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Brotzman LE, Zikmund-Fisher BJ. Perceived Barriers Among Clinicians and Older Adults Aged 65 and Older Regarding Use of Life Expectancy to Inform Cancer Screening: A Narrative Review and Comparison. Med Care Res Rev 2023; 80:372-385. [PMID: 36800914 DOI: 10.1177/10775587231153269] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/20/2023]
Abstract
While cancer screening guidelines increasingly recommend incorporating life expectancy estimates to inform screening decisions for older adults, little is known about how this happens in practice. This review summarizes current knowledge about primary care clinician and older adult (65+) perspectives about use of life expectancy to guide cancer screening decisions. Clinicians report operational barriers, uncertainty, and hesitation around use of life expectancy in screening decisions. They recognize it may help them more accurately weigh benefits and harms but are unsure how to estimate life expectancy for individual patients. Older adults face conceptual barriers and are generally unconvinced of the benefits of considering their life expectancy when making screening decisions. Life expectancy will always be a difficult topic for clinicians and patients, but there are advantages to incorporating it in cancer screening decisions. We highlight key takeaways from both clinician and older adult perspectives to guide future research.
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Gu J, Jia S, Chao H, Chen T, Wu X. Predictive factors based on the health belief model on cancer screening behaviour in first degree relatives of patients with Lynch syndrome-associated colorectal cancer. Int J Nurs Sci 2023; 10:251-257. [PMID: 37128484 PMCID: PMC10148252 DOI: 10.1016/j.ijnss.2023.03.013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Revised: 03/09/2023] [Accepted: 03/19/2023] [Indexed: 05/03/2023] Open
Abstract
Objectives This study aimed to investigate colorectal cancer-related knowledge, health beliefs, and screening behaviour in first-degree relatives (FDRs) of patients with Lynch syndrome-associated colorectal cancer (CRC) and explore the predictive factors of screening behaviour based on a health belief model. Methods This cross-sectional study was conducted in the colorectal department of a Class A tertiary hospital in Guangzhou from December 2017 to December 2019. A total of 265 FDRs of 96 patients with Lynch syndrome-related CRC were selected. The study was conducted in the colorectal department of a tertiary cancer centre in Guangzhou. The demographic questionnaire, the simplified CRC knowledge questionnaire, and the Champion's Health Belief Model Scale were used for evaluation. Data were analyzed using statistical description, between-group comparisons, and binary logistic regression. Results A total of 160 (60.4%), 61 (23.0%), and 44 (16.6%) of the participants had high, medium, and low levels of knowledge about CRC, respectively; the average overall score of health belief was 121.36 ± 13.02. Sixty-one participants (23.0%) underwent Lynch syndrome-associated cancer screening. The predictive factors of screening behaviour included sex (male), age (older), married status (married), multiple primary cancers of the index patients, and high levels of knowledge and health beliefs (P < 0.05). Conclusions The knowledge and health beliefs of cancer and cancer screening in FDRs of patients with Lynch syndrome-associated CRC should be improved. Both knowledge and beliefs are critical in promoting their cancer screening behaviour. Interventions should focus on health education and enhance health beliefs of the FDRs for better screening behaviour.
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Affiliation(s)
- Jiaojiao Gu
- The Third Affiliated Hospital, Sun Yat-Sen University, Guangzhou, China
| | - Shumin Jia
- Li Ka Shing Faculty of Medicine, The University of Hong Kong, Hong Kong, China
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Huaxiang Chao
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Tinglan Chen
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
| | - Xiaodan Wu
- State Key Laboratory of Oncology in South China, Collaborative Innovation Center for Cancer Medicine, Sun Yat-sen University Cancer Center, Guangzhou, China
- Corresponding author.
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Nichol BAB, Hurlbert AC, Read JCA. Predicting attitudes towards screening for neurodegenerative diseases using OCT and artificial intelligence: Findings from a literature review. J Public Health Res 2022; 11:22799036221127627. [PMID: 36310821 PMCID: PMC9597051 DOI: 10.1177/22799036221127627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Recent developments in artificial intelligence (AI) and machine learning raise the possibility of screening and early diagnosis for neurodegenerative diseases, using 3D scans of the retina. The eventual value of such screening will depend not only on scientific metrics such as specificity and sensitivity but, critically, also on public attitudes and uptake. Differential screening rates for various screening programmes in England indicate that multiple factors influence uptake. In this narrative literature review, some of these potential factors are explored in relation to predicting uptake of an early screening tool for neurodegenerative diseases using AI. These include: awareness of the disease, perceived risk, social influence, the use of AI, previous screening experience, socioeconomic status, health literacy, uncontrollable mortality risk, and demographic factors. The review finds the strongest and most consistent predictors to be ethnicity, social influence, the use of AI, and previous screening experience. Furthermore, it is likely that factors also interact to predict the uptake of such a tool. However, further experimental work is needed both to validate these predictions and explore interactions between the significant predictors.
