition, public health efforts must confront negative social norms around colorectal cancer screening.
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Affiliation(s)
- Elizabeth A Rohan
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Atlanta, Georgia, USA.
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Waller J, Macedo A, von Wagner C, Simon AE, Jones C, Hammersley V, Weller D, Wardle J, Campbell C. Communication about colorectal cancer screening in Britain: public preferences for an expert recommendation. Br J Cancer 2012; 107:1938-43. [PMID: 23175148 PMCID: PMC3516693 DOI: 10.1038/bjc.2012.512] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Revised: 10/08/2012] [Accepted: 10/22/2012] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Informed decision-making approaches to cancer screening emphasise the importance of decisions being determined by individuals' own values and preferences. However, advice from a trusted source may also contribute to autonomous decision-making. This study examined preferences regarding a recommendation from the NHS and information provision in the context of colorectal cancer (CRC) screening. METHODS In face-to-face interviews, a population-based sample of adults across Britain (n=1964; age 50-80 years) indicated their preference between: (1) a strong recommendation to participate in CRC screening, (2) a recommendation alongside advice to make an individual decision, and (3) no recommendation but advice to make an individual decision. Other measures included trust in the NHS and preferences for information on benefits and risks. RESULTS Most respondents (84%) preferred a recommendation (47% strong recommendation, 37% recommendation plus individual decision-making advice), but the majority also wanted full information on risks (77%) and benefits (78%). Men were more in favour of a recommendation than women (86% vs 81%). Trust in the NHS was high overall, but the minority who expressed low trust were less likely to want a recommendation. CONCLUSION Most British adults want full information on risks and benefits of screening but they also want a recommendation from an authoritative source. An 'expert' view may be an important part of autonomous health decision-making.
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Affiliation(s)
- J Waller
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
| | - A Macedo
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
| | - C von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
| | - A E Simon
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
- School of Health Sciences, City University London, College Building, Northampton Square, London EC1V 0HB, UK
| | - C Jones
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
| | - V Hammersley
- Centre for Population Health Sciences, The University of Edinburgh, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - D Weller
- Centre for Population Health Sciences, The University of Edinburgh, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
| | - J Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, UK
| | - C Campbell
- Centre for Population Health Sciences, The University of Edinburgh, Medical Quad, Teviot Place, Edinburgh, EH8 9AG, Scotland, UK
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Abstract
Colorectal cancer screening (CRCS) is the only way to detect colorectal cancer in its earlier stages when morbidity and mortality are low. The literature has shown provider-directed recommendations with office system-directed interventions are the best way to increase CRCS rates.
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Zapka J, Klabunde CN, Taplin S, Yuan G, Ransohoff D, Kobrin S. Screening colonoscopy in the US: attitudes and practices of primary care physicians. J Gen Intern Med 2012; 27:1150-8. [PMID: 22539065 PMCID: PMC3514996 DOI: 10.1007/s11606-012-2051-3] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2011] [Revised: 02/14/2012] [Accepted: 03/09/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Rising colorectal cancer (CRC) screening rates in the last decade are attributable almost entirely to increased colonoscopy use. Little is known about factors driving the increase, but primary care physicians (PCPs) play a central role in CRC screening delivery. OBJECTIVE Explore PCP attitudes toward screening colonoscopy and their associations with CRC screening practice patterns. DESIGN Cross-sectional analysis of data from a nationally representative survey conducted in 2006-2007. PARTICIPANTS 1,266 family physicians, general practitioners, general internists, and obstetrician-gynecologists. MAIN MEASURES Physician-reported changes in the volume of screening tests ordered, performed or supervised in the past 3 years, attitudes toward colonoscopy, the influence of evidence and perceived norms on their recommendations, challenges to screening, and practice characteristics. RESULTS The cooperation rate (excludes physicians without valid contact information) was 75%; 28% reported their volume of FOBT ordering had increased substantially or somewhat, and the majority (53%) reported their sigmoidoscopy volume decreased either substantially or somewhat. A majority (73%) reported that colonoscopy volume increased somewhat or substantially. The majority (86%) strongly agreed that colonoscopy was the best of the available CRC screening tests; 69% thought it was readily available for their patients; 59% strongly or somewhat agreed that they might be sued if they did not offer colonoscopy to their patients. All three attitudes were significantly related to substantial increases in colonoscopy ordering. CONCLUSIONS PCPs report greatly increased colonoscopy recommendation relative to other screening tests, and highly favorable attitudes about colonoscopy. Greater emphasis is needed on informed decision-making with patients about preferences for test options.
