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Selva A, López P, Puig T, Macià F, Selva C, Álvarez-Pérez Y, Terraza R, Burón A, Machlab ST, Pericay C, Solà I, Torà N, Rodríguez V, Barrufet C, Aymar A, Baré M. Patient experience, satisfaction and shared decision-making in colorectal cancer screening: protocol of the mixed-methods study CyDESA. BMJ Open 2022; 12:e057687. [PMID: 35636783 PMCID: PMC9152928 DOI: 10.1136/bmjopen-2021-057687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/25/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) screening programmes can reduce incidence and mortality from this condition if adherence to them is high. As patient experience and satisfaction are key factors in determining adherence to screening programmes, they need to be measured. Furthermore, to promote highly patient-centred healthcare, the perception of patients regarding shared decision-making during CRC screening needs to be known. This study aims to assess the experience, satisfaction and participation in decision-making of participants in a CRC screening programme and of patients diagnosed with CRC through this programme in relation to the diagnostic and therapeutic processes of cancer. METHODS AND ANALYSIS The CyDESA study is a mixed-methods study with a four phase sequential design. In phase 1, we will conduct a systematic review of patient-reported experience measures (PREMs) for patient experience or satisfaction with CRC screening. In case no located PREM can be applied, in phase 2, we will develop a new PREM. We will use the Delphi methodology to reach consensus among experts and patients and will conduct a pilot test of the developed PREM. Phase 3 is a multicentric cross-sectional study based on self-reported questionnaires that will be conducted at three Spanish hospitals (n=843). The objective is to find out about the experience, satisfaction and participation in decision-making of participants in the CRC screening programme who have had a positive screening test result according to their final screening diagnosis: false positives, colorectal polyps or CRC. Phase 4 is a qualitative phenomenological study based on individual interviews. It will explore the experiences of participants in the CRC screening programme and of those diagnosed with CRC. ETHICS AND DISSEMINATION Ethics approval by the Ethics Committees of Corporació Sanitària Parc Taulí, Hospital de Sant Pau and Parc de Salut Mar. Findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT04610086.
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Affiliation(s)
- Anna Selva
- Clinical Epidemiology and Cancer Screening, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalunya, Spain
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Autonomous University of Barcelona, Barcelona, Catalunya, Spain
| | - Pilar López
- Clinical Epidemiology and Cancer Screening, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalunya, Spain
| | - Teresa Puig
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Autonomous University of Barcelona, Barcelona, Catalunya, Spain
- Clinical Epidemiology and Healthcare Services, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Catalunya, Spain
| | - Francesc Macià
- Epidemiology and Evaluation Department, Hospital del Mar Institute for Medical Research, Barcelona, Catalunya, Spain
- Health Services Research on Chronic Patients Network, REDISSEC, Madrid, Spain
| | - Clara Selva
- Psychology and Educational Sciences Studies, UOC, Barcelona, Catalunya, Spain
| | - Yolanda Álvarez-Pérez
- Servicio de Evaluación del Servicio Canario de la Salud, Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Santa Cruz de Tenerife, Spain
| | | | - Andrea Burón
- Epidemiology and Evaluation Department, Hospital del Mar Institute for Medical Research, Barcelona, Catalunya, Spain
- Health Services Research on Chronic Patients Network, REDISSEC, Madrid, Spain
| | - Salvador Tarek Machlab
- Gastroenterology Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalunya, Spain
| | - Carles Pericay
- Medical Oncology Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalunya, Spain
| | - Ivan Solà
- Clinical Epidemiology and Healthcare Services, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Catalunya, Spain
- CIBERESP, CIBER, Madrid, Comunidad de Madrid, Spain
| | - Núria Torà
- Cancer Screening Programs, Althaia Foundation of Manresa, Manresa, Catalunya, Spain
| | - Vanesa Rodríguez
- TecnoCampus Superior School of Health Science, Pompeu Fabra University, Mataro, Catalunya, Spain
| | - Cristina Barrufet
- Epidemiology and Evaluation Department, Hospital del Mar Institute for Medical Research, Barcelona, Catalunya, Spain
| | - Anna Aymar
- Clinical Epidemiology and Healthcare Services, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Catalunya, Spain
| | - Marisa Baré
- Epidemiology and Cancer Screening, Consorcio Corporacion Sanitaria Parc Tauli, Sabadell, Spain