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Affiliation(s)
- Beth AB Nichol
- Department of Social Work, Education,
and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK,Beth AB Nichol, Department of Social Work,
Education, and Community Wellbeing, Northumbria University, Coach Lane,
Newcastle upon Tyne NE7 7XA, UK.
| | - Anya C Hurlbert
- Biosciences Institute, Newcastle
University, Newcastle upon Tyne, UK
| | - Jenny CA Read
- Biosciences Institute, Newcastle
University, Newcastle upon Tyne, UK
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Differences and Similarities in Breast and Colorectal Cancer Screening Uptake among Municipalities in Flanders, Belgium. GASTROINTESTINAL DISORDERS 2022. [DOI: 10.3390/gidisord4020010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
Despite the recognized benefits of fecal occult blood test (FOBT) and mammography screenings, participation in breast (BC) and colorectal cancer (CRC) screening programs is still suboptimal. This study investigates municipal characteristics associated with their BC/CRC screening uptake profiles among women aged 55–69 years. Using data from 308 municipalities of Flanders from 2014 to 2017, a profile for each municipality based on its BC/CRC screening uptake compared with the median screening uptake was created. Logistic regression with generalized estimating equations was used to assess the associations between municipal characteristics and BC/CRC screening uptake profiles. The overall median uptake of cancer screening was higher for CRC (57.4%) than for BC (54.6%). The following municipal characteristics were associated with worse performance in terms of only CRC, only BC, or both CRC and BC screening uptake, respectively: foreign nationality, self-employment rate, (early) retirement rate, diabetes, disabilities; (early) retirement rate; age group 65–69, foreign nationality, self-employment rate, (early) retirement rate, wage-earners, diabetes. The following municipal characteristics were associated with better performance in terms of only CRC, only BC, or both CRC and BC screening uptake respectively: residential stability, having a partner, having children, jobseeker rate, GP visits, preventive dental visits; having children, GP visits; age group 55–59, residential stability, having a partner, having children, jobseeker rate, higher education, GP visits, preventive dental visits. This study’s results regarding the interrelation between the BC and CRC screening could be used to tailor interventions to improve the participation of the target population in both programs.
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Aujoulat P, Le Goff D, Dany A, Robaskiewick M, Nousbaum JB, Derrienic J, Cariou M, Guillou M, Le Reste JY. Improvement of participation rate in colorectal cancer (CRC) screening by training general practitioners in motivational interviewing (AmDepCCR). Trials 2022; 23:144. [PMID: 35164836 PMCID: PMC8842548 DOI: 10.1186/s13063-022-06056-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second leading cause of cancer death in France (17,712 annual deaths). However, this cancer is preventable in the majority of cases by the early detection of adenomas. In France, the organized screening for CRC relies on general practitioners (GPs). The tests delivered by the GPs are carried out in 89% of cases. However, GPs do not systematically offer the test, because of time management and communication. Methods AmDepCCR is a cluster randomized trial. Patients are prospectively included by their GPs. The study is designed in 2 phases for the GPs: first, GPs who have never participated in motivational interviewing (MI) training will be recruited then randomly split in 2 groups. Secondly, a 6-day motivational interviewing training will be carried out for the intervention group. Then, patients will be included in both groups during a period of 1 year. The primary outcome will be the number of CRC screenings achieved in each group and its difference. The secondary outcome will be the reluctance to screening and the patient’s self-estimated life expectancy at 0, 6, 12, and 24 months using the Health Belief Model (HBM). Discussion This study will help to know if GPs motivational interviewing is useful to improve organized CRC screening. In addition, it may help to improve communication between patients and GPs. GPs will be able to improve their practice in other fields of application through motivational interviewing (other screenings, addictions…). Trial registration 2019-A01776-51 NCT04492215. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06056-8.
