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Acuti Martellucci C, Giacomini G, Flacco ME, Manzoli L, Morettini M, Martellucci M, Rosati S, Bizzarri S, Palmer M, Pascucci L, Uncini M, Pasqualini F. Effectiveness of tailored talks between a cancer screening specialist and general practitioners to improve the uptake of colorectal cancer screening in Ancona (Italy) during the pandemic period. Eur J Gen Pract 2024; 30:2340672. [PMID: 38618885 PMCID: PMC11020593 DOI: 10.1080/13814788.2024.2340672] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2023] [Accepted: 04/02/2024] [Indexed: 04/16/2024] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening uptake in many countries has been low and further impacted by the COVID-19 pandemic. General Practitioners (GPs) are key facilitators, however research on their impact on organised CRC screening is still limited. OBJECTIVES To evaluate the effectiveness of tailored talks with GPs to increase population uptake of the long-established CRC screening programme in Ancona province, Italy. METHODS In this prospective cohort study, one-to-one tailored talks were organised in January 2020 between the GPs of one county of the province (with GPs from other counties as controls) and the screening programme physician-in-chief to discuss the deployment and effectiveness of organised screening. Data was extracted from the National Healthcare System datasets and linear regression was used to assess the potential predictors of CRC screening uptake. RESULTS The mean CRC screening uptake remained stable from 39.9% in 2018-19 to 40.8% in 2020-21 in the 22 GPs of the intervention county, whereas it statistically significantly decreased from 38.7% to 34.7% in the 232 control GPs. In multivariate analyses, belonging to the intervention county was associated with an improved uptake compared to the control counties (+5.1%; 95% Confidence Intervals - CI: 2.0%; 8.1%). CONCLUSION Persons cared for by GPs who received a tailored talk with a cancer screening specialist avoided a drop in CRC screening adherence, which characterised all other Italian screening programmes during the COVID-19 emergency. If future randomised trials confirm the impact of tailored talks, they may be incorporated into existing strategies to improve population CRC screening uptake.
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Affiliation(s)
| | - Giusi Giacomini
- Oncologic Screening Unit, Ancona Healthcare Agency, Ancona, Italy
| | - Maria Elena Flacco
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Lamberto Manzoli
- Department of Medicine and Surgery, University of Bologna, Bologna, Italy
| | | | - Mosè Martellucci
- Department of Environmental and Prevention Sciences, University of Ferrara, Ferrara, Italy
| | - Sara Rosati
- Department of Biomedical Sciences and Public Health, University of the Marche Region, Ancona, Italy
| | - Silvia Bizzarri
- Department of Biomedical Sciences and Public Health, University of the Marche Region, Ancona, Italy
| | - Matthew Palmer
- The Daffodil Centre, University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, Australia
- Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Australia
| | - Lidia Pascucci
- Department of Biomedical Sciences and Public Health, University of the Marche Region, Ancona, Italy
| | - Marco Uncini
- Department of Biomedical Sciences and Public Health, University of the Marche Region, Ancona, Italy
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Verbunt EJ, Newman G, Creagh NS, Milley KM, Emery JD, Kelaher MA, Rankin NM, Nightingale CE. Primary care practice-based interventions and their effect on participation in population-based cancer screening programs: a systematic narrative review. Prim Health Care Res Dev 2024; 25:e12. [PMID: 38345096 PMCID: PMC10894721 DOI: 10.1017/s1463423623000713] [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: 02/15/2024] Open
Abstract
AIM To provide a systematic synthesis of primary care practice-based interventions and their effect on participation in population-based cancer screening programs. BACKGROUND Globally, population-based cancer screening programs (bowel, breast, and cervical) have sub-optimal participation rates. Primary healthcare workers (PHCWs) have an important role in facilitating a patient's decision to screen; however, barriers exist to their engagement. It remains unclear how to best optimize the role of PHCWs to increase screening participation. METHODS A comprehensive search was conducted from January 2010 until November 2023 in the following databases: Medline (OVID), EMBASE, and CINAHL. Data extraction, quality assessment, and synthesis were conducted. Studies were separated by whether they assessed the effect of a single-component or multi-component intervention and study type. FINDINGS Forty-nine studies were identified, of which 36 originated from the USA. Fifteen studies were investigations of single-component interventions, and 34 studies were of multi-component interventions. Interventions with a positive effect on screening participation were predominantly multi-component, and most included combinations of audit and feedback, provider reminders, practice-facilitated assessment and improvement, and patient education across all screening programs. Regarding bowel screening, provision of screening kits at point-of-care was an effective strategy to increase participation. Taking a 'whole-of-practice approach' and identifying a 'practice champion' were found to be contextual factors of effective interventions.The findings suggest that complex interventions comprised of practitioner-focused and patient-focused components are required to increase cancer screening participation in primary care settings. This study provides novel understanding as to what components and contextual factors should be included in primary care practice-based interventions.
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Affiliation(s)
- Ebony J Verbunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Grace Newman
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nicola S Creagh
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Kristi M Milley
- Centre for Cancer Research and Department of General Practice, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Jon D Emery
- Centre for Cancer Research and Department of General Practice, Victorian Comprehensive Cancer Centre, University of Melbourne, Melbourne, VIC, Australia
| | - Margaret A Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Nicole M Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
| | - Claire E Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC, Australia
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Alam Z, Cairns JM, Scott M, Dean JA, Janda M. Interventions to increase cervical screening uptake among immigrant women: A systematic review and meta-analysis. PLoS One 2023; 18:e0281976. [PMID: 37267330 DOI: 10.1371/journal.pone.0281976] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/05/2023] [Indexed: 06/04/2023] Open
Abstract
Numerous intervention studies have attempted to increase cervical screening uptake among immigrant women, nonetheless their screening participation remains low. This systematic review and meta-analysis aimed to summarise the evidence on interventions to improve cervical screening among immigrant women globally and identify their effectiveness. Databases PubMed, EMBASE, Scopus, PsycINFO, ERIC, CINAHL and CENTRAL were systematically searched from inception to October 12, 2021, for intervention studies, including randomised and clinical controlled trials (RCT, CCT) and one and two group pre-post studies. Peer-reviewed studies involving immigrant and refugee women, in community and clinical settings, were eligible. Comparator interventions were usual or minimal care or attention control. Data extraction, quality appraisal and risk of bias were assessed by two authors independently using COVIDENCE software. Narrative synthesis of findings was carried out, with the main outcome measure defined as the cervical screening uptake rate difference pre- and post-intervention followed by random effects meta-analysis of trials and two group pre-post studies, using Comprehensive Meta-Analysis software, to calculate pooled rate ratios and adjustment for publication bias, where found. The protocol followed PRISMA guidelines and was registered prospectively with PROSPERO (CRD42020192341). 1,900 studies were identified, of which 42 (21 RCTS, 4 CCTs, and 16 pre-post studies) with 44,224 participants, were included in the systematic review, and 28 with 35,495 participants in the meta-analysis. Overall, the uptake difference rate for interventions ranged from -6.7 to 96%. Meta-analysis demonstrated a pooled rate ratio of 1.15 (95% CI 1.03-1.29), with high heterogeneity. Culturally sensitive, multicomponent interventions, using different modes of information delivery and self-sampling modality were most promising. Interventions led to at least 15% increase in cervical screening participation among immigrant women. Interventions designed to overcome logistical barriers and use multiple channels to communicate culturally appropriate health promotion messages are most effective at achieving cervical screening uptake among immigrant women.