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Selva A, Selva C, Álvarez-Pérez Y, Torà N, López P, Terraza-Núñez R, Rodríguez V, Solà I. Satisfaction and experience with colorectal cancer screening: a systematic review of validated patient reported outcome measures. BMC Med Res Methodol 2021; 21:230. [PMID: 34706652 PMCID: PMC8549248 DOI: 10.1186/s12874-021-01430-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patient satisfaction or experience with colorectal cancer screening can determine adherence to screening programs. An evaluation of validated patient reported outcome measures (PROMs) for measuring experience or satisfaction with colorectal cancer screening does not exist. Our objective was to identify and critically appraise validated questionnaires for measuring patient satisfaction or experience with colorectal cancer screening. METHODS We conducted a systematic review following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. We conducted searches on MEDLINE, EMBASE, PsychINFO, CINAHL and BiblioPRO and assessed the methodological quality of studies and measurement properties of questionnaires according to the COSMIN guidelines for systematic reviews of PROMs. PROSPERO registration number: CRD42019118527. RESULTS We included 80 studies that used 75 questionnaires, of which only 5 were validated. Four questionnaires measured satisfaction with endoscopy: two in the context of colorectal cancer screening (for colonoscopy and sigmoidoscopy) and two for non-screening endoscopy. One questionnaire measured satisfaction with bowel preparation. The methodological quality of studies was variable. The questionnaires with evidence for sufficient content validity and internal consistency were: the CSSQP questionnaire, which measures safety and satisfaction with screening colonoscopy, and the Post-Procedure questionnaire which measures satisfaction with non-screening endoscopic procedures. CONCLUSIONS This systematic review shows that a minority of existing PROMs for measuring patient satisfaction with colorectal cancer screening are validated. We identified two questionnaires with high potential for further use (CSSQP and the Post-Procedure questionnaire).
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Affiliation(s)
- A Selva
- Clinical Epidemiology and Cancer Screening, Parc Taulí Hospital Universitari, Corporació Sanitària Parc Taulí, Edifici Santa Fè. Parc Taulí 1, Sabadell, 08208, Barcelona, Catalonia, Spain.
- Universitat Autònoma de Barcelona, Bellaterra, Spain.
- REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain.
| | - C Selva
- Universitat Oberta de Catalunya (Estudis de Psicologia i Ciències de l'Educació), Barcelona, Catalonia, Spain
| | - Y Álvarez-Pérez
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Tenerife, Spain
| | - N Torà
- Cancer Screening Programms. Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - P López
- Clinical Epidemiology and Cancer Screening, Parc Taulí Hospital Universitari, Corporació Sanitària Parc Taulí, Edifici Santa Fè. Parc Taulí 1, Sabadell, 08208, Barcelona, Catalonia, Spain
| | - R Terraza-Núñez
- Direcció General de Planificació en Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - V Rodríguez
- Tecnocampus, Universitat Pompeu Fabra, Mataró, Catalonia, Spain
| | - I Solà
- Institute of Biomedical Research, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
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Translational Research in Cancer Screening: Long-Term Population-Action Bridges to Diffuse Adherence. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18157883. [PMID: 34360176 PMCID: PMC8345519 DOI: 10.3390/ijerph18157883] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/10/2021] [Revised: 07/20/2021] [Accepted: 07/22/2021] [Indexed: 11/17/2022]
Abstract
The population-level implementation of innovative, evidence-based medical recommendations for adopting health-behaviors depends on the last link in the translation chain: the users. “User-friendly” medical interventions aimed at engaging users to adopt recommended health behaviors are best developed in a collaborative bio-medical and social sciences setting. In the 1990s, National Breast and Colorectal Cancer Early Detection Programs were launched at the Israeli Department of Community Medicine and Epidemiology. Operating under the largest HMO (Health Maintenance Organization) in Israel (“Clalit Health Services”), the department had direct access to HMO community primary-care clinics’ teams, insured members, and medical records. Academically affiliated, the department engaged in translational research. In a decades-long translational process, this multi-disciplinary unit led a series of interventions built upon basic and applied behavioral/social science phenomena such as framing, “Implementation Intentions,” and “Question-Behavior-Effect”. A heterogeneous team of disciplinary specialists created an integrated scientific environment. In order to enhance screening, the team focused on the establishment of a systematic mechanism actively inviting programs’ “users” (average-risk targeted individuals on the national level), and continuously applied social and health psychology concepts to study individuals’ perceptions, expectations, and needs related to cancer screening. The increase in adherence to screening recommendations was slow and incremental. A decrease in late-stage breast and colorectal cancer diagnoses was observed nationally, but participation was lower than expected. This paper positions screening adherence as a unique challenge and proposes new social and network avenues to enhance future participation.
