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Begum TF, Patil VS, Zhu L, Yeh MC, González E, Fraser MA, Lu W, Zhu S, Rubio-Torio N, Ma GX, Tan Y. Assessing Physicians' Recommendations for Hepatitis B Virus (HBV) and Hepatitis C Virus (HCV) Testing Among Minority Populations in Greater Philadelphia and New York City. J Community Health 2024; 49:588-597. [PMID: 38286964 DOI: 10.1007/s10900-023-01316-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/26/2023] [Indexed: 01/31/2024]
Abstract
Deaths from liver cancer are on the rise and disproportionately affect minority racial/ethnic groups. In this study, we examined associations between physicians' recommendations for hepatitis B virus (HBV) and hepatitis C virus (HCV) screening and sociodemographic and lifestyle factors among minority populations in the areas of Greater Philadelphia and New York City. Using Poisson regression with robust variance estimation, we evaluated potential associations for 576 Hispanic American (HA), African American (AA), and Asian Pacific American (APA) adults, using blood tests as an outcome measure, with adjustment for sociodemographic factors We found that APAs (34.2%) were most likely to have a physician recommend HBV and HCV screening tests (34.2% and 27.1%, respectively), while HAs were least likely to receive an HBV recommendation (15.0%) and AAs were least likely to receive an HCV recommendation (15.3%). HAs were significantly likely to have never received a blood test for either HBV or HCV (RR = 1.25, 95% CI: 1.05, 1.49). APAs were significantly more likely to receive a screening recommendation for HBV (RR = 1.10, 95%CI: 1.01, 1.20) and to have a blood test (RR = 1.57, 95% CI: 1.06, 2.33). Our findings show that, among HAs, AAs, and APAs, physician recommendations are strongly associated with patients undergoing blood tests for HBV and HCV and that minority populations should increasingly be recommended to screen for HBV and HCV, especially given their elevated risk.
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Affiliation(s)
- Thoin F Begum
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA.
| | - Vidya S Patil
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Lin Zhu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Ming-Chin Yeh
- Nutrition Program, Hunter College, City University of New York, New York, NY, USA
| | - Evelyn González
- Office of Community Outreach, Fox Chase Cancer Center, Temple University Health System, Philadelphia, PA, USA
| | | | - Wenyue Lu
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Steven Zhu
- Pennsylvania United Chinese Coalition, Philadelphia, PA, USA
| | | | - Grace X Ma
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
- Department of Urban Health and Population Science, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
| | - Yin Tan
- Center for Asian Health, Lewis Katz School of Medicine, Temple University, Philadelphia, PA, USA
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Shusted CS, Eberth JM, Juon HS, Barta JA. Characteristics associated with early vs. late adoption of lung cancer screening. Prev Med Rep 2024; 44:102820. [PMID: 39099771 PMCID: PMC11295929 DOI: 10.1016/j.pmedr.2024.102820] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2024] [Revised: 06/11/2024] [Accepted: 07/05/2024] [Indexed: 08/06/2024] Open
Abstract
Background Although lung cancer screening (LCS) reduces lung cancer mortality among high-risk individuals, uptake overall remains low. With all cancer screening modalities, a period of diffusion among medical providers and the public is expected, with screening uptake exhibiting a distribution among early vs. late adoption. We aimed to characterize individuals undergoing LCS based upon the timeframe of screening adoption. Methods This retrospective study examined patients who underwent LCS between January 2015 - December 2022 in a centralized LCS program. Based on United States Preventive Services Task Force (USPSTF) criteria for LCS, early and late adopters of LCS - defined by time from eligibility to screening completion - were compared. A multivariable regression model was constructed to identify factors associated with early adoption of LCS. Results Among patients screened during the study period, 90.4% were eligible based on USPSTF 2013 criteria, and 9.6% were eligible based on USPSTF 2021 criteria. Of the USPSTF 2013 eligible persons, multivariable analysis demonstrated Black/African-American individuals and current smokers had significantly greater odds of early adoption (aOR 1.428 and 1.514, respectively). Those without a family history of lung cancer or without a personal history of cancer had significantly lower odds of early adoption of LCS. Conclusions Early adopters were more likely to report Black/African-American race or current smoking status after adjustment for covariates. Future research should examine how screening diffuses across the overall LCS-eligible population, as well as identify factors that drive and inhibit diffusion to create programs and policies with the ultimate goal of increasing timely LCS uptake.
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Affiliation(s)
- Christine S. Shusted
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jan M. Eberth
- Dornsife School Of Public Health, Department of Health Management and Policy, Drexel University, Philadelphia, PA, USA
| | - Hee-Soon Juon
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA, USA
| | - Julie A. Barta
- The Jane and Leonard Korman Respiratory Institute, Division of Pulmonary and Critical Care Medicine, Thomas Jefferson University, Philadelphia, PA, USA
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MacLaughlin KL, Jenkins GD, St Sauver J, Fan C, Miller NE, Meyer AF, Jacobson RM, Finney Rutten LJ. Primary human papillomavirus testing by clinician- versus self-collection: Awareness and acceptance among cervical cancer screening-eligible women. J Med Screen 2024:9691413241260019. [PMID: 38869176 DOI: 10.1177/09691413241260019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/14/2024]
Abstract
OBJECTIVES Primary human papillomavirus (HPV) testing by clinician-collection is endorsed by U.S. guideline organizations for cervical cancer screening, but uptake remains low and insights into patients' understanding are limited. This study aims to primarily address patient awareness of primary HPV screening by clinician-collection and acceptance of primary HPV screening by clinician- and self-collection, and secondarily assess factors associated with awareness and acceptance. SETTING Primary care practices affiliated with an academic medical center. METHODS A cross-sectional survey study of screening-eligible women aged 30-65 years was conducted to assess awareness and acceptability of primary HPV screening. We analyzed bivariate associations of respondent characteristics with awareness of primary HPV screening by clinician-collection, willingness to have clinician- or self-collected primary HPV testing, and reasons for self-collection preference. RESULTS Respondents (n = 351; response rate = 23.4%) reported cervical cancer screening adherence of 82.8% but awareness of clinician-collected primary HPV as an option was low (18.9%) and only associated with HPV testing with recent screening (p = 0.003). After reviewing a description of primary HPV screening, willingness for clinician-collected (81.8%) or home self-collected (76.1%) HPV testing was high, if recommended by a provider. Acceptability of clinician-collected HPV testing was associated with higher income (p = 0.009) and for self-collection was associated with higher income (p = 0.002) and higher education (p = 0.02). Higher education was associated with reporting self-collection as easier than clinic-collection (p = 0.02). Women expected self-collection to be more convenient (94%), less embarrassing (85%), easier (85%), and less painful (81%) than clinician-collection. CONCLUSIONS Educational interventions are needed to address low awareness about the current clinician-collected primary HPV screening option and to prepare for anticipated federal licensure of self-collection kits. Informing women about self-collection allows them to recognize benefits which could address screening barriers.
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Affiliation(s)
| | - Gregory D Jenkins
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Jennifer St Sauver
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Chun Fan
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | - Amanda F Meyer
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
| | - Robert M Jacobson
- Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN, USA
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4
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McDowell A, Rieu-Werden ML, Atlas SJ, Fields CD, Goldstein RH, Gundersen GD, Haas JS, Higashi RT, Pruitt SL, Silver MI, Tiro JA, Kamineni A. Characteristics of Clinicians Caring for Transgender Men and Nonbinary Individuals and Guideline Concordance of Clinicians' Cervical Cancer Screening Counseling for Cisgender Individuals Versus Transgender Men and Nonbinary Individuals with a Cervix. LGBT Health 2024. [PMID: 38648535 DOI: 10.1089/lgbt.2023.0067] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024] Open
Abstract
Purpose: We examined characteristics of clinicians caring for transgender men and nonbinary (TMNB) individuals and guideline concordance of clinicians' cervical cancer screening recommendations. Methods: Using a survey of clinicians who performed ≥10 cervical cancer screenings in 2019, we studied characteristics of clinicians who do versus do not report caring for TMNB individuals and guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women. Results: In our sample (N = 492), 49.2% reported caring for TMNB individuals, and 25.4% reported performing cervical cancer screening for TMNB individuals with a cervix. Differences in guideline concordance of screening recommendations for TMNB individuals with a cervix versus cisgender women (45.8% vs. 50% concordant) were not statistically significant. Conclusion: Sizable proportions of clinicians cared for and performed cervical cancer screening for TMNB individuals. Research is needed to better understand clinicians' identified knowledge deficits to develop interventions (e.g., clinician trainings) to improve gender-affirming cervical cancer prevention.
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Affiliation(s)
- Alex McDowell
- Health Policy Research Center, Mongan Institute, Massachusetts General Hospital, Boston, Massachusetts, USA
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
| | - Meghan L Rieu-Werden
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Steven J Atlas
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Robert H Goldstein
- Division of Infectious Diseases, Massachusetts General Hospital, Boston, Massachusetts, USA
| | | | - Jennifer S Haas
- Department of Medicine, Harvard Medical School, Boston, Massachusetts, USA
- Division of General Internal Medicine, Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Robin T Higashi
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | - Sandi L Pruitt
- Peter O'Donnell Jr. School of Public Health, University of Texas Southwestern Medical Center, Dallas, Texas, USA
- Harold C. Simmons Comprehensive Cancer Center, Dallas, Texas, USA
| | - Michelle I Silver
- Division of Public Health Sciences, Department of Surgery, Washington University School of Medicine, St. Louis, Missouri, USA
| | - Jasmin A Tiro
- Department of Public Health Sciences, University of Chicago Biological Sciences Division, Chicago, Illinois, USA
| | - Aruna Kamineni
- Kaiser Permanente Washington Health Research Institute, Seattle, Washington, USA
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5
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Park SH. Socioeconomic inequality of health-related quality of life in cancer survivors in South Korea. Support Care Cancer 2024; 32:139. [PMID: 38289479 DOI: 10.1007/s00520-024-08341-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2023] [Accepted: 01/23/2024] [Indexed: 02/01/2024]
Abstract
BACKGROUND We investigated the inequalities in health-related quality of life (HRQoL) among cancer survivors in Korea, focusing on income and education levels. The slope index of inequality (SII) and relative index of inequality (RII) were utilized to analyze these disparities. METHODS Data from the Korea National Health and Nutrition Examination Survey (KNHANES) conducted between 2007 and 2021 was analyzed. The HRQoL was assessed using the EQ-5D questionnaire, which included five problem areas: mobility, self-care, usual activity, pain/discomfort, and anxiety/depression. Logistic regression was employed to calculate the odds ratios (ORs) for each education and income level, indicating the probability of reporting problems. Furthermore, the slope index of inequality (SII) and relative index of inequality (RII) were calculated to evaluate the inequalities in HRQoL. RESULTS Among the 3396 cancer survivors, a considerable proportion reported pain/discomfort (29.6%) and mobility problems (21.1%). The logistic regression results demonstrated a higher likelihood of experiencing problems in all five EQ-5D items among individuals with lower income or education levels. Specifically, compared to the high-income group, the adjusted ORs for mobility problems were 2.19, 1.64, and 1.08 for the low, low-medium, and medium-high-income groups, respectively (p-value < 0.05). Notably, significant income inequalities in HRQoL problems were observed, with the greatest disparities seen in self-care and usual activity problems, as indicated by the SII and RII values. CONCLUSION Socioeconomic disparities in HRQoL exist among cancer survivors in Korea, particularly related to income levels. Addressing the financial burdens of cancer treatment for individuals with low-income levels may help improve their HRQoL and mitigate these inequalities.
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Affiliation(s)
- Sung Hoon Park
- Division of New Health Technology Assessment, Innovation Health Technology Assessment, National Evidence-Based Healthcare Collaborating Agency, 3-5F, Neungdong-Ro, Gwangjin-Gu, Seoul, Korea.
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Filipas DK, Labban M, Beatrici E, Stone BV, Qian Z, D Andrea V, Ludwig TA, Reis LO, Cole AP, Trinh QD. Exploring preventive care practices among unvaccinated individuals in the United States during the COVID-19 pandemic. Vaccine 2024; 42:441-447. [PMID: 38184391 DOI: 10.1016/j.vaccine.2024.01.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 12/13/2023] [Accepted: 01/02/2024] [Indexed: 01/08/2024]
Abstract
INTRODUCTION Building on a Canadian study associating unvaccinated individuals to increased car accidents, we examined the relationship between COVID-19 vaccination status and US preventive care practices. METHODS We queried the 2021 National Health Interview Survey. First, we fitted a model to identify respondent-level factors associated with receipt of at least one COVID-19 vaccination. Second, we fitted a survey-weighted logistic regression model adjusted for respondent-level characteristics to examine whether the receipt of at least one COVID-19 vaccination predicted the receipt of preventive care services. Preventive care services assessed included serum cholesterol, glucose, and blood pressure measurements, as well as guideline-concordant cancer screening including breast, cervical, colorectal, and prostate cancer screening. RESULTS Factors predicting receipt of COVID-19 vaccination were age (adjusted Odds Ratio (aOR) 1.03; 95 % confidence interval (CI) [1.03-1.03]), Hispanic (aOR 1.25; 95 % CI [1.08-1.44]), and non-Hispanic Asian (aOR 3.52; 95 % CI [2.74-4.52]) ethnicity/race, and history of cancer (aOR 1.61; 95 % CI [1.13-2.30]). Unvaccinated respondents were less likely to have received serum cholesterol (aOR 0.69; 95 % CI [0.50-0.70), serum glucose (aOR 0.65; 95 % CI [0.56-0.75]), or blood pressure measurements (aOR 0.47; 95 % CI [0.33-0.66]); and were less likely to have received breast cancer (aOR 0.35; 95 % CI [0.25-0.48]), colorectal cancer (aOR 0.52; 95 % CI [0.46-0.60]) and prostate cancer screening (aOR 0.61; 95 % CI [0.48-0.76]). There was no significant association between unvaccinated respondents receiving cervical cancer screening (aOR 0.96; 95 % CI [0.81-1.13]; p = 0.616). CONCLUSION Non-receipt of COVID-19 vaccination was associated with non-receipt of preventive care services including cancer screening. Further studies are needed to assess if this association is due to system-level factors or reflects a general distrust of medical preventive care amongst this population.
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Affiliation(s)
- Dejan K Filipas
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA; University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany
| | - Muhieddien Labban
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Edoardo Beatrici
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Benjamin V Stone
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Zhiyu Qian
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Vincent D Andrea
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Tim A Ludwig
- University Medical Center Hamburg-Eppendorf, Department of Urology, Hamburg, Germany
| | - Leonardo O Reis
- UroScience, State University of Campinas, Unicamp and Pontifical Catholic University of Campinas, PUC-Campinas, Campinas, Sao Paulo State, Brazil
| | - Alexander P Cole
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA
| | - Quoc-Dien Trinh
- Division of Urological Surgery and Center for Surgery and Public Health, Brigham and Women's Hospital, Boston, MA, USA.
