1
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Laven-Law G, Symonds EL, Winter JM, Chen G, Flight IH, Hughes-Barton D, Wilson CJ, Young GP. Comparing a fecal immunochemical test and circulating tumor DNA blood test for colorectal cancer screening adherence. J Gastroenterol Hepatol 2024. [PMID: 38430185 DOI: 10.1111/jgh.16531] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Revised: 12/20/2023] [Accepted: 02/08/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND AND AIM Colorectal cancer (CRC) screening programs are most effective at reducing disease incidence and mortality through sustained screening participation. A novel blood test modality is being explored for CRC screening, but it is unclear whether it will provide sustained screening participation. This study aimed to investigate whether a circulating tumor DNA (ctDNA) blood test improved CRC screening re-participation when compared with a fecal immunochemical test (FIT) and to define the predictors of sustained CRC screening in an Australian population. METHODS South Australians who initially participated in CRC screening using a ctDNA blood test (n = 36) or FIT (n = 547) were offered the same CRC screening test approximately 2 years later through an extended phase of a randomized controlled trial. Surveys collected demographic, psychosocial, and clinical information. Predictors of CRC screening re-participation were explored using chi-square, Wilcoxon tests, and logistic regression. RESULTS Participants offered a second ctDNA blood test were equally likely to re-participate in CRC screening as those who completed a FIT in the first round and who were offered the same test (61% vs 66% re-participation respectively, P = 0.6). CRC fatalism, health activation, and self-efficacy were associated with repeated screening participation. Test awareness was predictive of repeated FIT-based CRC screening. CONCLUSIONS Targeted interventions to improve CRC screening awareness and increase patient health activation may improve CRC screening adherence. A ctDNA blood test may be a suitable CRC screening option to maintain CRC screening adherence in people who do not participate in screening with FIT.
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Affiliation(s)
- Geraldine Laven-Law
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Erin L Symonds
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
- Department of Gastroenterology and Hepatology, Flinders Medical Centre, Southern Adelaide Local Health Network, Adelaide, South Australia, Australia
| | - Jean M Winter
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caulfield East, Victoria, Australia
| | - Ingrid H Flight
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Donna Hughes-Barton
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Carlene J Wilson
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Parkville, Victoria, Australia
| | - Graeme P Young
- College of Medicine and Public Health, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
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2
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Scaglioni G, Guidetti M, Cavazza N. The role of disgust as an emotional barrier to colorectal cancer screening participation: a systematic review and meta-analysis. Psychol Health 2023; 38:389-408. [PMID: 34433347 DOI: 10.1080/08870446.2021.1967351] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Worldwide colorectal cancer (CRC) screening rates are suboptimal. This systematic review and meta-analysis examine the role of disgust in CRC screening avoidance. DESIGN A systematic literature search was conducted. In all, 46 studies were included in the review. Among these, 16 studies were compared with a meta-analytical approach in order to 1) estimate the effect size of state disgust on screening intention and attendance; 2) examine whether methodological characteristics moderate the effect of state disgust on screening behaviour; 3) estimate the effect sizes of trait disgust and type of exam kit on state disgust. RESULTS In the reviewed studies, state disgust was often associated with CRC screening and especially with CRC screening avoidance. The meta-analysis confirmed low-to-moderate negative effects of state disgust on screening intention and attendance. Population sampling strategy was the only significant moderator of the effect of state disgust on screening attendance, i.e. studies that used convenience (versus random/representative) samples found a significantly lower effect size. Trait disgust and type of exam kit exerted a large and a moderate-to-large positive effect, respectively, on state disgust. CONCLUSIONS Disgust can boost CRC screening avoidance. Further studies and interventions must be designed to help patients in overcoming this emotional barrier.
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Affiliation(s)
- Giulia Scaglioni
- Department of Humanities, Social Sciences, and Cultural Industries, University of Parma, Parma, Italy
| | - Margherita Guidetti
- Department of Communication and Economics, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Nicoletta Cavazza
- Department of Communication and Economics, University of Modena and Reggio Emilia, Reggio Emilia, Italy
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3
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Dix M, Wilson CJ, Flight IH, Wassie MM, Young GP, Cock C, Cohen-Woods S, Symonds EL. Patient attitudes towards changes in colorectal cancer surveillance: An application of the Health Belief Model. Eur J Cancer Care (Engl) 2022; 31:e13713. [PMID: 36151912 DOI: 10.1111/ecc.13713] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Revised: 09/09/2022] [Accepted: 09/14/2022] [Indexed: 11/29/2022]
Abstract
OBJECTIVE This is to determine whether health beliefs regarding colorectal cancer (CRC) screening could predict discomfort with a change to CRC surveillance proposing regular faecal immunochemical tests (FIT) instead of colonoscopy. METHODS Eight hundred individuals enrolled in a South Australian colonoscopy surveillance programme were invited to complete a survey on surveillance preferences. Responses were analysed using binary logistic regression predicting discomfort with a hypothetical FIT-based surveillance change. Predictor variables included constructs based on the Health Belief Model: perceived threat of CRC, perceived confidence to complete FIT and colonoscopy (self-efficacy), perceived benefits from current surveillance and perceived barriers to FIT and colonoscopy. RESULTS A total of 408 participants (51%) returned the survey (complete data n = 303; mean age 62 years, 52% male). Most participants (72%) were uncomfortable with FIT-based surveillance reducing colonoscopy frequency. This attitude was predicted by a higher perceived threat of CRC (OR = 1.03 [95% CI 1.01-1.04]), higher colonoscopy self-efficacy (OR = 1.34 [95% CI 1.13-1.59]) and lower perceived barriers to colonoscopy (OR = 0.92 [95% CI 0.86-0.99]). CONCLUSIONS Health beliefs regarding colonoscopy and perceived threat of CRC may be important to consider when changing CRC surveillance protocols. If guideline changes were introduced, these factors should be addressed to provide patients reassurance concerning the efficacy of the alternative protocol.
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Affiliation(s)
- Maddison Dix
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Carlene J Wilson
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.,Austin Health, Olivia Newton-John Cancer Wellness and Research Centre, Heidelberg, Victoria, Australia.,Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Ingrid H Flight
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Molla M Wassie
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia
| | - Charles Cock
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.,Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Sarah Cohen-Woods
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,College of Education, Psychology, and Social Work, Flinders University, Bedford Park, South Australia, Australia.,Orama Institute for Mental Health and Well-Being, Flinders University, Bedford Park, South Australia, Australia
| | - Erin L Symonds
- Flinders Centre for Innovation in Cancer, College of Medicine and Public Health, Flinders University, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Bedford Park, South Australia, Australia.,Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia
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4
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Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population? GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3040018] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite the recognized benefits of colorectal cancer (CRC) screening, uptake is still suboptimal in many countries. In addressing this issue, one important element that has not received sufficient attention is population preference. Our review provides a comprehensive summary of the up-to-date evidence relative to this topic. Four OVID databases were searched: Ovid MEDLINE® ALL, Biological Abstracts, CAB Abstracts, and Global Health. Among the 742 articles generated, 154 full texts were selected for a more thorough evaluation based on predefined inclusion criteria. Finally, 83 studies were included in our review. The general population preferred either colonoscopy as the most accurate test, or fecal occult blood test (FOBT) as the least invasive for CRC screening. The emerging blood test (SEPT9) and capsule colonoscopy (nanopill), with the potential to overcome the pitfalls of the available techniques, were also favored. Gender, age, race, screening experience, education and beliefs, the perceived risk of CRC, insurance, and health status influence one’s test preference. To improve uptake, CRC screening programs should consider offering test alternatives and tailoring the content and delivery of screening information to the public’s preferences. Other logistical measures in terms of the types of bowel preparation, gender of endoscopist, stool collection device, and reward for participants can also be useful.