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Affiliation(s)
- Zufishan Alam
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | | | - Marissa Scott
- School of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Judith Ann Dean
- School of Public Health, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
| | - Monika Janda
- Centre for Health Services Research, Faculty of Medicine, The University of Queensland, Brisbane, Queensland, Australia
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Oldfield LE, Jones V, Gill B, Kodous N, Fazelzad R, Rodin D, Sandhu H, Umakanthan B, Papadakos J, Giuliani ME. Synthesis of Existent Oncology Curricula for Primary Care Providers: A Scoping Review With a Global Equity Lens. JCO Glob Oncol 2023; 9:e2200298. [PMID: 37141562 DOI: 10.1200/go.22.00298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/06/2023] Open
Abstract
PURPOSE Global increases in cancer, coupled with a shortage of cancer specialists, has led to an increasing role for primary care providers (PCP) in cancer care. This review aimed to examine all extant cancer curricula for PCPs and to analyze the motivations for curriculum development. METHODS A comprehensive literature search was conducted from inception to October 13, 2021, with no language restrictions. The initial search yielded 11,162 articles and 10,902 articles underwent title and abstract review. After full-text review, 139 articles were included. Numeric and thematic analyses were conducted and education programs were evaluated using Bloom's taxonomy. RESULTS Most curricula were developed in high-income countries (HICs), with 58% in the United States. Cancer-specific curricula focused on HIC priority cancers, such as skin/melanoma, and did not represent the global cancer burden. Most (80%) curricula were developed for staff physicians and 73% focused on cancer screening. More than half (57%) of programs were delivered in person, with a shift toward online delivery over time. Less than half (46%) of programs were codeveloped with PCPs and 34% did not involve PCPs in the program design and development. Curricula were primarily developed to improve cancer knowledge, and 72 studies assessed multiple outcome measures. No studies included the top two levels of Bloom's taxonomy of learning (evaluating; creating). CONCLUSION To our knowledge, this is the first review to assess the current state of cancer curricula for PCPs with a global focus. This review shows that extant curricula are primarily developed in HICs, do not represent the global cancer burden, and focus on cancer screening. This review lays a foundation to advance the cocreation of curricula that are aligned to the global cancer burden.
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Affiliation(s)
| | - Vivien Jones
- Royal College of Surgeons in Ireland, Dublin, Ireland
| | - Bhajan Gill
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Nardeen Kodous
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Rouhi Fazelzad
- Library and Information Services, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Danielle Rodin
- Royal College of Surgeons in Ireland, Dublin, Ireland
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | | | - Ben Umakanthan
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
| | - Janet Papadakos
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
- The Institute for Education Research, University Health Network, Toronto, ON, Canada
| | - Meredith Elana Giuliani
- Cancer Education, Princess Margaret Cancer Centre, Toronto, ON, Canada
- Radiation Medicine Program, Princess Margaret Cancer Centre, Toronto, ON, Canada
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Borderiou A, Astruc A, Saab E, Chevallier F. [Can computer alerts in general practitioners' software upgrade cancer screening participation? A monocentric randomized study in France]. Bull Cancer 2023; 110:254-264. [PMID: 36707256 DOI: 10.1016/j.bulcan.2022.11.014] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 10/20/2022] [Accepted: 11/22/2022] [Indexed: 01/27/2023]
Abstract
Colorectal cancer is the third most common cancer in France, and the second regarding mortality with almost 17,100 deaths each year. When screened at an early stage, the five-year survival is around 90 %. Since 2008, a screening program has been introduced in France with the fecal occult blood test. Ten years later, the targeted participation for the screening program is at least 45 % when the actual French average participation is around 30,2 %. We tried to find an efficient way to help general practitioners to recognise patients that did not do the test with a pop-up alert in their informatics files. We built our prospective study in a health center in Val d'Oise (France). We randomized 2230 patients in two equal groups, one control at one with the alert in files. We controlled the patients' status each month for 6 months. At the end of study, 152 (13,6 %) patients did the test in the control group and 179 (16 %) in the intervention group. In intention to treat, we found no difference between the two groups (P=0.11). Multivariate analysis proved that consulting their general practitioner enhanced participation (P=0.02). We showed the positive influence of a consultation with the general practitioner who can improve participation for this screening program. Our study was certainly too short in time and with a too small sample to prove a significant difference, and more investigation could confirm our hypothesis.
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Affiliation(s)
| | - Alexis Astruc
- UFR SMBH, 74, rue Marcel-Cachin, 93017 Bobigny, France
| | - Emmy Saab
- UFR SMBH, 74, rue Marcel-Cachin, 93017 Bobigny, France
| | - Frédéric Chevallier
- UFR SMBH, 74, rue Marcel-Cachin, 93017 Bobigny, France; SFMG, 141, avenue de Verdun, 92130 Issy-les-Moulineaux, France; MUSSP, 14, rue de la République, 95120 Ermont, France.
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Crespi CM, Ziehl K. Cluster-randomized trials of cancer screening interventions: Has use of appropriate statistical methods increased over time? Contemp Clin Trials 2022; 123:106974. [PMID: 36343881 DOI: 10.1016/j.cct.2022.106974] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2022] [Revised: 09/30/2022] [Accepted: 10/20/2022] [Indexed: 11/06/2022]
Abstract
BACKGROUND In a cluster randomized trial, groups of individuals (e.g., clinics, schools) are randomized to conditions. The design and analysis of cluster randomized trials can require more care than individually randomized trials. Past reviews have noted deficiencies in the use of appropriate statistical methods for such trials. METHODS We reviewed cluster randomized trials of cancer screening interventions published 1995-2019 to determine whether appropriate statistical methods had been used for sample size calculation and outcome analysis and whether they reported intraclass correlation coefficient (ICC) values. This work expanded a previous review of articles published 1995-2010. RESULTS Our search identified 88 articles published 1995-2020 that reported outcomes of cluster randomized trials of breast, cervix, and colorectal cancer screening interventions. There was increased reporting of the trials' sample size calculations over time, with the percentage increasing from 31% in 1995-2004 to 77% in 2014-2019. However, the percentage of calculations failing to account for cluster randomization did not change over time and was 17% of studies in 2014-2019. There was a nonsignificant trend towards increased use of outcome analysis methods that accounted for the cluster randomized design. However, in lower impact journals, use of appropriate analysis methods was only 80% in 2014-2019. Only 33% of studies reported ICC values in 2014-2019. CONCLUSION For cluster randomized trials with cancer screening outcomes, there have been improvements in the reporting of sample size calculations but methodological and reporting deficiencies persist. Efforts to disseminate, adopt and report the use of appropriate statistical methodologies are still needed.