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Zhu X, Squiers L, Helmueller L, Madson G, Southwell BG, Alam S, Finney Rutten LJ. Provider communication contributes to colorectal cancer screening intention through improving screening outcome expectancies and perceived behavioral control. Soc Sci Med 2024; 340:116397. [PMID: 38043438 DOI: 10.1016/j.socscimed.2023.116397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2023] [Revised: 10/30/2023] [Accepted: 11/02/2023] [Indexed: 12/05/2023]
Abstract
Colorectal cancer (CRC) screening continues to be underutilized in the US despite the availability of multiple effective, guideline-recommended screening options. Provider recommendation has been consistently shown to improve screening completion. Yet, available literature provides little information as to how specific information providers communicate influence patient decision-making about CRC screening. We tested the pathways through which information communicated by providers about the "Why" and "How" of CRC screening using the mt-sDNA test contributes to intention to complete the test. Data came from a behavioral theory-informed survey that we developed to identify psychosocial factors associated with mt-sDNA screening. RTI International administered the survey between 03/2022-06/2022 to a sample of US adults ages 45-75 who received a valid order for mt-sDNA screening with a shipping date between 5/2021-9/2021. Participants completed an electronic or paper survey. We tested the proposed relationships using structural equation modeling and tested indirect effects using Monte Carlo method. A total of 2,973 participants completed the survey (response rate: 21.7%) and 81.6% (n = 2,427) reported have had a conversation with their health care provider about mt-sDNA screening before the test was ordered. We found that "Why" information from providers was positively associated with perceived effectiveness of mt-sDNA screening, while "How" information was positively associated with perceived ease of use. "Why" information contributed to screening intention through perceived effectiveness while "How" information contributed to screening intention through perceived ease of use. These findings emphasize the critical role of provider communication in shaping patient decision-making regarding CRC screening. CRC screening interventions could consider implementing provider-patient communication strategies focusing on improving patient understanding of the rationale for CRC screening and the effectiveness of available screening options as well as addressing barriers and enhancing patients' self-efficacy in completing their preferred screening option.
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Affiliation(s)
- Xuan Zhu
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA.
| | | | | | | | | | - Shama Alam
- Exact Sciences Corporation, Madison, WI, USA
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Jeong SM, Jung KW, Park J, Kim N, Shin DW, Suh M. Disparities in Cancer Incidence across Income Levels in South Korea. Cancers (Basel) 2023; 15:5898. [PMID: 38136441 PMCID: PMC10741676 DOI: 10.3390/cancers15245898] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2023] [Revised: 12/11/2023] [Accepted: 12/14/2023] [Indexed: 12/24/2023] Open
Abstract
BACKGROUND Recent nationwide studies of disparities in cancer incidence by income are scarce in Korea. This study investigated such disparities in cancer incidence and the stage at cancer diagnosis across income groups in Korea. METHODS This study utilized data from a national cancer database, specifically focusing on cases recorded in the year 2018. Income levels were categorized into quintiles according to the insurance premium paid in addition to the Medicaid benefit. The slope index of inequality (SII) and relative index of inequality (RII) were used to measure absolute and relative differences in cancer incidence by income. A multivariable logistic regression was performed to estimate the risk of a distant stage at cancer diagnosis. RESULTS The total number of cases of incident cancer was 223,371 (men: 116,320, women: 107,051) with shares of the total of 29.5% (5Q), 20.4% (4Q), 16.0% (3Q), 13.5% (2Q), 15.6% (1Q), and 5% (Medicaid). The most common cancer type was thyroid cancer, followed by gastric and colorectal cancers. The age-standardized incidence rate for all cancers was lowest in the highest income group, but the SII was not statistically significant (SII: -35.7), and the RII was -0.07. Colorectal and cervical cancers had lower incidence rates for higher income groups, while thyroid and prostate cancers had higher incidence rates for higher income groups. The odds ratio for a distant stage at diagnosis for all cancers increased for lower income groups relative to 5Q. CONCLUSIONS Disparities in cancer incidence in a Korean population differed by cancer type, and lower income was a significant predictor of a distant stage at diagnosis for cancers overall. These results emphasize the need for further study of the underlying causes of disparities in cancer incidence and the stage at diagnosis, as well as the need for interventions to mitigate these disparities.
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Affiliation(s)
- Su-Min Jeong
- Department of Medicine, Seoul National University College of Medicine, Seoul 03080, Republic of Korea;
- Department of Family Medicine, Seoul National University Hospital, Seoul 03080, Republic of Korea
| | - Kyu-Won Jung
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
| | - Juwon Park
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
| | - Nayeon Kim
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
| | - Dong Wook Shin
- Department of Clinical Research Design and Evaluation, Samsung Advanced Institute for Health Science and Technology, School of Medicine, Sungkyunkwan University, Seoul 16419, Republic of Korea
- Department of Family Medicine and Supportive Care Center, Samsung Medical Center, Seoul 06351, Republic of Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang 10408, Republic of Korea; (K.-W.J.); (J.P.); (N.K.)
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De Prez V, Jolidon V, Cullati S, Burton-Jeangros C, Bracke P. Cervical cancer (over-)screening in Europe: Balancing organised and opportunistic programmes. Scand J Public Health 2023; 51:1239-1247. [PMID: 36016469 DOI: 10.1177/14034948221118215] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
AIMS Cervical cancer (CC) over-screening has been understudied in Europe, yet is relevant for approaching inequalities in screening uptake. Focusing on countries' screening strategies (opportunistic systems versus organised programmes), we assess in which contexts CC over-screening is more prevalent, and which women are more likely to have engaged in cervical cancer screening (CCS) within the past year. METHODS A two-level (multilevel) design among screening women (N = 80,761) nested in 31 European countries was used to analyse data from the second wave (2013-2015) of the European Health Interview Survey. We focused on over-screening, defined as screening more frequently than the three-yearly screening interval prescribed in the European guidelines - that is, having screened within the past year. RESULTS Higher levels of over-screening were observed in opportunistic systems compared to systems with organised programmes. In opportunistic systems, women with a higher socioeconomic position had a higher likelihood of being screened within the past year than their socioeconomic counterparts. Moreover, these differences diminished under organised programmes. CONCLUSIONS Contexts with organised CCS programmes are more efficiently reducing over-screening, and enforcing the European guidelines. We suggest that the physician-patient relationship is an essential pathway for explaining socioeconomic differences in CC (over-)screening and for future interventions.
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Affiliation(s)
| | - Vladimir Jolidon
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, Switzerland
| | - Stéphane Cullati
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, Switzerland
- Population Health Laboratory, Department of Community Health, Faculty of Science and Medicine, University of Fribourg, Switzerland
| | - Claudine Burton-Jeangros
- Institute of Sociological Research, Geneva School of Social Sciences, University of Geneva, Switzerland
| | - Piet Bracke
- Department of Sociology, Ghent University, Belgium
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10
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Finney Rutten LJ, Zhu X, Treiman K, Madson G, Southwell B, Helmueller L, Alam S, Gates C, Squiers L. Attitudes and Experiential Factors Associated with Completion of mt-sDNA Test Kit for Colorectal Cancer Screening. J Patient Exp 2023; 10:23743735231213765. [PMID: 38026067 PMCID: PMC10666720 DOI: 10.1177/23743735231213765] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2023] Open
Abstract
Colorectal cancer (CRC) is the third leading cause of cancer-related deaths in the United States. Despite the availability of multiple screening options, CRC screening is underutilized. We conducted a survey of patients (n = 2973) who were prescribed the multi-target stool DNA (mt-sDNA) screening test (commercialized as Cologuard® and manufactured by Exact Sciences Corporation) to understand attitudes and experiences that influence test completion and likelihood of future test completion. Using exploratory factor analyses, we developed three scales: Perceived Effectiveness, Perceived Ease of Use, and Perceived Comfort.
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Affiliation(s)
| | - Xuan Zhu
- Division of Epidemiology, Mayo Clinic, Rochester, MN, USA
| | | | | | | | | | - Shama Alam
- Exact Sciences Corporation, Madison, WI, USA
| | - Carlye Gates
- RTI International, Research Triangle Park, NC, USA
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11
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Agunwamba AA, Zhu X, Sauver JS, Thompson G, Helmueller L, Finney Rutten LJ. Barriers and facilitators of colorectal cancer screening using the 5As framework: A systematic review of US studies. Prev Med Rep 2023; 35:102353. [PMID: 37576848 PMCID: PMC10415795 DOI: 10.1016/j.pmedr.2023.102353] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 06/20/2023] [Accepted: 07/28/2023] [Indexed: 08/15/2023] Open
Abstract
Despite clear evidence that regular screening reduces colorectal cancer (CRC) mortality and the availability of multiple effective screening options, CRC screening continues to be underutilized in the US. A systematic literature search of four databases - Ovid, Medline, EBSCHOhost, and Web of Science - was conducted to identify US studies published after 2017 that reported on barriers and facilitators to CRC screening adherence. Articles were extracted to categorize relevant CRC screening barriers or facilitators that were assessed against CRC screening outcomes using the 5As dimensions: Access, Affordability, Acceptance, Awareness, Activation. Sixty-one studies were included. Fifty determinants of screening within the 5As framework and two additional dimensions including Sociodemographics and Health Status were identified. The Sociodemographics, Access, and Affordability dimensions had the greatest number of studies included. The most common factor in the Access dimension was contact with healthcare systems, within the Affordability dimension was insurance, within the Awareness dimension was knowledge CRC screening, within the Acceptance dimension was health beliefs, within the Activation dimension was prompts and reminders, within the Sociodemographics dimension was race/ethnicity, and among the Health Status dimension was chronic disease history. Among all studies, contact with healthcare systems, insurance, race/ethnicity, age, and education were the most common factors identified. CRC screening barriers and facilitators were identified across individual, clinical, and sociocontextual levels. Interventions that consider multilevel strategies will most effectively increase CRC screening adherence.
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Affiliation(s)
- Amenah A. Agunwamba
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | - Xuan Zhu
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | - Jenny St. Sauver
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
| | | | | | - Lila J. Finney Rutten
- Division of Epidemiology, Department of Quantitative Health Sciences, Mayo Clinic, Rochester, MN, USA
- Exact Sciences Corporation, Madison WI, USA
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12
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Allen CJ, Bloom N, Rothka M, Rao P, Wagner PL, Bartlett DL, Farah K, Chalikonda S. Comprehensive Cost Implications of Commercially Available Noninvasive Colorectal Cancer Screening Modalities. J Am Coll Surg 2023; 237:465-472. [PMID: 37219020 DOI: 10.1097/xcs.0000000000000768] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/24/2023]
Abstract
BACKGROUND There is an increasing usage of noninvasive screening modalities for colorectal cancer (CRC), primarily the fecal immunochemical test (FIT) and multi-target stool DNA test (Cologuard [CG]). The aim of this study was to determine the comprehensive, long-term cost implications of these noninvasive screening modalities. STUDY DESIGN Using a national insurer-based administrative dataset, patients screened for CRC from January 1, 2019 to December 31, 2019 were analyzed. A hierarchical logic system was used to determine the primary screening modality for each patient. The total annual costs in US dollars ($) were extrapolated using number of patients screened, costs per test, screening intervals, and costs incurred from false results. Patients within our tumor registry diagnosed with CRC were matched to their claims data, and cancer stage distribution was compared. RESULTS Of 119,334 members who underwent noninvasive screening, 38.1% underwent screening with FIT and 40.0% with CG. The combined annual cost for these 2 screening modalities was $13.7 million. By transitioning to FIT alone for all noninvasive screening, the total annual cost would decrease to $7.9 million, resulting in a savings of approximately $5.8 million per year. Additionally, by combining data from the network cancer registry and insurer-based claims dataset, we were able to match 533 individuals who underwent screening and were later diagnosed with CRC. The rate of early-stage (stage 0 to II) disease was found to be similar between those screened with FIT and CG (59.5% FIT vs 63.2% CG; p = 0.77). CONCLUSIONS The adoption of FIT as the primary noninvasive CRC screening method has the potential to generate significant cost savings, and therefore, carries significant value implications for a large population health system.
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Affiliation(s)
- Casey J Allen
- From the Institute of Surgery, Division of Surgical Oncology, Allegheny Health Network, Pittsburgh, PA, (Allen, Rao, Wagener, Chalikonda)
| | - Nathan Bloom
- Right Care Administration, Highmark Health, Pittsburgh, PA (Bloom, Rothka)
| | - Michael Rothka
- Right Care Administration, Highmark Health, Pittsburgh, PA (Bloom, Rothka)
| | - Pavan Rao
- From the Institute of Surgery, Division of Surgical Oncology, Allegheny Health Network, Pittsburgh, PA, (Allen, Rao, Wagener, Chalikonda)
| | - Patrick L Wagner
- From the Institute of Surgery, Division of Surgical Oncology, Allegheny Health Network, Pittsburgh, PA, (Allen, Rao, Wagener, Chalikonda)
| | - David L Bartlett
- Allegheny Health Network Cancer Institute, Pittsburgh, PA (Bartlett)
| | - Katie Farah
- Institute of Medicine, Division of Gastrointestinal Diseases, Allegheny Health Network, Pittsburgh, PA (Farah)
| | - Sricharan Chalikonda
- From the Institute of Surgery, Division of Surgical Oncology, Allegheny Health Network, Pittsburgh, PA, (Allen, Rao, Wagener, Chalikonda)
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13
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Sedani AE, Davis OC, Clifton SC, Campbell JE, Chou AF. Facilitators and Barriers to Implementation of Lung Cancer Screening: A Framework-Driven Systematic Review. J Natl Cancer Inst 2022; 114:1449-1467. [PMID: 35993616 PMCID: PMC9664175 DOI: 10.1093/jnci/djac154] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 07/14/2022] [Accepted: 08/15/2022] [Indexed: 01/04/2023] Open
Abstract
BACKGROUND The purpose of this study is to undertake a comprehensive systematic review to describe multilevel factors (barriers and facilitators) that may influence the implementation of low-dose chest computed tomography for lung cancer screening in the United States. METHODS Systematic literature searches were performed using 6 online databases and citation indexes for peer-reviewed studies, for articles published from 2013 to 2021. Studies were classified into 3 perspectives, based on the study's unit of analysis: system, health-care provider, and patient. Barriers and facilitators identified for each study included in our final review were then coded and categorized using the Consolidate Framework for Implementation Research domains. RESULTS At the system level, the 2 most common constructs were external policy and incentives and executing the implementation process. At the provider level, the most common constructs were evidence strength and quality of the intervention characteristics, patient needs and resources, implementation climate, and an individual's knowledge and beliefs about the intervention. At the patient level, the most common constructs were patient needs and resources, individual's knowledge and beliefs about the intervention, and engaging in the implementation process. These constructs can act as facilitators or barriers to lung cancer screening implementation. CONCLUSIONS Applying the Consolidate Framework for Implementation Research domains and constructs to understand and specify factors facilitating uptake of lung cancer screening as well as cataloging the lessons learned from previous efforts helps inform the development and implementation processes of lung cancer screening programs in the community setting. REGISTRATION PROSPERO, CRD42021247677.