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5
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Young GP, Chen G, Wilson CJ, McGrane E, Hughes-Barton DLA, Flight IHK, Symonds EL. "Rescue" of Nonparticipants in Colorectal Cancer Screening: A Randomized Controlled Trial of Three Noninvasive Test Options. Cancer Prev Res (Phila) 2021; 14:803-810. [PMID: 34127509 DOI: 10.1158/1940-6207.capr-21-0080] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2021] [Revised: 05/07/2021] [Accepted: 06/08/2021] [Indexed: 11/16/2022]
Abstract
Few studies have directly targeted nonparticipants in colorectal cancer screening to identify effective engagement strategies. We undertook a randomized controlled trial that targeted nonparticipants in a previous trial of average-risk subjects which compared participation rates for mailed invitations offering a fecal test, a blood test or a choice of either. Nonparticipants (n = 899) were randomized to be offered a kit containing a fecal immunochemical test (FIT), directions on how to arrange a blood DNA test, or the option of doing either. Screening participation was assessed 12 weeks after the offer. To assess the cognitive and attitudinal variables related to participation and invitee choice, invitees were surveyed after 12 weeks, and associations were investigated using multinomial logistic regression. Participation rates were similar between groups (P = 0.88): 12.0% for FIT (35/292), 13.3% for the blood test (39/293), and 13.4% for choice (39/290). Within the choice group, participation was significantly higher with FIT (9.7%, 28/290) compared with the blood test (3.8%, 11/290, P = 0.005). The only variable significantly associated with participation was socioeconomic status when offered FIT, and age when offered choice but there was none when offered the blood test. Survey respondents indicated that convenience, time-saving, comfort, and familiarity were major influences on participation. There was no clear advantage between a fecal test, blood test, or choice of test although, when given a choice, the fecal test was preferred. Differences in variables associated with participation according to invitation strategy warrant consideration when deciding upon an invitation strategy for screening nonparticipants. PREVENTION RELEVANCE: This trial of screening for those at average risk for colorectal cancer targeted past fecal-test nonparticipants and compared participation rates for mailed invitations offering a fecal test, blood test, or choice of either. Although there was no clear advantage between strategies, factors associated with participation differed between each strategy.
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Affiliation(s)
- Graeme Paul Young
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia. .,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caufield East, Victoria, Australia
| | - Carlene J Wilson
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,School of Psychology and Public Health, LaTrobe University, Bundoora, Victoria, Australia
| | - Ellen McGrane
- School of Health and Related Research, University of Sheffield, Sheffield, United Kingdom
| | - Donna Lee-Ann Hughes-Barton
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Ingrid Helen K Flight
- Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia
| | - Erin Leigh Symonds
- Flinders Centre for Innovation in Cancer, Flinders Medical Centre, Bedford Park, South Australia, Australia.,Cancer Research, Flinders Health and Medical Research Institute, Flinders University, Adelaide, South Australia, Australia.,Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia
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6
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Dressler J, Johnsen AT, Madsen LJ, Rasmussen M, Jorgensen LN. Factors affecting patient adherence to publicly funded colorectal cancer screening programmes: a systematic review. Public Health 2020; 190:67-74. [PMID: 33360029 DOI: 10.1016/j.puhe.2020.10.025] [Citation(s) in RCA: 29] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Revised: 10/22/2020] [Accepted: 10/29/2020] [Indexed: 12/16/2022]
Abstract
OBJECTIVES Colorectal cancer (CRC) is the third most common cancer. Many countries in Europe have already implemented systematic screening programmes as per the recommendations by the European Union. The impact of screening is highly dependent on participation rates. The aim of the study was to identify barriers, facilitators and modifiers to participation in systematised, stool sample-based, publicly financed CRC screening programmes. STUDY DESIGN Systematic review. METHODS A systematic search in PubMed, Embase, MEDLINE, CINAHL, Cochrane CENTRAL, Google Scholar and PsycINFO was undertaken. We included both qualitative and quantitative studies reporting on barriers and facilitators (excluding sociodemographic variables) to participation in stool sample-based CRC screening. Barriers and facilitators to participation were summarised and analysed. RESULTS The inclusion criteria were met in 21 studies. Reported barriers and facilitators were categorised into the following seven themes (examples): psychology (fear of cancer), religion (believing cancer is the will of God), logistics (not knowing how to conduct the test), health-related factors (mental health), knowledge and awareness (lack of knowledge about the test), role of the general practitioner (being supported in taking the test by the general practitioner), and environmental factors (knowing someone who has participated in a screening programme). Six studies reported that non-participation was not due to a negative attitude towards screening for CRC. CONCLUSION Many barriers to screening were found. It is important to work with peoples' fear of screening. Moreover, this review suggests that it might be possible to increase participation rates, if the population-wide awareness and knowledge of potential health benefits of CRC screening are increased and proper logistical support is provided.
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Affiliation(s)
- J Dressler
- Digestive Disease Center, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - A T Johnsen
- Institute of Psychology, University of Southern Denmark, Odense, Denmark.
| | - L J Madsen
- Digestive Disease Center, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - M Rasmussen
- Digestive Disease Center, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
| | - L N Jorgensen
- Digestive Disease Center, Bispebjerg Hospital, Faculty of Health and Medical Sciences, University of Copenhagen, Copenhagen, Denmark.
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7
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Individual and Geospatial Characteristics Associated With Use and Nonuse of the Fecal Immunochemical Test (FIT) for Colorectal Cancer Screening in an Urban Minority Population. J Clin Gastroenterol 2019; 53:744-749. [PMID: 30222644 DOI: 10.1097/mcg.0000000000001132] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
PURPOSE Initiatives by the Centers for Disease Control and Prevention as well as the National Colorectal Cancer Roundtable aim to increase the rate of colorectal cancer (CRC) screening. We assess individual and geographic characteristics associated fecal immunochemical test (FIT) CRC screening over 3 years. METHODS This is a retrospective study of 1500 FIT kits which were mailed or opportunistically handed to eligible participants in Brooklyn, New York from January 2014 to December 2016. Eligibility criteria included increased risk for colon cancer, uninsured or underinsured, and a minimum age of 50 years to warrant CRC screening. We looked at the association of individual demographic characteristics and FIT screening by logistic regression using SPPS version 23 software. In addition, using ArcGIS, we coded patients address and layered census tract population information to find associations. RESULTS In total, 1367 Cancer Services Participants met our study criteria. The study sample was predominantly female (95.2%) and minority (46% African American, 24.7% Hispanic, 17.3% Caucasian, 11.4% Asian) and on average 59 years old (SD, 5.7). A large majority (73%) had household incomes below $20,000/year. Approximately half (49.9%) of all Cancer Services Participants returned their FIT kit. In participants who did not return their FIT kit, the majority were African American (41%), followed by Hispanics (26.5%), Caucasians (20.6%), and Asians (11.8%). Multivariable logistic regression showed that a screening history of prior colonoscopy or FIT, gender, ethnicity, and educational attainment were significantly associated with FIT CRC screening uptake (P<0.05). Geospatial mapping showed clusters of low screening uptake in areas of high poverty. Hot-spot analysis identified areas of significant vulnerability. CONCLUSIONS FIT uptake remains suboptimal. Individual predictors as well as area poverty is associated with low screening uptake. Geospatial mapping is an effective tool for evaluating CRC screening uptake.