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Affiliation(s)
- Catherine M Crespi
- Department of Biostatistics, University of California, Los Angeles, School of Public Health, Center for the Health Sciences 51-254, Box 951772, Los Angeles, CA 90095-1772, United States.
| | - Kevin Ziehl
- Department of Biostatistics, University of California, Los Angeles, School of Public Health, Center for the Health Sciences 51-254, Box 951772, Los Angeles, CA 90095-1772, United States
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Aujoulat P, Le Goff D, Dany A, Robaskiewick M, Nousbaum JB, Derrienic J, Cariou M, Guillou M, Le Reste JY. Improvement of participation rate in colorectal cancer (CRC) screening by training general practitioners in motivational interviewing (AmDepCCR). Trials 2022; 23:144. [PMID: 35164836 PMCID: PMC8842548 DOI: 10.1186/s13063-022-06056-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2021] [Accepted: 01/27/2022] [Indexed: 11/22/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second leading cause of cancer death in France (17,712 annual deaths). However, this cancer is preventable in the majority of cases by the early detection of adenomas. In France, the organized screening for CRC relies on general practitioners (GPs). The tests delivered by the GPs are carried out in 89% of cases. However, GPs do not systematically offer the test, because of time management and communication. Methods AmDepCCR is a cluster randomized trial. Patients are prospectively included by their GPs. The study is designed in 2 phases for the GPs: first, GPs who have never participated in motivational interviewing (MI) training will be recruited then randomly split in 2 groups. Secondly, a 6-day motivational interviewing training will be carried out for the intervention group. Then, patients will be included in both groups during a period of 1 year. The primary outcome will be the number of CRC screenings achieved in each group and its difference. The secondary outcome will be the reluctance to screening and the patient’s self-estimated life expectancy at 0, 6, 12, and 24 months using the Health Belief Model (HBM). Discussion This study will help to know if GPs motivational interviewing is useful to improve organized CRC screening. In addition, it may help to improve communication between patients and GPs. GPs will be able to improve their practice in other fields of application through motivational interviewing (other screenings, addictions…). Trial registration 2019-A01776-51 NCT04492215. Supplementary Information The online version contains supplementary material available at 10.1186/s13063-022-06056-8.
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Forsetlund L, O'Brien MA, Forsén L, Reinar LM, Okwen MP, Horsley T, Rose CJ. Continuing education meetings and workshops: effects on professional practice and healthcare outcomes. Cochrane Database Syst Rev 2021; 9:CD003030. [PMID: 34523128 PMCID: PMC8441047 DOI: 10.1002/14651858.cd003030.pub3] [Citation(s) in RCA: 34] [Impact Index Per Article: 11.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Educational meetings are used widely by health personnel to provide continuing medical education and to promote implementation of innovations or translate new knowledge to change practice within healthcare systems. Previous reviews have concluded that educational meetings can result in small changes in behaviour, but that effects vary considerably. Investigations into which characteristics of educational meetings might lead to greater impact have yielded varying results, and factors that might explain heterogeneity in effects remain unclear. This is the second update of this Cochrane Review. OBJECTIVES • To assess the effects of educational meetings on professional practice and healthcare outcomes • To investigate factors that might explain the heterogeneity of these effects SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, ERIC, Science Citation Index Expanded (ISI Web of Knowledge), and Social Sciences Citation Index (last search in November 2016). SELECTION CRITERIA We sought randomised trials examining the effects of educational meetings on professional practice and patient outcomes. DATA COLLECTION AND ANALYSIS Two review authors independently extracted data and assessed risk of bias. One review author assessed the certainty of evidence (GRADE) and discussed with a second review author. We included studies in the primary analysis that reported baseline data and that we judged to be at low or unclear risk of bias. For each comparison of dichotomous outcomes, we measured treatment effect as risk difference adjusted for baseline compliance. We expressed adjusted risk difference values as percentages, and we noted that values greater than zero favour educational meetings. For continuous outcomes, we measured treatment effect as per cent change relative to the control group mean post test, adjusted for baseline performance; we expressed values as percentages and noted that values greater than zero favour educational meetings. We report means and 95% confidence intervals (CIs) and, when appropriate, medians and interquartile ranges to facilitate comparisons to previous versions of this review. We analysed professional and patient outcomes separately and analysed 22 variables that were hypothesised a priori to explain heterogeneity. We explored heterogeneity by using univariate meta-regression and by inspecting violin plots. MAIN RESULTS We included 215 studies involving more than 28,167 health professionals, including 142 new studies for this update. Educational meetings as the single intervention or the main component of a multi-faceted intervention compared with no intervention • Probably slightly improve compliance with desired practice when compared with no intervention (65 comparisons, 7868 health professionals for dichotomous outcomes (adjusted risk difference 6.79%, 95% CI 6.62% to 6.97%; median 4.00%; interquartile range 0.29% to 13.00%); 28 comparisons, 2577 health professionals for continuous outcomes (adjusted relative percentage change 44.36%, 95% CI 41.98% to 46.75%; median 20.00%; interquartile range 6.00% to 65.00%)) • Probably slightly improve patient outcomes compared with no intervention (15 comparisons, 2530 health professionals for dichotomous outcomes (adjusted risk difference 3.30%, 95% CI 3.10% to 3.51%; median 0.10%; interquartile range 0.00% to 4.00%); 28 comparisons, 2294 health professionals for continuous outcomes (adjusted relative percentage change 8.35%, 95% CI 7.46% to 9.24%; median 2.00%; interquartile range -1.00% to 21.00%)) The certainty of evidence for this comparison is moderate. Educational meetings alone compared with other interventions • May improve compliance with desired practice when compared with other interventions (6 studies, 1402 health professionals for dichotomous outcomes (adjusted risk difference 9.99%, 95% CI 9.47% to 10.52%; median 16.5%; interquartile range 0.80% to 16.50%); 2 studies, 72 health professionals for continuous outcomes (adjusted relative percentage change 12.00%, 95% CI 9.16% to 14.84%; median 12.00%; interquartile range 0.00% to 24.00%)) No studies met the inclusion criteria for patient outcome measurements. The certainty of evidence for this comparison is low. Interactive educational meetings compared with didactic (lecture-based) educational meetings • We are uncertain of effects on compliance with desired practice (3 studies, 370 health professionals for dichotomous outcomes; 1 study, 192 health professionals for continuous outcomes) or on patient outcomes (1 study, 54 health professionals for continuous outcomes), as the certainty of evidence is very low Any other comparison of different formats and durations of educational meetings • We are uncertain of effects on compliance with desired practice (1 study, 19 health professionals for dichotomous outcomes; 1 study, 20 health professionals for continuous outcomes) or on patient outcomes (1 study, 113 health professionals for continuous outcomes), as the certainty of evidence is very low. Factors that might explain heterogeneity of effects Meta-regression suggests that larger estimates of effect are associated with studies judged to be at high risk of bias, with studies that had unit of analysis errors, and with studies in which the unit of analysis was the provider rather than the patient. Improved compliance with desired practice may be associated with: shorter meetings; poor baseline compliance; better attendance; shorter follow-up; professionals provided with additional take-home material; explicit building of educational meetings on theory; targeting of low- versus high-complexity behaviours; targeting of outcomes with high versus low importance; goal of increasing rather than decreasing behaviour; teaching by opinion leaders; and use of didactic versus interactive teaching methods. Pre-specified exploratory analyses of behaviour change techniques suggest that improved compliance with desired practice may be associated with use of a greater number of behaviour change techniques; goal-setting; provision of feedback; provision for social comparison; and provision for social support. Compliance may be decreased by the use of follow-up prompts, skills training, and barrier identification techniques. AUTHORS' CONCLUSIONS Compared with no intervention, educational meetings as the main component of an intervention probably slightly improve professional practice and, to a lesser extent, patient outcomes. Educational meetings may improve compliance with desired practice to a greater extent than other kinds of behaviour change interventions, such as text messages, fees, or office systems. Our findings suggest that multi-strategy approaches might positively influence the effects of educational meetings. Additional trials of educational meetings compared with no intervention are unlikely to change the review findings; therefore we will not further update this review comparison in the future. However, we note that randomised trials comparing different types of education are needed.
