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Kang J, Wang S, Yi J, Zhang Q. Effects of health education on screening rate of first-degree relatives of cancer patients: A systematic review and meta-analysis. J Med Screen 2024; 31:121-133. [PMID: 38409794 DOI: 10.1177/09691413241233993] [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: 02/28/2024]
Abstract
OBJECTIVE To synthesize the effects of educational intervention on the screening rate of first-degree relatives of cancer patients. METHODS A total of eight Chinese and English databases were searched (PubMed, Embase, Cochrane Library, CINAHL, Web of Science, Scopus, Medline and China Biology Medicine disc) from the time of library establishment to June 2023, for randomized controlled trials investigating the effects of educational intervention on screening rate of first-degree relatives of cancer patients. Two researchers independently screened and evaluated the quality of studies. RevMan 5.3 software was used to calculate the pooled effect size. RESULTS Thirteen studies involving 5628 participants were chosen to include in the meta-analysis. The results revealed that health education can increase screening rate of first-degree relatives of cancer patients (RR = 1.39, 95% CI = 1.16-1.65, P = 0.0002). The effect shown after short-term follow-up (≤6 months) was insignificant in terms of improving screening rate (RR = 1.46, 95% CI = 0.94-2.26, P = 0.09), but after long-term follow-up (>6 months) the improvement was greater (RR = 1.37, 95% CI = 1.13-1.65, P = 0.002). CONCLUSION Health education is effective in increasing the screening rate of first-degree relatives of cancer patients. The effect is more evident after long-term than short-term follow-up.
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Affiliation(s)
- Jiaxun Kang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Shanshan Wang
- School of Nursing, The Hong Kong Polytechnic University, Kowloon, Hong Kong SAR, China
| | - Jingna Yi
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
| | - Qiushi Zhang
- School of Nursing and Health, Zhengzhou University, Zhengzhou, China
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Ow TW, Sukocheva O, Bampton P, Iyngkaran G, Rayner CK, Tse E. Improving Concordance Between Clinicians With Australian Guidelines for Bowel Cancer Prevention Using a Digital Application: Randomized Controlled Crossover Study. JMIR Cancer 2024; 10:e46625. [PMID: 38238256 PMCID: PMC10921317 DOI: 10.2196/46625] [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: 03/08/2023] [Revised: 11/28/2023] [Accepted: 01/18/2024] [Indexed: 02/23/2024] Open
Abstract
BACKGROUND Australia's bowel cancer prevention guidelines, following a recent revision, are among the most complex in the world. Detailed decision tables outline screening or surveillance recommendations for 230 case scenarios alongside cessation recommendations for older patients. While these guidelines can help better allocate limited colonoscopy resources, their increasing complexity may limit their adoption and potential benefits. Therefore, tools to support clinicians in navigating these guidelines could be essential for national bowel cancer prevention efforts. Digital applications (DAs) represent a potentially inexpensive and scalable solution but are yet to be tested for this purpose. OBJECTIVE This study aims to assess whether a DA could increase clinician adherence to Australia's new colorectal cancer screening and surveillance guidelines and determine whether improved usability correlates with greater conformance to guidelines. METHODS As part of a randomized controlled crossover study, we created a clinical vignette quiz to evaluate the efficacy of a DA in comparison with the standard resource (SR) for making screening and surveillance decisions. Briefings were provided to study participants, which were tailored to their level of familiarity with the guidelines. We measured the adherence of clinicians according to their number of guideline-concordant responses to the scenarios in the quiz using either the DA or the SR. The maximum score was 18, with higher scores indicating improved adherence. We also tested the DA's usability using the System Usability Scale. RESULTS Of 117 participants, 80 were included in the final analysis. Using the SR, the adherence of participants was rated a median (IQR) score of 10 (7.75-13) out of 18. The participants' adherence improved by 40% (relative risk 1.4, P<.001) when using the DA, reaching a median (IQR) score of 14 (12-17) out of 18. The DA was rated highly for usability with a median (IQR) score of 90 (72.5-95) and ranked in the 96th percentile of systems. There was a moderate correlation between the usability of the DA and better adherence (rs=0.4; P<.001). No differences between the adherence of specialists and nonspecialists were found, either with the SR (10 vs 9; P=.47) or with the DA (13 vs 15; P=.24). There was no significant association between participants who were less adherent with the DA (n=17) and their age (P=.06), experience with decision support tools (P=.51), or academic involvement with a university (P=.39). CONCLUSIONS DAs can significantly improve the adoption of complex Australian bowel cancer prevention guidelines. As screening and surveillance guidelines become increasingly complex and personalized, these tools will be crucial to help clinicians accurately determine the most appropriate recommendations for their patients. Additional research to understand why some practitioners perform worse with DAs is required. Further improvements in application usability may optimize guideline concordance further.