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8
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Hunkin H, Turnbull D, Zajac IT. Considering anticipated regret may reduce colorectal cancer screening intentions: a randomised controlled trial. Psychol Health 2019; 35:555-572. [PMID: 31403327 DOI: 10.1080/08870446.2019.1649407] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Objective: Regular screening for colorectal cancer (CRC) can substantially improve outcomes. This study investigated how measuring regret expected from failing to screen might lead to stronger screening intentions. Five potential moderators were evaluated: perceived threat, psychological reactance, prior screening participation, concurrently measuring faecal aversion (FA) and anticipated regret (AR). Design: A 2 (AR measured pre/post intention) × 2 (FA measured pre/post intention) single blind parallel randomised controlled trial was used. Australians aged 45 and over completed an online survey measuring AR, FA, intention, theory of planned behaviour variables and potential moderators. Main outcome measures: The primary outcome was CRC screening intention. Results: Eight hundred and three participants were randomised, with 666 analysed. Measuring AR prior to intention unexpectedly resulted in a significantly lower intention to screen (d = 0.18, 95% CI [0.03, 0.33]) compared to measuring after intention. Trait reactance predicted a significantly lower intention when it was at least 0.52 SD above the mean; other moderators were not supported. Conclusion: The processes underlying anticipated regret manipulations must be better understood in order to have practical value in health promotion. More research is required to determine how to minimise or avoid the apparent negative effects of psychological reactance in CRC screening communication. Trial registration: Australian New Zealand Clinical Trials Registry: ACTRN12618001098224 http://www.ANZCTR.org.au/ACTRN12618001098224.aspx.
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Affiliation(s)
- Hugh Hunkin
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Adelaide, SA, Australia
| | - Ian T Zajac
- School of Psychology, University of Adelaide, Adelaide, SA, Australia.,Nutrition and Health Research Program, Commonwealth Scientific & Industrial Research Organisation (CSIRO), Adelaide, SA, Australia
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9
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Symonds EL, Hughes D, Flight I, Woodman R, Chen G, Ratcliffe J, Pedersen SK, Fraser RJL, Wilson CJ, Young GP. A Randomized Controlled Trial Testing Provision of Fecal and Blood Test Options on Participation for Colorectal Cancer Screening. Cancer Prev Res (Phila) 2019; 12:631-640. [PMID: 31266825 DOI: 10.1158/1940-6207.capr-19-0089] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2019] [Revised: 04/24/2019] [Accepted: 06/27/2019] [Indexed: 11/16/2022]
Abstract
Suboptimal participation is commonly observed in colorectal cancer screening programs utilizing fecal tests. This randomized controlled trial tested whether the offer of a blood test as either a "rescue" strategy for fecal test nonparticipants or an upfront choice, could improve participation. A total of 1,800 people (50-74 years) were randomized to control, rescue, or choice groups (n = 600/group). All were mailed a fecal immunochemical test (FIT, OC-Sensor, Eiken Chemical Company) and a survey assessing awareness of the screening tests. The rescue group was offered a blood test 12 weeks after FIT nonparticipation. The choice group was given the opportunity to choose to do a blood test (Colvera, Clinical Genomics) instead of FIT at baseline. Participation with any test after 24 weeks was not significantly different between groups (control, 37.8%; rescue, 36.9%; choice, 33.8%; P > 0.05). When the rescue strategy was offered after 12 weeks, an additional 6.5% participated with the blood test, which was greater than the blood test participation when offered as an upfront choice (1.5%; P < 0.001). Awareness of the tests was greater for FIT than for blood (96.2% vs. 23.1%; P < 0.0001). In a population familiar with FIT screening, provision of a blood test either as a rescue of FIT nonparticipants or as an upfront choice did not increase overall participation. This might reflect a lack of awareness of the blood test for screening compared with FIT.
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Affiliation(s)
- Erin L Symonds
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia. .,Bowel Health Service, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Donna Hughes
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia
| | - Richard Woodman
- Flinders Centre for Epidemiology and Biostatistics, School of Medicine, Flinders University, Bedford Park, South Australia, Australia
| | - Gang Chen
- Centre for Health Economics, Monash University, Caulfield East, Victoria, Australia
| | - Julie Ratcliffe
- College of Nursing and Health Sciences, Health and Social Care Economics Group, Flinders University, Bedford Park, South Australia, Australia
| | | | - Robert J L Fraser
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia.,Department of Gastroenterology and Hepatology, Flinders Medical Centre, Bedford Park, South Australia, Australia
| | - Carlene J Wilson
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia.,School of Psychology & Public Health, La Trobe University, Bundoora, Victoria, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Bedford Park, South Australia, Australia
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10
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Uptake of a colorectal cancer screening blood test in people with elevated risk for cancer who cannot or will not complete a faecal occult blood test. Eur J Cancer Prev 2019; 27:425-432. [PMID: 28368949 DOI: 10.1097/cej.0000000000000352] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
Participation rates in colorectal cancer (CRC) screening programmes using faecal occult blood tests (FOBTs) are low. Nonparticipation is commonly attributed to psychosocial factors, but some medical conditions also prevent screening. These barriers might be partially overcome if a blood test for CRC screening was available. This study determined whether people who had always declined screening by FOBT would participate if offered a blood test. An audit of registrants within a personalized CRC screening programme was undertaken to determine the reasons for regular nonparticipation in FOBT. Consistent nonparticipants (n=240) were randomly selected and invited for CRC screening with a blood test. Demographic characteristics and the reasons for prior FOBT nonparticipation were collected by means of a questionnaire. Nonparticipation in the screening programme could be classified as either behavioural (8.6%), with consistent noncompliance, or due to medical contraindications (8.5%), which included chronic rectal bleeding, being deemed unsuitable by a health professional, and needing personal assistance. Blood test uptake was 25%, with participation in the medical contraindications group greater than that in the behavioural group (43 vs. 12%, P<0.001). Reported behavioural reasons for nonparticipation in faecal immunochemical test included procrastination and dislike of the test, but these were not associated with blood test uptake (P>0.05). There is a subgroup of the community who have medical reasons for nonparticipation in CRC screening with FOBT but will participate if offered a blood test. The option of a blood test does not, however, improve uptake in those who admit to behavioural reasons for noncompliance with screening.
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11
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Todorov K, Wilson C, Sharplin G, Corsini N. Faecal occult blood testing (FOBT)-based colorectal cancer screening trends and predictors of non-use: findings from the South Australian setting and implications for increasing FOBT uptake. AUST HEALTH REV 2018; 42:45-52. [DOI: 10.1071/ah16126] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2016] [Accepted: 11/11/2016] [Indexed: 01/22/2023]
Abstract
Objective
The present study used data from three South Australian population health surveys to examine trends in knowledge, recent use and reasons for use or non-use of faecal occult blood testing (FOBT) for colorectal cancer (CRC) screening from 2011 to 2014. Screening awareness and demographic factors related to non-use were also examined.
Methods
FOBT trends were examined for respondents aged 50–75 years across survey years (n ~ 1000). Logistic regression analyses were undertaken to determine predictors of non-use and reasons for non-use of FOBT based on latest data.
Results
The proportion of respondents reporting recent FOBT use has trended up, whereas the proportion reporting non-use has trended down. Awareness of screening recommendations has increased. Respondents who were aware of screening recommendations and those aged 65–69 years were significantly less likely to report non-use. The most commonly reported reasons for FOBT use were as part the national screening program or routine examination, whereas reasons for non-use were not having symptoms and doctor not advising to have the test.
Conclusions
FOBT screening trends are indicative of the positive effect of the continued expansion of the national screening program. FOBT uptake may be increased by addressing salient barriers, as indicated by persisting reasons for non-use of FOBT.
What is known about the topic?
Australia has one of the highest age-standardised incidence rates of CRC (or bowel cancer) in the world. Population screening using non-invasive stool-based FOBT was implemented in Australia in 2006 with the introduction of the National Bowel Cancer Screening Program (NBCSP). To date, the NBCSP has been extended to only a small proportion of the target population and FOBT screening rates remain well below desired levels to effect changes in CRC outcomes at the population level. There is a recognised need for more robust data on CRC screening practices to inform interventions aimed at increasing FOBT uptake, beyond the scope of the NBCSP.
What does this paper add?