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Population-Based Data Reveal Factors Associated with Organised and Non-Organised Colorectal Cancer Screening: An Important Step towards Improving Coverage. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18168373. [PMID: 34444122 PMCID: PMC8392464 DOI: 10.3390/ijerph18168373] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/23/2021] [Revised: 08/02/2021] [Accepted: 08/05/2021] [Indexed: 02/05/2023]
Abstract
We investigated factors associated with organised and non-organised colorectal cancer screening using faecal occult blood tests, based on data from 308 municipalities in Flanders (6.6 million residents, 57% of Belgium) during 2015-2017. Logistic regression with generalized estimating equations was used to assess the associations between municipal characteristics and organised and non-organised screening coverages. Factors associated negatively with both organised and non-organised screening: percentage of people aged 70-74 in the target population [OR (odds ratios) = 0.98, 95%CI (confidence interval): 0.97-0.99 and OR = 0.98, 95%CI: 0.96-0.999, respectively]; negatively with organised screening: average income [OR = 0.97, 95%CI: 0.96-0.98], percentage of people with a non-Belgian/Dutch nationality [OR = 0.962, 95%CI: 0.957-0.967]; positively with organised screening: percentages of men in the target population [OR = 1.13, 95%CI: 1.11-1.14], jobseekers [OR = 1.12, 95%CI: 1.09-1.15] and people with at least one general practitioner (GP) visit in the last year [OR = 1.04, 95%CI: 1.03-1.05]; positively with non-organised screening: number of patients per GP [OR = 1.021, 95%CI: 1.016-1.026], percentage of people with a global medical dossier handled by a preferred GP [OR = 1.025, 95%CI: 1.018-1.031]. This study helps to identify the hard-to-reach subpopulations in CRC screening, and highlights the important role of GPs in the process of promoting screening among non-participants and encouraging non-organised participants to switch to organised screening.
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Schoenborn NL, Sheehan OC, Roth DL, Cidav T, Huang J, Chung SE, Zhang T, Lee S, Xue QL, Boyd CM. Association Between Receipt of Cancer Screening and All-Cause Mortality in Older Adults. JAMA Netw Open 2021; 4:e2112062. [PMID: 34061202 PMCID: PMC8170538 DOI: 10.1001/jamanetworkopen.2021.12062] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
IMPORTANCE Guidelines recommend against routine breast and prostate cancer screenings in older adults with less than 10 years' life expectancy. One study using a claims-based prognostic index showed that receipt of cancer screening itself was associated with lower mortality, suggesting that the index may misclassify individuals when used to inform cancer screening, but this finding was attributed to residual confounding because the index did not account for functional status. OBJECTIVE To examine whether cancer screening remains significantly associated with all-cause mortality in older adults after accounting for both comorbidities and functional status. DESIGN, SETTING, AND PARTICIPANTS This cohort study included individuals older than 65 years who were eligible for breast or prostate cancer screening and who participated in the 2004 Health and Retirement Study. Data were linked to Medicare claims from 2001 to 2015. Data analysis was conducted from January to November 2020. MAIN OUTCOMES AND MEASURES A Cox model was used to estimate the association between all-cause mortality over 10 years and receipt of screening mammogram or prostate-specific antigen (PSA) test, adjusting for variables in a prognostic index that included age, sex, comorbidities, and functional status. Potential confounders (ie, education, income, marital status, geographic region, cognition, self-reported health, self-care, and self-perceived mortality risk) of the association between cancer screening and mortality were also tested. RESULTS The breast cancer screening cohort included 3257 women (mean [SD] age, 77.8 [7.5] years); the prostate cancer screening cohort included 2085 men (mean [SD] age, 76.1 [6.8] years). Receipt of screening mammogram was associated with lower hazard of all-cause mortality after accounting for all index variables (adjusted hazard ratio [aHR], 0.67; 95% CI, 0.60-0.74). A weaker, but still statistically significant, association was found for screening PSA (aHR 0.88; 95% CI, 0.78-0.99). None of the potential confounders attenuated the association between screening and mortality except for cognition, which attenuated the aHR for mammogram from 0.67 (95% CI, 0.60-0.74) to 0.73 (95% CI, 0.64-0.82) and the aHR for PSA from 0.88 (95% CI, 0.78-0.99) to 0.92 (95% CI, 0.80-1.05), making PSA screening no longer statistically significant. CONCLUSIONS AND RELEVANCE In this study, cognition attenuated the observed association between cancer screening and mortality among older adults. These findings suggest that existing mortality prediction algorithms may be missing important variables that are associated with receipt of cancer screening and long-term mortality. Relying solely on algorithms to determine cancer screening may misclassify individuals as having limited life expectancy and stop screening prematurely. Screening decisions need to be individualized and not solely dependent on life expectancy prediction.
