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Stoffel ST, Bombagi M, Kerrison RS, von Wagner C, Herrmann B. Testing Enhanced Active Choice to Optimize Acceptance and Participation in a Population-Based Colorectal Cancer Screening Program in Malta. Behav Med 2022; 48:141-146. [PMID: 33710942 DOI: 10.1080/08964289.2020.1828254] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Opt-out strategies have been shown to improve participation in cancer screening; however, there are ethical concerns regarding the presumed consent. In this study, we tested an alternative opt-in strategy, called: "enhanced active choice," in which the response options summarize the consequences of the decision. The study was conducted as part of the Maltese colorectal cancer screening program, which offers men and women, aged 60-64, a "one-off" fecal immunochemical test (FIT). A total of 8349 individuals were randomly assigned to receive either an invitation letter that featured a standard opt-in strategy (control condition), or an alternative letter with a modified opt-in strategy (enhanced active choice condition). Our primary outcome was participation three months after the invitation was delivered. Additionally, we also compared the proportion who said they wanted to take part in screening. We used multivariable logistic regression for the analysis. Overall, 48.4% (N = 4042) accepted the invitation and 42.4% (N = 3542) did the screening test. While there were no statistically significant differences between the two conditions in terms of acceptance and participation, enhanced active choice did increase acceptance among men by 4.6 percentage points, which translated to a significant increase in participation of 3.4 percentage points. We conclude that enhanced active choice can improve male screening participation. Given the higher risk of CRC in men, as well as their lower participation screening, we believe this to be an important finding.
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Affiliation(s)
- Sandro T Stoffel
- Joint Research Centre, European Commission, Ispra, Italy.,Research Department of Behavioural Science and Health, University College London, London, UK.,Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | | | - Robert S Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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Sonoda N, Koh C, Yasumoto R, Li M, Watanabe K, Tsuzuki C, Morimoto A. Association between Recommendations from Public Health Nurses, Medical Professionals, and Family Members and Participation in Health Checkups among Middle-aged Community Residents with National Health Insurance. JMA J 2022; 5:199-206. [PMID: 35611232 PMCID: PMC9090542 DOI: 10.31662/jmaj.2021-0225] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/01/2022] [Indexed: 11/09/2022] Open
Abstract
Introduction Participation in specific health checkups is low in Japan, especially among middle-aged community residents with municipal National Health Insurance (NHI). This study explored associations between recommendations from public health nurses, medical professionals, and family members and participation in specific health checkups among middle-aged Japanese community residents with NHI. Methods This mail survey was conducted in 2020, and it included 33,902 community residents with NHI aged 40-64 years from five cities in Osaka Prefecture, Japan. Of these, 12,446 (36.7%) community residents agreed to participate in the survey. After excluding those with missing data, 11,180 participants were included in the analyses. Participants were classified into a participation group and a nonparticipation group. Those who selected "I underwent a specific health checkup in the past year" were classified as the participation group. Results Of the 11,180 community residents with NHI, 4,384 (39.2%) were classified in the participation group. After adjusting for confounding factors, the presence (vs. absence) of recommendations from public health nurses (multivariable-adjusted odds ratio [OR], 1.81; 95% confidence interval [CI], 1.47-2.24), primary care physicians (multivariable-adjusted OR, 2.79; 95% CI, 2.49-3.13), nurses (multivariable-adjusted OR, 2.06; 95% CI, 1.57-2.69), and family members (multivariable-adjusted OR, 1.22; 95% CI, 1.12-1.32) was positively associated with participation in specific health checkups. Conclusions Our findings suggest that recommendations from public health nurses, medical professionals (primary care physicians and nurses), and family members may be important to promote participation in specific health checkups among middle-aged Japanese community residents with NHI.
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Affiliation(s)
- Nao Sonoda
- Graduate School of Nursing, Osaka Prefecture University, Osaka, Japan
| | - Chie Koh
- Graduate School of Nursing, Osaka Prefecture University, Osaka, Japan
| | - Risa Yasumoto
- Graduate School of Nursing, Osaka Prefecture University, Osaka, Japan
| | - Meng Li
- Graduate School of Nursing, Osaka Prefecture University, Osaka, Japan
| | - Kaori Watanabe
- Graduate School of Nursing, Osaka Prefecture University, Osaka, Japan
| | - Chikage Tsuzuki
- Graduate School of Nursing, Osaka Prefecture University, Osaka, Japan
| | - Akiko Morimoto
- Graduate School of Nursing, Osaka Prefecture University, Osaka, Japan
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Hatamian S, Hadavandsiri F, Momenimovahed Z, Salehiniya H. Barriers and facilitators of colorectal cancer screening in Asia. Ecancermedicalscience 2021; 15:1285. [PMID: 34824608 PMCID: PMC8580594 DOI: 10.3332/ecancer.2021.1285] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2021] [Indexed: 12/24/2022] Open
Abstract
Purpose One of the most common cancers in Asia is colorectal cancer (CRC). Early diagnosis and timely treatment are necessary for preventing complications and advanced stages of the disease. It is important to evaluate barriers and facilitators of screening in different countries. This systematic review aimed to identify the barriers and facilitators of CRC screening in Asia. Methods In this systematic review, for identifying barriers and facilitators of CRC screening, a comprehensive search was conducted in PubMed, Web of Science and Scopus in 12 December 2020. Combination keywords such as colorectal cancer, screening, sigmoidoscopy, colonoscopy, faecal occult blood test, barriers, facilitators and the names of each Asian country were used for searching. Full text original studies in English language were accepted in the review. Results In total, 36 articles were included in the review. Barriers and facilitators were evaluated. The most common reported barriers were lack of knowledge, fear of result, fear of procedure, fear of pain, lack of awareness, high cost and lack of gastrointestinal symptoms. The most frequent facilitators were having knowledge and awareness of CRC screening, perceived risk and severity, family history of cancer and physician recommendation. Conclusion For promoting success in CRC screening programmes, knowing what the barriers and facilitators are is necessary. Awareness and various personal, professional and social factors have been shown to be the major barriers toward CRC screening in most Asian countries.
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Affiliation(s)
- Sare Hatamian
- Department of Epidemiology, School of Public Health and Safety, Iran University of Medical Sciences, Tehran, Iran
| | - Fatemeh Hadavandsiri
- Cancer Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Zohre Momenimovahed
- Department of Midwifery and Reproductive Health, Qom University of Medical Sciences, Qom, Iran
| | - Hamid Salehiniya
- Social Determinants of Health Research Center, Birjand University of Medical Sciences, Birjand, Iran
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Links AR, Callon W, Wasserman C, Beach MC, Ryan MA, Leu GR, Tunkel D, Boss EF. Treatment recommendations to parents during pediatric tonsillectomy consultations: A mixed methods analysis of surgeon language. PATIENT EDUCATION AND COUNSELING 2021; 104:1371-1379. [PMID: 33342578 DOI: 10.1016/j.pec.2020.11.015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/17/2020] [Revised: 10/19/2020] [Accepted: 11/11/2020] [Indexed: 06/12/2023]
Abstract
OBJECTIVE A deeper understanding of the dialogue clinicians use to relay treatment recommendations is needed to fully understand their influence on patient decisions about surgery. We characterize how otolaryngologists provide treatment recommendations and suggest a classification framework. METHODS We qualitatively analyzed surgeon recommendations from 55 encounters between otolaryngologists and parents of children evaluated for tonsillectomy, and classified recommendation types by phrasing. Multilevel logistic regression identified predictors of recommendation phrasing. RESULTS Clinicians provided 183 recommendations (mean/visit = 3.3). We identified four domains of recommendation-phrasing (direct, passive, acceptable, parent-oriented). Direct recommendations (n = 68, 37%) included presumptive statements phrasing intentions as inevitable. Passive recommendations (n = 65, 36%) included practice-based recommendations utilizing general statements. Acceptable recommendations (n = 29, 16%) included speaking positively about treatment options. Parent-oriented recommendations (n = 21, 11%) included parent choice statements. Clinicians more commonly made direct recommendations to parents who were racial minorities (OR = 2.7, p = .02, 95% CI [1.7, 5.9]) or had an annual income <$50,000 (OR = 2.2, p = .03, 95% CI [1.1, 4.4]). CONCLUSION Clinicians provide treatment recommendations in a variety of ways that may introduce more or less certainty and choice to parental treatment decisions. PRACTICE IMPLICATIONS Findings may be implemented into training which increases clinician awareness of dialogue use when recommending treatment alternatives to patients.