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Affiliation(s)
| | - Mary Ann O'Brien
- Department of Family and Community Medicine, University of Toronto, Toronto, Canada
| | - Lisa Forsén
- Norwegian Institute of Public Health, Oslo, Norway
| | | | - Mbah P Okwen
- Centre for the Development of Best Practices in Health (CDBPH), Yaoundé Central Hospital, Yaoundé, Cameroon
| | - Tanya Horsley
- Research Unit, Royal College of Physicians and Surgeons of Canada, Ottawa, Canada
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Holden CA, Frank O, Caruso J, Turnbull D, Reed RL, Miller CL, Olver I. From participation to diagnostic assessment: a systematic scoping review of the role of the primary healthcare sector in the National Bowel Cancer Screening Program. Aust J Prim Health 2021; 26:191-206. [PMID: 32536362 DOI: 10.1071/py19181] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2019] [Accepted: 01/07/2020] [Indexed: 12/19/2022]
Abstract
Primary health care (PHC) plays a vital support role in organised colorectal cancer (CRC) screening programs by encouraging patient participation and ensuring timely referral for diagnostic assessment follow up. A systematic scoping review of the current evidence was conducted to inform strategies that better engage the PHC sector in organised CRC screening programs. Articles published from 2005 to November 2019 were searched across five databases. Evidence was synthesised and interventions that specifically require PHC involvement were mapped to stages of the CRC screening pathway. Fifty-seven unique studies were identified in which patient, provider and system-level interventions align with defined stages of the CRC screening pathway: namely, identifying/reminding patients who have not responded to CRC screening (non-adherence) (n=46) and follow up of a positive screen referral (n=11). Self-management support initiatives (patient level) and improvement initiatives (system level) demonstrate consistent benefits along the CRC screening pathway. Interventions evaluated as part of a quality-improvement process tended to report effectiveness; however, the variation in reporting makes it difficult to determine which elements contributed to the overall study outcomes. To maximise the benefits of population-based screening programs, better integration into existing primary care services can be achieved through targeting preventive and quality care interventions along the entire screening pathway.
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Affiliation(s)
- Carol A Holden
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia; and Corresponding author.
| | - Oliver Frank
- Discipline of General Practice, University of Adelaide, Helen Mayo North, Frome Road, Adelaide, SA 5005, Australia
| | - Joanna Caruso
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia
| | - Deborah Turnbull
- School of Psychology, University of Adelaide, Level 7, Hughes Building, North Terrace Campus, Adelaide, SA 5000, Australia
| | - Richard L Reed
- College of Medicine and Public Health, Flinders University, GPO Box 2100, Adelaide, SA 5001, Australia
| | - Caroline L Miller
- South Australian Health and Medical Research Institute, PO Box 11060, Adelaide, SA 5001, Australia; and School of Public Health, University of Adelaide, 57 North Terrace, Adelaide, SA 5000, Australia
| | - Ian Olver
- School of Psychology, University of Adelaide, Level 7, Hughes Building, North Terrace Campus, Adelaide, SA 5000, Australia
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Haverfield MC, Tierney A, Schwartz R, Bass MB, Brown-Johnson C, Zionts DL, Safaeinili N, Fischer M, Shaw JG, Thadaney S, Piccininni G, Lorenz KA, Asch SM, Verghese A, Zulman DM. Can Patient-Provider Interpersonal Interventions Achieve the Quadruple Aim of Healthcare? A Systematic Review. J Gen Intern Med 2020; 35:2107-2117. [PMID: 31919725 PMCID: PMC7351919 DOI: 10.1007/s11606-019-05525-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Revised: 10/16/2019] [Accepted: 10/25/2019] [Indexed: 12/30/2022]
Abstract
BACKGROUND Human connection is at the heart of medical care, but questions remain as to the effectiveness of interpersonal interventions. The purpose of this review was to characterize the associations between patient-provider interpersonal interventions and the quadruple aim outcomes (population health, patient experience, cost, and provider experience). METHODS We sourced data from PubMed, EMBASE, and PsycInfo (January 1997-August 2017). Selected studies included randomized controlled trials and controlled observational studies that examined the association between patient-provider interpersonal interventions and at least one outcome measure of the quadruple aim. Two abstractors independently extracted information about study design, methods, and quality. We characterized evidence related to the objective of the intervention, type and duration of intervention training, target recipient (provider-only vs. provider-patient dyad), and quadruple aim outcomes. RESULTS Seventy-three out of 21,835 studies met the design and outcome inclusion criteria. The methodological quality of research was moderate to high for most included studies; 67% of interventions targeted the provider. Most studies measured impact on patient experience; improvements in experience (e.g., satisfaction, patient-centeredness, reduced unmet needs) often corresponded with a positive impact on other patient health outcomes (e.g., quality of life, depression, adherence). Enhanced interpersonal interactions improved provider well-being, burnout, stress, and confidence in communicating with difficult patients. Roughly a quarter of studies evaluated cost, but the majority reported no significant differences between intervention and control groups. Among studies that measured time in the clinical encounter, intervention effects varied. Interventions with lower demands on provider time and effort were often as effective as those with higher demands. DISCUSSION Simple, low-demand patient-provider interpersonal interventions may have the potential to improve patient health and patient and provider experience, but there is limited evidence that these interventions influence cost-related outcomes.