The study provides valuable insights into trends of FOBT screening indicators over time in the South Australia, drawing on data from population state health surveys undertaken from 2011 to 2014. A particular advantage of the dataset was that it included data on reasons for use and non-use of FOBT. These data are not routinely assessed in population-level studies of FOBT uptake, although such information would be beneficial for tracking implementation of the national program and identifying salient barriers to FOBT uptake in low-participation groups. Thus, the study also describes factors related to non-use and reasons for non-use of FOBT among the target population for CRC screening.
What are the implications for practitioners?
Results suggest that there have been considerable shifts in community knowledge and FOBT screening participation rates from 2011 to 2014, reflecting the positive effect of the NBCSP. Reliance on physician recommendation to screen, as well as knowledge deficits related to screening frequency and the perceived relevance of screening remain prominent barriers to FOBT uptake. Recommendations for increasing FOBT uptake are made in view of salient barriers and identified segments of the population less likely to report FOBT use.
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12
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Osborne JM, Flight I, Wilson CJ, Chen G, Ratcliffe J, Young GP. The impact of sample type and procedural attributes on relative acceptability of different colorectal cancer screening regimens. Patient Prefer Adherence 2018; 12:1825-1836. [PMID: 30271126 PMCID: PMC6154741 DOI: 10.2147/ppa.s172143] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
OBJECTIVE In Australia and other countries, participation in colorectal cancer (CRC) screening using fecal occult blood testing is low. Previous research suggests that fecal sampling induces disgust, so approaches not involving feces may increase participation. This study aimed to determine population preferences for CRC screening tests that utilize different sample collections (stool, blood, and saliva) and the extent to which specific attributes (convenience, performance, and cost) impact this preference. MATERIALS AND METHODS People aged 50-74 years completed a survey. Preference for screening for CRC through stool, blood, and saliva was judged through ranking of preference and attributes critical to preference and confirmed via a discrete choice experiment (DCE) where test attributes were described as varying by performance, cost, and sample type. Participants also completed a measure of aversion to sample type. RESULTS A total of 1,282 people participated in the survey. The DCE and ranking exercise confirmed that all test attributes had a statistically significant impact on respondents' preferences (P < 0.001). Blood and saliva were equally preferred over stool; however, test performance was the most influential attribute. In multivariable analyses, those who preferred blood to stool collection exhibited higher aversion to fecal (OR = 1.17; P ≤ 0.001) and saliva (OR = 1.06; P ≤ 0.05) sampling and perceived that they had less time for home sample collection (OR = 0.72, P ≤ 0.001). Those who preferred saliva to stool had higher aversion to fecal (OR = 1.15; P ≤ 0.001) and blood (OR = 1.06, P ≤ 0.01) sampling and less time for home sample collection (OR = 0.81, P ≤ 0.5). CONCLUSION Aversion to sample type and perceived inconvenience of sample collection are significant drivers of screening preference. While blood and saliva sampling were the most preferred methods, test performance was the most important attribute of a screening test, regardless of sample type. Efforts to increase CRC screening participation should focus on a test, or combination of tests, that combines the attributes of high performance, low aversion, and convenience of use.
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Affiliation(s)
- Joanne M Osborne
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia,
- Bowel Health Service, Repatriation General Hospital, Daw Park, SA, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia,
| | - Carlene J Wilson
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia,
- School of Psychology and Public Health, La Trobe University, Melbourne, VIC, Australia,
- Olivia Newton John Cancer Wellness and Research Centre, Austin Hospital, Heidelberg, VIC, Australia,
| | - Gang Chen
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia,
| | - Julie Ratcliffe
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia,
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University, Bedford Park, SA, Australia,
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13
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Davis M, Oaten M, Occhipinti S, Chambers SK, Stevenson RJ. An investigation of the emotion of disgust as an affective barrier to intention to screen for colorectal cancer. Eur J Cancer Care (Engl) 2016; 26. [PMID: 27704647 DOI: 10.1111/ecc.12582] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/26/2016] [Indexed: 12/12/2022]
Abstract
Colorectal cancer (CRC) screening participation remains unacceptably low. This study investigated the emotion of disgust as a potential deterrent to intention to screen for CRC. The study utilised a convenience sample of individuals' 40-70 years of age to complete an online survey. Participants included 30 men and 118 women recruited between December 1, 2013 and March 31, 2014. Data on socio-demographics, health status, screening intentions and emotional barriers to bowel screening were collected via an on-line survey. Logistic regression analysis was utilised to investigate predictors of screening intention. Individuals were more likely to report intention to screen if they had prior screening experience, and reported fewer emotional concerns to screening for CRC. Results implicate disgust as a predictor of screening avoidance among participants. Specifically, higher reported faecal disgust was predictive of a 3% decrease in screening intention. This study was the first to empirically position disgust alongside other negative emotional states as an affective barrier to screening for CRC. Trait disgust sensitivity was not a reliable predictor of screening intention. This research suggests that anticipated faecal disgust may contribute to avoidance of screening for CRC.
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Affiliation(s)
- M Davis
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - M Oaten
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - S Occhipinti
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - S K Chambers
- Menzies Health Institute Queensland, Griffith University, Southport, QLD, Australia
| | - R J Stevenson
- Department of Psychology, Macquarie University, Sydney, NSW, Australia
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Symonds EL, Pedersen S, Cole SR, Massolino J, Byrne D, Guy J, Backhouse P, Fraser RJ, LaPointe L, Young GP. Improving Participation in Colorectal Cancer Screening: a Randomised Controlled Trial of Sequential Offers of Faecal then Blood Based Non-Invasive Tests. Asian Pac J Cancer Prev 2016; 16:8455-60. [PMID: 26745101 DOI: 10.7314/apjcp.2015.16.18.8455] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Poor participation rates are often observed in colorectal cancer (CRC) screening programs utilising faecal occult blood tests. This may be from dislike of faecal sampling, or having benign bleeding conditions that can interfere with test results. These barriers may be circumvented by offering a blood-based DNA test for screening. The aim was to determine if program participation could be increased by offering a blood test following faecal immunochemical test (FIT) non-participation. MATERIALS AND METHODS People were invited into a CRC screening study through their General Practice and randomised into control or intervention (n=600/group). Both groups were mailed a FIT (matching conventional screening programs). Participation was defined as FIT completion within 12wk. Intervention group non-participants were offered a screening blood test (methylated BCAT1/IKZF1). Overall participation was compared between the groups. RESULTS After 12wk, FIT participation was 82% and 81% in the control and intervention groups. In the intervention 96 FIT non- participants were offered the blood test - 22 completed this test and 19 completed the FIT instead. Total screening in the intervention group was greater than the control (88% vs 82%, p<0.01). Of 12 invitees who indicated that FIT was inappropriate for them (mainly due to bleeding conditions), 10 completed the blood test (83%). CONCLUSIONS Offering a blood test to FIT non-participants increased overall screening participation compared to a conventional FIT program. Blood test participation was particularly high in invitees who considered FIT to be inappropriate for them. A blood test may be a useful adjunct test within a FIT program.
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Affiliation(s)
- Erin L Symonds
- Flinders Centre for Innovation in Cancer, Bedford Park, Australia E-mail :
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15
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Burón A, Posso M, Sivilla J, Grau J, Guayta R, Castells X, Castells A, Macià F. Analysis of participant satisfaction in the Barcelona colorectal cancer screening programme: Positive evaluation of the community pharmacy. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:265-275. [PMID: 27292268 DOI: 10.1016/j.gastrohep.2016.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Population-based bowel screening programmes with faecal occult blood (FOB) tests need to achieve high uptake rates and offer quality services. We invited participants in the Barcelona Programme to complete a satisfaction survey, in order to explore factors influencing uptake and respondents' opinion and satisfaction with each step of the screening process. MATERIAL AND METHOD Telephone survey using an ad hoc questionnaire (see annex) administered to a final sample of 1189 people: 310 non-participants in the programme (NoP), 553 participants with a negative test result (PNeg), and 326 participants with a positive result (PPos). RESULTS High scores were obtained for the clarity of the information provided by the programme (mean 8.9 on a scale 0-10), and for the accessibility and attention at the pharmacy as well as its role as the point for collection and return of FOB test cards (mean >9.3). Aspects that were not so highly rated were: preparation for the colonoscopy (41.6% reported quite a lot or a lot of discomfort), and to a lesser extent telephone accessibility (27.1% reported some difficulties). Participants also expressed concern about receiving a positive test result by telephone (78.9% reported some concern). CONCLUSIONS Respondents' opinion of the programme was positive overall, and supports the pharmacy as the point for distributing and collecting FOB test cards, as well as the role of the pharmacist in the context of the programme. Some aspects of the screening process will be reviewed in order to improve participant satisfaction and eventually increase uptake.