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Affiliation(s)
- Anne R Links
- Johns Hopkins University School of Medicine, Department of Otolaryngology, Baltimore, USA.
| | - Wynne Callon
- Harvard Medical School, Boston Children's Hospital, Boston, USA
| | - Carly Wasserman
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, USA
| | - Mary Catherine Beach
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, USA
| | - Marisa A Ryan
- Johns Hopkins University School of Medicine, Department of Otolaryngology, Baltimore, USA
| | - Grace R Leu
- Johns Hopkins University School of Medicine, Department of Otolaryngology, Baltimore, USA
| | - David Tunkel
- Johns Hopkins University School of Medicine, Department of Otolaryngology, Baltimore, USA
| | - Emily F Boss
- Johns Hopkins University School of Medicine, Department of Otolaryngology, Baltimore, USA
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Douma LN, Uiters E, Verweij MF, Timmermans DRM. Autonomous and informed decision-making: The case of colorectal cancer screening. PLoS One 2020; 15:e0233308. [PMID: 32469889 PMCID: PMC7259584 DOI: 10.1371/journal.pone.0233308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/01/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION It is increasingly considered important that people make an autonomous and informed decision concerning colorectal cancer (CRC) screening. However, the realisation of autonomy within the concept of informed decision-making might be interpreted too narrowly. Additionally, relatively little is known about what the eligible population believes to be a 'good' screening decision. Therefore, we aimed to explore how the concepts of autonomous and informed decision-making relate to how the eligible CRC screening population makes their decision and when they believe to have made a 'good' screening decision. METHODS We conducted 27 semi-structured interviews with the eligible CRC screening population (eighteen CRC screening participants and nine non-participants). The general topics discussed concerned how people made their CRC screening decision, how they experienced making this decision and when they considered they had made a 'good' decision. RESULTS Most interviewees viewed a 'good' CRC screening decision as one based on both reasoning and feeling/intuition, and that is made freely. However, many CRC screening non-participants experienced a certain social pressure to participate. All CRC screening non-participants viewed making an informed decision as essential. This appeared to be the case to a lesser extent for CRC screening participants. For most, experiences and values were involved in their decision-making. CONCLUSION Our sample of the eligible CRC screening population viewed aspects related to the concepts of autonomous and informed decision-making as important for making a 'good' CRC screening decision. However, in particular the existence of a social norm may be affecting a true autonomous decision-making process. Additionally, the present concept of informed decision-making with its strong emphasis on making a fully informed and well-considered decision does not appear to be entirely reflective of the process in practice. More efforts could be made to attune to the diverse values and factors that are involved in deciding about CRC screening participation.
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Affiliation(s)
- Linda N. Douma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marcel F. Verweij
- Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Danielle R. M. Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
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6
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Links AR, Callon W, Wasserman C, Walsh J, Tunkel DE, Beach MC, Boss EF. Parental role in decision-making for pediatric surgery: Perceptions of involvement in consultations for tonsillectomy. PATIENT EDUCATION AND COUNSELING 2020; 103:944-951. [PMID: 31866196 DOI: 10.1016/j.pec.2019.12.012] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2019] [Revised: 11/20/2019] [Accepted: 12/14/2019] [Indexed: 06/10/2023]
Abstract
OBJECTIVE Parental role in decision-making has implications for quality of care. We describe roles of parent participation in decision-making for tonsillectomy. METHODS Parents reported preferred role in decision-making before consultations for tonsillectomy and the role they experienced after their consult. Parents completed questionnaires, including items evaluating clinician/parent communication. Clinicians rated perception of parents' preferred role in decision-making. Congruence between parent and clinician responses was evaluated via kappa analysis. Logistic regression identified associations between decision-making roles and socioemotional and communication factors. RESULTS Consults between 63 parents and 8 otolaryngologists were analyzed.There was inadequate agreement between clinician and parent ratings of preferred roles (37%, p = 0.6, 95% CI [-0.09, 0.001]). Parents perceived greater involvement when clinicians discussed reasons to have (OR = 4.3, p = 0.03) or not have (OR = 4.1, p = 0.005) surgery. Parents perceived less involvement when clinicians used jargon (OR = 0.1, p = 0.03), and when parents trusted clinicians (OR = 0.4, p = 0.049), or experienced greater decisional conflict (OR = 0.9, p = 0.03). CONCLUSIONS Parents and clinicians perceived parental preference for decision-making involvement differently during consultations for tonsillectomy. Clinician information-sharing, jargon use, and parent trust in clinician predicted extent of perceived engagement. PRACTICE IMPLICATIONS Findings may enhance understanding of strategies to effectively communicate and engage parents in shared decision-making for pediatric surgical care.
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Affiliation(s)
- Anne R Links
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA.
| | - Wynne Callon
- Harvard Medical School, Boston Children's Hospital, Boston, USA
| | - Carly Wasserman
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, USA
| | - Jonathan Walsh
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA
| | - David E Tunkel
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA
| | - Mary Catherine Beach
- Johns Hopkins University School of Medicine, Department of Medicine, Baltimore, USA
| | - Emily F Boss
- Johns Hopkins University School of Medicine, Department of Otolaryngology-Head and Neck Surgery, Baltimore, USA
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Kostick KM, Trejo M, Volk RJ, Estep JD, Blumenthal-Barby JS. Using Nudges to Enhance Clinicians' Implementation of Shared Decision Making With Patient Decision Aids. MDM Policy Pract 2020; 5:2381468320915906. [PMID: 32440570 PMCID: PMC7227151 DOI: 10.1177/2381468320915906] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/12/2019] [Accepted: 02/15/2020] [Indexed: 01/26/2023] Open
Abstract
Background. Although effective interventions for shared decision making (SDM) exist, there is a lack of uptake of these tools into clinical practice. “Nudges,” which draw on behavioral economics and target automatic thinking processes, are used by policy makers to influence population-level behavior change. Nudges have not been applied in the context of SDM interventions but have potential to influence clinician motivation, a primary barrier to long-term adoption of SDM tools. Objective. Describe, evaluate, and propose recommendations for the use of a behavioral economics framework (MINDSPACE) on clinician motivation and behavior during implementation of a validated decision aid (DA) for left ventricular assist device at nine hospitals. Methods. Qualitative thematic analysis of process notes from stakeholder meetings during the first 6 months of implementation to identify examples of how the MINDSPACE framework was operationalized. Quantitative implementation progress was evaluated using the RE-AIM framework. Results. MINDSPACE components were translated into concrete approaches that leveraged influential stakeholders, fostered ownership over the DA and positive emotional associations, spread desirable norms across sites, and situated the DA within established default processes. DA reach to eligible patients increased from 9.8% in the first month of implementation to 70.0% in the sixth month. Larger gains in reach were observed following meetings using MINDSPACE approaches. Limitations. The MINDSPACE framework does not capture all possible influences on behavior and responses to nudges may differ across populations. Conclusions. Behavioral economics can be applied to implementation science to foster uptake of SDM tools by increasing clinician motivation. Our recommendations can help other researchers effectively apply these approaches in real-world settings when there are often limited incentives and opportunities to change organizational- or structural-level factors.