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Unim B, Boggi R, Napoli M, Fulgenzi R, Landi A, La Torre G. Predictors of Mammography Uptake Among Italian Women Aged 50-69: a Cross-sectional Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1089-1093. [PMID: 31183766 DOI: 10.1007/s13187-019-01560-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Screening coverage is of concern in several countries, including Italy. The aim of the study is to assess predictors of participation in the mammography screening program at the Local Health Unit RMA (Rome, Italy). A telephone-based questionnaire was administered to randomly selected eligible women. The study population was interviewed by the personnel of the health center. Five hundred two women were interviewed, of which 264(52.6%) have attended the breast cancer screening program at least once. The attendees received the invitation letter more often than the non-attendees (88.3% vs. 77.7%; p = 0.002) and were more willing to participate (85.6% vs. 69.3%; p < 0.001). Employees were more among the non-attendees of the screening program (66% vs. 52.3%; p = 0.002). Age over-61 (OR = 2.75; 95%CI 1.84-4.09), receiving the invitation letter (OR = 2.54; 95%CI = 1.52-4.24), and intention to participate (OR = 3.09; 95%CI = 1.94-4.91) were significantly associated with participation in the screening program. Although the invitation rate of the Local Health Unit RMA has improved in recent years, the mammography uptake rate remains very low. The presence of opportunistic screening activities, younger age, and low educational status could explain the low participation rates. Organizational barriers (e.g., screening hours coinciding with work hours, screening facilities located far away) may also limit participation. Major efforts should be made towards the regulation of opportunistic screening activities and reorganization of the screening centers and communication strategies to better comply with the needs of the target population. In this light, the involvement of different healthcare professionals, especially general practitioners, and gynecologists, is crucial.
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Affiliation(s)
- Brigid Unim
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Roberto Boggi
- Local Health Unit ASL Roma A, Department of Prevention - Hygiene and Public Health Service, 00187, Rome, Italy
| | - Massimo Napoli
- Local Health Unit ASL Roma A, Department of Prevention - Hygiene and Public Health Service, 00187, Rome, Italy
| | - Roberta Fulgenzi
- Local Health Unit ASL Roma A, Department of Prevention - Hygiene and Public Health Service, 00187, Rome, Italy
| | - Adelaide Landi
- Local Health Unit ASL Roma A, Department of Prevention - Hygiene and Public Health Service, 00187, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
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Deandrea S, Salakari M, Neamţiu L, Ulutürk A, Lerda D, Pylkkänen L. Validated tools measuring women's satisfaction in breast cancer screening programmes: A systematic review. Breast 2018. [DOI: 10.1016/j.breast.2018.03.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
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Savaridas S, Brook J, Codde J, Bulsara M, Wylie E. The effect of individual radiographers on rates of attendance to breast screening: a 7-year retrospective study. Clin Radiol 2018; 73:413.e7-413.e13. [DOI: 10.1016/j.crad.2017.11.010] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2017] [Accepted: 11/14/2017] [Indexed: 10/18/2022]
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Women's satisfaction with mammography and predictors of participation in an organized breast cancer screening program: Perspectives of a Local Health Unit in Rome. Public Health 2018; 155:91-94. [PMID: 29331770 DOI: 10.1016/j.puhe.2017.11.025] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2017] [Revised: 09/18/2017] [Accepted: 11/26/2017] [Indexed: 11/21/2022]
Abstract
OBJECTIVES The aims of the study were to evaluate satisfaction with the mammography service of the Local Health Unit RMA (Rome, Lazio Region) among women who have attended the program and to identify the predictors of participation. STUDY DESIGN Cross-sectional study. METHODS A telephone-based questionnaire was administered to women eligible for mammography screening. The respondents were randomly selected and interviewed by the health center staff. RESULTS A total of 502 women were interviewed, of which 264 (52.6%) have attended the screening program at least once. The attendees received the invitation letter more often than the non-attendees (88.3% vs 77.7%; P = 0.002), were more willing to participate (85.6% vs 69.3%; P = 0.001), they considered the letter very clear (15% vs 10.8%; P = 0.003), and information obtained through the hotline appropriate (64.7% vs 56.7%; P = 0.002). Overall satisfaction was high. Critical issues were lack of response from the hotline staff, medium-long waiting time for the results and further examinations. Age >61 years (odds ratio [OR] = 2.747; 95% confidence interval [CI] = 1.842-4.096), receiving the invitation letter (OR = 2.539; 95% CI = 1.519-4.242), and intention to participate (OR = 3.086; 95% CI = 1.938-4.915) were significantly associated with participation in the screening program. CONCLUSIONS Women's satisfaction with mammography is an important aspect of service utilization. Implementation of strategies to reduce waiting time, increase operating hours, and improve the invitation procedure and the hotline service could enhance satisfaction and attendance rate.