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Affiliation(s)
- Andrea Burón
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España.
| | - Margarita Posso
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - Judit Sivilla
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - Jaume Grau
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Rafael Guayta
- Direcció de Projectes i Recerca. Consell de Col·legis Farmacèutics de Catalunya, Barcelona, España
| | - Xavier Castells
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España
| | - Antoni Castells
- Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universitat de Barcelona, Barcelona, España
| | - Francesc Macià
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España
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Zajac IT, Duncan A, Turnbull D, Wilson C, Flight I. Blood-based screening for bowel cancer may not resolve suboptimal screening participation in Australia. Aust N Z J Public Health 2016; 40:337-41. [PMID: 27197629 DOI: 10.1111/1753-6405.12523] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2015] [Revised: 09/01/2015] [Accepted: 12/01/2015] [Indexed: 12/24/2022] Open
Abstract
OBJECTIVE Emerging blood-based screening technologies for bowel cancer may improve screening participation compared to at-home stool sampling. This study assessed the impact of different screening delivery scenarios with increasing health system interactions on sampling preferences and likelihood of screening participation. METHODS N=1,561 persons aged 45 to 74 years completed a behavioural survey measuring demographics, readiness to screen, overall collection method preference, and proposed participation in stool and blood methods across four screening scenarios differing in terms of the number of required health system interactions. RESULTS Overall, respondents preferred a blood test (79.6%) compared to a stool test (20.4%). However, increasing health system interactions had a strong impact on the likelihood of participating in either sampling method (p<0.001). Moreover, likelihood of participating in each of the four blood-screening scenarios was significantly lower than the current at-home stool sampling approach (all p<0.001). CONCLUSIONS Blood-based screening methods require increased contact with the health system but these interactions have negative impact on screening likelihood. All blood-based scenarios showed lower screening likelihood ratings than the current at-home FIT approach. Thus, blood-based screening may not resolve suboptimal screening participation rates in Australia.
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Affiliation(s)
- Ian T Zajac
- Nutrition and Health Research Program, Commonwealth Scientific & Industrial Research Organisation, South Australia
| | - Amy Duncan
- School of Psychology, University of Adelaide, South Australia.,Discipline of General Practice, Flinders University, South Australia
| | | | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, Flinders University, South Australia.,Cancer Council South Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, Flinders University, South Australia
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Ely JW, Levy BT, Daly J, Xu Y. Patient Beliefs About Colon Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2016; 31:39-46. [PMID: 25619196 PMCID: PMC7712459 DOI: 10.1007/s13187-015-0792-5] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Only about half of eligible individuals undergo colon cancer screening. We have limited knowledge about the patient beliefs that adversely affect screening decisions and about which beliefs might be amenable to change through education. As part of a clinical trial, 641 rural Iowans, aged 52 to 79 years, reported their beliefs about colon cancer screening in response to a mailed questionnaire. Consenting subjects were randomized into four groups, which were distinguished by four levels of increasingly intensive efforts to promote screening. Two of the groups received mailed educational materials and completed a follow-up questionnaire, which allowed us to determine whether their beliefs about screening changed following the education. We also completed a factor analysis to identify underlying (latent) factors that might explain the responses to 33 questions about readiness, attitudes, and perceived barriers related to colon cancer screening. The strongest predictors of a patient's stated readiness to be screened were a physician's recommendation to be screened (1 point difference on 10-point Likert scale, 95 % confidence interval [CI], 0.5 to 1.6 point difference), a family history of colon cancer (0.85-point Likert scale difference, 95 % CI, 0.1 to 1.6), and a belief that health-care decisions should be mostly left to physicians rather than patients (Spearman correlation coefficient 0.21, P < .001). Of the 33 questionnaire items about screening beliefs, 11 (33 %) changed favorably following the educational intervention. In the factor analysis, the 33 items were reduced to 8 underlying factors, such as being too busy to undergo screening and worries about screening procedures. We found a limited number of underlying factors that may help explain patient resistance to colon cancer screening.
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Affiliation(s)
- John W Ely
- Department of Family Medicine, Joy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA.
| | - Barcey T Levy
- Department of Family Medicine, Joy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
- Department of Epidemiology, College of Public Health, University of Iowa, Iowa City, IA, USA
| | - Jeanette Daly
- Department of Family Medicine, Joy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
| | - Yinghui Xu
- Department of Family Medicine, Joy J. and Lucille A. Carver College of Medicine, University of Iowa, Iowa City, IA, USA
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Hategekimana C, Karamouzian M. Self-perceived Mental Health Status and Uptake of Fecal Occult Blood Test for Colorectal Cancer Screening in Canada: A Cross-Sectional Study. Int J Health Policy Manag 2016; 5:365-71. [PMID: 27285514 DOI: 10.15171/ijhpm.2016.14] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2015] [Accepted: 02/06/2016] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND While colorectal cancer (CRC) is one of the most preventable causes of cancer mortality, it is one of the leading causes of cancer death in Canada where CRC screening uptake is suboptimal. Given the increased rate of mortality and morbidity among mental health patients, their condition could be a potential barrier to CRC screening due to greater difficulties in adhering to behaviours related to long-term health goals. Using a population-based study among Canadians, we hypothesize that self-perceived mental health (SPMH) status and fecal occult blood test (FOBT) uptake for the screening of CRC are associated. METHODS The current study is cross-sectional and utilised data from the Canadian Community Health Survey 2011-2012. Multinomial logistic regression analysis was undertaken to assess whether SPMH is independently associated with FOBT uptake among a representative sample of 11 386 respondents aged 50-74 years. RESULTS Nearly half of the respondents reported having ever had FOBT for CRC screening, including 37.28% who have been screened within two years of the survey and 12.41% who had been screened more than two years preceding the survey. Respondents who reported excellent mental health were more likely to have ever been screened two years or more before the survey (adjusted odds ratio [AOR] = 2.08; 95% CI, 1.00-4.43) and to have been screened in the last two years preceding the survey (AOR = 1.53; 95% CI, 0.86-2.71) than those reported poor mental health status. CONCLUSION This study supports the association between SPMH status and FOBT uptake for CRC screening. While the efforts to maximize CRC screening uptake should be deployed to all eligible people, those with poor mental health may need more attention.