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Affiliation(s)
- Kristin M Kostick
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Meredith Trejo
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
| | - Robert J Volk
- Department of Health Services Research, University of Texas MD Anderson Cancer Center, Houston, Texas
| | - Jerry D Estep
- Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, Ohio
| | - J S Blumenthal-Barby
- Center for Medical Ethics and Health Policy, Baylor College of Medicine, Houston, Texas
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Haug U, Senore C, Corley DA. Promises and Potential Pitfalls of Shared Decision Making in Cancer Screening. Gastroenterology 2020; 158:802-805. [PMID: 31812511 DOI: 10.1053/j.gastro.2019.11.293] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2019] [Revised: 11/04/2019] [Accepted: 11/16/2019] [Indexed: 01/29/2023]
Affiliation(s)
- Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS and, Faculty of Human and Health Sciences, University of Bremen, Bremen, Germany
| | - Carlo Senore
- SSD Epidemiologia e screening - CPO, University Hospital 'Città della Salute e della Scienza', Turin, Italy
| | - Douglas A Corley
- Division of Research, Kaiser Permanente Northern California, Oakland, California
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Ruparel M, Quaife S, Baldwin D, Waller J, Janes S. Defining the information needs of lung cancer screening participants: a qualitative study. BMJ Open Respir Res 2019; 6:e000448. [PMID: 31803474 PMCID: PMC6890387 DOI: 10.1136/bmjresp-2019-000448] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2019] [Revised: 10/09/2019] [Accepted: 11/06/2019] [Indexed: 01/10/2023] Open
Abstract
Introduction Lung cancer screening (LCS) by low-dose CT has been shown to improve mortality, but individuals must consider the potential benefits and harms before making an informed decision about taking part. Shared decision-making is required for LCS in USA, though screening-eligible individuals' specific views of these harms, and their preferences for accessing this information, are not well described. Methods In this qualitative study, we aimed to explore knowledge and perceptions around lung cancer and LCS with a focus on harms. We carried out seven focus groups with screening-eligible individuals, which were divided into current versus former smokers and lower versus higher educational backgrounds; and 16 interviews with health professionals including general practitioners, respiratory physicians, lung cancer nurse specialists and public health consultants. Interviews and focus groups were audio-recorded and transcribed. Data were coded inductively and analysed using the framework method. Results Fatalistic views about lung cancer as an incurable disease dominated, particularly among current smokers, and participants were often unaware of curative treatment options. Despite this, beliefs that screening is sensible and worthwhile were expressed. Generally participants felt they had the 'right' to an informed decision, though some cautioned against information overload. The potential harms of LCS were poorly understood, particularly overdiagnosis and radiation exposure, but participants were unlikely to be deterred by them. Strong concerns about false-negative results were expressed, while false-positive results and indeterminate nodules were also reported as concerning. Conclusions These findings demonstrate the need for LCS information materials to highlight information on the benefits of early detection and options for curative treatment, while accurately presenting the possible harms. Information needs are likely to vary between individuals and we recommend simple information materials to be made available to all individuals considering participating in LCS, with signposting to more detailed information for those who require it.
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Affiliation(s)
- Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Samantha Quaife
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - David Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals NHS Trust, Nottingham, UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, UK
- Cancer Prevention Group, King's College London, London, UK
| | - Samuel Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
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Ruparel M, Quaife SL, Ghimire B, Dickson JL, Bhowmik A, Navani N, Baldwin DR, Duffy S, Waller J, Janes SM. Impact of a Lung Cancer Screening Information Film on Informed Decision-making: A Randomized Trial. Ann Am Thorac Soc 2019; 16:744-751. [PMID: 31082267 PMCID: PMC6543473 DOI: 10.1513/annalsats.201811-841oc] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/01/2019] [Indexed: 11/20/2022] Open
Abstract
Rationale: Lung cancer screening has the potential to save lives, but it also carries a risk of potential harms. Explaining the benefits and harms of screening in a way that is balanced and comprehensible to individuals with various levels of education is essential. Although a shared decision-making approach is mandated by the Centers for Medicare & Medicaid Services, there have been no randomized studies to evaluate the impact of different forms of lung screening information. Objectives: To evaluate the impact of a novel information film on informed decision-making in individuals considering participating in lung cancer screening. Methods: A subset of participants from LSUT (Lung Screen Uptake Trial) were randomly allocated either to view the information film and receive a written information booklet or to receive the booklet alone. The primary outcome was the objective knowledge score after intervention. Secondary outcomes included subjective knowledge, decisional conflict, final screening participation, and acceptability of the materials. Univariate and multivariate analyses were performed to determine differences in pre- and postintervention knowledge scores in both groups and between groups for the primary and secondary outcomes. Results: In the final analysis of 229 participants, both groups showed significantly improved subjective and objective knowledge scores after intervention. This improvement was greatest in the film + booklet group, where mean objective knowledge improved by 2.16 points (standard deviation [SD] 1.8) compared with 1.84 points (SD 1.9) in the booklet-alone group (β coefficient 0.62; confidence interval, 0.17-1.08; P = 0.007 in the multivariable analysis). Mean subjective knowledge increased by 0.92 points (SD 1.0) in the film + booklet group and 0.55 points (SD 1.1) in the booklet-alone group (β coefficient 0.32; CI, 0.05-0.58; P = 0.02 in the multivariable analysis). Decisional certainty was higher in the film + booklet (mean 8.5/9 points [SD 1.3], group than in the booklet-alone group (mean 8.2/9 points [SD 1.5]). Both information materials were well accepted, and there were no differences in final screening participation rates between groups. Conclusions: The information film improved knowledge and reduced decisional conflict without affecting lung-screening uptake. Clinical trial registered with clinicaltrials.gov (NCT02558101).
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Affiliation(s)
- Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, and
| | - Samantha L. Quaife
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Bhagabati Ghimire
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | | | - Angshu Bhowmik
- Department of Thoracic Medicine, Homerton University Hospital, London, United Kingdom
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, and
- Department of Thoracic Medicine, University College London Hospital, London, United Kingdom; and
| | - David R. Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Stephen Duffy
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Sam M. Janes
- Lungs for Living Research Centre, UCL Respiratory, and
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Fit for Cancer Treatment: a prospective feasibility study of primary care initiated prehabilitation for patients with suspected cancer. BJGP Open 2019; 2:bjgpopen18X101608. [PMID: 30723794 PMCID: PMC6348330 DOI: 10.3399/bjgpopen18x101608] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2018] [Accepted: 04/23/2018] [Indexed: 01/07/2023] Open
Abstract
Background Risk profile assessment and corrective interventions using optimisation of health status and prehabilitation represent an important strategy in the management of patients with a suspected cancer diagnosis. Aim To determine the feasibility of pre-treatment optimisation and prehabilitation commenced at index primary care consultation, to improve patients’ preparation for treatment by maximising the time available. Design & setting Between January 2015 and May 2016, 195 patients presenting to 12 GP practices were deemed eligible to enter the study, of which 189 (96.9%, median age 60 [21–91] years and 65 months; 124 female) were recruited and consented to the prehabilitation bundle. Method All patients were simultaneously referred to secondary care using urgent suspected cancer (USC) pathways. The primary outcome measures were definitive diagnosis and treatment plan. Results Fifteen patients (7.9%) were diagnosed with cancer (three breast, three colon, two lung, two skin [one melanoma, one sarcoma], one tonsil, one vocal cord, one pancreas, one prostate, one ependymoma) and 62 were diagnosed with other significant medical conditions (47 gastrointestinal, 13 sepsis, two respiratory) requiring secondary care assessment and treatment. Of the 15 patients with cancer, 11 (73.3%) underwent potentially curative treatment, and four (26.7%) palliative treatment. Of the total study cohort, 84 (44%) required a form of optimisation in primary care, and patients with cancer were more likely to require optimisation than others (n = 10 [63%] versus n = 74 [43%], χ2 9.384, P = 0.002). Conclusion One in 12 primary care USC patients had cancer (5.6% receiving potentially curative treatment), one in three had other systemic health issues, and overall two in five benefited from healthcare intervention. Primary care optimisation was feasible and associated with important allied health benefits.