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Affiliation(s)
- Jane Zapka
- Department of Medicine, Medical University of South Carolina, Charleston, SC, USA.
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Abstract
Demand for laboratory testing is increasing disproportionately to medical activity, and the tests involved are becoming increasingly complex. When this phenomenon is seen in parallel with declining teaching of laboratory medicine in the medical curriculum, a need emerges to manage demand to avoid unnecessary expenditure and improve the use of laboratory services: 'the right test in the right patient at the right time.' Various methods have been tried to manage demand, with success depending on the medical context, type of health service and preintervention situation. Because many factors contribute to demand, and the different settings in which these exist, it is not realistic to meta-analyse the studies and we are limited to trying to identify trends in results in particular situations. The studies suggest that education combined with facilitating interventions, such as feedback, prompts and changes to laboratory request forms are the most successful. From the perspective of a whole health service, it is important that results are not exaggerated by assessing benefits in terms of total rather than marginal cost. It would be desirable, although difficult, to include the impact on downstream clinical activity caused or avoided by the interventions. Advances in information and web technology may make the elusive goal of achieving substantial demand control more achievable.
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Affiliation(s)
- W S A Smellie
- Department of Chemical Pathology, Bishop Auckland General Hospital, Cockton Hill Road, Bishop Auckland, County Durham DL14 6AD, UK.
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Klabunde CN, Marcus PM, Han PKJ, Richards TB, Vernon SW, Yuan G, Silvestri GA. Lung cancer screening practices of primary care physicians: results from a national survey. Ann Fam Med 2012; 10:102-10. [PMID: 22412001 PMCID: PMC3315128 DOI: 10.1370/afm.1340] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2011] [Revised: 08/02/2011] [Accepted: 08/23/2011] [Indexed: 11/09/2022] Open
Abstract
PURPOSE Although current practice guidelines do not recommend screening asymptomatic patients for lung cancer, physicians may still order lung cancer screening tests. No recent national survey of health care professionals has focused on lung cancer screening. In this study, we examined the lung cancer screening practices of US primary care physicians and characteristics of those who order lung cancer screening tests. METHODS We conducted a nationally representative survey of practicing primary care physicians in 2006-2007. Mailed questionnaires assessed the physicians' knowledge of lung cancer screening guidelines, beliefs about the effectiveness of screening tests, and ordering of screening chest radiograph, low-dose spiral computed tomography, or sputum cytology in the past 12 months. Clinical vignettes were used to assess the physicians' intentions to screen asymptomatic 50-year-old patients with varying smoking histories for lung cancer. RESULTS A total of 962 family physicians, general practitioners, and general internists completed questionnaires (cooperation rate = 76.8%). Overall, 38% had ordered no lung cancer screening tests; 55% had ordered chest radiograph, 22% low-dose spiral computed tomography, and less than 5% sputum cytology. In multivariate modeling, physicians were more likely to have ordered lung cancer screening tests if they believed that expert groups recommend lung cancer screening or that screening tests are effective; if they would recommend screening for asymptomatic patients, including patients without substantial smoking exposure; and if their patients had asked them about screening. CONCLUSIONS Primary care physicians in the United States frequently order lung cancer screening tests for asymptomatic patients, even though expert groups do not recommend it. Primary care physicians and patients need more information about lung cancer screening's evidence base, guidelines, potential harms, and costs to avert inappropriate ordering.
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Affiliation(s)
- Carrie N Klabunde
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland 20892-7344, USA.