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Affiliation(s)
- Celestin Hategekimana
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Mohammad Karamouzian
- School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada.,Regional Knowledge Hub, and WHO Collaborating Centre for HIV Surveillance, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
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19
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A Blood Test for Methylated BCAT1 and IKZF1 vs. a Fecal Immunochemical Test for Detection of Colorectal Neoplasia. Clin Transl Gastroenterol 2016; 7:e137. [PMID: 26765125 PMCID: PMC4737873 DOI: 10.1038/ctg.2015.67] [Citation(s) in RCA: 68] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Accepted: 12/04/2015] [Indexed: 02/06/2023] Open
Abstract
Objectives: To compare the performance of a new blood test for colorectal cancer (CRC) to an established fecal immunochemical test (FIT) in a study population with the full range of neoplastic and non-neoplastic pathologies encountered in the colon and rectum. Methods: Volunteers were asked to complete a FIT prior to colonoscopy. Blood was collected after bowel preparation but prior to colonoscopy, and plasma was assayed for the presence of methylated BCAT1 and IKZF1 DNA using a multiplex real-time PCR assay. Sensitivity and specificity estimates for the blood test were calculated from true- and false-positive rates for neoplasia and compared with FIT at a range of fecal hemoglobin (Hb) concentration positivity thresholds. Results: In total, 1,381 volunteers (median age 64 years; 49% male) completed both tests prior to colonoscopy. Estimated sensitivity of the BCAT1/IKZF1 blood test for CRC was 62% (41/66; 95% confidence interval 49–74%) with a specificity of 92% (1207/1315; 90–93%). FIT returned the same specificity at a cutoff of 60 μg Hb/g, at which its corresponding sensitivity for cancer was 64% (42/66; 51–75%). In the range of commonly used FIT cutoffs, respective cancer sensitivity and specificity estimates with FIT were: 59% (46–71%) and 93% (92–95%) at 80 μg Hb/g, and 79% (67–88%) and 81% (78–83%) at 10 μg Hb/g. Although estimated sensitivities were not significantly different between the two tests for any stage of cancer, FIT showed a significantly higher sensitivity for advanced adenoma at the lower cutoffs. Specificity of FIT, but not of the BCAT1/IKZF1 blood test, deteriorated substantially in people with overt blood in the feces. When combining FIT (cutoff 10 μg Hb/g) with the BCAT1/IKZF1 blood test, sensitivity for cancer was 89% (79–96%) at 74% (72–77%) specificity. Conclusions: A test based on detection of methylated BCAT1/IKZF1 DNA in blood has comparable sensitivity but better specificity for CRC than FIT at the commonly used positivity threshold of 10 μg Hb/g. Further evaluation of the new test relative to FIT in the population screening context is now required to fully understand the potential advantages and disadvantages of these biomarkers in screening.
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Taheri-Kharameh Z, Noorizadeh F, Sangy S, Zamanian H, Shouri-Bidgoli AR, Oveisi H. Factors Associated with Adherence to Colorectal Cancer Screening among Moderate Risk Individuals in Iran. Asian Pac J Cancer Prev 2016; 16:8371-5. [DOI: 10.7314/apjcp.2015.16.18.8371] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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21
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Blood Tests for Colorectal Cancer Screening in the Standard Risk Population. CURRENT COLORECTAL CANCER REPORTS 2015. [DOI: 10.1007/s11888-015-0293-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
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Gordon NP, Green BB. Factors associated with use and non-use of the Fecal Immunochemical Test (FIT) kit for Colorectal Cancer Screening in Response to a 2012 outreach screening program: a survey study. BMC Public Health 2015; 15:546. [PMID: 26062732 PMCID: PMC4462185 DOI: 10.1186/s12889-015-1908-x] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2015] [Accepted: 06/04/2015] [Indexed: 12/11/2022] Open
Abstract
Background The one-sample fecal immunochemical test (FIT) is gaining popularity for colorectal cancer (CRC) screening of average-risk people. However, uptake and annual use remain suboptimal. Methods In 2013, we mailed questionnaires to three groups of nonHispanic White, Black, and Latino Kaiser Permanente Northern California (KPNC) members ages 52–76 who received FIT kits in 2010–2012: Continuers did the FIT all 3 years; Converts in 2012, but not 2010 or 2011; and Nonusers in none of the 3 years. The questionnaires covered social influences, perceived CRC risk, reasons for using (Continuers, Converts) or avoiding using (Nonusers) the FIT, and recommendations for improving the kit. Results Continuers (n = 607, response rate 67.5 %), Converts (n = 317, response rate 35.6 %), and Nonusers (n = 215, response rate 21.1 %) did not differ in perceived risk or family history of CRC, but Nonusers were less likely than Continuers and Converts to know someone who had polyps or CRC. Continuers, Converts, and Nonusers did not differ in social network encouragement of CRC screening, but did differ in believing that it was very important that they be screened (88.3 %, 68.4 %, 47.7 %) and that their medical team thought it very important that they be screened (88.6 %, 79.9 %, 53.9 %). Approximately half of Continuers and Converts completed the FIT to please their doctor. Converts were less likely than Continuers to use the FIT to “make sure they were OK” (53.7 % vs. 72.6 %) or “protect their health” (46.1 % vs. 76.4 %). Nearly half of Converts completed the FIT out of guilt. Approximately half of FIT kit users suggested adding a disposable glove, extra paper, and wider-mouth tube to the kit. Nonusers’ reasons for not using the FIT included discomfort, disgust, or embarrassment (59.6 %); thinking it unnecessary (32.9 %); fatalism/fear (15.5 %); and thinking it too difficult to use (14.5 %), but <10 % did not want CRC screening at all. Conclusions Nonusers and irregular users of the FIT are less intrinsically motivated to get CRC screening than long-term users and more averse to preparing their stool sample. Changes to the FIT kit to address discomfort and difficulty factors might improve uptake and continued use. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-1908-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Nancy P Gordon
- Division of Research, Kaiser Permanente Medical Care Program, 2000 Broadway, Oakland, CA, 94611, USA.
| | - Beverly B Green
- Group Health Research Institute, Group Health Cooperative, Seattle, WA, USA. greenb.@ghc.org
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Wilson CJ, Flight IH, Turnbull D, Gregory T, Cole SR, Young GP, Zajac IT. A randomised controlled trial of personalised decision support delivered via the internet for bowel cancer screening with a faecal occult blood test: the effects of tailoring of messages according to social cognitive variables on participation. BMC Med Inform Decis Mak 2015; 15:25. [PMID: 25886492 PMCID: PMC4403749 DOI: 10.1186/s12911-015-0147-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2014] [Accepted: 03/17/2015] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In Australia, bowel cancer screening participation using faecal occult blood testing (FOBT) is low. Decision support tailored to psychological predictors of participation may increase screening. The study compared tailored computerised decision support to non-tailored computer or paper information. The primary outcome was FOBT return within 12 weeks. Additional analyses were conducted on movement in decision to screen and change on psychological variables. METHODS A parallel, randomised controlled, trial invited 25,511 people aged 50-74 years to complete an eligibility questionnaire. Eligible respondents (n = 3,408) were assigned to Tailored Personalised Decision Support (TPDS), Non-Tailored PDS (NTPDS), or Control (CG) (intention-to-treat, ITT sample). TPDS and NTPDS groups completed an on-line baseline survey (BS) and accessed generic information. The TPDS group additionally received a tailored intervention. CG participants completed a paper BS only. Those completing the BS (n = 2270) were mailed an FOBT and requested to complete an endpoint survey (ES) that re-measured BS variables (per-protocol, PP sample). RESULTS FOBT return: In the ITT sample, there was no significant difference between any group (χ (2)(2) = 2.57, p = .26; TPDS, 32.5%; NTPDS, 33%; and CG, 34.5%). In the PP sample, FOBT return in the internet groups was significantly higher than the paper group (χ (2)(2) = 17.01, p < .001; TPDS, 80%; NTPDS, 83%; and CG, 74%). FOBT completion by TPDS and NTPDS did not differ (χ (2)(1) = 2.23, p = .13). Age was positively associated with kit return. Decision to screen: 2227/2270 of the PP sample provided complete BS data. Participants not wanting to screen at baseline (1083/2227) and allocated to TPDS and NTPDS were significantly more likely to decide to screen and return an FOBT than those assigned to the CG. FOBT return by TPDS and NTPDS did not differ from one another (OR = 1.16, p = .42). Change on psychosocial predictors: Analysis of change indicated that salience and coherence of screening and self-efficacy were improved and faecal aversion decreased by tailored messaging. CONCLUSIONS Online information resources may have a role in encouraging internet-enabled people who are uncommitted to screening to change their attitudes, perceptions and behaviour. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12610000095066.