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Affiliation(s)
- Ami E Sedani
- Correspondence to: Ami E. Sedani, MPH, Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, 801 NE 13th Street, Oklahoma City, OK 73104, USA (e-mail: )
| | - Olivia C Davis
- College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Shari C Clifton
- Robert M. Bird Health Sciences Library, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Janis E Campbell
- Department of Biostatistics and Epidemiology, Hudson College of Public Health, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
| | - Ann F Chou
- Department of Family and Preventive Medicine, College of Medicine, University of Oklahoma Health Sciences Center, Oklahoma City, OK, USA
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14
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Griffin JM, Finney Rutten LJ, Zhu X, Feng Z, Rogers CR, Marsh TL, Inadomi JM. The COMPASS study: A prospective, randomized, multi-center trial testing the impact of a clinic-based intervention informing patients of colorectal cancer screening options on screening completion. Contemp Clin Trials 2022; 119:106852. [PMID: 35842109 PMCID: PMC9634616 DOI: 10.1016/j.cct.2022.106852] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2022] [Revised: 07/01/2022] [Accepted: 07/11/2022] [Indexed: 11/29/2022]
Abstract
Background: Colorectal cancer (CRC) screening is underutilized despite evidence that screening improves survival. Since healthcare provider recommendation is a strong predictor of CRC screening completion, providers are encouraged to engage eligible patients in collaborative decision-making that attends to patients’ values, needs, and preferences for guideline-concordant screening modalities. Methods: This three-arm randomized controlled trial is testing the effectiveness of an evidence-based video intervention informing patients of screening choices delivered in a clinic prior to a healthcare appointment. We hypothesize that participants randomized to watch a basic video describing CRC and screening in addition to an informed choice video showing the advantages and disadvantages of fecal immunochemical test (FIT), stool DNA FIT (s-DNA FIT), and colonoscopy (Arm 3) will exhibit a greater proportion of time adherent to CRC screening guidelines after 1, 3 and 6 years than those who only watch the basic video (Arm 2) or no video at all (Arm 1). Primary care and Obstetrician/Gynecology clinics across the United States are recruiting 5280 patients, half who have never been screened and half who previously screened but are currently not guideline adherent. Participants complete surveys prior to and following an index appointment to self-report personal, cognitive, and environmental factors potentially associated with screening. Proportion of time adherent to screening guidelines will be assessed using medical record data and supplemented with annual surveys self-reporting screening. Conclusion: Results will provide evidence on the effectiveness of informational and motivational videos to encourage CRC screening that can be easily integrated into clinical practice.
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Affiliation(s)
- Joan M Griffin
- Mayo Clinic, Division of Health Care Delivery Research, USA; Mayo Clinic, Kern Center for the Science of Health Care Delivery, USA.
| | | | - Xuan Zhu
- Mayo Clinic, Kern Center for the Science of Health Care Delivery, USA
| | - Ziding Feng
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Biostatistics Program, USA
| | - Charles R Rogers
- Medical College of Wisconsin, Institute for Health & Equity, Milwaukee, WI, USA
| | - Tracey L Marsh
- Fred Hutchinson Cancer Center, Division of Public Health Sciences, Biostatistics Program, USA
| | - John M Inadomi
- University of Utah School of Medicine, Department of Internal Medicine, Salt Lake City, UT, USA
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15
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Monahan KJ, Davies MM, Abulafi M, Banerjea A, Nicholson BD, Arasaradnam R, Barker N, Benton S, Booth R, Burling D, Carten RV, D'Souza N, East JE, Kleijnen J, Machesney M, Pettman M, Pipe J, Saker L, Sharp L, Stephenson J, Steele RJ. Faecal immunochemical testing (FIT) in patients with signs or symptoms of suspected colorectal cancer (CRC): a joint guideline from the Association of Coloproctology of Great Britain and Ireland (ACPGBI) and the British Society of Gastroenterology (BSG). Gut 2022; 71:gutjnl-2022-327985. [PMID: 35820780 PMCID: PMC9484376 DOI: 10.1136/gutjnl-2022-327985] [Citation(s) in RCA: 45] [Impact Index Per Article: 22.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 07/01/2022] [Indexed: 12/12/2022]
Abstract
Faecal immunochemical testing (FIT) has a high sensitivity for the detection of colorectal cancer (CRC). In a symptomatic population FIT may identify those patients who require colorectal investigation with the highest priority. FIT offers considerable advantages over the use of symptoms alone, as an objective measure of risk with a vastly superior positive predictive value for CRC, while conversely identifying a truly low risk cohort of patients. The aim of this guideline was to provide a clear strategy for the use of FIT in the diagnostic pathway of people with signs or symptoms of a suspected diagnosis of CRC. The guideline was jointly developed by the Association of Coloproctology of Great Britain and Ireland/British Society of Gastroenterology, specifically by a 21-member multidisciplinary guideline development group (GDG). A systematic review of 13 535 publications was undertaken to develop 23 evidence and expert opinion-based recommendations for the triage of people with symptoms of a suspected CRC diagnosis in primary care. In order to achieve consensus among a broad group of key stakeholders, we completed an extended Delphi of the GDG, and also 61 other individuals across the UK and Ireland, including by members of the public, charities and primary and secondary care. Seventeen research recommendations were also prioritised to inform clinical management.
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Affiliation(s)
- Kevin J Monahan
- The Wolfson Endoscopy Unit, Gastroenterology Department, St Mark's Hospital and Academic Institute, Harrow, London, UK
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College, London, UK
| | - Michael M Davies
- Department of Colorectal Surgery, University Hospital of Wales, Cardiff, UK
| | - Muti Abulafi
- Colorectal Surgery, Croydon Health Services NHS Trust, Croydon, Greater London, UK
| | - Ayan Banerjea
- Nottingham Colorectal Service, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Brian D Nicholson
- Department of Primary Care Health Sciences, University of Oxford, Oxford, UK
| | - Ramesh Arasaradnam
- University of Warwick, Clinical Sciences Research Institute, Coventry, UK
- Gastroenterology Department, University Hospital Coventry, Coventry, UK
| | | | - Sally Benton
- Hub Director, NHS Bowel Cancer Screening South of England Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - Richard Booth
- Colorectal Surgery, Croydon University Hospital, Croydon, UK
| | - David Burling
- Radiology, St Mark's Hospital and Academic Institute, Harrow, London, UK
| | | | | | - James Edward East
- Translational Gastroenterology Unit, Univerity of Oxford Nuffield Department of Medicine, Oxford, UK
- Gastroenterology, Mayo Clinic Healthcare, London, UK
| | - Jos Kleijnen
- Kleijnen Systematic Reviews Ltd, York, North Yorkshire, UK
| | - Michael Machesney
- Colorectal Surgery, Whipps Cross Hospital, Barts Health NHS Trust, London, UK
| | - Maria Pettman
- Colorectal Surgery, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | | | - Lance Saker
- General Practice, Oak Lodge Medical Centre, London, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | | | - Robert Jc Steele
- Surgery and Oncology Department, University of Dundee, Dundee, UK
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16
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Brennan LP, Rodriguez NM, Head KJ, Zimet GD, Kasting ML. Obstetrician/gynecologists' HPV vaccination recommendations among women and girls 26 and younger. Prev Med Rep 2022; 27:101772. [PMID: 35321213 PMCID: PMC8935521 DOI: 10.1016/j.pmedr.2022.101772] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2021] [Revised: 01/10/2022] [Accepted: 03/13/2022] [Indexed: 11/27/2022] Open
Abstract
Background Obstetrician/gynecologists (OB/GYNs) are well poised to vaccinate girls and young women against HPV, however little is known about if and how they recommend the HPV vaccine. This study aims to understand factors associated with strong and frequent HPV vaccine recommendations among OB/GYNs for patients 26 years and younger. Methods 224 practicing U.S. OB/GYNs were surveyed for how strongly and frequently they recommend the HPV vaccine to patients 26 and younger. Provider beliefs, knowledge, and preferences surrounding the vaccine, as well as clinic and patient-level variables were examined as covariates. We then examined the relationships using multivariable logistic regression analyses. Results Of the 224 respondents, 205 were included in the analysis, with 57% (n = 116) reporting strongly and frequently recommending the HPV vaccination to eligible patients 26 and younger. The regression showed two provider beliefs and two clinic-level attributes to be strongly associated with strong and frequent recommendations. Being a strong and frequent recommender was positively associated with believing other gynecologists frequently recommend the vaccine (aOR 24.33 95%CI[2.56-231.14]) and believing that 50% or more of their patients are interested in receiving the vaccine (aOR 2.77 95%CI[1.25-6.13]). The clinic-level attributes were having the vaccine stocked (aOR 2.66 95%CI[1.02-6.93]) and suburban (aOR 3.31 95%CI[1.07-10.19]) or urban (aOR 3.54 95%CI[1.07-11.76]) location versus rural. Conclusions These findings suggest that OB/GYN peer support and educating OB/GYN about patients' interest in HPV vaccination may improve HPV vaccination. This work can inform clinic-level interventions including stocking the vaccine and focusing improvement efforts on rural clinics.
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Affiliation(s)
- Luke P Brennan
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Dr, West Lafayette, IN 47907, USA
- Indiana University Medical Scientist/Engineer Training Program, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Natalia M Rodriguez
- Weldon School of Biomedical Engineering, Purdue University, 206 S Martin Jischke Dr, West Lafayette, IN 47907, USA
- Department of Public Health, Purdue University, Matthews Hall, 812 W State St, West Lafayette, IN 47907, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, 425 University Blvd, Indianapolis, IN 46202, USA
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, 410 W. 10th Street, Indianapolis, IN 46202, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
| | - Monica L Kasting
- Department of Public Health, Purdue University, Matthews Hall, 812 W State St, West Lafayette, IN 47907, USA
- Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, IN, USA
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17
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Zhu X, Weiser E, Jacobson DJ, Griffin JM, Limburg PJ, Finney Rutten LJ. Patient preferences on general health and colorectal cancer screening decision-making: Results from a national survey. PATIENT EDUCATION AND COUNSELING 2022; 105:1034-1040. [PMID: 34340846 DOI: 10.1016/j.pec.2021.07.033] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/29/2021] [Revised: 07/16/2021] [Accepted: 07/22/2021] [Indexed: 06/13/2023]
Abstract
OBJECTIVE We examined patient preferences regarding colorectal cancer (CRC) screening decision-making and factors associated with these preferences among screening-eligible US adults. METHODS Through a national survey of 1595 US adults ages 40-75 (response rate: 31.3%), we measured general medical decision-making and CRC screening decision-making preferences (0-100, 100 = highest desire for involvement) and preferred control level over three CRC screening decisions (whether to screen, what method to use, and when to screen). Analyses focused on respondents aged 45-75 at average CRC risk (N = 1062). RESULTS Respondents expressed strong desire for involvement in general medical decision-making and CRC screening decision-making (Mean = 68.1, 64.4). Over half of respondents reported preferring having equal control as their providers over whether to screen, what method to use, and when to screen. Women and people with higher education expressed higher desire for involvement in general medical decision-making. For CRC screening decision-making, variations exist in preferred level of involvement and control by race/ethnicity, educational attainment, insurance status, and recency of routine checkup. CONCLUSION Most respondents preferred a collaborative process of CRC screening decision-making, while variations existed across subgroups. PRACTICE IMPLICATIONS Providers should assess patients' values and preferences and involve them in CRC screening decision-making at a level they are comfortable with.
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Affiliation(s)
- Xuan Zhu
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA.
| | - Emily Weiser
- Exact Sciences Corporation, 441 Charmany Drive, Madison, WI 53719, USA
| | - Debra J Jacobson
- Division of Clinical Trials and Biostatistics, Department of Quantitative Health Sciences, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Paul J Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
| | - Lila J Finney Rutten
- Division of Epidemiology, Mayo Clinic, 200 First Street SW, Rochester, MN 55905, USA
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18
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Schear RM, Hoyos JM, Davis AQ, Woods PL, Poblete S, Richardson RN, Finney Rutten LJ. Patient engagement and advocacy considerations in development and implementation of a multicancer early detection program. Cancer 2022; 128 Suppl 4:909-917. [PMID: 35133663 DOI: 10.1002/cncr.34047] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Revised: 10/01/2021] [Accepted: 10/21/2021] [Indexed: 11/08/2022]
Affiliation(s)
- Rebekkah M Schear
- Livestrong Cancer Institutes, Dell Medical School, University of Texas at Austin, Austin, Texas
| | | | - Anjee Q Davis
- American Cancer Society Cancer Action Network, Inc, Washington, District of Columbia
| | - Phylicia L Woods
- American Cancer Society Cancer Action Network, Inc, Washington, District of Columbia.,Fight Colorectal Cancer, Springfield, Missouri
| | | | - Robin N Richardson
- Livestrong Cancer Institutes at the Dell Medical School, University of Texas at Austin, Austin, Texas
| | - Lila J Finney Rutten
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, Minnesota
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19
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Lien ASY, Chiu SYH, Chen SLS, Fann JCY, Yen AMF, Yeh MC, Lou MF, Huang KC, Sheu WHH, Chen HH, Gau BS. Community-based multiple screening for metabolic syndrome by innovative theory: A longitudinal study. Public Health Nurs 2022; 39:303-312. [PMID: 34984742 DOI: 10.1111/phn.13033] [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: 07/17/2021] [Revised: 11/23/2021] [Accepted: 11/26/2021] [Indexed: 11/27/2022]
Abstract
The purpose of this research is to elucidate whether metabolic syndrome affects the rate of adoption of a new multiple cancer screening programme, based on the Diffusion of Innovation theory. The time to attend the screening programme, conducted in Keelung, Taiwan, within 10 years was assessed by innovativeness (innovators, early adaptors, early majority, late majority and laggard) using data from 79,303 residents, with the information on metabolic syndrome accrued from routine adult health check-ups. The median time of adopting the programme and the relative rates of early adoption by metabolic syndrome and its severity score were estimated. The results show that the estimated times to adopt the programme ranged from 3 months for innovators to 10 years for the laggard. The rate of early adoption was 34% higher for participants without metabolic syndrome than for those with the disease, and the gradient relationship of disease severity was noted. The adjusted median time to adopt innovativeness was 0.82 years earlier for participants who were disease-free than those with the disease. Meanwhile, the adjusted median time was wider by up to 2.25 years for those with severe disease. The study suggests that innovation should prioritise the potential risk of the metabolic syndrome population.