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Affiliation(s)
- Marie C Haverfield
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA. .,Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Research and Policy (CHRP), Stanford, CA, USA.
| | - Aaron Tierney
- School of Medicine, Stanford University, Stanford, CA, USA
| | - Rachel Schwartz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Stanford University Center for Primary Care and Outcomes Research (PCOR) and Center for Health Research and Policy (CHRP), Stanford, CA, USA
| | | | - Cati Brown-Johnson
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Dani L Zionts
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Nadia Safaeinili
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Meredith Fischer
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Jonathan G Shaw
- Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Sonoo Thadaney
- School of Medicine, Stanford University, Stanford, CA, USA
| | | | - Karl A Lorenz
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | - Steven M Asch
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
| | | | - Donna M Zulman
- Center for Innovation to Implementation (Ci2i), VA Palo Alto Health Care System (152-MPD), Menlo Park, CA, USA.,Division of Primary Care and Population Health, Stanford University School of Medicine, Stanford, CA, USA
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11
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Dawidowicz S, Le Breton J, Moscova L, Renard V, Bercier S, Brixi Z, Audureau E, Clerc P, Bastuji-Garin S, Ferrat E. Predictive factors for non-participation or partial participation in breast, cervical and colorectal cancer screening programmes†. Fam Pract 2020; 37:15-24. [PMID: 31305884 DOI: 10.1093/fampra/cmz031] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND No study has investigated factors associated with non-participation or partial participation in the different combination patterns of screening programmes for all three cancers, that is, breast, colorectal and cervical cancer. METHODS In a retrospective cohort study, we sought to describe combinations of cancer screening participation rates among women in the Val-de-Marne area of France and to identify individual and contextual factors associated with non-participation or partial participation. RESULTS Women aged between 50 and 65 and who were eligible for all three screening programmes (n = 102 219) were analysed in multilevel logistic models, with the individual as the Level 1 variable and the place of residence as the Level 2 variable. The women who did not participate in any of the screening programmes were 34.4%, whereas 30.1%, 24% and 11.5% participated in one, two or all three screening programmes, respectively. Age below 55, a previous false-positive mammography, prior opportunistic mammography only, no previous mammography, membership of certain health insurance schemes (all P < 0.05) and residence in a deprived area (P < 0.001) were independently associated with non-participation or partial participation. We observed a stronger effect of deprivation on non-participation in all three cancers than in combinations of screening programmes. CONCLUSION Our findings suggest that the health authorities should focus on improving cancer screenings in general rather than screenings for specific types of cancer, especially among younger women and those living in the most socially deprived areas.
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Affiliation(s)
- Sébastien Dawidowicz
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France.,Maison de Santé Pluri-professionnelle de Sucy-en-Brie, Sucy-en-Brie, France
| | - Julien Le Breton
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France.,DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Laura Moscova
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France
| | - Vincent Renard
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France.,DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France
| | - Sandrine Bercier
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France.,Association de Dépistage Organisé des Cancers dans le Val-de-Marne, ADOC, Joinville-le-Pont, France
| | - Zahida Brixi
- Association de Dépistage Organisé des Cancers dans le Val-de-Marne, ADOC, Joinville-le-Pont, France
| | - Etienne Audureau
- DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France.,Department of Public Health, Assistance Publique Hôpitaux de Paris (APHP), Henri Mondor Hospital, Créteil, France
| | - Pascal Clerc
- DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France.,Primary Care Department, School of Medicine, Université de Versailles, Versailles, France
| | - Sylvie Bastuji-Garin
- DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France.,Department of Public Health, Assistance Publique Hôpitaux de Paris (APHP), Henri Mondor Hospital, Créteil, France
| | - Emilie Ferrat
- Primary Care Department, School of Medicine, Université Paris-Est Créteil (UPEC), Créteil, France.,DHU A-TVB, IMRB, EA 7376 CEpiA (Clinical Epidemiology And Ageing Unit), Université Paris-Est Créteil (UPEC), Créteil, France
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12
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Bauer A, Riemann JF, Seufferlein T, Reinshagen M, Hollerbach S, Haug U, Unverzagt S, Boese S, Ritter-Herschbach M, Jahn P, Frese T, Harris M, Landenberger M. Invitation to Screening Colonoscopy in the Population at Familial Risk for Colorectal Cancer. DEUTSCHES ARZTEBLATT INTERNATIONAL 2019; 115:715-722. [PMID: 30518470 DOI: 10.3238/arztebl.2018.0715] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2018] [Revised: 01/19/2018] [Accepted: 05/30/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Screening colonoscopy can lower the incidence of colorectal cancer (CRC), yet participation rates are low even in groups at high risk. The goal of this study was to double the rate of participation in screening colonoscopy among persons at familial risk and then to determine the frequency of neoplasia in this risk group. METHODS In a nationwide, cluster-randomized, multicenter study, first-degree relatives (FDR) of patients with CRC across Germany received written informational materials concerning the familial risk of CRC, along with an invitation to undergo colonoscopy. Participants in the intervention group were additionally counseled by nurses over the telephone. The primary endpoint of the study was colonoscopy uptake within 30 days. RESULTS The participants' mean age was 50.8 years. The colonoscopy uptake rates were 99/125 (79%) in the intervention group and 97/136 (71%) in the control group (RR = 1.11; 95% confidence interval [0.97; 1.28]). A polypectomy was performed in 72 of 196 asymptomatic persons (37%). In 13 cases (7%), an advanced neoplasia was detected; two of these persons had colon cancer (stages T0 and T1). 42% of the participants expressed barriers against colonoscopy. 22 reported mild side effects; there were no serious side effects. CONCLUSION Additional counseling by nurses over the telephone does not increase the participation rate. Approaching patients who have CRC is an opportunity to increase the participation of their first-degree relatives in screening colonoscopy. The frequency of neoplasia that was found in this study underscores the need to screen relatives even before they reach the usual age threshold for screening.
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Affiliation(s)
- Alexander Bauer
- Institute for General Medicine, Faculty of Medicine, University of Halle-Wittenberg, Halle; Institute for Health and Nursing Sciences, Faculty of Medicine, University of Halle-Wittenberg, Halle; Director Emeritus, Department of Medicine C, Ludwigshafen Hospital, c/o LebensBlicke Foundation, Ludwigshafen; Department of Internal Medicine I, Ulm University Hospital, Ulm; Department of Medicine I, Braunschweig Municipal Hospital, Braunschweig; Department of Gastroenterology, Celle General Hospital, Celle; Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Bremen; Faculty of Human and Health Sciences, University of Bremen; Institute for Medical Epidemiology, Biometrics, and Information Science, Faculty of Medicine, University of Halle-Wittenberg, Halle; Nursing Research Unit, Halle University Hospital, Halle: Madeleine Ritter-Herschbach, MScN, RN; Department for Health, University of Bath, Claverton Down, Bath, UK
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13
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Delaney H, Devane D, Hunter A, Hennessy M, Parker A, Murphy L, Cronin P, Smith V. Limited evidence exists on the effectiveness of education and training interventions on trial recruitment; a systematic review. J Clin Epidemiol 2019; 113:75-82. [PMID: 31128220 DOI: 10.1016/j.jclinepi.2019.05.013] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2019] [Revised: 05/15/2019] [Accepted: 05/18/2019] [Indexed: 10/26/2022]
Abstract
OBJECTIVE The objective of this study was to examine the effectiveness of education and training interventions on recruitment to randomized and non-randomized trials. STUDY DESIGN AND SETTING A systematic review of the effectiveness of education and training interventions for recruiters to trials. The review included randomized and non-randomized controlled trials of any type of education and training intervention for recruiters to trials, within any health care field. The primary outcome was recruitment rates, and secondary outcomes were quality of informed consent, recruiter self-confidence, understanding/knowledge of trial information, numbers of potential trial participants approached, satisfaction with training, and retention rates. RESULTS Of the 19 records reviewed at full-text level, six met the inclusion criteria for our review. Owing to heterogeneity of outcomes and methods between the included studies, meta-analysis was not possible for the primary outcome. Of the three studies that reported recruitment rates, one favored the education and training intervention for increased recruitment; the remaining two found no differences between the groups. Of the reported secondary outcomes, quality of informed consent was improved, but no differences between groups in understanding/knowledge of trial information were found. CONCLUSION There is limited evidence of effectiveness on the impact of education and training interventions on trial recruitment. Further work on developing a substantial evidence base around the effectiveness of education and training interventions for recruiters to trials is required.