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Affiliation(s)
- Nancy L. Schoenborn
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Orla C. Sheehan
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - David L. Roth
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Tansu Cidav
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Jin Huang
- The Johns Hopkins Center on Aging and Health, Baltimore, Maryland
- Bon Secours Mercy Health St Elizabeth Youngstown Hospital, Youngstown, Ohio
| | - Shang-En Chung
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Talan Zhang
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Sei Lee
- University of California, San Francisco School of Medicine
| | - Qian-Li Xue
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Johns Hopkins Center on Aging and Health, Baltimore, Maryland
| | - Cynthia M. Boyd
- The Johns Hopkins University School of Medicine, Baltimore, Maryland
- The Johns Hopkins Center on Aging and Health, Baltimore, Maryland
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Doria-Rose VP, Lansdorp-Vogelaar I, McCarthy S, Puricelli-Perin DM, Butera V, Segnan N, Taplin SH, Senore C. Measures of longitudinal adherence to fecal-based colorectal cancer screening: Literature review and recommended approaches. Int J Cancer 2021; 149:316-326. [PMID: 33811643 DOI: 10.1002/ijc.33589] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 02/11/2021] [Accepted: 03/12/2021] [Indexed: 12/14/2022]
Abstract
The success of fecal occult blood-based colorectal cancer screening programs is dependent on repeating screening at short intervals (ie, every 1-2 years). We conducted a literature review to assess measures that have been used to assess longitudinal adherence to fecal-based screening. Among 46 citations identified and included in this review, six broad classifications of longitudinal adherence were identified: (a) stratified single-round attendance, (b) all possible adherence permutations, (c) consistent/inconsistent/never attendance, (d) number of times attended, (e) program adherence and (f) proportion of time covered. Advantages and disadvantages of these measures are described, and recommendations on which measures to use based on data availability and scientific question are also given. Stratified single round attendance is particularly useful for describing the yield of screening, while programmatic adherence measures are best suited to evaluating screening efficacy. We recommend that screening programs collect detailed longitudinal, individual-level data, not only for the screening tests themselves but additionally for diagnostic follow-up and surveillance exams, to allow for maximum flexibility in reporting adherence patterns using the measure of choice.
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Affiliation(s)
- V Paul Doria-Rose
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | | | - Sharon McCarthy
- Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland, USA
| | - Douglas M Puricelli-Perin
- Clinical Monitoring Research Program Directorate, Frederick National Laboratory for Cancer Research, Frederick, Maryland, USA
| | - Vicent Butera
- Center for Global Health, National Cancer Institute, Bethesda, Maryland, USA
| | - Nereo Segnan
- AOU Cittadella Salute e della Scienza, Centro di Prevenzione Oncologica Piemonte, Turin, Italy
| | - Stephen H Taplin
- Center for Global Health, National Cancer Institute, Bethesda, Maryland, USA
| | - Carlo Senore
- AOU Cittadella Salute e della Scienza, Centro di Prevenzione Oncologica Piemonte, Turin, Italy
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Chen Z, Zhu D, Hu X, Gao G. Subjective life expectancy and associated factors among cancer survivors over 45 years old: evidence from the CHARLS. Qual Life Res 2021; 30:1571-1582. [PMID: 33462662 DOI: 10.1007/s11136-020-02751-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/28/2020] [Indexed: 11/29/2022]
Abstract
PURPOSE Associations between subjective life expectancy (SLE) and a variety of factors are well documented, but the relationship regarding cancer is limited. The purpose of this study was to disclose this potential relationship and identify the covariates that might influence this relationship. METHODS Data were extracted from the China Health and Retirement Longitudinal Study (CHARLS), and a sample of 448 cancer survivors and 43,795 individuals without cancer were analyzed. Multilevel mixed-effects logistic regression was performed to examine the SLE associated with cancer survivors and participants without cancer after controlling for demographic, socioeconomic, health-related, and psychosocial factors. RESULTS The findings revealed that cancer survivors had a 39% reduction in longer life expectancy compared to respondents without cancer. Disparities in SLE existed based on diverse individual characteristics. The rate of high SLE in urban citizens was 75% higher compared to that of rural residents, while the rate of high SLE in participants with disability fell by 55%. The rate of high SLE decreased by 22% and 35% in respondents with high blood pressure and diabetes, respectively. The proportion of respondents with high SLE was reduced by 70% when depression was present. Furthermore, the out-of-pocket expenditures of participants with and without cancer showed a significant difference, but discrepancies with respect to SLE among different cancer treatment options were not found. CONCLUSION The more challenging one's socioeconomic status is and the unhealthier one's physical and mental conditions are, the lower one's prospect of subjective life expectancy is. Further work is warranted to confirm the causal association between subjective life expectancy and certain characteristics in cancer survivors.