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Affiliation(s)
- Tsai-Wing Ow
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Olga Sukocheva
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Peter Bampton
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
| | - Guruparan Iyngkaran
- Department of Gastroenterology and Hepatology, Royal Melbourne Hospital, Melbourne, Australia
| | - Christopher K Rayner
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Edmund Tse
- Department of Gastroenterology and Hepatology, Royal Adelaide Hospital, Adelaide, Australia
- Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
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Choe L, Lau J, Fong SY, Chew E, Chow WM, Pang Y, Lim TZ, Chong CS, Chew MH, Foo FJ, Koh FHX, Wong ML, Koh GCH, Tan KK. Colorectal cancer patients advocating screening to their siblings: a randomized behavioral intervention. Gastrointest Endosc 2022; 95:519-526.e2. [PMID: 34896444 DOI: 10.1016/j.gie.2021.11.042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 11/20/2021] [Indexed: 02/08/2023]
Abstract
BACKGROUND AND AIMS Siblings of colorectal cancer (CRC) patients are at increased risk of developing CRC, but screening rates remain low. Through a randomized behavioral intervention, this study aimed to determine whether patients can advocate screening to their siblings using a tailored educational package. METHODS CRC survivors were recruited and randomized into relaying either tailored materials (intervention group) or existing national screening guidelines (control group) to their siblings. Siblings could respond to the study team if they were interested in learning about CRC screening. Study outcomes were patient advocacy rates (number of patients who had successfully contacted at least 1 eligible sibling) between groups and the proportion of eligible siblings who responded. RESULTS Between May 2017 and March 2021, 219 CRC patients were randomized to the intervention (n = 110) and control (n = 109) groups. Patient advocacy rates were high and did not differ significantly between groups. However, only 14.3% of eligible siblings (n = 85) responded to the study team. Siblings of patients from the intervention group were more likely to respond (adjusted odds ratio, 1.8; 95% confidence interval, 1.1-3.0; P < .05). Moreover, after controlling for potential confounders, siblings aged ≥60 years were significantly less likely to respond (adjusted odds ratio, .3; 95% confidence interval, .1-.7; P < .01). CONCLUSIONS CRC patients are willing advocates of screening, and siblings contacted by patients from the intervention group were also more likely to reach out to the study team. However, overall sibling response rates were low despite advocacy, suggesting that patient-led advocacy should at best be used as an adjunct to other, multipronged CRC screening promotion modalities.