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Affiliation(s)
- Hannah Delaney
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), National University of Ireland Galway, Galway, Ireland; School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland; School of Nursing and Midwifery, University of Dublin Trinity College Dublin, Dublin, Ireland.
| | - Declan Devane
- Health Research Board-Trials Methodology Research Network (HRB-TMRN), National University of Ireland Galway, Galway, Ireland; School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Andrew Hunter
- School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland; Qualitative Research in Trials Centre (QUESTS), School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland
| | - Marita Hennessy
- Qualitative Research in Trials Centre (QUESTS), School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland; Health Behaviour Change Research Group, School of Psychology, National University of Ireland Galway, Galway, Ireland
| | - Adwoa Parker
- York Trials Unit, Department of Health Sciences, University of York, York, UK
| | - Louise Murphy
- Qualitative Research in Trials Centre (QUESTS), School of Nursing and Midwifery, National University of Ireland Galway, Galway, Ireland; Department of Nursing and Midwifery, University of Limerick, Limerick, Ireland
| | - Patricia Cronin
- School of Nursing and Midwifery, University of Dublin Trinity College Dublin, Dublin, Ireland
| | - Valerie Smith
- School of Nursing and Midwifery, University of Dublin Trinity College Dublin, Dublin, Ireland
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14
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[Cancer prevention and screening: What french GPs could do?]. Bull Cancer 2019; 106:707-713. [PMID: 30661748 DOI: 10.1016/j.bulcan.2018.11.015] [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] [Received: 10/18/2018] [Revised: 11/22/2018] [Accepted: 11/23/2018] [Indexed: 11/21/2022]
Abstract
An effective health system is based on effective primary care, at the center of which is family medicine. Cancer prevention and screening are integral aspects of general practitioners skills. Prevention is linked with the notion of risk. The relationship between the general practitioner and his or her patient reinforces the prevention of the development of preventable risk factors. It also strengthens information on intrinsic risk factors for patients. The protective factors highlighted by the general practitioner can thus reduce the risk a little more. Screening strategies differs across cancers and countries. In France, general practitioner's involvement is important for colorectal cancer screening. The active participation of their general practitioner, strengths patient's adherence and participation. Their role is to inform and collect data for breast cancer screening. Recently organized cervical cancer screening requires greater involvement of general practitioners who can act as both actors and informants. Family medicine is at the heart of cancer prevention and screening. It is a central hub for improving the health of patients in our healthcare system. The general practitioner knows the patient, which gives him an important advantage to accompany him in the prevention and screening of his risk factors.
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15
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Carlsson E, Pettersson ME. Communicative and pedagogical strategies in nurses' and surgeons' discharge consultations with patients undergoing surgery for colorectal cancer. J Adv Nurs 2018; 74:2840-2850. [PMID: 30019343 DOI: 10.1111/jan.13798] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2018] [Revised: 05/21/2018] [Accepted: 06/08/2018] [Indexed: 11/29/2022]
Abstract
AIM To describe the structure, content, and the communicative and pedagogic strategies in discharge consultations between patients and professionals after colorectal cancer surgery. BACKGROUND Both nurses and surgeons play an important role in preparing patients for discharge from hospital following surgery for colorectal cancer (CRC). DESIGN An explorative quantitative and qualitative research based on analysis of transcriptions of 13 audio-taped discharge consultations between patients and nurses and patients and surgeons conducted between January - March 2012. METHODS In the quantitative analysis, the structure of each consultation was described in phases, subtopics, and main topics. The proportion of the main topics in relation to the whole conversation was counted in percentages. The text from the consultations was then analysed qualitatively with the support from Ricoeur's theory of interpretation. RESULTS The language constituted the essence in the consultations regardless of other communicative and pedagogical strategies. The pedagogic strategies used were explanation model, information transfer, task orientation, and dialogue. Topics occurring in the consultations were Operation, Symptoms, Medication, Thromboprophylaxis, Recovery after surgery, Bowel function, Spreading, and Follow-up. The surgeons and nurses used similar topics, but the surgeons used more communicative and pedagogic strategies. CONCLUSION Language was fundamental for communication and independent of the communicative and pedagogical strategies. Using preparedness communication more consistent in discharge consultation can help patients to better understand the recovery process after CRC surgery and regain control over their life. It is important that the consultations build on the patient as an active and learning person.
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Affiliation(s)
- Eva Carlsson
- The Surgical Department, Sahlgrenska University Hospital/Östra, Göteborg, Sweden.,Institute of Health and Care Sciences, and Gothenburg Centre for Person-centred Care, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden
| | - Monica E Pettersson
- Institute of Health and Care Sciences, and Gothenburg Centre for Person-centred Care, Sahlgrenska Academy at the University of Gothenburg, Göteborg, Sweden.,The Vascular Department Sahlgrenska University Hospital/Sahlgrenska, Göteborg, Sweden
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16
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Moore PM, Rivera S, Bravo‐Soto GA, Olivares C, Lawrie TA. Communication skills training for healthcare professionals working with people who have cancer. Cochrane Database Syst Rev 2018; 7:CD003751. [PMID: 30039853 PMCID: PMC6513291 DOI: 10.1002/14651858.cd003751.pub4] [Citation(s) in RCA: 90] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022]
Abstract
BACKGROUND This is the third update of a review that was originally published in the Cochrane Library in 2002, Issue 2. People with cancer, their families and carers have a high prevalence of psychological stress, which may be minimised by effective communication and support from their attending healthcare professionals (HCPs). Research suggests communication skills do not reliably improve with experience, therefore, considerable effort is dedicated to courses that may improve communication skills for HCPs involved in cancer care. A variety of communication skills training (CST) courses are in practice. We conducted this review to determine whether CST works and which types of CST, if any, are the most effective. OBJECTIVES To assess whether communication skills training is effective in changing behaviour of HCPs working in cancer care and in improving HCP well-being, patient health status and satisfaction. SEARCH METHODS For this update, we searched the following electronic databases: Cochrane Central Register of Controlled Trials (CENTRAL; 2018, Issue 4), MEDLINE via Ovid, Embase via Ovid, PsycInfo and CINAHL up to May 2018. In addition, we searched the US National Library of Medicine Clinical Trial Registry and handsearched the reference lists of relevant articles and conference proceedings for additional studies. SELECTION CRITERIA The original review was a narrative review that included randomised controlled trials (RCTs) and controlled before-and-after studies. In updated versions, we limited our criteria to RCTs evaluating CST compared with no CST or other CST in HCPs working in cancer care. Primary outcomes were changes in HCP communication skills measured in interactions with real or simulated people with cancer