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Gabel P, Larsen MB, Nielsen PB, Svendstrup DB, Andersen B. Satisfaction, discomfort, obligations, and concerns in population-based breast cancer screening: cross-sectional study in a Danish population. BMC Health Serv Res 2017; 17:489. [PMID: 28709436 PMCID: PMC5513139 DOI: 10.1186/s12913-017-2438-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/06/2017] [Indexed: 11/27/2022] Open
Abstract
Background Potential barriers to breast cancer screening adherence include patient satisfaction, as well as pain, feeling obliged to participate, and other concerns that might compromise the level of satisfaction. The present study aimed to assess the overall satisfaction of Danish citizens with their breast cancer screening experiences, as well as their level of discomfort, concerns, and feelings of obligation to participate. Furthermore, we analyzed the associations between overall satisfaction and the remaining outcomes. Methods Questionnaires were mailed to 3000 women in the Central Denmark Region who received screening examination results in the fall of 2013. The questionnaire assessed satisfaction (overall, telephone hot-line, and web-based self-service), discomfort (pain and boundaries of modesty), concerns (at invitation, while waiting for results, and after receiving results), and feelings of obligation to participate. Background information was retrieved from Statistics Denmark. Pearson’s chi-square test was used to test differences in outcomes and demographic characteristic distributions between respondents and non-respondents and highly satisfied vs. less satisfied participants. Prevalence ratios (PR) with 95% CI were assessed using Poisson regression with robust variance, to estimate associations between satisfaction and the remaining outcomes. Results Among the participants, 70.3% and 29.4%, respectively, reported really good and good impressions of the screening program. Lower satisfaction was associated with feeling pain (prevalence ratio (PR), 0.82), feeling that modesty boundaries were transgressed (PR, 0.79), experiencing screening-induced concerns (PR, 0.84), and feeling obliged to participate (PR, 0.96). Of the participants, 36.2% and 12.9%, respectively, felt very much and moderately obliged to participate. A total of 72.6% reported no screening-induced concerns, including 73.3% of those with negative screening results and 38.1% of those with positive screening results. Conclusions Overall satisfaction with breast cancer screening was very high, but discomfort, feelings of obligation, and concerns were associated with lower satisfaction levels. A continuing focus on high service in breast cancer screening is important for achieving the highest benefit from the program. This includes initiatives to employ the least painful techniques, to respect the patients’ modesty as much as possible, and to deliver fast screening results and thus minimize concerns among women awaiting results. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2438-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pernille Gabel
- Department of Public Health Programmes, Regional Hospital Randers, Skovlyvej 15, DK-8930, Randers NØ, Denmark.
| | - Mette Bach Larsen
- Department of Public Health Programmes, Regional Hospital Randers, Skovlyvej 15, DK-8930, Randers NØ, Denmark
| | | | | | - Berit Andersen
- Department of Public Health Programmes, Regional Hospital Randers, Skovlyvej 15, DK-8930, Randers NØ, Denmark
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Whelehan P, Evans A, Ozakinci G. Client and practitioner perspectives on the screening mammography experience. Eur J Cancer Care (Engl) 2017; 26:e12580. [PMID: 27739138 PMCID: PMC5484333 DOI: 10.1111/ecc.12580] [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] [Accepted: 08/26/2016] [Indexed: 12/30/2022]
Abstract
Mammography can be painful and unpleasant, but effective interventions to improve the experience remain scarce. As a first step towards more effective interventions, we aimed to achieve a thorough, contemporary understanding of thoughts, feelings and behaviours which affect and arise from mammography experiences. Research and professional experience suggest that the interaction between client and practitioner may be paramount in determining the quality of a client's experience. Therefore, this study aimed to capture the perspectives of clients and mammography staff from UK breast screening programmes. Thematic analysis of semi-structured qualitative in-depth interviews with 22 clients and 18 staff revealed that clients had positive attitudes to breast screening and mostly low knowledge about potential harms. Staff data indicated that some women attend for breast screening under pressure from others. Pain and coping with it were prominent themes, with wide variations in pain experiences. Clients recognised differences in mammographers' abilities to put them at ease. Staff difficulties included empowering clients within the confines of a taxing technique, and maintaining compassionate care when under strain. Future intervention development should focus on the information and support needs of women prior to the appointment and on effectively training and supporting mammographers to deal with challenging encounters.