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Affiliation(s)
- Lina Choe
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Jerrald Lau
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Si-Ying Fong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Emily Chew
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen-Min Chow
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Yan Pang
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Tian-Zhi Lim
- Division of Surgical Oncology, National University Cancer Institute, Singapore
| | - Choon-Seng Chong
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Surgical Oncology, National University Cancer Institute, Singapore; University Surgical Cluster, National University Health System, Singapore
| | - Min-Hoe Chew
- Department of Colorectal Surgery, Division of General Surgery, Sengkang General Hospital, Singapore
| | - Fung-Joon Foo
- Department of Colorectal Surgery, Division of General Surgery, Sengkang General Hospital, Singapore
| | - Frederick Hong-Xiang Koh
- Department of Colorectal Surgery, Division of General Surgery, Sengkang General Hospital, Singapore
| | - Mee-Lian Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | | | - Ker-Kan Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Division of Surgical Oncology, National University Cancer Institute, Singapore; University Surgical Cluster, National University Health System, Singapore
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Carroll JC, Permaul JA, Semotiuk K, Yung EM, Blaine S, Dicks E, Warner E, Rothenmund H, Esplen MJ, Moineddin R, McLaughlin J. Hereditary colorectal cancer screening: A 10-year longitudinal cohort study following an educational intervention. Prev Med Rep 2020; 20:101189. [PMID: 33117641 PMCID: PMC7581973 DOI: 10.1016/j.pmedr.2020.101189] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2020] [Revised: 07/23/2020] [Accepted: 08/23/2020] [Indexed: 01/08/2023] Open
Abstract
Family history (FH) of a first-degree relative with colorectal cancer (CRC) is associated with two to fourfold increased risk, yet screening uptake is suboptimal despite proven mortality reduction. We developed a FH-based CRC Risk Triage/Management tool for family physicians (FPs), and educational booklet for patients with CRC FH. This report describes physician referral and patient screening behavior 5 and 10 years post-educational intervention, and factors associated with screening. Longitudinal cohort study. FPs/patients in Ontario and Newfoundland, Canada were sent questionnaires at baseline (2005), 5 and 10 years (2015) following tool/booklet receipt. FPs were asked about CRC screening, patients about FH, screening type and timing. "Correct" screening was concordance with tool recommendations. Results reported for 29/121 (24%) FPs and 98/297 (33%) patients who completed all 3 questionnaires. Over 10 years 2/3 patients received the correct CRC screening test at appropriate timing (baseline 75%, 5-year 62%, 10-year 65%). About half reported their FP recommended CRC screening (5-year 51%, 10-year 63%). Fewer than half the patients correctly assessed their CRC risk (44%, 40%, 41%). Patients were less likely to have correct screening timing if female (RR 0.78; 95% CI 0.61, 0.99; p = 0.045). Patients were less likely to have both correct test and timing if moderate/high CRC risk (RR 0.66; 95% CI 0.47, 0.93; p = 0.017) and more likely if their physician recommended screening (RR1.69; 95% CI 1.15, 2.49; p = 0.007). Physician discussion of CRC risk and screening can positively impact patient screening behavior. Efforts are particularly needed for women and patients at moderate/high CRC risk.
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Affiliation(s)
- June C. Carroll
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Joanne A. Permaul
- Ray D. Wolfe Department of Family Medicine, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Kara Semotiuk
- Zane Cohen Centre for Digestive Diseases, Mount Sinai Hospital, Sinai Health System, Toronto, Ontario, Canada
| | - Eric M. Yung
- Department of Anesthesia, University of Toronto, Toronto, Ontario, Canada
| | - Sean Blaine
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Elizabeth Dicks
- Craig L. Dobbin Centre for Genetics Research, Memorial University of Newfoundland, St. John’s, Newfoundland, Canada
| | - Ellen Warner
- Odette Cancer Centre, Sunnybrook Health Sciences Centre, Toronto, Ontario, Canada
- Department of Medicine, University of Toronto, Toronto, Ontario, Canada
| | | | - Mary Jane Esplen
- Department of Psychiatry, University of Toronto, Toronto, Ontario, Canada
| | - Rahim Moineddin
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - John McLaughlin
- Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
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Tan KK, Lim TZ, Chew E, Chow WM, Koh GCH. Colorectal cancer patients can be advocates for colorectal cancer screening for their siblings: A study on siblings' perspectives. Psychooncology 2020; 29:2028-2032. [PMID: 32715510 DOI: 10.1002/pon.5496] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2020] [Revised: 07/06/2020] [Accepted: 07/22/2020] [Indexed: 02/06/2023]
Abstract
OBJECTIVE This study was performed to explore in-depth, the issues and barriers pertaining to colorectal cancer (CRC) screening amongst the siblings of CRC patients in view of their higher risk of developing CRC. METHODS A qualitative study of siblings of CRC patients was performed from August 2017 to October 2018. Semi-structured interviewed were performed until data saturation was achieved. The data was then thematically analysed. RESULTS A total of 36 siblings of CRC patients, with a median age of 59 (range 39-78) years old completed the interviews. All the interviews were conducted alone with the participants. Each interview lasted between 30 and 45 minutes. None of the participants has undergone screening colonoscopy prior to the interviews. After thematic analysis, five themes were identified. These include: (i) Misunderstanding their own risk of developing colorectal cancer; (ii) Misperceptions of the role of "screening" for colorectal cancer.; (iii) Misconception of the CRC screening modality for FDRs; (iv) Barriers and facilitators of undergoing screening; (v) Misperceptions of national healthcare policies. CONCLUSIONS Identifying and addressing the identified barriers for these siblings to undergo screening colonoscopy is easily attainable. A multi-pronged approach should also be adopted to address the various concerns so as to reduce the incidence of CRC amongst these higher risk individuals.