or both, using objective scales. We excluded studies whose focus was communication skills in encounters related to informed consent for research. DATA COLLECTION AND ANALYSIS Two review authors independently assessed trials and extracted data to a pre-designed data collection form. We pooled data using the random-effects method. For continuous data, we used standardised mean differences (SMDs). MAIN RESULTS We included 17 RCTs conducted mainly in outpatient settings. Eleven trials compared CST with no CST intervention; three trials compared the effect of a follow-up CST intervention after initial CST training; two trials compared the effect of CST and patient coaching; and one trial compared two types of CST. The types of CST courses evaluated in these trials were diverse. Study participants included oncologists, residents, other doctors, nurses and a mixed team of HCPs. Overall, 1240 HCPs participated (612 doctors including 151 residents, 532 nurses, and 96 mixed HCPs).Ten trials contributed data to the meta-analyses. HCPs in the intervention groups were more likely to use open questions in the post-intervention interviews than the control group (SMD 0.25, 95% CI 0.02 to 0.48; P = 0.03, I² = 62%; 5 studies, 796 participant interviews; very low-certainty evidence); more likely to show empathy towards their patients (SMD 0.18, 95% CI 0.05 to 0.32; P = 0.008, I² = 0%; 6 studies, 844 participant interviews; moderate-certainty evidence), and less likely to give facts only (SMD -0.26, 95% CI -0.51 to -0.01; P = 0.05, I² = 68%; 5 studies, 780 participant interviews; low-certainty evidence). Evidence suggesting no difference between CST and no CST on eliciting patient concerns and providing appropriate information was of a moderate-certainty. There was no evidence of differences in the other HCP communication skills, including clarifying and/or summarising information, and negotiation. Doctors and nurses did not perform differently for any HCP outcomes.There were no differences between the groups with regard to HCP 'burnout' (low-certainty evidence) nor with regard to patient satisfaction or patient perception of the HCPs communication skills (very low-certainty evidence). Out of the 17 included RCTs 15 were considered to be at a low risk of overall bias. AUTHORS' CONCLUSIONS Various CST courses appear to be effective in improving HCP communication skills related to supportive skills and to help HCPs to be less likely to give facts only without individualising their responses to the patient's emotions or offering support. We were unable to determine whether the effects of CST are sustained over time, whether consolidation sessions are necessary, and which types of CST programs are most likely to work. We found no evidence to support a beneficial effect of CST on HCP 'burnout', the mental or physical health and satisfaction of people with cancer.
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Affiliation(s)
- Philippa M Moore
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Solange Rivera
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Gonzalo A Bravo‐Soto
- Pontificia Universidad Católica de ChileCentro Evidencia UCDiagonal Paraguay476SantiagoMetropolitanaChile7770371
| | - Camila Olivares
- Pontificia Universidad Catolica de ChileFamily MedicineLira 44SantiagoChile
| | - Theresa A Lawrie
- Evidence‐Based Medicine ConsultancyThe Old BarnPipehouse, FreshfordBathUKBA2 7UJ
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Sahin MK, Aker S, Arslan HN. Barriers to Colorectal Cancer Screening in a Primary Care Setting in Turkey. J Community Health 2018; 42:101-108. [PMID: 27516067 DOI: 10.1007/s10900-016-0235-1] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
Colorectal cancer (CRC) is the third most common form of cancer in men worldwide and the second most common in women. The purpose of this study was to determine both barriers established by primary health care providers (PHCPs) and barriers perceived by them and to produce solutions for achieving the desired results. A four-part questionnaire was administered to family physicians (FPs) and family health personnels (FHPs) in Samsun, Turkey on 01-15 May, 2016. Sixty-six percent of PHCPs were contacted. Data were evaluated as numbers and percentages, and statistical significance was analyzed using the Chi square and t tests. 478 PHCPs participated; 49.4 % were FPs and 50.6 % FHPs. Of the participants, 86.6 % stated that they performed CRC screening on patients. The level of participants knowing that screening should start at age 50 and conclude at age 70 was 49.7 %. The level of subjects requesting the fecal occult blood test (FOBT) at the correct intervals was 29.7 %, but only 6.9 % recommended colonoscopy at the correct intervals. Additionally, 18.2 % of subjects knew that the test used is immunochemical FOBT, and 60.5 % reported not using reminders. PHCPs' low levels of knowledge, awareness and advice compatible with guidelines concerning CRC screening may represent an obstacle to such screening. Barriers perceived by PHCPs include patients' inability to access definite medical information, deficiencies in the reminder system and patients' lack of interest in CRC screening. Additions to the screening program will be useful in overcoming barriers.
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Affiliation(s)
- Mustafa Kursat Sahin
- Department of Family Medicine, School of Medicine, Ondokuz Mayis University, 55138, Samsun, Turkey.
| | - Servet Aker
- Canik Community Health Center, Samsun Public Health Directorate, Samsun, Turkey
| | - Hatice Nilden Arslan
- Department of Non-Communicable Diseases, Samsun Public Health Directorate, Samsun, Turkey
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18
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Le Pimpec F, Moutel G, Piette C, Lièvre A, Bretagne JF. Fecal immunological blood test is more appealing than the guaiac-based test for colorectal cancer screening. Dig Liver Dis 2017; 49:1267-1272. [PMID: 28867474 DOI: 10.1016/j.dld.2017.08.018] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/11/2017] [Revised: 06/29/2017] [Accepted: 08/01/2017] [Indexed: 12/11/2022]
Abstract
BACKGROUND The reasons for participation in fecal immunological testing (FIT) of subjects who were previously non-respondents to guaiac fecal occult blood testing (g-FOBT) have not been assessed. POPULATION AND METHODS We aimed to determine the reasons for current compliance with FIT among non-responders to g-FOBT, termed "converts‿, in a French district. A questionnaire was returned by 170 converts aged from 55 to 75 years (response rate 75.2% after exclusions). RESULTS The major barriers to participation in screening with g-FOBT were test-related: the test was perceived as complicated (24%) and it required three consecutive stools (28%). Among the test-related major determinants of FIT compliance was the perception that the test was less complicated than previous test (30%) and that a unique stool sample was required (29%). Among the non-test related major determinants of FIT compliance were the perception that the general practitioner was more convincing (31%) and the feeling to be more concerned because of age (21%). The reasons for compliance among converts did not differ according to age, sex, and rural or urban residence. CONCLUSIONS Our study demonstrated that the simplicity of FIT and the endorsement of practitioners were both major motivations for FIT compliance among non-respondents in at least two previous consecutive campaigns.
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Affiliation(s)
- Fanny Le Pimpec
- Département de médecine générale, Faculté de médecine, Université de Rennes 1, France
| | - Grégoire Moutel
- Normandie Univ, Unicaen, Inserm U1086, Cancers et préventions, et CHU Caen, Caen, France
| | - Christine Piette
- Association pour le dépistage des cancers en Ille-et-Vilaine (ADECI 35), Rennes, France
| | - Astrid Lièvre
- Service des maladies de l'appareil digestif, CHU Rennes, Rennes, France; Université de Rennes 1, Rennes, France; Inserm ER440-Oncogenesis, Stress and Signaling, Université de Rennes 1, Rennes, France
| | - Jean-François Bretagne
- Association pour le dépistage des cancers en Ille-et-Vilaine (ADECI 35), Rennes, France; Service des maladies de l'appareil digestif, CHU Rennes, Rennes, France; Université de Rennes 1, Rennes, France.