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Affiliation(s)
- Zhishui Chen
- Department of Medical Insurance, Key Laboratory of Carcinogenesis and Translational Research (Ministry of Education), Peking University Cancer Hospital & Institute, Beijing, China
| | - Dawei Zhu
- Center for Health Development Studies, Peking University, Beijing, China
| | - Xingyu Hu
- School of Public Health, Capital Medical University, Beijing, China
| | - Guangying Gao
- School of Public Health, Capital Medical University, Beijing, China.
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Moss JL, Roy S, Shen C, Cooper JD, Lennon RP, Lengerich EJ, Adelman A, Curry W, Ruffin MT. Geographic Variation in Overscreening for Colorectal, Cervical, and Breast Cancer Among Older Adults. JAMA Netw Open 2020; 3:e2011645. [PMID: 32716514 PMCID: PMC8127072 DOI: 10.1001/jamanetworkopen.2020.11645] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
IMPORTANCE National guidelines balance risks and benefits of population-level cancer screening among adults with average risk. Older adults are not recommended to receive routine screening, but many continue to be screened (ie, are overscreened). OBJECTIVE To assess the prevalence of overscreening for colorectal, cervical, and breast cancers among older adults as well as differences in overscreening by metropolitan status. DESIGN, SETTING, AND PARTICIPANTS The cross-sectional study examined responses to a telephone survey of 176 348 community-dwelling adults. Participants were included if they met age and sex criteria, and they were excluded from each cancer-specific subsample if they had a history of that cancer. Data came from the 2018 Behavioral Risk Factor Surveillance System, administered by the US Centers for Disease Control and Prevention. EXPOSURES Metropolitan status, according to whether participants lived in a metropolitan statistical area. MAIN OUTCOMES AND MEASURES Overscreening was assessed using US Preventive Services Task Force definitions, ie, whether participants self-reported having a screening after the recommended upper age limit for colorectal (75 years), cervical (65 years), or breast (74 years) cancer. RESULTS Of 176 348 participants (155 411 [88.1%] women; mean [SE] age, 75.0 [0.04] years; 150 871 [85.6%] non-Hispanic white; 60 456 [34.3%] with nonmetropolitan residence) the cancer-specific subsamples contained 20 937 [11.9%] men and 34 244 [19.4%] women for colorectal cancer, 82 811 [47.0%] women for cervical cancer, and 38 356 [21.8%] women for breast cancer. Overall, 9461 men (59.3%; 95% CI, 57.6%-61.1%) were overscreened for colorectal cancer; 14 463 women (56.2%; 95% CI, 54.7%-57.6%), for colorectal cancer; 31 988 women (45.8%; 95% CI, 44.9%-46.7%), for cervical cancer; and 26 198 women (74.1%; 95% CI, 73.0%-75.3%), for breast cancer. Overscreening was more common in metropolitan than nonmetropolitan areas for colorectal cancer among women (adjusted odds ratio [aOR], 1.23; 95% CI, 1.08-1.39), cervical cancer (aOR, 1.20; 95% CI, 1.11-1.29), and breast cancer (aOR, 1.36; 95% CI, 1.17-1.57). Overscreening for cervical and breast cancers was also associated with having a usual source of care compared with not (eg, cervical cancer: aOR, 1.87; 95% CI, 1.56-2.25; breast cancer: aOR, 2.08; 95% CI, 1.58-2.76), good, very good, or excellent self-reported health compared with fair or poor self-reported health (eg, cervical cancer: aOR, 1.21; 95% CI, 1.11-1.32; breast cancer: aOR, 1.47; 95% CI, 1.28-1.69), an educational attainment greater than a high school diploma compared with a high school diploma or less (eg, cervical cancer: aOR, 1.14; 95% CI, 1.06-1.23; breast cancer: aOR, 1.30; 95% CI, 1.16-1.46), and being married or living as married compared with other marital status (eg, cervical cancer: OR, 1.36; 95% CI, 1.26-1.46; breast cancer: OR, 1.54; 95% CI, 1.34-1.77). CONCLUSIONS AND RELEVANCE In this study, overscreening for cancer among older adults was high, particularly for women living in metropolitan areas. Overscreening could be associated with health care access and patient-clinician relationships. Additional research on why overscreening persists and how to reduce overscreening is needed to minimize risks associated with cancer screening among older adults.