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Affiliation(s)
- Ker-Kan Tan
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.,Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Tian-Zhi Lim
- Division of Colorectal Surgery, University Surgical Cluster, National University Health System, Singapore, Singapore
| | - Emily Chew
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Wen-Min Chow
- Department of Surgery, Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gerald Choon-Huat Koh
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore, Singapore
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Reeves P, Doran C, Carey M, Cameron E, Sanson-Fisher R, Macrae F, Hill D. Costs and Cost-Effectiveness of Targeted, Personalized Risk Information to Increase Appropriate Screening by First-Degree Relatives of People With Colorectal Cancer. HEALTH EDUCATION & BEHAVIOR 2019; 46:798-808. [PMID: 30857431 DOI: 10.1177/1090198119835294] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background. Economic evaluations are less commonly applied to implementation interventions compared to clinical interventions. The efficacy of an implementation strategy to improve adherence to screening guidelines among first-degree relatives of people with colorectal cancer was recently evaluated in a randomized-controlled trial. Using these trial data, we examined the costs and cost-effectiveness of the intervention from societal and health care funder perspectives. Method. In this prospective, trial-based evaluation, mean costs, and outcomes were calculated. The primary outcome of the trial was the proportion of participants who had screening tests in the year following the intervention commensurate with their risk category. Quality-adjusted life years were included as secondary outcomes. Intervention costs were determined from trial records. Standard Australian unit costs for 2016/2017 were applied. Cost-effectiveness was assessed using the net benefit framework. Nonparametric bootstrapping was used to calculate uncertainty intervals (UIs) around the costs and the incremental net monetary benefit statistic. Results. Compared with usual care, mean health sector costs were $17 (95% UI [$14, $24]) higher for those receiving the intervention. The incremental cost-effectiveness ratio for the primary trial outcome was calculated to be $258 (95% UI [$184, $441]) per additional person appropriately screened. The significant difference in adherence to screening guidelines between the usual care and intervention groups did not translate into a mean quality-adjusted life year difference. Discussion. Providing information on both the costs and outcomes of implementation interventions is important to inform public health care investment decisions. Challenges in the application of cost-utility analysis hampered the interpretation of results and potentially underestimated the value of the intervention. Further research in the form of a modeled extrapolation of the intermediate increased adherence effect and distributional cost-effectiveness to include equity requirements is warranted.
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Affiliation(s)
- Penny Reeves
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia
| | | | - Mariko Carey
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia
| | - Emilie Cameron
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia
| | - Robert Sanson-Fisher
- Hunter Medical Research Institute, New Lambton, New South Wales, Australia.,University of Newcastle, Callaghan, New South Wales, Australia
| | - Finlay Macrae
- University of Melbourne, Carlton, Victoria, Australia.,The Royal Melbourne Hospital, Melbourne, Victoria, Australia
| | - David Hill
- University of Melbourne, Carlton, Victoria, Australia.,Cancer Council Victoria, Carlton, Victoria, Australia
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