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Nishioka M, Okuyama T, Uchida M, Aiki S, Ito Y, Osaga S, Imai F, Akechi T. What is the appropriate communication style for family members confronting difficult surrogate decision-making in palliative care?: A randomized video vignette study in medical staff with working experiences of clinical oncology. Jpn J Clin Oncol 2019; 49:48-56. [PMID: 30508206 DOI: 10.1093/jjco/hyy178] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2018] [Accepted: 11/07/2018] [Indexed: 02/06/2023] Open
Abstract
Background The family members of terminally ill patients are often requested to make difficult surrogate decisions during palliative care. This study sought to clarify the appropriate communication style for physicians as perceived by family members confronting difficult surrogate decision-making. Methods This experimental psychological study used scripted videos. In the videos, the physician described treatment options including continuous deep sedation to the family members of patients with cancer and terminal delirium using an autonomous or paternalistic style. Medical professionals with clinical experience in oncology were randomly assigned to either group viewing the videos. The primary outcomes were physician compassion, decisional conflict and emotion scores. We also evaluated the communication style preference. Results In total, 251 participants completed this study. Although participants in both groups reported high physician compassion, participants in the autonomous style group reported lower compassion scores (reflecting higher physician compassion) (mean 15.0 vs. 17.3, P = 0.050), lower decisional conflicts scores (51.1 vs. 56.8, P = 0.002) and comparable emotions compared with those in the paternalistic style group. Seventy-six percent of participants preferred the autonomous style. Conclusions Regarding difficult surrogate decision-making, the autonomous style might be more appropriate than the paternalistic style. However, various factors, such as family members' communication style preferences, family members' values, physician-family relationships and ethnic cultures, should be considered.
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Affiliation(s)
- Masahiro Nishioka
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.,Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Toru Okuyama
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.,Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Megumi Uchida
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.,Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Sayo Aiki
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.,Department of Palliative Care, National Hospital Organization Osaka National Hospital, 2-1-14, Hoenzaka, Chuo-ku, Osaka, Japan.,Department of Palliative Medicine, Higashi-Osaka Hospital, Chuo, Joto-ku, Osaka, Japan
| | - Yoshinori Ito
- Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Satoshi Osaga
- Clinical Research Management Center, Nagoya City University Hospital, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Fuminobu Imai
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.,Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan.,Division of Psycho-oncology and Palliative Care, Nagoya City University Hospital, Mizuho-cho, Mizuho-ku, Nagoya, Aichi, Japan
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13
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Lee SJ, O'Leary MC, Umble KE, Wheeler SB. Eliciting vulnerable patients' preferences regarding colorectal cancer screening: a systematic review. Patient Prefer Adherence 2018; 12:2267-2282. [PMID: 30464417 PMCID: PMC6216965 DOI: 10.2147/ppa.s156552] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND Patient preferences are important to consider in the decision-making process for colorectal cancer (CRC) screening. Vulnerable populations, such as racial/ethnic minorities and low-income, veteran, and rural populations, exhibit lower screening uptake. This systematic review summarizes the existing literature on vulnerable patient populations' preferences regarding CRC screening. METHODS We searched the CINAHL, PsycINFO, PubMed, Scopus, and Web of Science databases for articles published between January 1, 1996 and December 31, 2017. We screened studies for eligibility and systematically abstracted and compared study designs and outcomes. RESULTS A total of 43 articles met the inclusion criteria, out of 2,106 articles found in our search. These 43 articles were organized by the primary sub-population(s) whose preferences were reported: 27 report on preferences among racial/ethnic minorities, eight among low-income groups, six among veterans, and two among rural populations. The majority of studies (n=34) focused on preferences related to test modality. No single test modality was overwhelmingly supported by all sub-populations, although veterans seemed to prefer colonoscopy. Test attributes such as accuracy, sensitivity, cost, and convenience were also noted as important features. Furthermore, a preference for shared decision-making between vulnerable patients and providers was found. CONCLUSION The heterogeneity in study design, populations, and outcomes of the selected studies revealed a wide spectrum of CRC screening preferences within vulnerable populations. More decision aids and discrete choice experiments that focus on vulnerable populations are needed to gain a more nuanced understanding of how vulnerable populations weigh particular features of screening methods. Improved CRC screening rates may be achieved through the alignment of vulnerable populations' preferences with screening program design and provider practices. Collaborative decision-making between providers and vulnerable patients in preventive care decisions may also be important.
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Affiliation(s)
- Samuel J Lee
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
| | - Meghan C O'Leary
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
| | - Karl E Umble
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
| | - Stephanie B Wheeler
- Department of Health Policy and Management, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
- Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, NC, USA,
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14
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Cavers D, Calanzani N, Orbell S, Vojt G, Steele RJC, Brownlee L, Smith S, Patnick J, Weller D, Campbell C. Development of an evidence-based brief 'talking' intervention for non-responders to bowel screening for use in primary care: stakeholder interviews. BMC FAMILY PRACTICE 2018; 19:105. [PMID: 29960599 PMCID: PMC6026505 DOI: 10.1186/s12875-018-0794-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 06/13/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Bowel cancer is the third most common cause of cancer death worldwide. Bowel screening has been shown to reduce mortality and primary care interventions have been successful in increasing uptake of screening. Using evidence-based theory to inform the development of such interventions has been shown to increase their effectiveness. This study aimed to develop and refine a brief evidence-based intervention for eligible individuals whom have not responded to their last bowel screening invitation (non-responders), for opportunistic use by primary care providers during routine consultations. METHODS The development of a brief intervention involving a conversation between primary care providers and non-responders was informed by a multi-faceted model comprising: research team workshop and meetings to draw on expertise; evidence from the literature regarding barriers to bowel screening and effective strategies to promote informed participation; relevant psychological theory, and intervention development and behaviour change guidance. Qualitative telephone interviews with 1) bowel screening stakeholders and 2) patient non-responders explored views regarding the acceptability of the intervention to help refine its content and process. RESULTS The intervention provides a theory and evidence-based tool designed to be incorporated within current primary care practice. Bowel screening stakeholders were supportive of the intervention and recognised the importance of the role of primary care. Interviews highlighted the importance of brevity and simplicity to incorporate the intervention into routine clinical care. Non-responders similarly found the intervention acceptable, valuing a holistic approach to their care. Moreover, they expected their primary care provider to encourage participation. CONCLUSIONS A theory-based brief conversation for use in a primary care consultation was acceptable to bowel screening stakeholders and potential recipients, reflecting a health promoting primary care ethos. Findings indicate that it is appropriate to test the intervention in primary care in a feasibility study.
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Affiliation(s)
- Debbie Cavers
- The Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Doorway 1, Teviot Place, Edinburgh, EH8 9AG, UK.
| | - Natalia Calanzani
- The Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Doorway 1, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Sheina Orbell
- Department of Psychology, University of Essex, Wivenhoe Park, Colchester, CO4 3SQ, UK
| | - Gabriele Vojt
- Department of Psychology, Social Work and Health Sciences, Glasgow Caledonian University, 70 Cowcaddens Road, Glasgow, UK
| | - Robert J C Steele
- Division of Cancer Research, Ninewells Hospital and Medical School, Mailbox 4, Level 6, Dundee, DD1 9SY, UK
| | - Linda Brownlee
- Scottish Bowel Screening Centre, Kings Cross Hospital, Clepington Road, Dundee, DD3 8EA, UK
| | - Steve Smith
- NHS Bowel Cancer Screening Midlands and North West Programme Hub, St. Cross Hospital, Barby Road, Rugby, CV22 5PX, UK
| | - Julietta Patnick
- Cancer Epidemiology Unit, Oxford University, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - David Weller
- The Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Doorway 1, Teviot Place, Edinburgh, EH8 9AG, UK
| | - Christine Campbell
- The Usher Institute of Population Health Sciences and Informatics, Medical School, University of Edinburgh, Doorway 1, Teviot Place, Edinburgh, EH8 9AG, UK
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15
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Brandhof SD, Fagerlin A, Hawley S, Toes-Zoutendijk E, Trevena L, McCaffery K, Korfage IJ. Colorectal cancer screening: Associations between information provision, attitudes and intended participation. PATIENT EDUCATION AND COUNSELING 2018; 101:546-550. [PMID: 28899711 DOI: 10.1016/j.pec.2017.08.021] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/16/2017] [Revised: 07/31/2017] [Accepted: 08/30/2017] [Indexed: 06/07/2023]
Abstract
OBJECTIVE Properly informing target audiences is crucial in population-based screening programs. We aimed to evaluate the impact of information about CRC screening on attitudes and intended participation in a screening-naive population. METHODS 614 persons (aged 55-75 years) received a survey. Information on CRC and screening was provided piece by piece, and per piece its impact on attitudes and intended participation was assessed. All persons received the same information content, but the sequence of information differed per condition: information on the high mortality rate of colorectal cancer was presented in the first or the second piece. Educational levels, the extent people considered future consequences, and value concordance between attitudes and intentions were assessed. RESULTS 436 persons (response 71%) completed the survey. Overall most respondents reported positive attitudes towards CRC screening (78%) and intentions to participate in CRC screening (83%), independent of sequence of information provision. Intentions about participation were value concordant in the majority (88%). Results were similar in low educated groups. CONCLUSION Providing balanced information about CRC screening (also addressing negative effects) did not impede value concordance and high rates of intended participation. PRACTICE IMPLICATIONS High rates of screening intentions are possible without omitting threatening health information in communication materials.