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Affiliation(s)
- Angela Shin-Yu Lien
- School of Nursing, College of Medicine and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan.,Division of Endocrinology and Metabolism, Department of Internal Medicine, Chang Gung Memorial Hospital Linkou Branch, Taoyuan, Taiwan
| | - Sherry Yueh-Hsia Chiu
- Department of Health Care, College of Management and Healthy Aging Research Center, Chang Gung University, Taoyuan, Taiwan
| | - Sam Li-Sheng Chen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | | | - Amy Ming-Fang Yen
- School of Oral Hygiene, College of Oral Medicine, Taipei Medical University, Taipei, Taiwan
| | - Mei Chang Yeh
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Meei-Fang Lou
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
| | - Kuo-Chin Huang
- Department of Family Medicine, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Family Medicine, National Taiwan University Hospital Bei-Hu Branch, Taipei, Taiwan
| | - Wayne Huey-Herng Sheu
- Division of Endocrinology and Metabolism, Department of Internal Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Medicine, School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsiu-Hsi Chen
- Institute of Epidemiology and Preventive Medicine, College of Public Health, National Taiwan University and Tampere School of Public Health, University of Tampere, Tampere, Finland
| | - Bih-Shya Gau
- School of Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan.,Department of Nursing, National Taiwan University Hospital, Taipei, Taiwan.,Second Degree of Bachelor of Science in Nursing, College of Medicine, National Taiwan University, Taipei, Taiwan
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20
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Finney Rutten LJ, Parks PD, Weiser E, Fan C, Jacobson DJ, Jenkins GD, Zhu X, Griffin JM, Limburg PJ. Health Care Provider Characteristics Associated With Colorectal Cancer Screening Preferences and Use. Mayo Clin Proc 2022; 97:101-109. [PMID: 34920895 DOI: 10.1016/j.mayocp.2021.06.028] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/08/2020] [Revised: 06/16/2021] [Accepted: 06/30/2021] [Indexed: 02/03/2023]
Abstract
OBJECTIVE To assess health care provider (HCP) preferences related to colorectal cancer (CRC) screening overall, and by HCP and patient characteristics. PARTICIPANTS AND METHODS We developed a survey based on the Theoretical Domains Framework to assess factors associated with CRC screening preferences in clinical practice. The survey was administered online November 6 through December 6, 2019, to a validated panel of HCPs drawn from US national databases and professional organizations. The final analysis sample included 779 primary care clinicians (PCCs) and 159 gastroenterologists (GIs). RESULTS HCPs chose colonoscopy as their preferred screening method for average-risk patients (96.9% (154/159) for GIs, 75.7% (590/779) for PCCs). Among PCCs, 12.2% (95/779) preferred multi-target stool DNA (mt-sDNA), followed by fecal immunochemical test (FIT), (7.3%; 57/779) and guaiac-based fecal occult blood test (gFOBT) (4.8%; 37/779). Preference among PCCs and GIs generally shifted toward noninvasive screening options for patients who were unable to undergo invasive procedures; concerned about taking time from work; unconvinced about need for screening; and refusing other screening recommendations. Among PCCs, preference for mt-sDNA over FIT and gFOBT was less frequent in larger compared with smaller clinical practices. Additionally, preference for mt-sDNA over FIT was more likely among PCCs with more years of clinical experience, higher patient volumes (> 25/day), and practice locations in suburban and rural settings (compared to urban). CONCLUSION Both PCCs and GIs preferred colonoscopy for CRC screening of average-risk patients, although PCCs did so less frequently and with approximately a quarter preferring stool-based tests (particularly mt-sDNA). PCCs' preference varied by provider and patient characteristics. Our findings underscore the importance of informed choice and shared decision-making about CRC screening options.
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Affiliation(s)
| | | | | | - Chun Fan
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Gregory D Jenkins
- Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA
| | - Xuan Zhu
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA
| | - Joan M Griffin
- Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA; Division of Health Care Delivery Research, Mayo Clinic, rochester, MN, USA
| | - Paul J Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
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21
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Alcalá HE, Keim-Malpass J, Mitchell EM. Sexual Assault and Cancer Screening Among Men and Women. JOURNAL OF INTERPERSONAL VIOLENCE 2021; 36:NP6243-NP6259. [PMID: 30477387 DOI: 10.1177/0886260518812797] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Emerging research has shown that experiences of sexual violence are associated with cancer screening behaviors. However, to date, little attention has been given to the impact of sexual assault on cancer screening behaviors, particularly among men. To address this, we used data from the 2014 Kansas Behavioral Risk Factor Surveillance System. This survey is conducted annually via telephone. Logistic regressions were used to calculate odds of ever engaging (i.e., lifetime) in specific screening behaviors (clinical breast exam [CBE], mammogram, Pap test, colonoscopy/sigmoidoscopy, fecal occult blood test and prostate-specific antigen [PSA] test) and current compliance with cancer screening recommendations (CBE, mammogram, Pap test, colorectal cancer screening, and PSA test), with lifetime sexual assault as the independent variables. Colorectal cancer screening models were stratified by gender. All models adjusted for confounders. Sexual assault was associated with lower odds of ever receiving a PSA test and, for women, higher odds of ever receiving a colonoscopy or sigmoidoscopy. Sexual assault was associated with lower odds of current compliance with CBE, mammogram, Pap test, and PSA test screening recommendations. A history of sexual assault was associated with lower odds of current compliance with cancer screening procedures, with the notable exception of colorectal cancer screening. Less consistent patterns were seen for lifetime screenings. Results suggest that alternatives to currently recommended procedures (like self-collection of HPV [human papilloma virus] DNA) or modified screening procedures may be a promising route to increase current compliance with cancer screening among a population that may avoid these procedures due to pain or fear of retraumatization.
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22
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Zhu X, Parks PD, Weiser E, Fischer K, Griffin JM, Limburg PJ, Finney Rutten LJ. National Survey of Patient Factors Associated with Colorectal Cancer Screening Preferences. Cancer Prev Res (Phila) 2021; 14:603-614. [PMID: 33888515 DOI: 10.1158/1940-6207.capr-20-0524] [Citation(s) in RCA: 23] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2020] [Revised: 01/21/2021] [Accepted: 02/15/2021] [Indexed: 11/16/2022]
Abstract
Recommended colorectal cancer screening modalities vary with respect to safety, efficacy, and cost. Better understanding of the factors that influence patient preference is, therefore, critical for improving population adherence to colorectal cancer screening. To address this knowledge gap, we conducted a panel survey focused on three commonly utilized colorectal cancer screening options [fecal immunochemical test or guaiac-based fecal occult blood test (FIT/gFOBT), multi-target stool DNA (mt-sDNA) test, and colonoscopy] with a national sample of U.S. adults, ages 40-75 years and at average risk of colorectal cancer, in November 2019. Of 5,097 panelists invited to participate, 1,595 completed the survey (completion rate, 31.3%). Our results showed that when presented a choice between two colorectal cancer screening modalities, more respondents preferred mt-sDNA (65.4%) over colonoscopy, FIT/gFOBT (61%) over colonoscopy, and mt-sDNA (66.9%) over FIT/gFOBT. Certain demographic characteristics and awareness of and/or experience with various screening modalities influenced preferences. For example, uninsured people were more likely to prefer stool-based tests over colonoscopy [OR, 2.53; 95% confidence interval (CI), 1.22-5.65 and OR, 2.73; 95% CI, 1.13-7.47]. People who had heard of stool-based screening were more likely to prefer mt-sDNA over FIT/gFOBT (OR, 2.07; 95% CI, 1.26-3.40). People who previously had a stool-based test were more likely to prefer FIT/gFOBT over colonoscopy (OR, 2.75; 95% CI, 1.74-4.41), while people who previously had a colonoscopy were less likely to prefer mt-sDNA or FIT/gFOBT over colonoscopy (OR, 0.39; 95% CI, 0.24-0.63 and OR, 0.40; 95% CI, 0.26-0.62). Our survey demonstrated broad patient preference for stool-based tests over colonoscopy, contrasting the heavy reliance on colonoscopy for colorectal cancer screening in clinical practice and highlighting the importance of considering patient preference in colorectal cancer screening recommendations. PREVENTION RELEVANCE: Our national survey demonstrated broad patient preference for stool-based tests over colonoscopy, contrasting the heavy reliance on colonoscopy for colorectal cancer screening in clinical practice and highlighting the importance of considering patient preference in colorectal screening recommendations.
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Affiliation(s)
- Xuan Zhu
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota.
| | | | | | - Kristin Fischer
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota
| | - Joan M Griffin
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
| | - Paul J Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, Minnesota
| | - Lila J Finney Rutten
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Rochester, Minnesota.,Division of Health Care Delivery Research, Mayo Clinic, Rochester, Minnesota
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23
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Zhu X, Parks PD, Weiser E, Griffin JM, Limburg PJ, Finney Rutten LJ. An examination of socioeconomic and racial/ethnic disparities in the awareness, knowledge and utilization of three colorectal cancer screening modalities. SSM Popul Health 2021; 14:100780. [PMID: 33898727 PMCID: PMC8053800 DOI: 10.1016/j.ssmph.2021.100780] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Revised: 03/09/2021] [Accepted: 03/18/2021] [Indexed: 11/05/2022] Open
Abstract
While colorectal cancer (CRC) mortality rates have been decreasing, disparities by socioeconomic status (SES) and race/ethnicity persist. CRC screening rates remain suboptimal among low SES and racial/ethnic minority populations, despite the availability of multiple screening modalities. Understanding awareness, knowledge, and utilization of common screening modalities within different racial/ethnic and SES groups is critical to inform efforts to improve population screening uptake and reduce disparities in CRC-related health outcomes. Through the theoretical lenses of diffusion of innovation and fundamental cause theory, we examined the associations of race/ethnicity and SES with awareness, knowledge, and utilization of three guideline recommended CRC screening strategies among individuals at average risk for CRC. Data were obtained from a survey of a nationally representative panel of US adults conducted in November 2019. The survey was completed by 31.3% of invited panelists (1595 of 5097). Analyses were focused on individuals at average risk for CRC, aged 45–75 for awareness and knowledge outcomes (n = 1062) and aged 50–75 for utilization outcomes (n = 858). Analyses revealed racial/ethnic and SES disparities among the three CRC screening modalities, with more racial/ethnic and SES differences observed in the awareness, knowledge, and utilization of screening colonoscopy and mt-sDNA than FIT/gFOBT. Patterns of disparities are consistent with previous research showing that inequities in social and economic resources are associated with an imbalanced adoption of medical innovations. Our findings demonstrate a need to increase awareness, knowledge, and access of various CRC screening modalities in specific populations defined by race/ethnicity or SES indicators. Efforts to increase CRC screening should be tailored to the needs and social-cultural context of populations. Interventions addressing inequalities in social and economic resources are also needed to achieve more equitable adoption of CRC screening modalities and reduce disparities in CRC-related health outcomes. Socioeconomic status linked to screening method awareness gap, notably mt-sDNA. Screening modalities with low demand on patient resources more likely to be adopted. Screening education needs to emphasize uniform starting age for all modalities. Tailoring education to low resource communities may improve screening uptake.
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Affiliation(s)
- Xuan Zhu
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA
| | | | | | - Joan M Griffin
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
| | - Paul J Limburg
- Division of Gastroenterology and Hepatology, Mayo Clinic, Rochester, MN, USA
| | - Lila J Finney Rutten
- Division of Health Care Policy & Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, USA.,Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Healthcare Delivery, Mayo Clinic, Rochester, MN, USA
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24
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Kasting ML, Head KJ, DeMaria AL, Neuman MK, Russell AL, Robertson SE, Rouse CE, Zimet GD. A National Survey of Obstetrician/Gynecologists' Knowledge, Attitudes, and Beliefs Regarding Adult Human Papillomavirus Vaccination. J Womens Health (Larchmt) 2021; 30:1476-1484. [PMID: 33428518 DOI: 10.1089/jwh.2020.8727] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
Background: Many women see an obstetrician/gynecologist (OB/GYN) annually and receive their primary care from an OB/GYN. Understanding OB/GYNs' human papillomavirus (HPV) vaccination practices, including knowledge of and barriers to vaccination, is essential to design effective interventions to increase vaccination. This study evaluated OB/GYN knowledge, attitudes, and beliefs regarding vaccinating both younger (18-26 years) and mid-adult (27-45 years) women. Materials and Methods: Data were collected from OB/GYN providers in October 2019 through a nationwide web-based survey. Items included the following: HPV-related vaccination practices, recommendation strength, knowledge (seven items), benefits (four items), and barriers (eight items). Results: The sample (n = 224) was majority were White (69%), men (56%), and practice in suburban clinics (55%). Most (84%) reported they usually or always recommend HPV vaccine to eligible patients, but estimated only about half (51%) of other OB/GYNs did the same. Recommendation strength varied by patient age with 84% strongly recommending it to patients ≤18 years, compared with 79% and 25% strongly recommending to younger and mid-adult patients, respectively (p < 0.01). Participants reported lower benefits (p = 0.007) and higher barriers (p < 0.001) for 27- to 45-year-old patients compared with younger patients. Cost was the most frequently reported barrier, regardless of patient age. Overall knowledge was high (m = 5.2/7) but 33% of participants did not know the vaccine was safe while breastfeeding. Conclusions: Although providers reported strongly and consistently recommending the HPV vaccination to their adult patients, there were gaps in knowledge and attitudinal barriers that need to be addressed. Provider performance feedback may be important in improving HPV vaccination awareness among providers.