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Affiliation(s)
- Carlene J Wilson
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia. .,Cancer Council South Australia, Eastwood, South Australia, Australia.
| | - Ingrid Hk Flight
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia.,Cancer Council South Australia, Eastwood, South Australia, Australia.,Commonwealth Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Adelaide, South Australia, Australia
| | - Tess Gregory
- Telethon Kids Institute, University of Western Australia, Perth, Australia.,School of Population Health, University of Adelaide, Adelaide, South Australia, Australia
| | - Stephen R Cole
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, Bedford Park, South Australia, Australia
| | - Ian T Zajac
- Commonwealth Industrial Research Organisation, Food and Nutrition Flagship, Adelaide, South Australia, Australia
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Varlow M, Stacey I, Dunlop S, Young J, Kite J, Dessaix A, McAulay C. Self-reported participation and beliefs about bowel cancer screening in New South Wales, Australia. Health Promot J Austr 2014; 25:97-103. [PMID: 25017447 DOI: 10.1071/he13102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/11/2014] [Indexed: 12/28/2022] Open
Abstract
ISSUE ADDRESSED To describe self-reported bowel cancer screening participation, beliefs and attitudes in a sample of New South Wales (NSW) adults, and to identify beliefs and demographic factors associated with self-reported bowel cancer screening participation. METHODS This study used data from the International Cancer Benchmarking Partnership Module 2, a representative population-based telephone survey. Self-reported participation in and beliefs about bowel cancer screening were measured using the Awareness and Beliefs about Cancer survey of people aged 50 years and over living in NSW, Australia (n=2001). Logistic regression modelling was used to identify explanatory variables associated with bowel cancer screening participation. RESULTS Half of all women (54.1%, 95% CI: 50.8-57.4%) and two-thirds of men (65.7%, 95% CI: 61.5-69.9%) reported screening for bowel cancer within the previous 5 years. Believing that screening was only necessary when experiencing symptoms was more likely to be endorsed by people aged 65 years and over (25.5%, 95% CI: 22.2-28.7%) rather than younger (50-64 years; 16.7%, 95% CI: 13.8-19.7%), non-English-speaking migrants (35.4%, 95% CI: 26.7-44.1%) versus others (18.6%, 95% CI: 16.4-20.7%), and people in metropolitan (23.3%, 95% CI: 20.4-26.1%) versus non-metropolitan areas (16.4%, 95% CI: 12.8-20%). People who disagreed that screening was only necessary when experiencing symptoms were four times more likely to report screening participation (OR 3.96, 95% CI: 3.11-5.03). CONCLUSIONS Community education about bowel cancer screening is needed to correct misperceptions regarding screening in the absence of symptoms. Tailored strategies for older, migrant and urban communities may be beneficial. SO WHAT? Education strategies that promote the need for screening in the absence of symptoms and correct misconceptions about bowel cancer screening amongst subgroups of the NSW population may improve screening rates and decrease the burden of bowel cancer in NSW.
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Affiliation(s)
- Megan Varlow
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Ingrid Stacey
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Sally Dunlop
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Jane Young
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - James Kite
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Anita Dessaix
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Claire McAulay
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), NSW 2006, Australia
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Duncan A, Turnbull D, Wilson C, Osborne JM, Cole SR, Flight I, Young GP. Behavioural and demographic predictors of adherence to three consecutive faecal occult blood test screening opportunities: a population study. BMC Public Health 2014; 14:238. [PMID: 24606951 PMCID: PMC4234274 DOI: 10.1186/1471-2458-14-238] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/03/2014] [Indexed: 12/12/2022] Open
Abstract
Background Social cognitive variables are often examined for their association with initial participation in colorectal cancer screening. Few studies have examined the association of these variables with adherence to multiple screening offers i.e., rescreening. This study aimed to describe patterns of participatory behaviour after three rounds of screening using faecal immunochemical tests (FIT) and to determine social cognitive, demographic and background variables predictive of variations in adherence. Methods Participants were 1,540 men and women aged 50 to 75 living in South Australia who completed a behavioural survey measuring demographic (for example, age, gender) and social cognitive variables relevant to FIT screening (for example, perceived barriers, benefits, self-efficacy). The survey was followed by three, free FIT screening offers mailed on an annual basis from 2008 to 2010. Patterns of participation after three screening rounds were described as one of five screening behaviours; 1) consistent re-participation (adherent with all screening rounds), 2) consistent refusal (adherent with no screening rounds), 3) drop out (adherent with earlier but not later rounds), 4) intermittent re-participation (adherent with alternate rounds) and 5) delayed entry (adherent with later but not initial round(s)). Univariate (Chi Square and Analysis of Variance) and multivariate (Generalised Estimating Equations) analyses were conducted to determine variables predictive of each category of non-adherence (those that did not participate in every screening offer, groups 2, 3, 4 and 5) relative to consistent re-participation. Results Significant social cognitive predictors of non-adherence were; less self-efficacy (drop out and consistent refusal), greater perceived barriers (drop out) and lower levels of response efficacy (consistent refusal). Demographic predictors of non-adherence included; male gender (delayed entry), younger age (intermittent, delayed and consistent refusal), less frequent GP visits (intermittent re-participation) and 'ancillary only' private health insurance (drop out). Less satisfaction with screening at baseline predicted drop out, consistent refusal and delayed entry. Conclusions Different combinations of demographic and behavioural variables predicted different patterns of rescreening adherence. Rescreening interventions may benefit from a targeted approach that considers the different needs of the population subgroups. Satisfaction with past FOBT screening measured prior to the study screening offers was an important predictor of adherence.
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Affiliation(s)
- Amy Duncan
- School of Psychology, The University of Adelaide, Adelaide 5005, South Australia, Australia.
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26
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Zajac IT, Flight I, Turnbull D, Young G, Cole S, Wilson C. Self-reported bowel screening rates in older Australians and the implications for public health screening programs. Australas Med J 2013; 6:411-7. [PMID: 24039635 DOI: 10.4066/amj.2013.1808] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
BACKGROUND This paper sought to determine the status of older Australians with regard to Bowel Cancer screening practices occurring outside of the National Bowel Cancer Screening Program. METHOD A random sample of N=25,511 urban Australians aged 50 to 74 years received a questionnaire via mail asking questions relating to bowel screening. N=8,762 (34.3%) returned a completed questionnaire. RESULTS Approximately 33% (N=2863) of respondents indicated they had undergone colonoscopy in the preceding five years and 21% (N=1840) had used a Faecal Occult Blood Test (FOBT) in the preceding 12 months. Furthermore, 27% (N=497) of those who had completed an FOBT had also undergone colonoscopy. CONCLUSION A significant proportion of older Australians might be participating in bowel screening practices outside of the national program (NBCSP). Moreover, the proportion of individuals reporting use of both FOBT and endoscopic services is much higher than the positivity rate of FOBT. Large population FOBT screening programs, such as the NBCSP, that do not consider participation in screening external to the program may underestimate true population screening rates.