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Affiliation(s)
- P. Whelehan
- School of MedicineUniversity of DundeeMailbox 4Ninewells Hospital & Medical SchoolDundeeUK
- School of MedicineUniversity of St AndrewsSt AndrewsUK
| | - A. Evans
- School of MedicineUniversity of DundeeMailbox 4Ninewells Hospital & Medical SchoolDundeeUK
| | - G. Ozakinci
- School of MedicineUniversity of St AndrewsSt AndrewsUK
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Hayek S, Enav T, Shohat T, Keinan-Boker L. Factors Associated with Breast Cancer Screening in a Country with National Health Insurance: Did We Succeed in Reducing Healthcare Disparities? J Womens Health (Larchmt) 2017; 26:159-168. [DOI: 10.1089/jwh.2016.5835] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022] Open
Affiliation(s)
- Samah Hayek
- Israel Centre for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
| | - Teena Enav
- Israel Centre for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
| | - Tamy Shohat
- Israel Centre for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Lital Keinan-Boker
- Israel Centre for Disease Control, Israel Ministry of Health, Ramat-Gan, Israel
- School of Public Health, University of Haifa, Haifa, Israel
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What Do Patients Tweet About Their Mammography Experience? Acad Radiol 2016; 23:1367-1371. [PMID: 27658329 DOI: 10.1016/j.acra.2016.07.012] [Citation(s) in RCA: 30] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2016] [Revised: 07/16/2016] [Accepted: 07/19/2016] [Indexed: 11/23/2022]
Abstract
RATIONALE AND OBJECTIVE The purpose of this study was to evaluate themes related to patients' experience in undergoing mammography, as expressed on Twitter. METHODS A total of 464 tweets from July to December 2015 containing the hashtag #mammogram and relating to a patient's experience in undergoing mammography were reviewed. RESULTS Of the tweets, 45.5% occurred before the mammogram compared to 49.6% that occurred afterward (remainder of tweets indeterminate). However, in patients undergoing their first mammogram, 32.8% occurred before the examination, whereas in those undergoing follow-up mammogram, 53.0% occurred before the examination. Identified themes included breast compression (24.4%), advising other patients to undergo screening (23.9%), recognition of the health importance of the examination (18.8%), the act of waiting (10.1%), relief regarding results (9.7%), reflection that the examination was not that bad (9.1%), generalized apprehension regarding the examination (8.2%), interactions with staff (8.0%), the gown (5.0%), examination costs or access (3.4%), offering or reaching out for online support from other patients (3.2%), perception of screening as a sign of aging (2.4%), and the waiting room or waiting room amenities (1.3%). Of the tweets, 31.9% contained humor, of which 56.1% related to compression. Themes that were more common in patients undergoing their first, rather than follow-up, mammogram included breast compression (16.4% vs 9.1%, respectively) and that the test was not that bad (26.2% vs 7.6%, respectively). CONCLUSION Online social media provides a platform for women to share their experiences and reactions in undergoing mammography, including humor, positive reflections, and encouragement of others to undergo the examination. Social media thus warrants further evaluation as a potential tool to help foster greater adherence to screening guidelines.
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Fernández-Feito A, Lana A, Cabello-Gutiérrez L, Franco-Correia S, Baldonedo-Cernuda R, Mosteiro-Díaz P. Face-to-face Information and Emotional Support from Trained Nurses Reduce Pain During Screening Mammography: Results from a Randomized Controlled Trial. Pain Manag Nurs 2015; 16:862-70. [DOI: 10.1016/j.pmn.2015.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 07/21/2015] [Accepted: 07/23/2015] [Indexed: 12/25/2022]
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Bond M, Garside R, Hyde C. Improving screening recall services for women with false-positive mammograms: a comparison of qualitative evidence with UK guidelines. BMJ Open 2015; 5:e005855. [PMID: 25618139 PMCID: PMC4316556 DOI: 10.1136/bmjopen-2014-005855] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To gain an understanding of the views of women with false-positive screening mammograms of screening recall services, their ideas for service improvements and how these compare with current UK guidelines. METHODS Inductive qualitative content analysis of semistructured interviews of 21 women who had false-positive screening mammograms. These were then compared with UK National Health Service (NHS) guidelines. RESULTS Participants' concerns about mammography screening recall services focused on issues of communication and choice. Many of the issues raised indicated that the 1998 NHS Breast Screening Programme guidelines on improving the quality of written information sent to women who are recalled, had not been fully implemented. This included being told a clear reason for recall, who may attend with them, the length of appointment, who they will see and what tests will be carried out. Additionally women voiced a need for: reassurance that a swift appointment did not imply they had cancer; choice about invasive assessment or watchful waiting; the offer of a follow-up mammogram for those uncertain about the validity of their all-clear and an extension of the role of the clinical nurse specialist, outlined in the 2012 NHS Breast Screening Programme (NHSBSP) guidelines, to include availability at the clinic after the all-clear for women with false-positive mammograms. CONCLUSIONS It is time the NHSBSP 1998 recall information guidelines were fully implemented. Additionally, the further suggestions from this research, including extending the role of the clinical nurses from the 2012 NHSBSP guidelines, should be considered. These actions have the potential to reduce the anxiety of being recalled.