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Affiliation(s)
- Monica L Kasting
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA.,Cancer Prevention and Control Program, Indiana University Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Katharine J Head
- Department of Communication Studies, Indiana University-Purdue University Indianapolis, Indianapolis, Indiana, USA
| | - Andrea L DeMaria
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Monica K Neuman
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Allissa L Russell
- Department of Public Health, Purdue University, West Lafayette, Indiana, USA
| | - Sharon E Robertson
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Caroline E Rouse
- Department of Obstetrics and Gynecology, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gregory D Zimet
- Department of Pediatrics, Indiana University School of Medicine, Indianapolis, Indiana, USA
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25
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Kasting ML, Rathwell J, Gabhart KM, Garcia J, Roetzheim RG, Carrasquillo O, Giuliano AR, Vadaparampil ST. There's just not enough time: a mixed methods pilot study of hepatitis C virus screening among baby boomers in primary care. BMC FAMILY PRACTICE 2020; 21:248. [PMID: 33267799 PMCID: PMC7713319 DOI: 10.1186/s12875-020-01327-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/02/2020] [Accepted: 11/22/2020] [Indexed: 11/26/2022]
Abstract
BACKGROUND Liver cancer rates are rising and hepatitis C virus (HCV) is the primary cause. The CDC recommends a one-time HCV screening for all persons born 1945-1965 (baby boomers). However, 14% of baby boomers have been screened. Few studies have examined primary care providers' (PCP) perspectives on barriers to HCV screening. This study examines current HCV screening practices, knowledge, barriers, and facilitators to HCV screening recommendation for baby boomers among PCPs. METHODS We conducted a mixed methods pilot study of PCPs. Quantitative: We surveyed PCPs from 3 large academic health systems assessing screening practices, knowledge (range:0-9), self-efficacy to identify and treat HCV (range:0-32), and barriers (range:0-10). Qualitative: We conducted interviews assessing patient, provider, and clinic-level barriers to HCV screening for baby boomers in primary care. Interviews were audio recorded, transcribed, and analyzed with content analysis. RESULTS The study sample consisted of 31 PCPs (22 survey participants and nine interview participants). All PCPs were aware of the birth cohort screening recommendation and survey participants reported high HCV testing recommendation, but qualitative interviews indicated other priorities may supersede recommending HCV testing. Provider knowledge of viral transmission was high, but lower for infection prevalence. While survey participants reported very few barriers to HCV screening in primary care, interview participants provided a more nuanced description of barriers such as lack of time. CONCLUSIONS There is a need for provider education on both HCV treatment as well as how to effectively recommend HCV screening for their patients. As HCV screening guidelines continue to expand to a larger segment of the primary care population, it is important to understand ways to improve HCV screening in primary care.
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Affiliation(s)
- Monica L Kasting
- Department of Public Health, Purdue University, 812 W. State Street, West Lafayette, IN, 47907, USA
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Julie Rathwell
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Kaitlyn M Gabhart
- Department of Public Health, Purdue University, 812 W. State Street, West Lafayette, IN, 47907, USA
| | - Jennifer Garcia
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive MRC-COEE, Tampa, FL, 33612, USA
| | - Richard G Roetzheim
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive MRC-COEE, Tampa, FL, 33612, USA
- Department of Family Medicine, University of South Florida, Tampa, USA
| | - Olveen Carrasquillo
- Division of General Internal Medicine, University of Miami, 1120 NW 14th Street, Miami, FL, 33136, USA
| | - Anna R Giuliano
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
- Department of Cancer Epidemiology, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA
| | - Susan T Vadaparampil
- Center for Immunization and Infection Research in Cancer, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive, Tampa, FL, 33612, USA.
- Department of Health Outcomes and Behavior, H. Lee Moffitt Cancer Center, 12902 Magnolia Drive MRC-COEE, Tampa, FL, 33612, USA.
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26
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Finney Rutten LJ, Jacobson DJ, Jenkins GD, Fan C, Weiser E, Parks P, Doroshenk M, Limburg PJ, St Sauver JL. Colorectal cancer screening completion: An examination of differences by screening modality. Prev Med Rep 2020; 20:101202. [PMID: 32995145 PMCID: PMC7516167 DOI: 10.1016/j.pmedr.2020.101202] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Revised: 08/26/2020] [Accepted: 08/30/2020] [Indexed: 01/08/2023] Open
Abstract
Average-risk colorectal cancer (CRC) screening is broadly recommended, using one of several endorsed test options. However, CRC screening participation rates remain below national goals. To gain further insights regarding recent, population-based patterns in overall and test-specific CRC screening participation, we conducted a retrospective study of adults, ages 50-75 years, utilizing comprehensive data resources from the Rochester Epidemiology Project (REP). Among residents of Olmsted County, MN eligible and due for CRC screening, we identified 5818 residents across three annual cohorts who completed screening between 1/1/2016 and 12/31/2018. We summarized CRC screening rates as incidence per 1000 population and used Poisson regression to test for overall and mode-specific CRC trends. We also analyzed rates of follow-up colonoscopy within 6-months after a positive stool-based screening result. While no significant differences over time were observed in overall CRC screening incidence rates among those due for screening, we observed a statistically significant increase in mt-sDNA test and statistically significant decreases in screening colonoscopy and FIT/FOBT test completion rates; differences in screening overall and by modality were observed by age, sex, and race/ethnicity. The diagnostic colonoscopy follow-up rate within six months after a positive stool-based test was significantly higher following mt-sDNA (84.9%) compared to FIT/FOBT (42.6%). In this retrospective, population-based study, overall CRC screening incidence rates remained stable from 2016 to 2018, while test-specific rates for mt-sDNA significantly increased and decreased for colonoscopy and FIT/FOBT. Adherence with follow-up colonoscopy after a positive stool-based test was significantly higher among patients who underwent mt-sDNA screening compared to FIT/FOBT.
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Affiliation(s)
- Lila J Finney Rutten
- Population Health Science Program, Robert D. and Patricia E. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Health Care Policy and Research, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Debra J Jacobson
- Population Health Science Program, Robert D. and Patricia E. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Gregory D Jenkins
- Population Health Science Program, Robert D. and Patricia E. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Chun Fan
- Population Health Science Program, Robert D. and Patricia E. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
| | - Emily Weiser
- Exact Sciences Corporation, Madison, WI, United States
| | - Philip Parks
- Exact Sciences Corporation, Madison, WI, United States
| | | | - Paul J Limburg
- Exact Sciences Corporation, Madison, WI, United States
- Division of Gastroenterology and Hepatology, College of Medicine, Mayo Clinic, Rochester, MN, United States
| | - Jennifer L St Sauver
- Population Health Science Program, Robert D. and Patricia E. Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, United States
- Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN, United States
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27
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Goding Sauer A, Bandi P, Saslow D, Islami F, Jemal A, Fedewa SA. Geographic and sociodemographic differences in cervical cancer screening modalities. Prev Med 2020; 133:106014. [PMID: 32027912 DOI: 10.1016/j.ypmed.2020.106014] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 01/29/2020] [Accepted: 02/01/2020] [Indexed: 10/25/2022]
Abstract
Cervical cancer screening recommendations for women aged 30-65 years include co-testing (high-risk human papillomavirus [hrHPV] with Pap testing) every five years or Pap testing alone every three years. Geographic variations of these different screening modalities across the United States have not been examined. We selected 82,426 non-pregnant women aged 30-65 years from the 2016 Behavioral Risk Factor Surveillance System with data on sociodemographics, hysterectomy, and cervical cancer screening, representing 42 states and the District of Columbia. Logistic regression models with predicted marginal probabilities were used to calculate state-level prevalence estimates of recent cervical cancer screening and uptake of co-testing, Pap testing, and hrHPV testing among those who were recently screened. Analysis was conducted in 2018-2019. Recent screening prevalence ranged from 80.0% (Idaho) to 92.2% (Massachusetts), with more state-level geographic variability in co-testing than Pap testing alone. Uptake of co-testing ranged from 27.5% (Utah) to 49.9% (District of Columbia); compared to the national estimate, co-testing was lower in 12 states and higher in six states. Overall, Midwestern and Southern states had the lowest uptake of co-testing whereas Northeastern states had the highest. Sociodemographic, healthcare, and behavioral factors accounted for some but not all state-level variation in co-testing. There was substantial state-level variability in co-testing prevalence, which was lowest in Midwestern and Southern states; the variation was not entirely explained by individual sociodemographic, healthcare, and behavioral factors. Future studies should monitor the impact of geographic variations in screening modalities on state-level differences in cervical cancer incidence, survival, and mortality.
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Affiliation(s)
- Ann Goding Sauer
- Intramural Research Department, American Cancer Society, United States of America.
| | - Priti Bandi
- Intramural Research Department, American Cancer Society, United States of America
| | - Debbie Saslow
- Cancer Control Department, American Cancer Society, United States of America
| | - Farhad Islami
- Intramural Research Department, American Cancer Society, United States of America
| | - Ahmedin Jemal
- Intramural Research Department, American Cancer Society, United States of America
| | - Stacey A Fedewa
- Intramural Research Department, American Cancer Society, United States of America
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28
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Miles RC, Narayan AK, Lopez DB, Lehman CD, Harvey HB, Mishra V, Glover M, Flores EJ. Chronic Medical Illness as a Risk Factor for Poor Mammography Screening Adherence. J Womens Health (Larchmt) 2019; 28:1378-1383. [DOI: 10.1089/jwh.2018.7315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Randy C. Miles
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K. Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Diego B. Lopez
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D. Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - H. Benjamin Harvey
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Vishala Mishra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J. Flores
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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29
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Huang Y, Soon YY, Ngo LP, Dina Ee YH, Tai BC, Wong HC, Lee SC. A Cross-sectional Study of Knowledge, Attitude and Barriers to Colorectal Cancer Screening among Cancer Survivors. Asian Pac J Cancer Prev 2019; 20:1817-1824. [PMID: 31244305 PMCID: PMC7021622 DOI: 10.31557/apjcp.2019.20.6.1817] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2019] [Indexed: 11/25/2022] Open
Abstract
Introduction: Understanding behaviour of cancer survivors is imperative as they are at risk of recurrence or second cancers. Colorectal cancer (CRC) is one of the most common cancers globally. We aim to determine the uptake rate, barriers and predictors of CRC screening among cancer survivors. Methods: Within a public hospital in Singapore, 150 non-CRC survivors were enrolled. Questionnaire on knowledge, screening behaviour, motivators and barriers towards CRC screening was administered. Results: Majority were survivors of breast (69.3%), prostate (7.3%), endometrial (4%) and ovarian (4%) cancers. More than half had high knowledge scores for CRC symptoms, screening tests and risk factors. About a third had received physician’s recommendation on CRC screening. Approximately half had undergone screening. The most common barriers to CRC screening were lack of symptoms and physician’s recommendation. Cancer survivors with higher education, higher household income, family history and those who perceived “great need” or “some need” were more likely to have undergone screening (56.4% vs 30.6%, p=0.003; 62.2% vs 41.9%, p=0.022; 70.6% vs 45.1%, p=0.048; 70.8% vs 27.4%, p<0.001). Physician’s recommendation (76.4% vs 31.6%, p<0.001) and high CRC symptom knowledge (55.8% vs 34.5%, p=0.012) were associated with increased likelihood of screening.On multivariate analysis, physician’s recommendation, higher household income and survivors’ perceived need to undergo screening remained strong predictors for CRC screening (p<0.001; p=0.010; p<0.001). Conclusion: The uptake rate of CRC screening among non-CRC survivors was modest. Physicians need to be more active in discussing CRC screening with cancer survivors as part of the survivorship care plan.
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Affiliation(s)
- Yiqing Huang
- Department of Haematology-Oncology, National University Cancer Institute, Singapore.
| | - Yu Yang Soon
- Department of Radiation Oncology, National University Cancer Institute, Singapore
| | - Lay Poh Ngo
- Division of Oncology Nursing, National University Cancer Institute, Singapore
| | - Ying Hui Dina Ee
- University Medicine Cluster, National University Health System, Singapore
| | - Bee Choo Tai
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Hung Chew Wong
- Biostatistics Unit, Yong Loo Lin School of Medicine, National University Health System, Singapore
| | - Soo Chin Lee
- Department of Haematology-Oncology, National University Cancer Institute, Singapore. ,Cancer Science Institute of Singapore,National University of Singapore, Singapore
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30
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Willems B, Bracke P. The impact of regional screening policies on the diffusion of cancer screening participation in Belgium: time trends in educational inequalities in Flanders and Wallonia. BMC Health Serv Res 2018; 18:943. [PMID: 30514273 PMCID: PMC6280447 DOI: 10.1186/s12913-018-3746-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2018] [Accepted: 11/21/2018] [Indexed: 01/16/2023] Open
Abstract
BACKGROUND We investigate whether the extent of educational inequalities in the use of Pap smears (cervical cancer screening) and mammograms (breast cancer screening) in Belgium has changed over time in accordance with the pattern predicted by diffusion of innovation theory, as well as how the regional cancer screening policies of Flanders and Wallonia influence this pattern. METHODS Data were obtained from five successive cross-sectional waves (1997-2001-2004-2008-2013) of the Belgian Health Interview Survey. Final sample sizes consisted of 8988 women aged 25-64 years for cervical cancer screening and 4194 women aged 50-69 years for breast cancer screening. We calculated absolute and relative measures of inequality, more specifically, the slope index of inequality (SII) and the relative index of inequality (RII), and their development over time. RESULTS In both Flanders and Wallonia, mammogram use increased greatly between 1997 and 2013, while Pap smear use has remained quite stable over time. Educational inequalities in cervical-cancer screening have been largely persistent over time in both regions. In contrast, educational inequalities in breast cancer screening fluctuated more between 1997 and 2013. Between 1997 and 2001, when the breast cancer screening programme was implemented in Flanders, RII reduced significantly by 45%. Inequality measures did not change significantly in Wallonia, where it is known that most women are screened opportunistically outside the programme. CONCLUSIONS By focussing on Belgium, this study demonstrates that regional variations in the support of a national screening programme can result in regional variations in the pattern of diffusion for cancer screening, as well as to the development of inequalities in cancer screening participation. Moreover, the findings demonstrate that high visibility and awareness of the screening programme, as was more the case in Flanders than it was in Wallonia, are required in order to reduce or eliminate educational inequalities in cancer screening participation over time. General practitioners and gynaecologists can play a decisive role in this regard.
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Affiliation(s)
- Barbara Willems
- Health and Demographic Research, Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium.
| | - Piet Bracke
- Health and Demographic Research, Department of Sociology, Ghent University, Korte Meer 5, 9000, Ghent, Belgium
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31
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Mai TTX, Lee YY, Suh M, Choi E, Lee EY, Ki M, Cho H, Park B, Jun JK, Kim Y, Oh JK, Choi KS. Socioeconomic Inequalities in Colorectal Cancer Screening in Korea, 2005-2015: After the Introduction of the National Cancer Screening Program. Yonsei Med J 2018; 59:1034-1040. [PMID: 30328317 PMCID: PMC6192887 DOI: 10.3349/ymj.2018.59.9.1034] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2018] [Revised: 08/02/2018] [Accepted: 09/03/2018] [Indexed: 12/01/2022] Open
Abstract
PURPOSE This study aimed to investigate inequalities in colorectal cancer (CRC) screening rates in Korea and trends therein using the slope index of inequality (SII) and relative index of inequality (RII) across income and education groups. MATERIALS AND METHODS Data from the Korean National Cancer Screening Survey, an annually conducted, nationwide cross-sectional survey, were utilized. A total of 17174 men and women aged 50 to 74 years were included for analysis. Prior experience with CRC screening was defined as having either a fecal occult blood test within the past year or a lifetime colonoscopy. CRC screening rates and annual percentage changes (APCs) were evaluated. Then, SII and RII were calculated to assess inequality in CRC screening for each survey year. RESULTS CRC screening rates increased from 23.4% in 2005 to 50.9% in 2015 (APC, 7.8%; 95% CI, 6.0 to 9.6). Upward trends in CRC screening rates were observed for all age, education, and household income groups. Education inequalities were noted in 2009, 2014, and overall pooled estimates in both indices. Income inequalities were inconsistent among survey years, and overall estimates did not reach statistical significance. CONCLUSION Education inequalities in CRC screening among men and women aged 50 to 74 years were observed in Korea. No apparent pattern, however, was found for income inequalities. Further studies are needed to thoroughly outline socio-economic inequalities in CRC screening.