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Affiliation(s)
- Ian T Zajac
- CSIRO Preventative Health Research Flagship, South Australia
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27
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Flight IH, Wilson CJ, Zajac IT, Hart E, McGillivray JA. Decision Support and the Effectiveness of Web-based Delivery and Information Tailoring for Bowel Cancer Screening: An Exploratory Study. JMIR Res Protoc 2012; 1:e12. [PMID: 23611950 PMCID: PMC3626147 DOI: 10.2196/resprot.2135] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2012] [Revised: 08/13/2012] [Accepted: 08/10/2012] [Indexed: 11/20/2022] Open
Abstract
Background Colorectal cancer (CRC) is the third most commonly diagnosed cancer in males and the second in females throughout the developed world. Population screening using fecal occult blood tests (FOBTs) facilitates early detection and greater chance of survival, but participation rates are low. We developed a Web-based decision tool to provide information tailored to an individual’s decision stage for CRC screening and attitude toward screening utilizing the Preventive Health Model (PHM) and Precaution Adoption Process Model (PAPM) as theoretical frameworks for screening behavior. We describe the practical steps employed in the tool’s design and the subsequent conduct of an exploratory study. Objective To design a decision tool for CRC screening and conduct an exploratory study among average-risk men and women to (1) test the impact of message type (tailored vs non-tailored) and message delivery modality (Web-based vs paper-based) on attitudes toward screening and screening uptake, and (2) investigate the acceptability of the decision tool and relevance of materials. Methods Participants (n = 100), recruited from a population sample of men and women aged 50-76 residing in urban Adelaide, Australia, were randomly assigned to a control group or one of 4 interventions: (1) Web-based and tailored information, (2) paper-based and tailored information, (3) Web-based and non-tailored (generic) information, or (4) paper-based and non-tailored information. Participation was augmented by snowball recruitment (n = 19). Questionnaires based on PHM variables were administered pre- and post-intervention. Participants were given the opportunity to request an FOBT. Following the intervention, participants discussed the acceptability of the tool. Results Full data were available for 87.4% (104/119) of participants. Post-intervention, perceived susceptibility scores for individuals receiving tailored information increased from mean 10.6 (SD 2.1) to mean 11.8 (SD 2.2). Scores on self-efficacy increased in the tailored group from mean 11.7 (SD 2.0) to mean 12.6 (SD 1.8). There were significant time x modality x message effects for social influence and salience and coherence, reflecting an increase in these scores for tailored Web-based participants only; social influence scores increased from mean 11.7 (SD 2.6) to mean 14.9 (SD 2.3), and salience and coherence scores increased from mean 16.0 (SD 2.2) to mean 17.7 (SD 2.1). There was no greater influence of modality or message type on movement toward a decision to screen or screening uptake, indicating that neither tailored messages nor a Web modality had superior effect. Overall, participants regarded tailored messages positively, but thought that the Web tool lacked “media richness.” Conclusions This exploratory study confirms that tailoring on PHM predictors of CRC screening has the potential to positively address attitudes toward screening. However, tailoring on these variables did not result in significantly increased screening uptake. Future research should consider other possible psychosocial influences. Mode of delivery did not affect outcomes, but as a delivery medium, the Web has economic and logistical advantages over paper.
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Affiliation(s)
- Ingrid H Flight
- Preventative Health Research Flagship, Commonwealth Scientific and Industrial Research Organisation (CSIRO), Adelaide BC, Australia.
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28
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Lo S, Vart G, Snowball J, Halloran S, Wardle J, Von Wagner C. The impact of media coverage of the Flexible Sigmoidoscopy Trial on English colorectal screening uptake. J Med Screen 2012; 19:83-8. [DOI: 10.1258/jms.2012.012017] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
Objective To assess the impact of media coverage of the UK Flexible Sigmoidoscopy Trial on colorectal screening uptake in England. Setting In April 2010, publication of the UK Flexible Sigmoidoscopy (FS) Trial results generated considerable media interest in both FS and colorectal cancer (CRC) generally. Methods We used routinely collected data from the south of England (excluding London) to analyse return of faecal occult blood test (FOBt) kits within 28 days of the invitation (early uptake) among 60–69 year olds, before (T1, n = 31,229), around the time of (T2, n = 39,571), and one month after (T3, n = 33,430) the FS publicity. Results FOBt uptake over the whole period was 58.2%, with 38.4% of the kits returned within 28 days (early uptake). Across the three time periods, early uptake was 35.8% at T1, 39.4% at T2, and 39.7% at T3. Multivariate regression controlling for age, gender and socioeconomic status confirmed that uptake was higher if people received the FOBt kit around the time of the media coverage (T2: odds ratio [OR] = 1.17, 95% CI = 1.13–1.20), or one month after (T3: OR = 1.18, 95% CI = 1.15–1.22) than before (T1). Sub-group analyses demonstrated that the impact was stronger among previous non-responders than among first-time invitees or previous responders (P < 0.001). Conclusion Media coverage of the FS Trial appeared to have a small but positive impact on FOBt screening uptake, especially among people who had previously abstained from screening.
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Affiliation(s)
- Sh Lo
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
| | - G Vart
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
| | - J Snowball
- Bowel Cancer Screening Programme, Southern Hub, Royal Surrey County Hospital
| | - Sp Halloran
- Bowel Cancer Screening Programme, Southern Hub, University of Surrey and Royal Surrey County Hospital NHS Trust
| | - J Wardle
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
| | - C Von Wagner
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
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Editorial for International Journal of Behavioral Medicine: special issue on cancer. Int J Behav Med 2012; 18:288-92. [PMID: 21989532 DOI: 10.1007/s12529-011-9200-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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von Wagner C, Good A, Smith SG, Wardle J. Responses to procedural information about colorectal cancer screening using faecal occult blood testing: the role of consideration of future consequences. Health Expect 2011; 15:176-86. [PMID: 21501350 DOI: 10.1111/j.1369-7625.2011.00675.x] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening participation is low despite its effectiveness in reducing CRC mortality. Identifying benefits and barriers requires consideration of specific characteristics of screening modalities. AIMS AND RESEARCH QUESTIONS: To monitor the impact of providing information about CRC screening via faecal occult blood testing (FOBt) on intentions to participate. To investigate moderation by individual differences in consideration of future consequences (CFC). DESIGN, SETTING AND PARTICIPANTS A total of 211 healthy adults (aged 45-59) with no experience of CRC screening were presented with eight consecutive statements about FOBt-based screening in a web survey. Participants completed measures of i) intention (after each statement), ii) CFC and iii) the importance of screening practicalities (e.g. unpleasantness of completing the test) and benefits (e.g. early detection of cancer). RESULTS An 8 (information)×2 (CFC) mixed ancova showed that intentions varied across the eight statements. (P<0.001): increasing after information about FOBt being completed at home (P<0.001) before subsequently decreasing after information about the requirement to collect faecal samples (P<0.001) in a plastic tub (P<0.01) on three occasions (P<0.01) with the low CFC group generally being less inclined to complete the test (P<0.01). Two between-group anovas demonstrated that the low CFC group attributed greater importance to practicalities of screening than the high CFC group while the opposite was found for the importance of benefits (both P's<0.001). CONCLUSION Deconstructing FOBt-based screening pointed to specific benefits and barriers which can advance research into public preferences of screening and educational materials.
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Affiliation(s)
- Christian von Wagner
- Cancer Research UK, Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK.
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31
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Gregory TA, Wilson C, Duncan A, Turnbull D, Cole SR, Young G. Demographic, social cognitive and social ecological predictors of intention and participation in screening for colorectal cancer. BMC Public Health 2011; 11:38. [PMID: 21232156 PMCID: PMC3034679 DOI: 10.1186/1471-2458-11-38] [Citation(s) in RCA: 44] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2010] [Accepted: 01/14/2011] [Indexed: 11/10/2022] Open
Abstract
Background Previous research points to differences between predictors of intention to screen for colorectal cancer (CRC) and screening behavior, and suggests social ecological factors may influence screening behavior. The aim of this study was to compare the social cognitive and social ecological predictors of intention to screen with predictors of participation. Methods People aged 50 to 74 years recruited from the electoral roll completed a baseline survey (n = 376) and were subsequently invited to complete an immunochemical faecal occult blood test (iFOBT). Results Multivariate analyses revealed five predictors of intention to screen and two predictors of participation. Perceived barriers to CRC screening and perceived benefits of CRC screening were the only predictor of both outcomes. There was little support for social ecological factors, but measurement problems may have impacted this finding. Conclusions This study has confirmed that the predictors of intention to screen for CRC and screening behaviour, although overlapping, are not the same. Research should focus predominantly on those factors shown to predict participation. Perceptions about the barriers to screening and benefits of screening are key predictors of participation, and provide a focus for intervention programs.
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Affiliation(s)
- Tess A Gregory
- School of Psychology, University of Adelaide, Adelaide 5000, Australia.
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