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Affiliation(s)
| | | | - Chan Shen
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Joie D Cooper
- Penn State College of Medicine, Hershey, Pennsylvania
| | | | | | - Alan Adelman
- Penn State College of Medicine, Hershey, Pennsylvania
| | - William Curry
- Penn State College of Medicine, Hershey, Pennsylvania
| | - Mack T Ruffin
- Penn State College of Medicine, Hershey, Pennsylvania
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Dodd RH, Kobayashi LC, von Wagner C. Perceived life expectancy and colorectal cancer screening intentions and behaviour: A population-based UK study. Prev Med Rep 2019; 16:101002. [PMID: 31709135 PMCID: PMC6831878 DOI: 10.1016/j.pmedr.2019.101002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2019] [Accepted: 09/27/2019] [Indexed: 01/05/2023] Open
Abstract
The relationships between perceived life expectancy (PLE), cancer screening intentions and behaviour are not well understood, despite the importance of remaining life expectancy for the early diagnosis benefits of screening. This study investigates the relationships between PLE and each of: the intention to complete faecal occult blood test (FOBt) screening, ‘ever’ uptake of FOBt screening, and repeat uptake of FOBt screening for colorectal cancer. Data were from the population-representative Attitudes, Behaviour and Cancer UK Survey II (ABACUS II) in England in 2015. Eligible respondents for the present analysis were aged 60–70 years (FOBt eligible age range), who completed the survey question on perceived life expectancy (N = 824). We used logistic regression models to estimate the associations between PLE and the intention to complete screening, ‘ever’ uptake of screening, and repeat uptake of screening, with adjustment for age, gender, occupation-based social grade, marital status, ethnicity, and smoking status. PLE was positively associated with repeated uptake of FOBt (adjusted OR = 2.55; 95% CI: 1.04–6.30 for expecting to live to ≥90 years versus <80 years). Older adults may base decisions to continually participate in cancer screening on their expectations of remaining life expectancy. Future research should investigate the feasibility and acceptability of individualised cancer screening recommendations that take life expectancy into account.
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Affiliation(s)
- Rachael H Dodd
- The University of Sydney, Faculty of Medicine and Health, School of Public Health, New South Wales 2006, Australia.,Department of Behavioural Science and Health, University College London, Gower Street, London WC1E 6BT, United Kingdom
| | - Lindsay C Kobayashi
- Department of Epidemiology, University of Michigan School of Public Health, Ann Arbor, MI 48109, USA
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, Gower Street, London WC1E 6BT, United Kingdom
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12
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Warner DF, Koroukian SM, Schiltz NK, Smyth KA, Cooper GS, Owusu C, Stange KC, Berger NA. Complex Multimorbidity and Breast Cancer Screening Among Midlife and Older Women: The Role of Perceived Need. THE GERONTOLOGIST 2019; 59:S77-S87. [PMID: 31100139 PMCID: PMC6524759 DOI: 10.1093/geront/gny180] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Indexed: 01/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES There is minimal survival benefit to cancer screening for those with poor clinical presentation (complex multimorbidity) or at advanced ages. The current screening mammography guidelines consider these objective indicators. There has been less attention, however, to women's subjective assessment of screening need. This study examines the interplay between complex multimorbidity, age, and subjective assessments of health and longevity for screening mammography receipt. RESEARCH DESIGN AND METHOD This cross-sectional study uses self-reported data from 8,938 women over the age of 52 in the 2012 Health and Retirement Study. Logistic regression models estimated the association between women's complex multimorbidity (co-occurrence of chronic conditions, functional limitations, and/or geriatric syndromes), subjective health and longevity assessments, age, and screening mammography in the 2 years before the interview. These associations were evaluated adjusting for sociodemographic and behavioral factors. RESULTS Both age and complex multimorbidity were negatively associated with screening mammography. However, women's perceived need for screening moderated these effects. Most significantly, women optimistic about their chances of living another 10-15 years were more likely to have had screening mammography regardless of their health conditions or advanced age. DISCUSSION AND IMPLICATIONS Women with more favorable self-assessed health and perceived life expectancy were more likely to receive screening mammography even if they have poor clinical presentation or advanced age. This is contrary to current cancer screening guidelines and suggests an opportunity to engage women's subjective health and longevity assessments for cancer screening decision making in both for screening policy and in individual clinician recommendations.