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Affiliation(s)
- Mary Bond
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ruth Garside
- University of Exeter Medical School, University of Exeter, Truro, UK
| | - Christopher Hyde
- University of Exeter Medical School, University of Exeter, Exeter, UK
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Morris N. When health means suffering: mammograms, pain and compassionate care. Eur J Cancer Care (Engl) 2014; 24:483-92. [PMID: 25521596 DOI: 10.1111/ecc.12272] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2014] [Indexed: 11/27/2022]
Abstract
The X-ray mammogram remains the cornerstone of most public health programmes aimed at the early diagnosis of breast cancer. Its virtues of safety, reliability and cheapness maintain its established position, and Western social and cultural traditions of ambivalence to pain push any questions concerning the painfulness of the procedure into the background. As part of a larger UK/USA-based empirical study, we undertook a qualitative analysis of women's accounts of pain experienced in mammograms and their reaction to it, comparing their accounts with professional views and advice to patients as reflected in interviews, patient leaflets and practice guidelines. We found considerable variability of experience and reaction to pain among patients, and indications of similar variability in professionals' views and practice, contrasting with a uniformly reassuring message in formal institutional advice. We suggest that in practice professional work-arounds and patients' felt obligation to tolerate pain bridge this gap, but that action to tackle the problems of dropout and the emotional and operational costs of the current system is nonetheless needed. The need is for concerned groups to combine to establish a serious and sustained programme of amelioration and innovative technological development to assure more compassionate patient care and operational efficiency.
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Affiliation(s)
- N Morris
- Department of Science and Technology Studies, University College London, London, UK
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Goossens M, Van Hal G, Van der Burg M, Kellen E, Van Herck K, De Grève J, Martens P, Van Limbergen E. Quantifying independent risk factors for failing to rescreen in a breast cancer screening program in Flanders, Belgium. Prev Med 2014; 69:280-6. [PMID: 25456812 DOI: 10.1016/j.ypmed.2014.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/11/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mammographic screening may reduce breast cancer mortality by about 20%, provided participation is high and women screen regularly. We quantified independent risk factors for failing to rescreen and built a model to predict how rescreening rates change if these risk factors would be modified. METHODS Multivariate analysis was used to analyze data from a prospective study which included a self-administered questionnaire and rescreening status 30months after a t0 mammogram, using a random sample of women 50-67years (Belgium 2010-2013). RESULTS A false positive result at the most recent past mammogram (Odds Ratio=5.0, 95% Confidence Interval 3.6-6.8), an interval until new invitation greater than 25months (Odds Ratio=4.8 for >29months, 95% Confidence Interval 2.9-8.1), waiting times in the mammography unit >1h (Odds Ratio=2.1, 95% Confidence Interval 1.2-3.7) and difficulties in reaching the unit (Odds Ratio=2.5, 95% Confidence Interval 1.4-4.4) were the strongest independent predictors for failing to rescreen. The area under the curve of the receiver operating characteristic analysis was 0.705 for the model development stage and 0.717 for the validation stage and goodness-of-fit was good. CONCLUSIONS Maintaining an invitation cycle of maximum 25months, limiting waiting time in the mammography unit and lowering the number of false positives could increase breast cancer screening compliance.
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Affiliation(s)
- M Goossens
- Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium.