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Affiliation(s)
- Tran Thi Xuan Mai
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Yoon Young Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Mina Suh
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Eunji Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Eun Young Lee
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Moran Ki
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Hyunsoon Cho
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Boyoung Park
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea
| | - Jae Kwan Jun
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Yeol Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jin Kyoung Oh
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
| | - Kui Son Choi
- Graduate School of Cancer Science and Policy, National Cancer Center, Goyang, Korea.
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Jenkins WD, Matthews AK, Bailey A, Zahnd WE, Watson KS, Mueller-Luckey G, Molina Y, Crumly D, Patera J. Rural areas are disproportionately impacted by smoking and lung cancer. Prev Med Rep 2018; 10:200-203. [PMID: 29868368 PMCID: PMC5984228 DOI: 10.1016/j.pmedr.2018.03.011] [Citation(s) in RCA: 39] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2017] [Revised: 03/14/2018] [Accepted: 03/21/2018] [Indexed: 10/27/2022] Open
Abstract
Rural populations have higher rates of late stage lung cancer incidence and mortality compared to urban populations, making them important target populations for low dose computed tomography (LDCT) screening. LDCT screening has been shown to reduce lung cancer mortality and is recommended by the United States Preventive Services Task Force for individuals who meet certain risk criteria. However, rural populations may experience greater system, provider, and individual-level barriers to screening and related health-seeking behavior (e.g. smoking cessation). LDCT screening was first tested in urban, academic centers, so it is still unknown how readily it may be implemented in rural areas. Additionally, rural populations have limited access to both primary care physicians who may refer to LDCT screening and specialty physicians who may perform the screening. Further, rural populations may be less likely to seek screening due to lack of awareness and understanding or other unknown knowledge or psychosocial barriers. There are several strategies that may address these rural specific challenges. First, further research is needed to better understand the individual-level barriers that rural patients experience. Second, to reduce system-level barriers, additional efforts should be made to increase rural access to screening through improved referral processes. Third, creation of decision support materials to equip rural providers to engage their patients in a shared decision making process regarding screening may help reduce physician level barriers. Fourth, development of a holistic approach to smoking cessation may help reduce lung cancer risk in conjunction with LDCT screening.
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Affiliation(s)
- Wiley D Jenkins
- Office of Population Science and Policy, SIU School of Medicine, Springfield, IL 62794-9664, United States
| | - Alicia K Matthews
- College of Nursing, University of Illinois at Chicago, Chicago, IL, United States
| | - Angie Bailey
- Southern Illinois Healthcare, Carbondale, IL 62902, United States
| | - Whitney E Zahnd
- Office of Population Science and Policy, SIU School of Medicine, Springfield, IL 62794-9664, United States
| | - Karriem S Watson
- Community Engaged Research and Implementation Science, University of Illinois at Chicago, Chicago, IL, United States.,Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - Georgia Mueller-Luckey
- Applied Health Department, Southern Illinois University, Edwardsville, IL, United States
| | - Yamile Molina
- Community Engaged Research and Implementation Science, University of Illinois at Chicago, Chicago, IL, United States.,Division of Community Health Sciences, School of Public Health, University of Illinois at Chicago, Chicago, IL, United States
| | - David Crumly
- Office of Population Science and Policy, SIU School of Medicine, Springfield, IL 62794-9664, United States
| | - Julie Patera
- Southern Illinois Healthcare, Carbondale, IL 62902, United States
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Tabaac AR, Sutter ME, Wall CSJ, Baker KE. Gender Identity Disparities in Cancer Screening Behaviors. Am J Prev Med 2018; 54:385-393. [PMID: 29338956 DOI: 10.1016/j.amepre.2017.11.009] [Citation(s) in RCA: 102] [Impact Index Per Article: 17.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2017] [Revised: 10/20/2017] [Accepted: 11/07/2017] [Indexed: 01/06/2023]
Abstract
INTRODUCTION Transgender (trans) and gender-nonconforming adults have reported reduced access to health care because of discrimination and lack of knowledgeable care. This study aimed to contribute to the nascent cancer prevention literature among trans and gender-nonconforming individuals by ascertaining rates of breast, cervical, prostate, and colorectal cancer screening behaviors by gender identity. METHODS Publicly available de-identified data from the 2014-2016 Behavioral Risk Factor Surveillance System surveys were utilized to evaluate rates of cancer screenings by gender identity, while controlling for healthcare access, sociodemographics, and survey year. Analyses were conducted in 2017. RESULTS Weighted chi-square tests identified significant differences in the proportion of cancer screening behaviors by gender identity among lifetime colorectal cancer screenings, Pap tests, prostate-specific antigen tests, discussing prostate-specific antigen test advantages/disadvantages with their healthcare provider, and up-to-date colorectal cancer screenings and Pap tests (p<0.036). Weighted logistic regressions found that although some differences based on gender identity were fully explained by covariates, trans women had reduced odds of having up-to-date colorectal cancer screenings compared to cisgender (cis) men (AOR=0.20) and cis women (AOR=0.24), whereas trans men were more likely to ever receive a sigmoidoscopy/colonoscopy as compared to cis men (AOR=2.76) and cis women (AOR=2.65). Trans women were more likely than cis men to have up-to-date prostate-specific antigen tests (AOR=3.19). Finally, trans men and gender-nonconforming individuals had reduced odds of lifetime Pap tests versus cis women (AOR=0.14 and 0.08, respectively), and gender-nonconforming individuals had lower odds of discussing prostate-specific antigen tests than cis men (AOR=0.09; all p<0.05). CONCLUSIONS The findings indicate that gender identity disparities in cancer screenings persist beyond known sociodemographic and healthcare factors. It is critical that gender identity questions are included in cancer and other health-related surveillance systems to create knowledge to better inform healthcare practitioners and policymakers of appropriate screenings for trans and gender-nonconforming individuals.
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Affiliation(s)
- Ariella R Tabaac
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia.
| | - Megan E Sutter
- Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, Florida
| | - Catherine S J Wall
- Department of Psychology, Virginia Commonwealth University, Richmond, Virginia
| | - Kellan E Baker
- Center for American Progress, Washington, District of Columbia; Department of Health Policy and Management, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland
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Vaisson G, Witteman HO, Bouck Z, Bravo CA, Desveaux L, Llovet D, Presseau J, Saragosa M, Taljaard M, Umar S, Grimshaw JM, Tinmouth J, Ivers NM. Testing Behavior Change Techniques to Encourage Primary Care Physicians to Access Cancer Screening Audit and Feedback Reports: Protocol for a Factorial Randomized Experiment of Email Content. JMIR Res Protoc 2018; 7:e11. [PMID: 29453190 PMCID: PMC5834752 DOI: 10.2196/resprot.9090] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2017] [Revised: 11/20/2017] [Accepted: 11/22/2017] [Indexed: 12/29/2022] Open
Abstract
Background Cancer Care Ontario’s Screening Activity Report (SAR) is an online audit and feedback tool designed to help primary care physicians in Ontario, Canada, identify patients who are overdue for cancer screening or have abnormal results requiring follow-up. Use of the SAR is associated with increased screening rates. To encourage SAR use, Cancer Care Ontario sends monthly emails to registered primary care physicians announcing that updated data are available. However, analytics reveal that 50% of email recipients do not open the email and less than 7% click the embedded link to log in to their report. Objective The goal of the study is to determine whether rewritten emails result in increased log-ins. This manuscript describes how different user- and theory-informed messages intended to improve the impact of the monthly emails will be experimentally tested and how a process evaluation will explore why and how any effects observed were (or were not) achieved. Methods A user-centered approach was used to rewrite the content of the monthly email, including messages operationalizing 3 behavior change techniques: anticipated regret, material incentive (behavior), and problem solving. A pragmatic, 2x2x2 factorial experiment within a multiphase optimization strategy will test the redesigned emails with an embedded qualitative process evaluation to understand how and why the emails may or may not have worked. Trial outcomes will be ascertained using routinely collected administrative data. Physicians will be recruited for semistructured interviews using convenience and snowball sampling. Results As of April 2017, 5576 primary care physicians across the province of Ontario, Canada, had voluntarily registered for the SAR, and in so doing, signed up to receive the monthly email updates. From May to August 2017 participants received the redesigned monthly emails with content specific to their allocated experimental condition prompting use of the SAR. We have not yet begun analyses. Conclusions This study will inform how to communicate effectively with primary care providers by email and identify which behavior change techniques tested are most effective at encouraging engagement with an audit and feedback report. Trial Registration ClinicalTrials.gov NCT03124316; https://clinicaltrials.gov/ct2/show/NCT03124316 (Archived by WebCite at http://www.webcitation.org/6w2MqDWGu)
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Affiliation(s)
- Gratianne Vaisson
- Department of Epidemiology, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada
| | - Holly O Witteman
- Office of Education and Continuing Professional Development, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Department of Family and Emergency Medicine, Faculty of Medicine, Laval University, Quebec City, QC, Canada.,Research Centre of the Centre Hospitalier Universitaire de Québec, Laval University, Quebec City, QC, Canada
| | - Zachary Bouck
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Caroline A Bravo
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Laura Desveaux
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Diego Llovet
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada
| | - Justin Presseau
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada.,School of Psychology, University of Ottawa, Ottawa, ON, Canada
| | - Marianne Saragosa
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada
| | - Monica Taljaard
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,School of Epidemiology and Public Health, University of Ottawa, Ottawa, ON, Canada
| | - Shama Umar
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada
| | - Jeremy M Grimshaw
- Clinical Epidemiology Program, Ottawa Hospital Research Institute, Ottawa, ON, Canada.,Department of Medicine, University of Ottawa, Ottawa, ON, Canada
| | - Jill Tinmouth
- Prevention and Cancer Control, Cancer Care Ontario, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,Sunnybrook Research Institute, Toronto, ON, Canada
| | - Noah M Ivers
- Institute for Health Systems Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Family Practice Health Centre, Women's College Hospital, Toronto, ON, Canada.,Institute for Clinical Evaluative Sciences, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Alcalá HE, Mitchell EM, Keim-Malpass J. Heterogeneous impacts: adverse childhood experiences and cancer screening. Cancer Causes Control 2018; 29:343-351. [PMID: 29411203 DOI: 10.1007/s10552-018-1007-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2017] [Accepted: 01/30/2018] [Indexed: 01/09/2023]
Abstract
BACKGROUND Adverse childhood experiences (ACEs) have been associated with higher odds of cancer in adulthood. One potential explanation for this association is the impact of ACEs on cancer screening. To address this shortcoming, this study examined how ACEs were associated with current compliance and ever use of prostate, breast, cervical, and colorectal cancer screening. METHODS Data from the 2014 Kansas Behavioral Risk Factor Surveillance System were used (n = 11,794). Logistic regressions were used to calculate odds of cancer screening behaviors from each of nine different ACE items and a count of ACEs. RESULTS Individual ACE items were associated with lower odds of compliance with PSA screening, clinical breast exam, and pap test guidelines. Certain ACEs were associated with increased odds of compliance with colorectal cancer screening guidelines among women and lower odds of compliance among men. ACEs were associated with ever screening for PSA and ever use of colonoscopy or sigmoidoscopy among men and women. Physical abuse was most consistently associated with cancer screening, across outcomes. CONCLUSIONS Most significant associations showed that specific ACEs were associated with lower odds of cancer screening. Therefore, efforts should be made to promote screening among those with histories of ACEs.
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Affiliation(s)
- Héctor E Alcalá
- Department of Family, Population and Preventive Medicine; Program in Public Health, Stony Brook University, 101 Nicolls Road, Stony Brook, NY, 11794, USA.
| | - Emma M Mitchell
- School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
| | - Jessica Keim-Malpass
- School of Nursing, University of Virginia, 225 Jeanette Lancaster Way, Charlottesville, VA, 22903, USA
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Şahin MK, Aker S. Family Physicians' Knowledge, Attitudes, and Practices Toward Colorectal Cancer Screening. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2017; 32:908-913. [PMID: 27193411 DOI: 10.1007/s13187-016-1047-9] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/05/2023]
Abstract
The purpose of this study was to assess family physicians' knowledge, attitudes, and practices toward colorectal cancer (CRC) screening. The population in this cross-sectional study consisted of 290 family physicians working in Samsun, Turkey, contacted between 15 June and 15 July 2015 and agreeing to participate. A questionnaire prepared by the authors on the basis of the relevant literature was applied at face-to-face interviews. The first part of the questionnaire inquired into sociodemographic information, while the second contained questions evaluating family physicians' knowledge, attitudes, and practices toward CRC screening. Physicians completed the questionnaire in approximately 10 min. 65.9 % of the family physicians in the study were men. Mean age of the participants was 43.40 ± 6.54 years, and mean number of years in service was 18.43 ± 6.42. The average number of patients seen by physicians on a daily basis was 51-99. CRC screening was performed by 83.1 % of physicians. The fecal occult blood test (FOBT) was recommended at the correct frequency by 30.7 % of physicians and colonoscopy by 11.7 %. A further 68.6 % of physicians followed no CRC guideline. Only 3.8 % of those reporting using a guideline were able to name it. The great majority of physicians in this study apply CRC screening. However, family physicians lack sufficient information concerning the ages at which screening tests should be started and concluded and how frequently they should be performed. They also do not attach sufficient importance to CRC guidelines. This results in excessive demand for screening tests.
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Affiliation(s)
- Mustafa Kürşat Şahin
- Samsun Public Health Directorate, Canik Community Health Center, Gaziosmanpaşa Mah. Alaca Sok. No: 31, Canik, Samsun, Turkey.
| | - Servet Aker
- Samsun Public Health Directorate, Canik Community Health Center, Gaziosmanpaşa Mah. Alaca Sok. No: 31, Canik, Samsun, Turkey
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Engler J, Dahlhaus A, Güthlin C. The readiness of German GPs to recommend and conduct cancer screening is associated with patient-physician gender concordance. Results of a survey. Eur J Gen Pract 2017; 23:11-19. [PMID: 27841043 PMCID: PMC5774290 DOI: 10.1080/13814788.2016.1240166] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2015] [Revised: 08/23/2016] [Accepted: 09/14/2016] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Cancer screening participation rates in Germany differ depending on patients' gender. International studies have found that patient-physician gender concordance fosters recommendation and conducting of cancer screening, and especially cancer screening for women. OBJECTIVES We aimed to ascertain whether gender concordance influences general practitioners' (GPs') rating of the usefulness of cancer screening, as well as their recommendations and readiness to conduct cancer screening in general practice in Germany. METHODS For an exploratory cross-sectional survey, 500 randomly selected GPs from all over Germany were asked to fill in a questionnaire on cancer screening in general practice between March and June 2015. We asked them to rate the usefulness of each cancer screening examination, how frequently they recommended and conducted them and whether they viewed GPs or specialists as responsible for carrying them out. We used multiple logistic regression to analyse gender effect size by calculating odds ratios. RESULTS Our study sample consisted of 139 GPs of which 65% were male. Male and female GPs did not differ significantly in their rating of the general usefulness of any of the specified cancer screening examinations. Male GPs were 2.9 to 6.8 times as likely to consider GPs responsible for recommending and conducting PSA testing and digital rectal examinations and were 3.7 to 7.9 times as likely to recommend and conduct these examinations on a regular basis. CONCLUSION Patient-physician gender concordance made it more likely that male-specific cancer screenings would be recommended and conducted, but not female-specific screenings. [Box: see text].