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Davis TC, Arnold CL, Rademaker AW, Platt DJ, Esparza J, Liu D, Wolf MS. FOBT completion in FQHCs: impact of physician recommendation, FOBT information, or receipt of the FOBT kit. J Rural Health 2012; 28:306-11. [PMID: 22757955 DOI: 10.1111/j.1748-0361.2011.00402.x] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
PURPOSE To determine the effect of common components of primary care-based colorectal cancer (CRC) screening interventions on fecal occult blood test (FOBT) completion within rural and urban community clinics, including: (1) physician's spoken recommendation, (2) providing information or education about FOBTs, and (3) physician providing the FOBT kit; to determine the relative effect of these interventions; and to compare the effect of each intervention between rural and urban clinics. METHODS We conducted structured interviews with patients aged 50 years and over receiving care at community clinics that were noncompliant with CRC screening. Self-report of ever receiving a physician's recommendation for screening, FOBT information or education, physician providing an FOBT kit, and FOBT completion were collected. FINDINGS Participants included 849 screening-eligible adults; 77% were female and 68% were African American. The median age was 57; 33% lacked a high school diploma and 51% had low literacy. In multivariable analysis, all services were predictive of rural participants completing screening (physician recommendation: P = .002; FOBT education: P = .001; physician giving FOBT kit: P < .0001). In urban clinics, only physician giving the kit predicted FOBT completion (P < .0001). Compared to urban patients, rural patients showed a stronger relationship between FOBT completion and receiving a physician recommendation (risk ratio [RR]: 5.3 vs. 2.1; P = .0001), receiving information or education on FOBTs (RR: 3.8 vs 1.9; P = .0002), or receiving an FOBT kit from their physician (RR: 22.3 vs. 10.1; P = .035). CONCLUSIONS Participants who receive an FOBT kit from their physician are more likely to complete screening.
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Affiliation(s)
- Terry C Davis
- Department of Medicine and Pediatrics, Louisiana State University Health Sciences Center, Shreveport, Louisiana 71130, USA.
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Atassi K, Nemeth L, Edlund B, Mueller M, Tessaro I. Adapting the PPRNet TRIP QI Model to Increase Colorectal Cancer Screening in Primary Care. ACTA ACUST UNITED AC 2012. [DOI: 10.4236/jct.2012.326111] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022]
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Factors influencing colorectal cancer screening participation. Gastroenterol Res Pract 2011; 2012:483417. [PMID: 22190913 PMCID: PMC3235570 DOI: 10.1155/2012/483417] [Citation(s) in RCA: 98] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2011] [Accepted: 10/18/2011] [Indexed: 02/07/2023] Open
Abstract
Colorectal cancer (CRC) is a major health problem worldwide. Although population-based CRC screening is strongly recommended in average-risk population, compliance rates are still far from the desirable rates. High levels of screening uptake are necessary for the success of any screening program. Therefore, the investigation of factors influencing participation is crucial prior to design and launches a population-based organized screening campaign. Several studies have identified screening behaviour factors related to potential participants, providers, or health care system. These influencing factors can also be classified in non-modifiable (i.e., demographic factors, education, health insurance, or income) and modifiable factors (i.e., knowledge about CRC and screening, patient and provider attitudes or structural barriers for screening). Modifiable determinants are of great interest as they are plausible targets for interventions. Interventions at different levels (patient, providers or health care system) have been tested across the studies with different results. This paper analyzes factors related to CRC screening behaviour and potential interventions designed to improve screening uptake.
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Ho MY, Lai JY, Cheung WY. The influence of physicians on colorectal cancer screening behavior. Cancer Causes Control 2011; 22:1659-68. [PMID: 21971815 DOI: 10.1007/s10552-011-9842-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2010] [Accepted: 09/08/2011] [Indexed: 10/17/2022]
Abstract
BACKGROUND Our aims were to determine clinical factors associated with colorectal cancer (CRC) screening and to evaluate the relative role of patient contact with physicians and the quality of these patient-physician interactions in affecting screening. METHODS Screening-eligible patients were identified from the Health Information National Trends Survey. Determinants of CRC screening were assessed with logistic regression, and a joint effects model that considered the frequency and quality of contact with physicians was developed to explore their influence on screening. RESULTS There were 4,615 respondents of whom only 66% reported receiving CRC screening. Older age, personal history of non-CRC, family history of any cancer, high-income earners, individuals who visited their physicians ≥5 times per year, and those who rated the interactions with their physicians highly were more likely to be screened (all p < 0.05). The joint effects model revealed that quality rather than frequency of physician contact was a stronger predictor of CRC screening, but the odds of screening was highest for those who experienced both frequent and high-quality interactions with their physicians. CONCLUSIONS Contact with physicians and the quality of this interaction are associated with screening behavior. Interventions to improve these provider-related factors may promote CRC screening.