| | - G Van Hal
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University of Antwerp, Medical Sociology and Health Policy, Universiteitsplein 1, 2610 Antwerp, Belgium. https://www.bevolkingsonderzoek.be
| | - M Van der Burg
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University of Antwerp, Medical Sociology and Health Policy, Universiteitsplein 1, 2610 Antwerp, Belgium. https://www.bevolkingsonderzoek.be
| | - E Kellen
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University Hospital Leuven, Campus St. Rafael, Kapucijnenvoer 33, 3000 Leuven, Belgium. https://www.bevolkingsonderzoek.be
| | - K Van Herck
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; Ghent University, Department of Public Health, De Pintelaan 185, 9000 Ghent, Belgium. https://www.bevolkingsonderzoek.be
| | - J De Grève
- Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - P Martens
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium
| | - E Van Limbergen
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University Hospital Leuven, Campus St. Rafael, Kapucijnenvoer 33, 3000 Leuven, Belgium. https://www.bevolkingsonderzoek.be
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16
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Bairati I, Turcotte S, Doray G, Belleau F, Grégoire L. Development and validation of an instrument assessing women's satisfaction with screening mammography in an organized breast cancer screening program. BMC Health Serv Res 2014; 14:9. [PMID: 24397342 PMCID: PMC3893508 DOI: 10.1186/1472-6963-14-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 01/02/2014] [Indexed: 02/26/2023] Open
Abstract
Background The assessment of the quality of mammography services delivered in organized breast cancer screening programs should include measures centered on women’s perceptions. The objective of this study was to develop and validate an instrument in French designed to evaluate the satisfaction of women having a screening mammography. Methods An instrument evaluating women’s satisfaction with mammography services was developed using published research, the perceptions of screened women, the expertise of health professionals and a pilot study. Between November 9 and 21, 2011, the questionnaire was sent to 1500 consecutive women having had a screening mammography in eight radiologic facilities designated by the Québec Breast Cancer Screening Program, in Quebec City, Canada. Construct validity, convergent and discriminant validity, reliability and sensitivity of the instrument were examined. Results A total of 819 women (55%) participated in the validation study. The factor analysis retained four satisfaction dimensions: satisfaction with 1) the technician’s skills (four items), 2) the physical environment (four items), 3) the staff’s communication skills (three items) and 4) the information given by the program (3 items). The multitrait-scaling analysis showed good convergent and discriminant validity: scaling success was 100% for all subscales. All subscales had good internal consistency (Cronbach’s alphas ≥ 0.86). The satisfaction scores were able to identify groups of women with lower levels of satisfaction, such as younger women or women with pain during breast compression. Conclusion This brief satisfaction instrument, developed in French, showed good psychometric properties to evaluate satisfaction in women receiving mammographic services in an organized breast cancer screening program.
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Affiliation(s)
- Isabelle Bairati
- Public Health Agency of the Capitale-Nationale, Quebec City, Canada.
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17
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Geffen DB, Tokar M, Abu-Ghanem S, Braunstein R, Koretz M, Amir N, Delgado B, Sion-Vardi N, Ariad S, Lazarev I. Adjuvant aromatase inhibitor therapy in patients with stage I breast cancer at a regional oncology center in Israel: implementation of a 'switching' policy in postmenopausal patients after initial tamoxifen. Oncology 2013; 85:145-52. [PMID: 23988814 DOI: 10.1159/000353978] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Accepted: 06/18/2013] [Indexed: 11/19/2022]
Abstract
OBJECTIVE To analyze the implementation of a switching policy of adjuvant aromatase inhibitor (AI) therapy sequentially after tamoxifen in consecutively treated stage I (T1N0M0) hormone receptor (HR)-positive breast cancer (BC) patients. METHODS The records of 279 consecutive HR-positive BC patients diagnosed between 2002 and 2006 and followed at the Soroka Medical Center were reviewed. RESULTS Two-hundred-seventeen patients who initially received tamoxifen were suitable for switching and 28 received an AI as initial adjuvant treatment. The switch was accomplished in 82.5% of the 217 patients. Those who switched to an AI had a higher proportion of T1c stage than patients eligible who were not switched, but did not differ in age, histologic grade, or having received chemotherapy. Of the 179 patients who switched, 155 (86.6%) completed at least 4.5-5 years of adjuvant tamoxifen/AI therapy. Eighteen patients discontinued AI therapy prematurely because of toxicity. CONCLUSIONS In this stage I BC population, despite the toxicities of AI therapy, >84% of eligible patients received an AI as adjuvant therapy. Measures to improve the management of AI toxicity, such as changing to a different AI, may reduce early stopping.
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Affiliation(s)
- D B Geffen
- Department of Oncology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel
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18
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Han MA, Jun JK, Choi KS, Park EC, Lee HY. Satisfaction in the National Cancer Screening Program for breast cancer with and without clinical breast examination. Asian Pac J Cancer Prev 2012; 13:63-7. [PMID: 22502715 DOI: 10.7314/apjcp.2012.13.1.063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
The purpose of this study was to evaluate whether screening by clinical breast examination (CBE) in addition to mammography affected participant satisfaction in the National Cancer Screening Program (NCSP). Data were derived from the Quality Evaluation of National Cancer Screening satisfaction survey. This population-based nationwide telephone survey included participants who had been screened by the NCSP for breast cancer between June and August 2010 (n=2,370), and collected information on satisfaction with screening and screening service use. Five multiple regression models were used to determine satisfaction according to screening method, and according to each of five satisfaction measures (pre- screening information transfer, staff interpersonal skills, physical surroundings, reporting of results and general satisfaction). A total of 1,858 (78.4%) participants were screened by mammography alone and 512 (21.6%) by both mammography and CBE. Satisfaction was significantly higher in subjects screened by both mammography and CBE compared with those screened by mammography alone.