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Affiliation(s)
- David F Warner
- Department of Sociology, University of Nebraska–Lincoln
- Center for Family & Demographic Research, Bowling Green State University, Ohio
| | - Siran M Koroukian
- Department of Population and Quantitative Health Sciences
- Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | | | | | - Gregory S Cooper
- Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Division of Gastroenterology, Case Western Reserve University, Cleveland, Ohio
| | - Cynthia Owusu
- Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio
| | - Kurt C Stange
- Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Family Medicine and Community Health, Case Western Reserve University, Cleveland, Ohio
- Center for Community Health Integration, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Department of Sociology, Case Western Reserve University, Cleveland, Ohio
| | - Nathan A Berger
- Case Comprehensive Cancer Center, School of Medicine, Case Western Reserve University, Cleveland, Ohio
- Division of Hematology/Oncology, Department of Medicine, School of Medicine, Case Western Reserve University, Cleveland, Ohio
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13
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Low participation in organized colorectal cancer screening in France: underlying ethical issues. Eur J Cancer Prev 2019; 28:27-32. [PMID: 29176350 DOI: 10.1097/cej.0000000000000417] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
International studies have shown a significant reduction in colorectal cancer (CRC) mortality following the implementation of organized screening programs, given a sufficient participation rate and adequate follow-up. The French national CRC screening program has been generalized since 2008 and targets 18 million men and women aged 50-74 years. Despite broad recommendations, the participation rate remains low (29.8%), questioning the efficiency of the program. A panel of experts was appointed by the French National Cancer Institute to critically examine the place of autonomy and efficiency in CRC screening and propose recommendations. In this paper, we explore the ethical significance of a public health intervention that falls short of its objectives owing to low take-up by the population targeted. First, we analyze the reasons for the low CRC screening participation. Second, we examine the models that can be proposed for public health actions, reconciling respect for the individual and the collective good. Our expert panel explored possible ways to enhance take-up of CRC screening within the bounds of individual autonomy, adapting awareness campaigns, and new educational approaches that take into account knowledge and analysis of sociocultural hurdles. Although public health actions must be universal, target actions should nonetheless be developed for nonparticipating population subgroups.
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Chon D, Yoo KB, Kim JH. Belief about the future possibility of national aging security system and its association with mortality. PLoS One 2019; 14:e0212282. [PMID: 30763373 PMCID: PMC6375624 DOI: 10.1371/journal.pone.0212282] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2018] [Accepted: 01/30/2019] [Indexed: 11/18/2022] Open
Abstract
In line with well-known subjective measures of health, such as self-rated health and subjective life expectancy, an individual's belief about future security provided by the government could also be an important factor affecting his life expectancy. The aim of this study was to use the response of the elderly Korean population in regards to the National Aging Security System (NASS), and assess its association with the risk of mortality even with SRH included in the analysis. Data from the Korean Longitudinal Study of Ageing (KLoSA) from 2006 to 2016 were assessed using longitudinal data analysis and 10,254 research subjects were included at baseline in 2006. To analyze the association between belief about future possibility of NASS and all-cause mortality, Cox proportional hazards model was used. In terms of the future possibility of NASS, people who thought more negatively displayed greater risk of mortality at the end of the follow-up. With the Positive group as reference: Moderate group showed a 18% increase (HR = 1.178, 95% CI: 1.022, 1.357), and Negative groups showed a 19% increase (HR = 1.192, 95% CI: 1.043, 1.362). The results of our study showed that people's belief regarding future security could be associated with mortality rates. Our finding is important, because it provides additional support to the importance of considering subjective measures of health in epidemiological research. Furthermore, the findings of our research could be useful in terms of future policy making.