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Affiliation(s)
- Stephanie D Brandhof
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Angela Fagerlin
- Department of Population Health Services, University of Utah, Salt Lake City, UT, USA; Veterans Affairs Center Salt Lake City Salt Lake City VA Center for Informatics Decision Enhancement and Surveillance (IDEAS), Salt Lake City, UT, USA
| | - Sarah Hawley
- Veterans Affairs Ann Arbor Center for Clinical Management Research, Ann Arbor, MI, USA; Department of Internal Medicine, University of Michigan, Ann Arbor, MI, USA; Center for Bioethics and Social Sciences in Medicine, University of Michigan, Ann Arbor, MI, USA; Cancer Surveillance & Outcomes Research Team (CanSORT), University of Michigan, North Campus Research Complex, Ann Arbor, MI, USA
| | - Esther Toes-Zoutendijk
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Lyndal Trevena
- Discipline of General Practice, Sydney Public Health, University of Sydney, Australia
| | - Kirsten McCaffery
- Screening & Test Evaluation Program (STEP), The University of Sydney, Sydney, NSW 2006, Australia; Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), The University of Sydney, Sydney, Australia
| | - Ida J Korfage
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
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16
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Hofmann B. Ethical issues with colorectal cancer screening-a systematic review. J Eval Clin Pract 2017; 23:631-641. [PMID: 28026076 DOI: 10.1111/jep.12690] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2016] [Revised: 11/16/2016] [Accepted: 11/16/2016] [Indexed: 12/26/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Colorectal cancer (CRC) screening is widely recommended and implemented. However, sometimes CRC screening is not implemented despite good evidence, and some types of CRC screening are implemented despite lack of evidence. The objective of this article is to expose and elucidate relevant ethical issues in the literature on CRC screening that are important for open and transparent deliberation on CRC screening. METHODS An axiological question-based method is used for exposing and elucidating ethical issues relevant in HTA. A literature search in MEDLINE, Embase, PsycINFO, PubMed Bioethics subset, ISI Web of Knowledge, Bioethics Literature Database (BELIT), Ethics in Medicine (ETHMED), SIBIL Base dati di bioetica, LEWI Bibliographic Database on Ethics in the Sciences and Humanities, and EUROETHICS identified 870 references of which 114 were found relevant according to title and abstract. The content of the included papers were subject to ethical analysis to highlight the ethical issues, concerns, and arguments. RESULTS A wide range of important ethical issues were identified. The main benefits are reduced relative CRC mortality rate, and potentially incidence rate, but there is no evidence of reduced absolute mortality rate. Potential harms are bleeding, perforation, false test results, overdetection, overdiagnosis, overtreatment (including unnecessary removal of polyps), and (rarely) death. Other important issues are related to autonomy and informed choice equity, justice, medicalization, and expanding disease. CONCLUSION A series of important ethical issues have been identified and need to be addressed in open and transparent deliberation on CRC screening.
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Affiliation(s)
- Bjørn Hofmann
- Department of Health Science, the Norwegian University for Science and Technology, Gjøvik, Norway.,The Centre of Medical Ethics at the University of Oslo, Norway
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17
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Marlow LAV, Meisel SF, Wardle J. Ethnic minority women prefer strong recommendations to be screened for cancer. BMC Public Health 2017; 17:164. [PMID: 28158990 PMCID: PMC5291956 DOI: 10.1186/s12889-017-4093-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2016] [Accepted: 01/31/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancer screening invitations can explicitly recommend attendance or encourage individuals to consider the risks and benefits before deciding for themselves. Public preferences for these approaches might vary. We explored ethnic minority women's preferences for a strong recommendation to be screened. METHODS Women aged 30-60 years from Indian, Pakistani, Bangladeshi, Caribbean, African and white British backgrounds (n = 120 per group) completed face-to-face interviews with a multi-lingual interviewer. The interview included a question on which approach to screening invitations they would prefer: i) A strong recommendation from the National Health Service (NHS) to go for screening, ii) A statement that the NHS thinks you should go for screening, but it's up to you to decide, iii) No recommendation. Analyses examined predictors of preference for a strong recommendation. RESULTS Preferences varied by ethnicity (χ 2(5) = 98.20, p <.001). All ethnic minority groups had a preference for a strong recommendation to be screened (53-86% across ethnic groups vs 31% white British). Socio-demographic factors (marital status, education and employment), and indicators of acculturation (main language and migration status), contributed to explaining recommendation preferences (χ 2(5) = 35.95 and χ 2(3) = 11.59, respectively, both p <.001), but did not mediate the ethnicity effect entirely. Self-rated comprehension of written health information did not contribute to the model. CONCLUSIONS A strong recommendation to participate in cancer screening appears to be important for ethnic minority women, particularly non-English speakers. Future research could explore how to best arrive at a consensus that respects patient autonomy while also accommodating those that would prefer to be guided by a trusted source.
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Affiliation(s)
- Laura A V Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, London, WC1E 6BT, UK.
| | - Susanne F Meisel
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, London, WC1E 6BT, UK
| | - Jane Wardle
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, London, WC1E 6BT, UK
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18
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Ghanouni A, Renzi C, Meisel SF, Waller J. Common methods of measuring 'informed choice' in screening participation: Challenges and future directions. Prev Med Rep 2016; 4:601-607. [PMID: 27843761 PMCID: PMC5107638 DOI: 10.1016/j.pmedr.2016.10.017] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Revised: 09/09/2016] [Accepted: 10/27/2016] [Indexed: 02/06/2023] Open
Abstract
There is general agreement among public health practitioners, academics, and policymakers that people offered health screening tests should be able to make informed choices about whether to accept. Robust measures are necessary in order to gauge the extent to which informed choice is achieved in practice and whether efforts to improve it have succeeded. This review aims to add to the literature on how to improve methods of measuring informed choice. We discuss and critique commonly-used approaches and outline possible alternative methods that might address the issues identified. We explore the challenges of defining what information should be provided about screening and hence understood by service users, appraise the use of 'thresholds' to define e.g. positive attitudes towards screening, and describe problems inherent in conceptualising 'informed choice' as a single dichotomous outcome that either does or does not occur. Suggestions for future research include providing greater detail on why particular aspects of screening information were considered important, analysing knowledge and attitude measures at an ordinal or continuous level (avoiding problematic decisions about dichotomising data in order to set thresholds), and reconceptualising informed choice as a multifactorial set of outcomes, rather than a unitary one.