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Affiliation(s)
- Maria Y Ho
- Division of Medical Oncology, British Columbia Cancer Agency, Vancouver Clinic, 600 W. 10th Ave, Vancouver, BC, Canada
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Zapka JM, Klabunde CN, Arora NK, Yuan G, Smith JL, Kobrin SC. Physicians' colorectal cancer screening discussion and recommendation patterns. Cancer Epidemiol Biomarkers Prev 2011; 20:509-21. [PMID: 21239688 PMCID: PMC3050999 DOI: 10.1158/1055-9965.epi-10-0749] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Primary care physician (PCP) actions are pivotal to colorectal cancer (CRC) screening performance, and guidelines recommend discussion with patients about test options and potential benefits and harms. This article profiles patterns of discussion about and recommendations for screening and explores potential associations with multilevel factors (patient, clinician, practice, and environment). METHODS In 2009, we analyzed data from 1,266 physicians responding to the 2006-2007 National Survey of Primary Care Physicians' Recommendations and Practices for Breast, Cervical, Colorectal, and Lung Cancer Screening (absolute response rate=69.3%; cooperation rate=75.0%). Descriptive statistics examined physicians' reports of discussion and recommendations. Multivariate analyses assessed the associations of these practices with multilevel factors. RESULTS Although few respondents reported discussion of all options, 46% usually discuss more than one option; the vast majority of these respondents discuss fecal occult blood testing (FOBT) and colonoscopy (49%) or FOBT, sigmoidoscopy, and colonoscopy (32%). Of physicians who discuss more than one option, a majority reported usually recommending one or more test options, most commonly colonoscopy alone (43%) and FOBT and colonoscopy (43%). Several personal characteristics (specialty), perceived patient characteristics (prefer physician to decide), practice characteristics (geographic location), and community barriers (specialist availability) were independently associated with discussion and/or recommendation patterns. CONCLUSIONS PCPs do not discuss the full menu of test options, but many report selecting one or two options for discussion and recommendation. To ensure that patients' perspectives and concerns are elicited and considered, patient decision-making approaches should be considered. IMPACT Attention to informed decision making in CRC screening will be important for enhancing patient-centered quality care.
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Affiliation(s)
- Jane M Zapka
- Department of Medicine, Division of Biostatistics and Epidemiology, 135 Cannon Street, Medical University of South Carolina, Charleston, SC 29425, USA.
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Low-Income Women with Abnormal Breast Findings: Results of a Randomized Trial to Increase Rates of Diagnostic Resolution. Cancer Epidemiol Biomarkers Prev 2010; 19:1927-36. [DOI: 10.1158/1055-9965.epi-09-0481] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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Hade EM, Murray DM, Pennell ML, Rhoda D, Paskett ED, Champion VL, Crabtree BF, Dietrich A, Dignan MB, Farmer M, Fenton JJ, Flocke S, Hiatt RA, Hudson SV, Mitchell M, Monahan P, Shariff-Marco S, Slone SL, Stange K, Stewart SL, Strickland PAO. Intraclass correlation estimates for cancer screening outcomes: estimates and applications in the design of group-randomized cancer screening studies. J Natl Cancer Inst Monogr 2010; 2010:97-103. [PMID: 20386058 DOI: 10.1093/jncimonographs/lgq011] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND Screening has become one of our best tools for early detection and prevention of cancer. The group-randomized trial is the most rigorous experimental design for evaluating multilevel interventions. However, identifying the proper sample size for a group-randomized trial requires reliable estimates of intraclass correlation (ICC) for screening outcomes, which are not available to researchers. We present crude and adjusted ICC estimates for cancer screening outcomes for various levels of aggregation (physician, clinic, and county) and provide an example of how these ICC estimates may be used in the design of a future trial. METHODS Investigators working in the area of cancer screening were contacted and asked to provide crude and adjusted ICC estimates using the analysis of variance method estimator. RESULTS Of the 29 investigators identified, estimates were obtained from 10 investigators who had relevant data. ICC estimates were calculated from 13 different studies, with more than half of the studies collecting information on colorectal screening. In the majority of cases, ICC estimates could be adjusted for age, education, and other demographic characteristics, leading to a reduction in the ICC. ICC estimates varied considerably by cancer site and level of aggregation of the groups. CONCLUSIONS Previously, only two articles had published ICCs for cancer screening outcomes. We have complied more than 130 crude and adjusted ICC estimates covering breast, cervical, colon, and prostate screening and have detailed them by level of aggregation, screening measure, and study characteristics. We have also demonstrated their use in planning a future trial and the need for the evaluation of the proposed interval estimator for binary outcomes under conditions typically seen in GRTs.