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Affiliation(s)
- Mi Ah Han
- Department of Preventive Medicine, College of Medicine, Chosun University, Gwangju, Korea
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Abstract
While consensus has grown that primary care is the essential access point in a high-performing health care system, the current model of primary care underperforms in both chronic disease management and prevention. The Patient Centered Medical Home model (PCMH) is at the center of efforts to reinvent primary care practice, and is regarded as the most promising approach to addressing the burden of chronic disease, improving health outcomes, and reducing health spending. However, the potential for the medical home to improve the delivery of cancer screening (and preventive services in general) has received limited attention in both conceptualization and practice. Medical home demonstrations to date have included few evidence-based preventive services in their outcome measures, and few have evaluated the effect of different payment models. Decreasing use of hospitals and emergency rooms and an emphasis on improving chronic care represent improvements in effective delivery of healthcare, but leave opportunities for reducing the burden of cancer untouched. Data confirm that what does or does not happen in the primary care setting has a substantial impact on cancer outcomes. Insofar as cancer is the leading cause of death before age 80, the PCMH model must prioritize adherence to cancer screening according to recommended guidelines, and systems, financial incentives, and reimbursements must be aligned to achieve that goal. This article explores capacities that are needed in the medical home model to facilitate the integration of cancer screening and other preventive services. These capacities include improved patient access and communication, health risk assessments, periodic preventive health exams, use of registries that store cancer risk information and screening history, ability to track and follow up on tests and referrals, feedback on performance, and payment models that reward cancer screening.
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Affiliation(s)
- Mona Sarfaty
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Jeon BY, Lee HY, Park EC, Choi KS, Jun JK, Kim Y, Han MA, Yoon NH, Kim EJ, Jeon SM. Satisfaction with mammography in the National Cancer Screening Programme participants of age 40s in Korea. Eur J Cancer Care (Engl) 2010; 20:803-9. [PMID: 20649810 DOI: 10.1111/j.1365-2354.2010.01210.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate satisfaction with the National Cancer Screening Programme of mammography in Korea and to examine the association between subscales of satisfaction and general satisfaction. We conducted a cross-sectional telephone survey for women who had obtained a National Cancer Screening Programme mammographic screening at general hospitals between May and October 2008. The present study included 2005 women in their forties. We performed multivariate linear regression using dependent variable as general satisfaction and independent variables as subscales of satisfaction, such as pre-screening information transfer, staff interpersonal skills, physical surroundings and results reporting. Participants were stratified according to the result of their mammogram as negative or positive. Mean score of satisfaction was above 2.5 of 4 for all subscales. Women who received positive results were less satisfied with all of subscale factors. Staff interpersonal skills were the most important factor that contributed to general satisfaction. Future efforts such as staff training programme of communication/attitude skills, ensuring privacy and explanation of possible discomfort of the screening would be needed.
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Affiliation(s)
- B Y Jeon
- National Cancer Control Research Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
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21
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Geffen DB, Amir N, Sion-Vardy N, Ariad S, Kachko L, Bayme M, Delgado B, Dyomin V, Argov S, Koretz M. Stage I breast cancer in a regional oncology practice in Israel 2002-2006: clinicopathologic features, risk estimation and planned therapy of 328 consecutive patients. Breast 2009; 18:316-21. [PMID: 19819143 DOI: 10.1016/j.breast.2009.08.004] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2009] [Revised: 07/30/2009] [Accepted: 08/31/2009] [Indexed: 12/19/2022] Open
Abstract
We present the clinicopathologic features and treatment plans of 328 consecutive stage I (T1N0M0) breast cancer patients seen at a regional medical center in Israel. Predicted 10-year mortality risk was calculated using the Adjuvant! Online website. The 21-gene recurrence score (RS) (OncotypeDx) was obtained on a minority of patients. Eighty-nine per cent of patients had estrogen receptor (ER) and/or progesterone receptor (PgR) positive tumors. In 43.3% of patients history of an invasive malignancy was reported in a first degree relative and in 15.5% specifically breast and/or ovarian cancer was reported. Chemotherapy was added to endocrine therapy in 59 ER/PgR positive patients, decreasing predicted 10-year mortality risk by a median of 1.8%. Individualized risk estimation by genetic analysis may further decrease the use of chemotherapy in stage I patients. Breast cancer screening may provide an opportunity to identify cancer prone families.
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Affiliation(s)
- D B Geffen
- Department of Oncology, Soroka University Medical Center, Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer Sheva, Israel.
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