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Affiliation(s)
| | | | | | - Jo Waller
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, United Kingdom
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19
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Dharni N, Armstrong D, Chung-Faye G, Wright AJ. Factors influencing participation in colorectal cancer screening-a qualitative study in an ethnic and socio-economically diverse inner city population. Health Expect 2016; 20:608-617. [PMID: 27550367 PMCID: PMC5513014 DOI: 10.1111/hex.12489] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/14/2016] [Indexed: 11/27/2022] Open
Abstract
Background Ethnic and socio‐economic inequalities have been reported in the uptake of colorectal cancer (CRC) screening. This study aimed to explore the factors affecting CRC screening participation in an ethnically and socio‐economically diverse inner city population. Methods Semi‐structured interviews were undertaken with 50 people aged 55–74 years, recruited from GP practices in south‐east London. Participants were from Black African (n=13), Black Caribbean (n=15), White British (n=17), Black other (n=2) and White other (n=3) backgrounds. Participants' socio‐economic status (SES) was assessed using a combined measure of educational attainment, housing tenure and car ownership. Participants' SES varied although there were more participants from less deprived backgrounds than those from more deprived backgrounds. The interview topic guide was informed by the Theoretical Domains Framework. Interviews were recorded, transcribed and analysed using framework analysis. Findings Lack of awareness of CRC screening was a barrier for all participants. There were also some notable group differences by ethnicity and SES. Cancer fear was a barrier for White British participants of varying SES. Misunderstanding instructions for completing the guaiac faecal occult blood test (gFOBt) was a barrier for people of low SES regardless of ethnicity. For Black African and Black Caribbean participants, of any SES, religious faith and a perceived civic duty to participate in screening encouraged participation. Discussion and conclusions This is the first study to provide detailed information on the separate views of Black African and Black Caribbean participants about screening. Consideration of ethnicity and SES together also allowed us to identify pertinent barriers for particular groups that can be targeted to improve access to screening for those who wish to take part.
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Affiliation(s)
- Nimarta Dharni
- Bradford Institute for Health Research, Bradford Teaching Hospitals NHS Foundation Trust, Bradford, UK
| | - David Armstrong
- Department of Primary Care and Public Health Services, King's College London, London, UK
| | - Guy Chung-Faye
- King's College Hospital NHS Foundation Trust, London, UK
| | - Alison J Wright
- Department of Primary Care and Public Health Services, King's College London, London, UK
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20
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Kobayashi LC, Waller J, von Wagner C, Wardle J. A lack of information engagement among colorectal cancer screening non-attenders: cross-sectional survey. BMC Public Health 2016; 16:659. [PMID: 27473593 PMCID: PMC4966703 DOI: 10.1186/s12889-016-3374-5] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 07/26/2016] [Indexed: 12/31/2022] Open
Abstract
Background The NHS Cancer Screening Programmes in England now operate a policy of ‘informed choice’ about participation in cancer screening. Engagement with written information about screening is important to facilitate informed choice, although the degree to which the screening-eligible public engages with the available information is unknown. We examined the association between reading of the standard informational booklet (‘Bowel Cancer Screening: The Facts') and participation in the nationally organised NHS Bowel Cancer Screening Programme in England. Methods Face-to-face interviews were conducted with 1307 adults who were age-eligible for nationally organised colorectal cancer (CRC; also called bowel cancer) in a population-based survey in England in 2014. Respondents were shown an image of ‘The Facts’ booklet and were asked how much of it they had read when they received their screening invitation (‘none’, ‘a little’, ‘some’, ‘most’, ‘almost all’, or ‘all’). Logistic regression was used to estimate the associations between screening uptake status (‘never’ vs. ‘ever’) and self-reported reading of ‘The Facts’ booklet (dichotomised to ‘none vs. ‘any’), adjusting for age, sex, ethnicity, educational attainment, and occupation-based social grade. Results Overall, 69 % of the sample (908/1307) had participated in CRC screening at least once (‘ever’ screeners). One-fifth of the sample reported that they had read ‘none’ of ‘The Facts’ booklet (22 %; 287/1307), while half reported having read ‘all’ of it (52 %; 680/1307). Reading of the booklet was strongly differential according to screening uptake status: nearly two-thirds of ‘never’ screeners had read none of ‘The Facts’ booklet (63 %; 251/399), compared to less than one in twenty ‘ever’ screeners (4 %; 36/908); adjusted OR = 39.0; 95 % CI: 26.2-58.1 for reading ‘none’ in ‘never’ vs. ‘ever’ screeners. Conclusions Although ‘The Facts’ booklet is intended to support informed choices about CRC screening, the majority of unscreened individuals report that they have read none of it. The degree to which public engagement with the decision-making process about cancer screening is socially unequal must be better understood so that comprehensive and equitable public communication strategies can be developed.
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Affiliation(s)
- Lindsay C Kobayashi
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Jo Waller
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK.
| | - Christian von Wagner
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK
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21
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Smith SG, Pandit A, Rush SR, Wolf MS, Simon CJ. The Role of Patient Activation in Preferences for Shared Decision Making: Results From a National Survey of U.S. Adults. JOURNAL OF HEALTH COMMUNICATION 2015; 21:67-75. [PMID: 26313690 PMCID: PMC4706032 DOI: 10.1080/10810730.2015.1033115] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Studies investigating preferences for shared decision making (SDM) have focused on associations with sociodemographic variables, with few investigations exploring patient factors. We aimed to investigate the relationship between patient activation and preferences for SDM in 6 common medical decisions among a nationally representative cross-sectional survey of American adults. Adults older than 18 were recruited online (n = 2,700) and by telephone (n = 700). Respondents completed sociodemographic assessments and the Patient Activation Measure. They were also asked whether they perceived benefit (yes/no) in SDM in 6 common medical decisions. Nearly half of the sample (45.9%) reached the highest level of activation (Level 4). Activation was associated with age (p < .001), higher income (p = .001), higher education (p = .010), better self-rated health (p < .001), and fewer chronic conditions (p = .050). The proportion of people who agreed that SDM was beneficial varied from 53.1% (deciding the necessity of a diagnostic test) to 71.8% (decisions associated with making lifestyle changes). After we controlled for participant characteristics, higher activation was associated with greater perceived benefit in SDM across 4 of the 6 decisions. Preferences for SDM varied among 6 common medical scenarios. Low patient activation is an important barrier to SDM that could be ameliorated through the development of behavioral interventions.
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Affiliation(s)
- Samuel G. Smith
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, United Kingdom
| | - Anjali Pandit
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
| | | | - Michael S. Wolf
- Division of General Internal Medicine, Feinberg School of Medicine, Northwestern University, Chicago, Illinois, USA
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22
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Lafata JE, Wunderlich T, Flocke SA, Oja-Tebbe N, Dyer KE, Siminoff LA. Physician use of persuasion and colorectal cancer screening. Transl Behav Med 2015; 5:87-93. [PMID: 25729457 DOI: 10.1007/s13142-014-0284-x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
The impact of patient-physician communication on subsequent patient behavior has rarely been evaluated in the context of colorectal cancer (CRC) screening discussions. We describe physicians' use of persuasive techniques when recommending CRC screening and evaluate its association with patients' subsequent adherence to screening. Audio recordings of N = 414 periodic health examinations were joined with screening use data from electronic medical records and pre-/post-visit patient surveys. The association between persuasion and screening was assessed using generalized estimating equations. According to observer ratings, primary care physicians frequently use persuasive techniques (63 %) when recommending CRC screening, most commonly argument or refutation. However, physician persuasion was not associated with subsequent screening adherence. Physician use of persuasion may be a common vehicle for information provision during CRC screening discussions; however, our results do not support the sole reliance on persuasive techniques if the goal is to improve adherence to recommended screening.