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Affiliation(s)
- Erinn M Hade
- Center for Biostatistics, The Ohio State University, 2012 Kenny Rd, Columbus, OH 43221, USA.
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Taplin SH, Rodgers AB. Toward improving the quality of cancer care: addressing the interfaces of primary and oncology-related subspecialty care. J Natl Cancer Inst Monogr 2010; 2010:3-10. [PMID: 20386048 DOI: 10.1093/jncimonographs/lgq006] [Citation(s) in RCA: 102] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Affiliation(s)
- Stephen Hunt Taplin
- Applied Research Program, Division of Cancer Control and Population Sciences, National Cancer Institute, 6130 Executive Blvd, MSC 7344, EPN 4005, Rockville, MD 20852-7344, USA.
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A randomized controlled trial of a multilevel intervention to increase colorectal cancer screening among Latino immigrants in a primary care facility. J Gen Intern Med 2010; 25:564-7. [PMID: 20213208 PMCID: PMC2869418 DOI: 10.1007/s11606-010-1266-4] [Citation(s) in RCA: 50] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2009] [Revised: 10/15/2009] [Accepted: 01/20/2010] [Indexed: 10/19/2022]
Abstract
BACKGROUND Latino immigrants face a higher burden of colorectal cancer (CRC) and screening rates are low. OBJECTIVE To assess the effectiveness of a multilevel intervention in increasing the rate of CRC screening among Latino immigrants. DESIGN A randomized controlled trial, with randomization at the physician level. PARTICIPANTS Pairs of 65 primary care physicians and 65 Latino immigrant patients participated, 31 in the intervention and 34 in the control group. INTERVENTION CRC educational video in Spanish on a portable personal digital video display device accompanied by a brochure with key information for the patient, and a patient-delivered paper-based reminder for their physician. MEASUREMENTS Completed CRC screening, physician recommendation for CRC screening, and patient adherence to physician recommended CRC screening. RESULTS The overall rate of completed screening for CRC was 55% for the intervention and 18% for the control group (p = 0.002). Physicians recommended CRC screening for 61% of patients in the intervention group versus 41% in the control group (p = 0.08). Of those that received a recommendation, 90% in the intervention group adhered to it versus 26% in the control group (p = 0.007). CONCLUSIONS The intervention was successful in increasing rates of completed CRC screening primarily through increasing adherence after screening was recommended. Additional efforts should focus on developing new strategies to increase physician recommendation for CRC screening, while employing effective patient adherence interventions.
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Too much of a good thing? Physician practices and patient willingness for less frequent pap test screening intervals. Med Care 2010; 48:249-59. [PMID: 20182268 DOI: 10.1097/mlr.0b013e3181ca4015] [Citation(s) in RCA: 47] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Recent guidelines recommend longer Pap test intervals. However, physicians and patients may not be adopting these recommendations. OBJECTIVES Identify (1) physician and practice characteristics associated with recommending a less frequent interval, and (2) characteristics associated with women's willingness to adhere to a 3-year interval. RESEARCH DESIGN We used 2 national surveys: (1) a 2006/2007 National Survey of Primary Care Physicians for physician cervical cancer screening practices (N = 1114), and (2) the 2005 Health Information Trends Survey for women's acceptance of longer Pap intervals (N = 2206). MEASURES AND METHODS: Physician recommendation regarding Pap intervals was measured using a clinical vignette involving a 35-year-old with no new sexual partners and 3 consecutive negative Pap tests; associations with independent variables were evaluated with logistic regression. In parallel models, we evaluated women's willingness to follow a 3-year Pap test interval. RESULTS A minority of physicians (32%) have adopted-but more than half of women are willing to adopt-3-year Pap test intervals. In adjusted models, physician factors associated with less frequent screening were: serving a higher proportion of Medicaid patients, white, non-Hispanic race, fewer years since medical school graduation, and US Preventive Services Task Force being very influential in physician clinical practice. Women were more willing to follow a 3-year interval if they were older, but less willing if they had personal or family experiences with cancer or followed an annual Pap test schedule. CONCLUSIONS Many women are accepting of a 3-year interval for Pap tests, although most primary care physicians continue to recommend shorter intervals.