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Affiliation(s)
- Jennifer Engler
- Institute of General Practice, Goethe University Frankfurt/MainFrankfurtGermany
| | - Anne Dahlhaus
- Institute of General Practice, Goethe University Frankfurt/MainFrankfurtGermany
- German Cancer Research Center (DKFZ)HeidelbergGermany
- German Cancer Consortium (DKTK)HeidelbergGermany
| | - Corina Güthlin
- Institute of General Practice, Goethe University Frankfurt/MainFrankfurtGermany
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An Out-of-Pocket Cost Removal Intervention on Fecal Occult Blood Test Attendance. Am J Prev Med 2017; 53:e51-e62. [PMID: 28236518 DOI: 10.1016/j.amepre.2017.01.004] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/05/2016] [Revised: 11/14/2016] [Accepted: 01/05/2017] [Indexed: 12/14/2022]
Abstract
INTRODUCTION To date, no comparative study has assessed the impact of a cost-removal intervention on fecal occult blood testing (FOBT). In 2012, the Japanese government introduced a nationwide project to remove out-of-pocket costs for FOBT. The study objective was to evaluate the differential impact of the intervention on FOBT attendance in the total population and various subgroups. METHODS This study analyzed 309,103 people in national, repeated cross-sectional studies, observed pre- and post-intervention (2010 and 2013), using covariate-adjusted difference-in-differences estimates to compare intervention and no-intervention groups. The outcome measure was uptake of FOBT attendance resulting from the intervention. Stratified analyses were conducted according to sociodemographic and health-related characteristics. RESULTS The intervention was associated with significantly positive uptake of FOBT in both genders, but the impact was greater in women than men: 6.7% (95% CI=5.2, 8.1) for women and 2.7% (95% CI=1.1, 4.3) for men in the covariate-adjusted models. Post-intervention, attendance increased in almost all subgroups in women. However, among men, some socially advantaged subgroups, such as high expenditure, high education, and public officers, showed no effect. Some subgroups such as current smokers and less than high school education were identified as hard-to-reach populations that may be less sensitive to the intervention, irrespective of gender. CONCLUSIONS This is the first comparative study of cost-removal intervention for uptake of FOBT. The intervention may increase FOBT attendance. However, the size of the effect is not great, especially in men, and differential effects occurred across subgroups including gender and socioeconomic differences.
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Finney Rutten LJ, Jacobson RM, Wilson PM, Jacobson DJ, Fan C, Kisiel JB, Sweetser S, Tulledge-Scheitel SM, St Sauver JL. Early Adoption of a Multitarget Stool DNA Test for Colorectal Cancer Screening. Mayo Clin Proc 2017; 92:726-733. [PMID: 28473037 PMCID: PMC5505626 DOI: 10.1016/j.mayocp.2017.01.019] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/01/2016] [Revised: 12/14/2016] [Accepted: 01/09/2017] [Indexed: 01/05/2023]
Abstract
OBJECTIVES To characterize early adoption of a novel multitarget stool DNA (MT-sDNA) screening test for colorectal cancer (CRC) screening and to test the hypothesis that adoption differs by demographic characteristics and prior CRC screening behavior and proceeds predictably over time. PATIENTS AND METHODS We used the Rochester Epidemiology Project research infrastructure to assess the use of the MT-sDNA screening test in adults aged 50 to 75 years living in Olmsted County, Minnesota, in 2014 and identified 27,147 individuals eligible or due for screening colonoscopy from November 1, 2014, through November 30, 2015. We used electronic Current Procedure Terminology and Health Care Common Procedure codes to evaluate early adoption of the MT-sDNA screening test in this population and to test whether early adoption varies by age, sex, race, and prior CRC screening behavior. RESULTS Overall, 2193 (8.1%) and 974 (3.6%) individuals were screened by colonoscopy and MT-sDNA, respectively. Age, sex, race, and prior CRC screening behavior were significantly and independently associated with MT-sDNA screening use compared with colonoscopy use after adjustment for all other variables (P<.05 for all). The rates of adoption of MT-sDNA screening increased over time and were highest in those aged 50 to 54 years, women, whites, and those who had a history of screening. The use of the MT-sDNA screening test varied predictably by insurance coverage. The rates of colonoscopy decreased over time, whereas overall CRC screening rates remained steady. CONCLUSION The results of the present study are generally consistent with predictions derived from prior research and the diffusion of innovation framework, pointing to increasing use of the new screening test over time and early adoption by younger patients, women, whites, and those with prior CRC screening.
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Affiliation(s)
- Lila J Finney Rutten
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN.
| | - Robert M Jacobson
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Community Pediatric and Adolescent Medicine, Department of Pediatric and Adolescent Medicine, Mayo Clinic, Rochester, MN
| | - Patrick M Wilson
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Debra J Jacobson
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - Chun Fan
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Biomedical Statistics and Informatics, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
| | - John B Kisiel
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | - Seth Sweetser
- Division of Gastroenterology and Hepatology, Department of Medicine, Mayo Clinic, Rochester, MN
| | | | - Jennifer L St Sauver
- Population Health Science Program, Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN; Division of Epidemiology, Department of Health Sciences Research, Mayo Clinic, Rochester, MN
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Agénor M, Peitzmeier SM, Bernstein IM, McDowell M, Alizaga NM, Reisner SL, Pardee DJ, Potter J. Perceptions of cervical cancer risk and screening among transmasculine individuals: patient and provider perspectives. CULTURE, HEALTH & SEXUALITY 2016; 18:1192-206. [PMID: 27142466 DOI: 10.1080/13691058.2016.1177203] [Citation(s) in RCA: 49] [Impact Index Per Article: 6.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/14/2023]
Abstract
Transmasculine people (individuals assigned a female sex at birth who identify as male or masculine) are at risk of cervical cancer. Despite low rates of Pap test use in this population, research examining the determinants of cervical cancer screening among transmasculine individuals is scarce. We conducted in-depth interviews and focus groups with 49 participants (32 transmasculine patients and 17 healthcare providers) in order to examine transmasculine individuals' and healthcare providers' perceptions of cervical cancer risk and screening among individuals on the transmasculine continuum. Overall, patients believed that transmasculine individuals should receive regular Pap tests, especially in the event of gynaecological concerns. While healthcare providers' views varied, many perceived transmasculine individuals to be at low risk of cervical cancer. Contrary to existing screening guidelines, several providers believed that transmasculine individuals who did not engage in penile-vaginal intercourse with cisgender men, expressed discomfort about Pap testing or intended to obtain a hysterectomy might not need to be screened regularly or at all. Our findings underscore the importance of educating patients and providers about cervical cancer risk among transmasculine individuals and establishing evidence-based guidelines for cervical cancer screening in this underserved population.
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Affiliation(s)
- Madina Agénor
- a Department of Social and Behavioral Sciences , Harvard TH Chan School of Public Health , Boston , USA
| | - Sarah M Peitzmeier
- b Department of Population, Family and Reproductive Health , Johns Hopkins Bloomberg School of Public Health , Baltimore , USA
| | | | | | - Natalie M Alizaga
- d Department of Psychology , The George Washington University , Washington , USA
| | - Sari L Reisner
- e Division of General Pediatrics , Boston Children's Hospital/Harvard Medical School , Boston , USA
| | - Dana J Pardee
- f Fenway Health , The Fenway Institute , Boston , USA
| | - Jennifer Potter
- g Department of Medicine , Beth Israel Deaconess Medical Center/Harvard Medical School , Boston , USA
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Zhu J, Strickler JH. Clinical applications of liquid biopsies in gastrointestinal oncology. J Gastrointest Oncol 2016; 7:675-686. [PMID: 27747082 PMCID: PMC5056252 DOI: 10.21037/jgo.2016.08.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/04/2016] [Indexed: 12/11/2022] Open
Abstract
"Liquid biopsies" are blood based assays used to detect and analyze circulating tumor products, including circulating tumor cells (CTCs), circulating tumor DNA (ctDNA), circulating messenger RNA (mRNA), circulating microRNA (miRNA), circulating exosomes, and tumor educated platelets (TEP). For patients with gastrointestinal (GI) malignancies, blood based biopsies may offer several advantages. First, tumor tissue samples are often challenging to procure, and when obtainable, are often insufficient for genomic profiling. Second, blood based assays offer a real-time overview of the entire tumor burden, and allow anatomically unbiased genomic profiling. Third, given the convenience and relative safety of liquid biopsies, this technology may facilitate identification of genomic alterations that confer sensitivity and resistance to targeted therapeutics. This review will assess the clinical applications of circulating tumor products for patients with GI tumors.
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Affiliation(s)
- Jason Zhu
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA
| | - John H Strickler
- Department of Medicine, Division of Medical Oncology, Duke University Medical Center, Durham, NC 27710, USA
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Oertelt-Prigione S, Ruecke M, Seeland U, Regitz-Zagrosek V. Gynecological Practice Represents the Ideal Setting for Early Opportunistic Cardiovascular Prevention: A Cross-Sectional Survey in an Urban Female Population. J Womens Health (Larchmt) 2016; 26:29-35. [PMID: 27673723 DOI: 10.1089/jwh.2015.5729] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Cardiovascular diseases are the main cause of mortality for women worldwide, yet their impact is frequently underestimated. To raise awareness for preventative lifestyle measures other contacts with the healthcare system should be exploited. We analyzed access patterns to other healthcare specialists and population screening measures to identify options for opportunistic counseling on cardiovascular risk. MATERIALS AND METHODS We enrolled 1062 randomly selected German urban women aged 25-74 years in 2012-2013, divided into 5 age bands. Women were asked about sociodemographic characteristics, clinical and gynecological history, physician attendance patterns, screening behavior and primary sources of health and preventative information, and clinical examination attendance. RESULTS Obstetrician/gynecologists (OBGYN) were the most frequently consulted physicians within the last 12 months (75.3%), more than general practitioners (GP; 74%). Attendance rates to OBGYNs were not affected by education or income, solely a body mass index (BMI) >30 associated with significantly reduced rates of attendance (OR = 0.4, CI 95% = 0.17-0.78, p = 0.009). Women with low to medium Framingham risk scores were more likely to attend an OBGYN than a GP if they attended only one specialist. Attendance of population screening measures is limited (<60% for all offers) and hence unsuitable for systematic cardiovascular counseling. CONCLUSION OBGYN represent a very popular and equitable healthcare contact for women of all ages and this could be exploited for cardiovascular screening. Furthermore, the strikingly different sources of health information reported highlight a need for improved health communication and differentiation of messages.
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Affiliation(s)
- Sabine Oertelt-Prigione
- 1 Institute of Legal Medicine , Charité-Universitätsmedizin, Berlin, Germany .,2 German Center for Cardiovascular Research (DZHK) , Berlin, Germany
| | - Mirjam Ruecke
- 1 Institute of Legal Medicine , Charité-Universitätsmedizin, Berlin, Germany
| | - Ute Seeland
- 1 Institute of Legal Medicine , Charité-Universitätsmedizin, Berlin, Germany .,2 German Center for Cardiovascular Research (DZHK) , Berlin, Germany
| | - Vera Regitz-Zagrosek
- 1 Institute of Legal Medicine , Charité-Universitätsmedizin, Berlin, Germany .,2 German Center for Cardiovascular Research (DZHK) , Berlin, Germany .,3 Center for Cardiovascular Research , Charité-Universitätsmedizin, Berlin, Germany
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Fedewa SA, Sauer AG, Siegel RL, Smith RA, Torre LA, Jemal A. Temporal Trends in Colorectal Cancer Screening among Asian Americans. Cancer Epidemiol Biomarkers Prev 2016; 25:995-1000. [PMID: 27197273 DOI: 10.1158/1055-9965.epi-15-1147] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2015] [Accepted: 03/22/2016] [Indexed: 11/16/2022] Open
Abstract
Asian Americans (AA) are less likely to be screened for colorectal cancer compared with non-Hispanic Whites (NHW), with a widening disparity for some AA subgroups in the early 2000s. Whether these patterns have continued in more recent years is unknown. We examined temporal trends in colorectal cancer screening among AA overall compared with NHWs and by AA subgroup (Chinese, Japanese, Korean, Filipino, South Asian, Vietnamese) using data from the 2003, 2005, 2007, and 2009 California Health Interview Surveys. Unadjusted (PR) and adjusted (aPR) prevalence ratios for colorectal cancer screening, accounting for sociodemographic, health care, and acculturation factors, were calculated for respondents ages 50 to 75 years (NHW n = 60,125; AA n = 6,630). Between 2003 and 2009, colorectal cancer screening prevalence increased from 43.3% to 64.6% in AA (P ≤ 0.001) and from 58.1% to 71.4% in NHW (P ≤ 0.001). Unadjusted colorectal cancer screening was significantly lower among AA compared with NHW in 2003 [PR = 0.74; 95% confidence interval (CI), 0.68-0.82], 2005 (PR = 0.78; 95% CI, 0.72-0.84), 2007 (PR = 0.91; 95% CI, 0.85-0.96), and 2009 (PR = 0.90; 95% CI, 0.84-0.97), though disparities narrowed over time. After adjustment, there were no significant differences in colorectal cancer screening between the two groups, except in 2003. In subgroup analyses, between 2003 and 2009, colorectal cancer screening significantly increased by 22% in Japanese, 56% in Chinese, 47% in Filipino, and 94% in Koreans. In our study of California residents, colorectal cancer screening disparities between AA and NHW narrowed, but were not eliminated and screening prevalence among AA remains below nationwide goals, including the Healthy People 2020 goal of increasing colorectal cancer screening prevalence to 70.5%. Cancer Epidemiol Biomarkers Prev; 25(6); 995-1000. ©2016 AACR.