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Affiliation(s)
- Jennifer Elston Lafata
- Henry Ford Health System, MI, USA, Detroit, MI USA ; Virginia Commonwealth University, Richmond, VA USA
| | - Tracy Wunderlich
- Henry Ford Health System, MI, USA, Detroit, MI USA ; Oakland University, Detroit, MI USA
| | | | | | - Karen E Dyer
- Virginia Commonwealth University, Richmond, VA USA
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Smith SG, Raine R, Obichere A, Wolf MS, Wardle J, von Wagner C. The effect of a supplementary ('Gist-based') information leaflet on colorectal cancer knowledge and screening intention: a randomized controlled trial. J Behav Med 2014; 38:261-72. [PMID: 25253443 PMCID: PMC4353886 DOI: 10.1007/s10865-014-9596-z] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2014] [Accepted: 08/30/2014] [Indexed: 01/22/2023]
Abstract
Guided by Fuzzy Trace Theory, this study examined the impact of a ‘Gist-based’ leaflet on colorectal cancer screening knowledge and intentions; and tested the interaction with participants’ numerical ability. Adults aged 45–59 years from four UK general practices were randomly assigned to receive standard information (‘The Facts’, n = 2,216) versus standard information plus ‘The Gist’ leaflet (Gist + Facts, n = 2,236). Questionnaires were returned by 964/4,452 individuals (22 %). 82 % of respondents reported having read the information, but those with poor numeracy were less likely (74 vs. 88 %, p < .001). The ‘Gist + Facts’ group were more likely to reach the criterion for adequate knowledge (95 vs. 91 %; p < .01), but this was not moderated by numeracy. Most respondents (98 %) intended to participate in screening, with no group differences and no interaction with numeracy. The improved levels of knowledge and self-reported reading suggest ‘The Gist’ leaflet may increase engagement with colorectal cancer screening, but ceiling effects reduced the likelihood that screening intentions would be affected.
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Affiliation(s)
- Samuel G Smith
- Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London, WC1E 6BT, UK,
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Falzon C, Radel R, Cantor A, d'Arripe-Longueville F. Understanding narrative effects in physical activity promotion: the influence of breast cancer survivor testimony on exercise beliefs, self-efficacy, and intention in breast cancer patients. Support Care Cancer 2014; 23:761-8. [PMID: 25186211 DOI: 10.1007/s00520-014-2422-x] [Citation(s) in RCA: 29] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/21/2014] [Accepted: 08/25/2014] [Indexed: 11/30/2022]
Abstract
PURPOSE Research in health communication has shown that narratives contribute more positively to changing health behaviors than informational messages. The main purposes of this study were to examine and to compare the effects of two messages promoting physical activity, one narrative and the other informational, on the perceptions and behavioral intentions of cancer patients. METHODS A total of 158 women with breast cancer, undergoing chemotherapy and sedentary, were assigned to read the testimony of a breast cancer survivor who had been physically active during and after treatment (TE group), a content-equivalent message composed of expert recommendations about physical activity in breast cancer patients (RE group), or no message (control group). RESULTS Source trust was higher in TE group than RE group (p < 0.001). Exercise self-efficacy and exercise intention were higher in TE group than RE and control groups (p < 0.001). However, scores in RE group were higher than those of TE group for beliefs about exercise benefits (p < 0.001) and lower than those of TE and control groups for beliefs about exercise risks (p < 0.001). Source trust, exercise self-efficacy, and beliefs about exercise benefits and risks mediated the relationship between the message and exercise intention. CONCLUSIONS The results suggest that narratives may be more effective in improving perceived physical abilities and involvement in physical activity, whereas informational messages seem to be more appropriate to convey the benefits and the absence of risks related to physical activity.
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Affiliation(s)
- Charlène Falzon
- Laboratory of Human Motricity, Education Sport and Health - EA 6309, University of Nice Sophia-Antipolis, Nice, France,
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Marlow LAV, Waller J. Communicating the changes to cervical cancer screening in England: the choice to have an HPV test. WOMENS HEALTH 2014; 10:221-3. [PMID: 24956287 DOI: 10.2217/whe.14.12] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Affiliation(s)
- Laura A V Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology & Public Health, UCL, Gower Street, London WC1E 6BT, UK
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Smith SK, Simpson JM, Trevena LJ, McCaffery KJ. Factors Associated with Informed Decisions and Participation in Bowel Cancer Screening among Adults with Lower Education and Literacy. Med Decis Making 2014; 34:756-72. [DOI: 10.1177/0272989x13518976] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2012] [Accepted: 12/06/2013] [Indexed: 11/17/2022]
Abstract
Background. Making informed decisions about cancer screening involves understanding the benefits and harms in conjunction with personal values. There is little research examining factors associated with informed decision making or participation in screening in the context of a decision aid trial. Objectives. To identify factors associated with informed choice and participation in fecal occult blood testing (FOBT) among lower education populations. Design. Randomized controlled trial of an FOBT decision aid conducted between July and November 2008. Setting. Socioeconomically disadvantaged areas in New South Wales, Australia. Participants. Included 572 adults aged 55 to 64 years with lower education. Measurements. Sociodemographic variables, perceived health literacy, and involvement preferences in decision making were examined to identify predictors of informed choice (knowledge, attitudes, and behavior). Results. Multivariate analysis identified independent predictors of making an informed choice as having higher education (relative risk [RR], 1.49; 95% confidence interval [CI], 1.13–1.95; P = 0.001), receiving the decision aid (RR, 2.88; 95% CI, 1.87–4.44; P < 0.001), and being male (RR, 1.48; 95% CI, 1.11–1.97; P = 0.009). Participants with no confidence in completing forms and poorer self-reported health were less likely to make an informed choice (RR, 0.74; 95% CI, 0.53–1.03; P = 0.05 and RR, 0.57; 95% CI, 0.36–0.89; P = 0.007, respectively). Independent predictors of completing the FOBT were positive screening attitudes, receiving the standard information, preference for making the decision alone, and knowing that screening may lead to false-positive/negative results. Limitations. We did not objectively measure health literacy. Conclusions. Participants with the lowest levels of education had greater difficulties making an informed choice about participation in bowel screening. Alternative methods are needed to support informed decision making among lower education populations.
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Affiliation(s)
- Sian K. Smith
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine University of New South Wales, NSW, Australia (SKS)
- Sydney School of Public Health, University of Sydney, NSW, Australia (JMS)
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, NSW, Australia (LJT, KJM)
- Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, NSW, Australia (LJT, KJM)
| | - Judy M. Simpson
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine University of New South Wales, NSW, Australia (SKS)
- Sydney School of Public Health, University of Sydney, NSW, Australia (JMS)
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, NSW, Australia (LJT, KJM)
- Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, NSW, Australia (LJT, KJM)
| | - Lyndal J. Trevena
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine University of New South Wales, NSW, Australia (SKS)
- Sydney School of Public Health, University of Sydney, NSW, Australia (JMS)
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, NSW, Australia (LJT, KJM)
- Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, NSW, Australia (LJT, KJM)
| | - Kirsten J. McCaffery
- Psychosocial Research Group, Prince of Wales Clinical School, Faculty of Medicine University of New South Wales, NSW, Australia (SKS)
- Sydney School of Public Health, University of Sydney, NSW, Australia (JMS)
- Screening and Test Evaluation Program, Sydney School of Public Health, University of Sydney, NSW, Australia (LJT, KJM)
- Centre for Medical Psychology and Evidence-Based Decision-Making, University of Sydney, NSW, Australia (LJT, KJM)
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Smith SG, Wolf MS, Obichere A, Raine R, Wardle J, von Wagner C. The development and testing of a brief ('gist-based') supplementary colorectal cancer screening information leaflet. PATIENT EDUCATION AND COUNSELING 2013; 93:619-25. [PMID: 24007765 PMCID: PMC3863947 DOI: 10.1016/j.pec.2013.08.013] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2013] [Revised: 07/25/2013] [Accepted: 08/11/2013] [Indexed: 06/02/2023]
Abstract
OBJECTIVE To design and user-test a 'gist-based' colorectal cancer screening information leaflet, which promotes comprehension of the screening offer. METHODS Twenty-eight individuals approaching screening age were recruited from organisations in deprived areas of England. Using a between-subjects design, we tested iterations of a newly-designed gist-based information leaflet. Participants read the leaflet and answered 8 'true' or 'false' comprehension statements. For the leaflet to be considered fit-for-purpose, all statements had to be answered correctly by at least 80% of participants in each round. Alterations were made if this threshold was not met and additional rounds of testing were undertaken. RESULTS At round 1, answers to 2/8 statements did not meet the threshold. After changes, answers in round 2 did not reach the threshold for 1/8 statements. In round 3, all answers were adequate and the leaflet was deemed fit-for-purpose. Qualitative data offered solutions such as language and layout changes which led to improved comprehension of the leaflet. CONCLUSION User-testing substantially improved the design and subsequent comprehensibility of a theory-driven gist-based colorectal cancer screening information leaflet. PRACTICAL IMPLICATIONS This leaflet will be evaluated as part of a large national randomised controlled trial designed to reduce socioeconomic inequalities in colorectal cancer screening participation.