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Ngwakongnwi E, Hemmelgarn B, Quan H. Documentation of preventive screening interventions by general practitioners: a retrospective chart audit. BMC FAMILY PRACTICE 2010; 11:21. [PMID: 20214813 PMCID: PMC2841654 DOI: 10.1186/1471-2296-11-21] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2009] [Accepted: 03/09/2010] [Indexed: 11/17/2022]
Abstract
Background Screening and early diagnosis has been shown to reduce the morbidity and mortality associated with certain conditions such as cervical cancer. The role of general practitioners in promoting primary prevention of diseases is particularly important given that they have frequent contact with a large proportion of the population. This study assessed the extent to which general practitioners documented recommended preventive screening interventions among eligible patients. Methods We used a retrospective chart audit to assess patient visits to primary care clinics in Calgary, Canada from 2002-2004. We included fee for service physicians who practiced ≥ 2 days per week at their current location and excluded those whose primary practice was at walk-in clinics, community health centers, hospitals or emergency rooms. We included charts of patients who during the study period were age 35 years or older and had at least 2 visits to a clinic. We randomly selected and reviewed charts (N = 600) from 12 primary care clinics and abstracted information on 6 conditions recommended for preventive screening. Opportunities for preventive screening were determined based on recommendations of the Canadian Task Force on Preventive Health Care, the American College of Physicians, and the Canadian Cancer Society. Our main outcome measures included cancer screening (mammography and pap smears), immunization (influenza and pneumococcal), and risk factor assessment (cholesterol measurement and smoking cessation consultation). Results Patient visits to GP clinics present opportunities for preventive screening. However, we found that documentation of interventions was low, ranging from 40.3% (cholesterol measurement) to 0.9% (pneumococcal vaccination) within 1 year, and from 67.4% to 1.8% within the prior 3 years. Conclusions Documentation of preventive screening interventions by general practitioners was relatively low compared to the number of patients eligible for preventive screening. Some physicians opt to screen for PSA and DRE which is not recommended by the Canadian Task Force on Preventive HealthCare.
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Affiliation(s)
- Emmanuel Ngwakongnwi
- Department of Community Health Sciences, University of Calgary, Calgary, Alberta, Canada
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Pruitt SL, Shim MJ, Mullen PD, Vernon SW, Amick BC. Association of area socioeconomic status and breast, cervical, and colorectal cancer screening: a systematic review. Cancer Epidemiol Biomarkers Prev 2010; 18:2579-99. [PMID: 19815634 DOI: 10.1158/1055-9965.epi-09-0135] [Citation(s) in RCA: 130] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023] Open
Abstract
BACKGROUND Although numerous studies have examined the association of area socioeconomic status (SES) and cancer screening after controlling for individual SES, findings have been inconsistent. A systematic review of existing studies is timely to identify conceptual and methodologic limitations and to provide a basis for future research directions and policy. OBJECTIVE The objectives were to (a) describe the study designs, constructs, methods, and measures; (b) describe the independent association of area SES and cancer screening; and (c) identify neglected areas of research. METHODS We searched six electronic databases and manually searched cited and citing articles. Eligible studies were published before 2008 in peer-reviewed journals in English, represented primary data on individuals ages > or = 18 years from developed countries, and measured the association of area and individual SES with breast, cervical, or colorectal cancer screening. RESULTS Of 19 eligible studies, most measured breast cancer screening. Studies varied widely in research design, definitions, and measures of SES, cancer screening behaviors, and covariates. Eight employed multilevel logistic regression, whereas the remainder analyzed data with standard single-level logistic regression. The majority measured one or two indicators of area and individual SES; common indicators at both levels were poverty, income, and education. There was no consistent pattern in the association between area SES and cancer screening. DISCUSSION The gaps and conceptual and methodologic heterogeneity in the literature to date limit definitive conclusions about an underlying association between area SES and cancer screening. We identify five areas of research deserving greater attention in the literature.
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Affiliation(s)
- Sandi L Pruitt
- Division of Health Behavior Research, Washington University School of Medicine, Campus Box 8504, 4444 Forest Park Avenue, Suite 6700, St. Louis, MO 63108, USA.
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