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Affiliation(s)
- Stacey A Fedewa
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia. Department of Epidemiology, Emory University School of Public Health, Atlanta, Georgia.
| | - Ann Goding Sauer
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Robert A Smith
- Cancer Control Sciences, American Cancer Society, Atlanta, Georgia
| | - Lindsey A Torre
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Surveillance and Health Services Research, American Cancer Society, Atlanta, Georgia
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Lin JY, Diwanji TP, Snider JW, Knight N, Regine WF. Cancer Screening Patterns and Concerns in Caregivers of Patients Undergoing Radiation Therapy. J Oncol Pract 2016; 12:e405-12. [PMID: 26931401 DOI: 10.1200/jop.2015.009290] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
PURPOSE Evolving cancer screening guidelines can confuse the public. Caregivers of patients undergoing radiation oncology may represent a promising outreach target for disseminating and clarifying screening information. We aimed to: (1) determine the incidence of cancer screening in this cohort, and (2) identify barriers to and deficiencies in screening. METHODS We distributed a 21-item survey on cancer screening history and related concerns to caregivers ≥ 18 years old at one urban and two suburban radiation oncology centers. Reported screening habits were compared with American Cancer Society/American Urological Association guidelines for breast, cervical, colon, and prostate cancer. Statistical analysis included Pearson χ(2) tests. RESULTS A total of 209 caregivers (median age, 55.5 years; 146 women) were surveyed. Although 92% had primary care physicians (PCPs), only 58% reported being informed about recommended screening intervals. Participants ≤ 49 years old were less likely to report PCP discussion of cancer screening than older participants (41% and 66%, respectively; P = .006). Ninety-eight respondents (47%) had one or more screening concern(s). Among screening-eligible caregivers, 23 (18%) reported not undergoing regular colonoscopies. Fourteen women (13%) did not have Papanicolaou smears at recommended intervals, and 21 (18%) did not have annual mammograms. Six men (21%) did not undergo annual prostate screening. Decreased recommended screening with colonoscopy and mammography correlated with younger age. CONCLUSION This survey of relatively unexplored caregivers identified cancer screening deficiencies and concerns that might be addressed by targeted interventions. With approximately 60% of patients with cancer receiving radiation therapy, advice in the radiation oncology setting could positively affect cancer screening behaviors in caregivers.
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Affiliation(s)
- Jolinta Y Lin
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - Tejan P Diwanji
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - James W Snider
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - Nancy Knight
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
| | - William F Regine
- University of Maryland Medical Center, and University of Maryland School of Medicine, Baltimore, MD
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Kim S, Hwang J. Assessment of trends in socioeconomic inequalities in cancer screening services in Korea, 1998-2012. Int J Equity Health 2016; 15:30. [PMID: 26912345 PMCID: PMC4765127 DOI: 10.1186/s12939-016-0319-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2015] [Accepted: 02/11/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND This study aimed to examine how income-related inequalities in screening services for gastric and colorectal cancer in Korea have changed over the past decades, along with the implementation of the national cancer screening program, and also to quantify each contribution from various socio-demographic factors income-related inequalities with respect to these cancer screening services. METHODS Three cycles (1998, 2005, and 2010-2012) of Korea National Health and Nutrition Examination Survey (KNHANES) were utilized. To measure income-related inequalities in the use of gastric and colorectal cancer, individuals over the age of 40 and the age of 50 were included respectively, and the Concentration Index (CI) was calculated for each cycle. To identify and quantify contribution from each socio-demographic factor, decomposition of the CIs was conducted. RESULTS Throughout this study, CIs and horizontal inequity indices (HIs) steadily but consistently decreased, suggesting that inequalities and inequities in participation in gastric and colorectal cancer screening were weakened after the implementation of the national public cancer screening program. Decomposition analyses revealed that whereas decreases in inequalities mostly stemmed from income and educational levels; higher income and better education levels are still major contributors to the observed inequalities that influence participation in cancer screening services in Korea. CONCLUSION Our empirical findings suggest that, although the policy of reducing out-of-pocket payment for cancer screening may contribute to the observed decreases in inequality, it alone is not likely to completely eliminate inequality. Further research is required to identify barriers that prevent people with lower socioeconomic status from participation in cancer screening, which allows equal access for equal need.
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Affiliation(s)
- Sujin Kim
- Takemi program in International Health, Harvard School of Public Health, Boston, MA, USA.
| | - Jongnam Hwang
- Centre for Research on Inner City Health, St. Michael's Hospital, 30 Bond Street, Toronto, ON, M5B 1 W8, Canada.
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Kim S, Kwon S, Subramanian SV. Has the National Cancer Screening Program reduced income inequalities in screening attendance in South Korea? Cancer Causes Control 2015; 26:1617-25. [PMID: 26335263 DOI: 10.1007/s10552-015-0655-8] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2015] [Accepted: 08/18/2015] [Indexed: 01/17/2023]
Abstract
PURPOSE In 1999, the Korean government introduced the National Cancer Screening Program (NCSP) to increase the cancer-screening rate, particularly among the low-income population. This study investigates how the NCSP has decreased both relative and absolute income inequalities in the uptake of cancer screening in South Korea. METHODS A nationally representative cross-sectional repeated data from the Korea National Health and Nutrition Examination Survey 1998-2012, managed by the Ministry of Health and Welfare, was used to assess changes over time and the extent of discontinuity at the NCSP-recommended initiation age in the uptake of screening for breast, colorectal, and gastric cancers across income quartiles. RESULTS Relative inequalities in the uptake of screening for all cancers decreased significantly over the policy period. Absolute inequalities did not change for most cancers, but marginally increased from 9 to 14% points in the uptake of screening for colorectal cancer among men. At the recommended initiation age, absolute inequalities did not change for breast and colorectal cancers but increased from 5 to 16% points for gastric cancer, for which relative inequality significantly decreased. CONCLUSIONS The NCSP, which reduced out-of-pocket payment, may not decrease absolute gap although it leads to overall increases in the uptake of cancer screening and decreases in relative inequalities. Further investigations are needed to understand barriers that prevent the low-income population from attending cancer screening.
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Affiliation(s)
- Sujin Kim
- Takemi Program in International Health, Harvard School of Public Health, 665 Huntington Avenue, Boston, MA, 02115, USA.
| | - Soonman Kwon
- Department of Health Policy and Management, School of Public Health, Seoul National University, Seoul, South Korea
| | - S V Subramanian
- Department of Social and Behavioral Sciences, Harvard School of Public Health, Boston, MA, USA
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Perceived effectiveness of HPV test as a primary screening modality among US providers. Prev Med 2015; 78:33-7. [PMID: 26116889 PMCID: PMC4547872 DOI: 10.1016/j.ypmed.2015.06.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2015] [Revised: 06/17/2015] [Accepted: 06/19/2015] [Indexed: 11/21/2022]
Abstract
BACKGROUND The human papillomavirus (HPV) test, administered alone without the Papanicolaou (Pap) test, was recently recognized as a cervical cancer screening option in the United States by the Society of Gynecologic Oncology and the American Society for Colposcopy and Cervical Pathology, and the Food and Drug Administration has approved an HPV test for primary screening. METHODS Surveys of US internists, family practitioners, nurse practitioners, and obstetrician-gynecologists were conducted in 2009 and 2012 to investigate providers' perceptions of the effectiveness of the HPV test administered alone as a population-based screening modality (2009: N=1040, 141-494 per provider group; 2012: N=1039, 155-435 per provider group). RESULTS The majority in each provider group agreed that the HPV test administered alone is an effective screening modality in 2009 (75.3%-86.1%) and 2012 (79.5%-91.8%), and agreement rose significantly during this time period among family practitioners (χ(2)=15.26, df=1, p<0.001) and nurse practitioners (χ(2)=4.53, df=1, p=0.033). CONCLUSIONS Agreement that the HPV test administered alone is an effective cervical cancer screening modality was widespread among providers in both 2009 and 2012, however implementation of guidelines for screening with the HPV test may be influenced by many other factors including reimbursement and patient preferences.
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Carney TJ, Morgan GP, Jones J, McDaniel AM, Weaver MT, Weiner B, Haggstrom DA. Hypothesis generation using network structures on community health center cancer-screening performance. J Biomed Inform 2015; 57:288-307. [PMID: 26276399 DOI: 10.1016/j.jbi.2015.08.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2014] [Revised: 07/31/2015] [Accepted: 08/04/2015] [Indexed: 11/30/2022]
Abstract
RESEARCH OBJECTIVES Nationally sponsored cancer-care quality-improvement efforts have been deployed in community health centers to increase breast, cervical, and colorectal cancer-screening rates among vulnerable populations. Despite several immediate and short-term gains, screening rates remain below national benchmark objectives. Overall improvement has been both difficult to sustain over time in some organizational settings and/or challenging to diffuse to other settings as repeatable best practices. Reasons for this include facility-level changes, which typically occur in dynamic organizational environments that are complex, adaptive, and unpredictable. This study seeks to understand the factors that shape community health center facility-level cancer-screening performance over time. This study applies a computational-modeling approach, combining principles of health-services research, health informatics, network theory, and systems science. METHODS To investigate the roles of knowledge acquisition, retention, and sharing within the setting of the community health center and to examine their effects on the relationship between clinical decision support capabilities and improvement in cancer-screening rate improvement, we employed Construct-TM to create simulated community health centers using previously collected point-in-time survey data. Construct-TM is a multi-agent model of network evolution. Because social, knowledge, and belief networks co-evolve, groups and organizations are treated as complex systems to capture the variability of human and organizational factors. In Construct-TM, individuals and groups interact by communicating, learning, and making decisions in a continuous cycle. Data from the survey was used to differentiate high-performing simulated community health centers from low-performing ones based on computer-based decision support usage and self-reported cancer-screening improvement. RESULTS This virtual experiment revealed that patterns of overall network symmetry, agent cohesion, and connectedness varied by community health center performance level. Visual assessment of both the agent-to-agent knowledge sharing network and agent-to-resource knowledge use network diagrams demonstrated that community health centers labeled as high performers typically showed higher levels of collaboration and cohesiveness among agent classes, faster knowledge-absorption rates, and fewer agents that were unconnected to key knowledge resources. Conclusions and research implications: Using the point-in-time survey data outlining community health center cancer-screening practices, our computational model successfully distinguished between high and low performers. Results indicated that high-performance environments displayed distinctive network characteristics in patterns of interaction among agents, as well as in the access and utilization of key knowledge resources. Our study demonstrated how non-network-specific data obtained from a point-in-time survey can be employed to forecast community health center performance over time, thereby enhancing the sustainability of long-term strategic-improvement efforts. Our results revealed a strategic profile for community health center cancer-screening improvement via simulation over a projected 10-year period. The use of computational modeling allows additional inferential knowledge to be drawn from existing data when examining organizational performance in increasingly complex environments.
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Affiliation(s)
- Timothy Jay Carney
- Indiana University School of Informatics (IUPUI), United States; University of North Carolina, Gillings School of Global Public Health, United States; Global Health Equity Intelligence Collaborative (GHEIC), LLC, United States.
| | - Geoffrey P Morgan
- Carnegie Mellon University, Computational Analysis of Social and Organizational Systems (CASOS), United States.
| | - Josette Jones
- Indiana University School of Informatics (IUPUI), United States.
| | - Anna M McDaniel
- Indiana University School of Informatics (IUPUI), United States; Indiana University School of Nursing, United States.
| | | | - Bryan Weiner
- University of North Carolina, Gillings School of Global Public Health, United States.
| | - David A Haggstrom
- VA HSR&D Center of Excellence on Implementing Evidence-based Practice, Roudebush VA Medical Center, United States; Division of General Internal Medicine, Indiana University School of Medicine, United States; IU Center for Health Services and Outcomes Research, Regenstrief Institute, Inc., United States.
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Ouellette-Kuntz H, Cobigo V, Balogh R, Wilton A, Lunsky Y. The Uptake of Secondary Prevention by Adults with Intellectual and Developmental Disabilities. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2014; 28:43-54. [DOI: 10.1111/jar.12133] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/23/2014] [Indexed: 12/01/2022]
Affiliation(s)
- H. Ouellette-Kuntz
- Department of Public Health Sciences; Queen's University; Kingston ON Canada
- Ongwanada; Kingston ON Canada
| | - V. Cobigo
- School of Psychology; University of Ottawa; Ottawa ON Canada
| | - R. Balogh
- University of Ontario Institute of Technology; Toronto ON Canada
| | - A. Wilton
- Institute for Clinical Evaluative Sciences; Toronto ON Canada
| | - Y. Lunsky
- Centre for Addiction and Mental Health; Toronto ON Canada
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50
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Finney Rutten LJ, Ebbert JO, Jacobson DJ, Squiers LB, Fan C, Breitkopf CR, Roger VL, St Sauver JL. Changes in U.S. Preventive Services Task Force recommendations: effect on mammography screening in Olmsted County, MN 2004-2013. Prev Med 2014; 69:235-8. [PMID: 25450494 PMCID: PMC4312230 DOI: 10.1016/j.ypmed.2014.10.024] [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: 06/20/2014] [Revised: 09/10/2014] [Accepted: 10/19/2014] [Indexed: 11/24/2022]
Abstract
OBJECTIVE We assessed changes in adherence to screening mammography recommendations with the introduction of the new U.S. Preventive Services Task Force (USPSTF) recommendations in 2009. METHODS Using the Rochester Epidemiology Project data linkage system, we examined mammography screening from 2004 to 2013 in 31,377 women 40years of age and older residing in Olmsted County, MN before and after the 2009 change in recommendations. Chi-square was used to compare screening rates before and after changes in recommendations overall, by age group, and by baseline adherence. RESULTS Among women 40 years and older, declines in screening were observed: 69% of the population was adherent in 2004-2005, 61% in 2006-2009 and 53% in 2010-2013. Absolute decreases in screening were observed from pre- to post-change for those ages 40-49 (4%), 50-74 (9%), and those 75+ (19%, all p<0.0001). Relative declines in screening rates were observed among women aged 70-74 years who were non-adherent at baseline and among women who were adherent at baseline, overall, and in each age group (all p<.001). CONCLUSIONS Declines in screening, both absolute and relative, were most pronounced among women who were adherent at baseline. Research is needed to assess factors that influence screening in the context of evolving recommendations.
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Affiliation(s)
- Lila J Finney Rutten
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, USA; Department of Health Sciences Research, Mayo Clinic, USA.
| | - Jon O Ebbert
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, USA; Department of Medicine, Mayo Clinic, Rochester, MN, USA
| | - Debra J Jacobson
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, USA; Department of Health Sciences Research, Mayo Clinic, USA
| | | | - Chun Fan
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, USA; Department of Health Sciences Research, Mayo Clinic, USA
| | | | - Véronique L Roger
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, USA; Department of Health Sciences Research, Mayo Clinic, USA
| | - Jennifer L St Sauver
- Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, USA; Department of Health Sciences Research, Mayo Clinic, USA
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