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Affiliation(s)
- Samuel G Smith
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, London, UK.
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von Wagner C, Macedo A, Campbell C, Simon AE, Wardle J, Hammersley V, Weller D, Waller J. Continuing cancer screening later in life: attitudes and intentions among older adults in England. Age Ageing 2013; 42:770-5. [PMID: 23999536 PMCID: PMC3942134 DOI: 10.1093/ageing/aft132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Background: the rise in life expectancy, together with age-related increase in the incidence of most cancers, has led to mounting interest in cancer screening in older people. In England, routine invitations stop and an ‘opt-in’ (individual request) process is available from ages 71 to 76 years for breast and colorectal screening respectively. Little is known about public attitudes towards age-stoppage policy. Objective: this study examined public attitudes to current stoppage policy, information preferences and intentions to request screening beyond the age of routine invitations. Sample: participants (n = 927; age 60–74 years) were recruited as part of a TNS Research International survey and took part in home-based, computer-assisted interviews. Methods: measures included: (i) attitudes towards current stoppage policy, (ii) preference for communications about screening after the end of the routine invitation period and (iii) intention to opt-in. Results: the majority of respondents (78%) did not agree with age-based stoppage policies. Most (83%) wanted a strong recommendation to opt-in after this age, although the number who thought they would follow such a recommendation was much lower (27%). A majority of participants (54%) thought information on screening at older ages should come from their general practitioner (GP). Conclusion: this survey indicates that older people in England wish to continue to be actively invited for cancer screening, although only a minority think that they would ultimately take up the offer. Primary care may play a role in negotiating a shared decision that is based on individual circumstances.
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Affiliation(s)
- Christian von Wagner
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, Gower Street, London WC1E 6BT, UK
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29
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Elwood PC, Steward WP, Galante J. Colorectal cancer prevention: screening and the role of aspirin. COLORECTAL CANCER 2013. [DOI: 10.2217/crc.13.48] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
SUMMARY Colon cancer is the third most common cancer worldwide. Sigmoidoscopy and colonoscopy, with the removal of rectal and colon polyps, are proven strategies for the prevention of colon cancer, and testing for fecal occult blood helps to identify subjects suitable for endoscopy. Evidence that low-dose aspirin is associated with a substantial reduction in colon cancer risk and reduces the number and growth of colon polyps is accumulating from randomized trials and observational studies. Advantages and disadvantages of endoscopy and aspirin prophylaxis are discussed extensively in this review. The reduction in cancer incidence by the two approaches together is considerably enhanced as they complement each other. Expenditure could become more cost effective if the two were promoted together.
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Affiliation(s)
- Peter C Elwood
- Cochrane Institute of Primary Care & Public Health, Cardiff University School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
| | - William P Steward
- Cancer Biomarkers & Prevention Group, Department of Cancer Studies & Molecular Medicine, University of Leicester, Leicester Royal Infirmary, Leicester, LE2 7LX, UK
| | - Julieta Galante
- Cochrane Institute of Primary Care & Public Health, Cardiff University School of Medicine, Cardiff University, Cardiff, CF14 4XN, UK
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Wong RK, Wong ML, Chan YH, Feng Z, Wai CT, Yeoh KG. Gender differences in predictors of colorectal cancer screening uptake: a national cross sectional study based on the health belief model. BMC Public Health 2013; 13:677. [PMID: 23879593 PMCID: PMC3726512 DOI: 10.1186/1471-2458-13-677] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/11/2012] [Accepted: 07/19/2013] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Colorectal Cancer (CRC) is rapidly rising in Asia, but screening uptake remains poor. Although studies have reported gender differences in screening rates, there have been few studies assessing gender specific perceptions and barriers towards CRC screening, based on behavioral frameworks. We applied the Health Belief Model to identify gender-specific predictors of CRC screening in an Asian population. METHODS A nationwide representative household survey was conducted on 2000 subjects aged 50 years and above in Singapore from 2007 to 2008. Screening behaviour, knowledge and beliefs on CRC screening were assessed by face-to-face structured interviews. The response rate was 88.2%. RESULTS 26.7 percent had undergone current CRC screening with no gender difference in rates. Almost all agreed that CRC would lead to suffering (89.8%), death (84.6%) and would pose significant treatment cost and expense (83.1%). The majority (88.5%) agreed that screening aids early detection and cure but only 35.4% felt susceptible to CRC. Nearly three-quarters (74.3%) of the respondents recalled reading or hearing information on CRC in the print or broadcast media. However, only 22.6% were advised by their physicians to undergo screening. Significantly more women than men had feared a positive diagnosis, held embarrassment, pain and risk concerns about colonoscopy and had friends and family members who encouraged screening. On multivariate analysis, screening uptake showed a positive association with worry about contracting CRC and a physician's recommendation and a negative association with perceived pain about colonoscopy for both genders. For women only, screening was positively associated with having attended a public talk on CRC and having a family member with CRC, and was negatively associated with Malay race and perceived danger of colonoscopy. CONCLUSIONS CRC screening remains poor despite high levels of awareness of its benefits in this Asian population. Race, worry about contracting cancer, psychological barriers, and cues from the doctor and a public talk on CRC were associated with screening with gender specific differences. Strategies to increase CRC screening uptake should consider gender specific approaches to address psychological barriers and increase disease susceptibility through public health education and active promotion by physicians.
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Affiliation(s)
- Reuben K Wong
- Division of Gastroenterology and Hepatology, University Medical Cluster, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Mee Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, National University Health System, Singapore, Singapore
| | - Yiong Huak Chan
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Zhu Feng
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
| | - Chun Tao Wai
- Desmond Wai Liver & Gastrointestinal Diseases Centre, Gleneagles Medical Center, Singapore, Singapore
| | - Khay Guan Yeoh
- Division of Gastroenterology and Hepatology, University Medical Cluster, National University Health System, Singapore, Singapore
- Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore
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Ascunce Elizaga N. En apoyo a la inversión en cribado. GACETA SANITARIA 2013; 27:369-71. [DOI: 10.1016/j.gaceta.2013.03.008] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/24/2013] [Revised: 03/19/2013] [Accepted: 03/19/2013] [Indexed: 01/08/2023]
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Waller J, Douglas E, Whitaker KL, Wardle J. Women's responses to information about overdiagnosis in the UK breast cancer screening programme: a qualitative study. BMJ Open 2013; 3:bmjopen-2013-002703. [PMID: 23610383 PMCID: PMC3641428 DOI: 10.1136/bmjopen-2013-002703] [Citation(s) in RCA: 69] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVES To explore the influence of overdiagnosis information on women's decisions about mammography. DESIGN A qualitative focus group study with purposive sampling and thematic analysis, in which overdiagnosis information was presented. SETTING Community and university settings in London. PARTICIPANTS 40 women within the breast screening age range (50-71 years) including attenders and non-attenders were recruited using a recruitment agency as well as convenience sampling methods. RESULTS Women expressed surprise at the possible extent of overdiagnosis and recognised the information as important, although many struggled to interpret the numerical data. Overdiagnosis was viewed as less-personally relevant than the possibility of 'under diagnosis' (false negatives), and often considered to be an issue for follow-up care decisions rather than screening participation. Women also expressed concern that information on overdiagnosis could deter others from attending screening, although they rarely saw it as a deterrent. After discussing overdiagnosis, few women felt that they would make different decisions about breast screening in the future. CONCLUSIONS Women regard it as important to be informed about overdiagnosis to get a complete picture of the risks and benefits of mammography, but the results of this study indicate that understanding overdiagnosis may not always influence women's attitudes towards participation in breast screening. The results also highlight the challenge of communicating the individual significance of information derived from population-level modelling.
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Affiliation(s)
- Jo Waller
- Department of Epidemiology and Public Health, Health Behaviour Research Centre, University College London, London, UK
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