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Affiliation(s)
- Doukyoung Chon
- Department of Preventive Medicine and Public Health, Ajou University School of Medicine, Suwon, Republic of Korea
- Institute on Aging, Ajou University Medical Center, Suwon, Republic of Korea
| | - Ki Bong Yoo
- College of Health Sciences, Yonsei University, Wonju, Korea
| | - Jae-Hyun Kim
- Department of Health Administration, College of Health Science, Dankook University, Cheonan, Korea
- Institute of Health Promotion and Policy, Dankook University, Cheonan, Korea
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15
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An JY. Levels of Health and Subjective Life Expectancy among Community-dwelling Elders in Korea. ACTA ACUST UNITED AC 2018. [DOI: 10.17079/jkgn.2018.20.1.22] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
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16
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Kobayashi LC, Beeken RJ, Meisel SF. Biopsychosocial predictors of perceived life expectancy in a national sample of older men and women. PLoS One 2017; 12:e0189245. [PMID: 29240778 PMCID: PMC5730115 DOI: 10.1371/journal.pone.0189245] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2017] [Accepted: 11/24/2017] [Indexed: 12/03/2022] Open
Abstract
Perceived life expectancy (PLE) is predictive of mortality risk in older adults, but the factors that may contribute to mental conceptions of PLE are unknown. We aimed to describe the sociodemographic, biomedical, behavioral, and psychological predictors of self-reported PLE estimates among older English adults. Data were from 6662 adults aged 50–79 years in the population-based English Longitudinal Study of Ageing (cross-sectional sample from 2012/13). PLE was assessed in the face-to-face study interview (“What are the chances you will live to be age x or more?” where x = current age plus 10–15 years). Responses were categorized as ‘low’ (0–49%), ‘medium’ (50–74%), and ‘high’ (75–100%). Adjusted prevalence ratios (PRs) and 95% confidence intervals (CIs) for low vs. high PLE were estimated using population-weighted modified Poisson regression with robust error variance. Overall, 1208/6662 (18%) participants reported a low PLE, 2806/6662 (42%) reported a medium PLE, and 2648/6662 (40%) reported a high PLE. The predictors of reporting a low PLE included older age (PR = 1.64; 95% CI: 1.50–1.76 per 10 years), male sex (PR = 1.14; 95% CI: 1.02–1.26), being a smoker (PR = 1.39; 95% CI: 1.22–1.59 vs. never/former smoker), and having a diagnosis of cancer or diabetes. A low sense of control over life was associated with low PLE, as was low satisfaction with life and worse self-rated health. Those with a higher perceived social standing were less likely to report a low PLE (PR = 0.90; 95% CI: 0.87–0.93 per 10-point increase, out of 100). This study provides novel insight into potential influences on older adults’ expectations of their longevity, including aspects of psychological well-being. These results should be corroborated to better determine their implications for health-related decision-making, planning, and behavior among older adults.
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Affiliation(s)
- Lindsay C. Kobayashi
- Harvard Center for Population and Development Studies, Harvard T. H. Chan School of Public Health, Cambridge, Massachusetts, United States of America
- Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Rebecca J. Beeken
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Leeds Institute of Health Sciences, University of Leeds, Leeds, United Kingdom
- * E-mail:
| | - Susanne F. Meisel
- Department of Behavioural Science and Health, University College London, London, United Kingdom
- Institute of Psychiatry, Psychology & Neuroscience, King’s College London, London, United Kingdom
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17
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Kim JH, Kim JM. Subjective life expectancy is a risk factor for perceived health status and mortality. Health Qual Life Outcomes 2017; 15:190. [PMID: 28969645 PMCID: PMC5625600 DOI: 10.1186/s12955-017-0763-0] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2017] [Accepted: 09/20/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The purpose of this study was to investigate the association between subjective life expectancy (SLE) and self-rated health and further SLE will predict higher risk for mortality. METHODS Data from the Korean Longitudinal Study of Aging (KLoSA) from 2006 to 2014 was assessed using longitudinal data analysis and 10,244 research subjects were included at baseline in 2006. Our modeling approach was based on generalized estimating equation (GEE) for self-rated health and Cox proportional hazards models for mortality. RESULTS SLE was significantly associated with mortality (p for trend <0.0001), with the following ORs predicting mortality (yes vs. no): HR = 2.133 (p < .0001) for 0%, HR = 1.805 (p < .0001) for 10-20%, HR = 1.494 (p 0.002) for 30-40%, HR = 1.423 (p 0.002) for 50-60%, HR = 1.157 (p 0.235) for 70-80%, vs. 90-100%. In terms of age-specific association with SLE for self-rated health and mortality, as subjects got older, self-rated health tended to lean more toward poor self-rated health, but as for mortality, the probability of dying increased for people who are younger and HR also tended to increase. CONCLUSION This study has shown that SLE is associated with self-rated health and further is a powerful predictor of mortality after adjusting for self-rated health as well as sociodemographic factors and health risk status and behavior factors in a representative population of Koreans.
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Affiliation(s)
- Jae-Hyun Kim
- Department of Health Administration, College of Health Science, Dankook University, 201, Manghyang-ro, Dongnam-gu, Cheonan-si, 330-714, Chungnam, Republic of Korea
- Institute of Health Promotion and Policy, Dankook University, Cheonan, Republic of Korea
| | - Jang-Mook Kim
- Department of Health Administration, College of Health Science, Dankook University, 201, Manghyang-ro, Dongnam-gu, Cheonan-si, 330-714, Chungnam, Republic of Korea.
- Institute of Health Promotion and Policy, Dankook University, Cheonan, Republic of Korea.
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