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19
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Rat C, Pogu C, Le Donné D, Latour C, Bianco G, Nanin F, Cowppli-Bony A, Gaultier A, Nguyen JM. Effect of Physician Notification Regarding Nonadherence to Colorectal Cancer Screening on Patient Participation in Fecal Immunochemical Test Cancer Screening: A Randomized Clinical Trial. JAMA 2017; 318:816-824. [PMID: 28873160 PMCID: PMC5817465 DOI: 10.1001/jama.2017.11387] [Citation(s) in RCA: 31] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
IMPORTANCE Increasing participation in fecal screening tests is a major challenge in countries that have implemented colorectal cancer (CRC) screening programs. OBJECTIVE To determine whether providing general practitioners (GPs) a list of patients who are nonadherent to CRC screening enhances patient participation in fecal immunochemical testing (FIT). DESIGN, SETTING, AND PARTICIPANTS A 3-group, cluster-randomized study was conducted from July 14, 2015, to July 14, 2016, on the west coast of France, with GPs in 801 practices participating and involving adult patients (50-74 years) who were at average risk of CRC and not up-to-date with CRC screening. The final follow-up date was July 14, 2016. INTERVENTIONS General practitioners were randomly assigned to 1 of 3 groups: 496 received a list of patients who had not undergone CRC screening (patient-specific reminders group, 10 476 patients), 495 received a letter describing region-specific CRC screening adherence rates (generic reminders group, 10 606 patients), and 455 did not receive any reminders (usual care group, 10 147 patients). MAIN OUTCOMES AND MEASURES The primary end point was patient participation in CRC screening 1 year after the intervention. RESULTS Among 1482 randomized GPs (mean age, 53.4 years; 576 women [38.9%]), 1446 participated; of the 33 044 patients of these GPs (mean age, 59.7 years; 17 949 women [54.3%]), follow-up at 1 year was available for 31 229 (94.5%). At 1 year, 24.8% (95% CI, 23.4%-26.2%) of patients in the specific reminders group, 21.7% (95% CI, 20.5%-22.8%) in the generic reminders group, and 20.6% (95% CI, 19.3%-21.8%) in the usual care group participated in the FIT screening. The between-group differences were 3.1% (95% CI, 1.3%-5.0%) for the patient-specific reminders group vs the generic reminders group, 4.2% (95% CI, 2.3%-6.2%) for the patient-specific reminders group vs the usual care group, and 1.1% (95% CI, -0.6% to 2.8%) for generic reminders group vs the usual care group. CONCLUSIONS AND RELEVANCE Providing French GPs caring for adults at average risk of CRC with a list of their patients who were not up-to-date with their CRC screening resulted in a small but significant increase in patient participation in FIT screening at 1 year compared with patients who received usual care. Providing GPs with generic reminders about regional rates of CRC screening did not increase screening rates compared with usual care. TRIAL REGISTRATION clinicaltrials.gov Identifier: NCT02515344.
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Affiliation(s)
- Cédric Rat
- Department of General Practice, Faculty of Medicine, Nantes, France
- French National Institute of Health and Medical Research, INSERM U1232 - Team 2, Nantes, France
| | - Corinne Pogu
- Association in charge of colorectal cancer screening program, CAPSANTE 44, Nantes, France
| | | | - Chloé Latour
- Department of General Practice, Faculty of Medicine, Nantes, France
| | - Gaelle Bianco
- Association in charge of colorectal cancer screening program, AUDACE, La Roche sur Yon, France
| | - France Nanin
- French Health Insurance System, Division of Nantes, Nantes, France
| | - Anne Cowppli-Bony
- Cancer registry for Loire-Atlantique and Vendée geographic areas, Nantes, France
| | - Aurélie Gaultier
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
| | - Jean-Michel Nguyen
- French National Institute of Health and Medical Research, INSERM U1232 - Team 2, Nantes, France
- Department of Epidemiology and Biostatistics, Nantes University Hospital, Nantes, France
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20
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van der Velde JL, Blanker MH, Stegmann ME, de Bock GH, Berger MY, Berendsen AJ. A systematic review of the psychological impact of false-positive colorectal cancer screening: What is the role of the general practitioner? Eur J Cancer Care (Engl) 2017; 26. [PMID: 28493375 DOI: 10.1111/ecc.12709] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/06/2017] [Indexed: 12/28/2022]
Abstract
Screening for colorectal cancer (CRC) has both advantages (e.g. reduction in morbidity and mortality) and disadvantages (e.g. false positives and distress). A systematic review was therefore performed to improve our understanding of how false-positive CRC screening results affect patients psychologically (and to make recommendations for primary care). The PubMed, Embase, PsychINFO, CINAHL and Cochrane databases were searched in October 2014 and supplemented in December 2016 to identify studies on the psychological impact of false-positive CRC screening. Original studies were eligible when they assessed psychological impact in a screening setting, provided they also included false-positive CRC screening results. Two authors independently assessed 2,367 available manuscripts and included seven. Heterogeneity in their outcome measures meant that data could not be pooled. Two studies showed that a false-positive CRC screening result caused some moderate psychological distress shortly before and after colonoscopy. The remaining five studies illustrated that the psychological distress of patients with true-positive and false-positive CRC screening results was comparable. We conclude that a false-positive CRC screening result may cause some moderate psychological distress, especially just before or after colonoscopy. We recommend that general practitioners mention this when discussing CRC screening with patients and monitor those with a false-positive outcome for psychological distress.
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Affiliation(s)
- J L van der Velde
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M H Blanker
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M E Stegmann
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - G H de Bock
- Department of Epidemiology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - M Y Berger
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
| | - A J Berendsen
- Department of General Practice, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands
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21
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Engler J, Güthlin C, Dahlhaus A, Kojima E, Müller-Nordhorn J, Weißbach L, Holmberg C. Physician cooperation in outpatient cancer care. An amplified secondary analysis of qualitative interview data. Eur J Cancer Care (Engl) 2017; 26. [PMID: 28295783 DOI: 10.1111/ecc.12675] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/07/2017] [Indexed: 11/26/2022]
Abstract
The importance of outpatient cancer care services is increasing due to the growing number of patients having or having had cancer. However, little is known about cooperation among physicians in outpatient settings. To understand what inter- and multidisciplinary care means in community settings, we conducted an amplified secondary analysis that combined qualitative interview data with 42 general practitioners (GPs), 21 oncologists and 21 urologists that mainly worked in medical practices in Germany. We compared their perspectives on cooperation relationships in cancer care. Our results indicate that all participants regarded cooperation as a prerequisite for good cancer care. Oncologists and urologists mainly reported cooperating for tumour-specific treatment tasks, while GPs' reasoning for cooperation was more patient-centred. While oncologists and urologists reported experiencing reciprocal communication with other physicians, GPs had to gather the information they needed. GPs seldom reported engaging in formal cooperation structures, while for specialists, participation in formal spaces of cooperation, such as tumour boards, facilitated a more frequent and informal discussion of patients, for instance on the phone. Further research should focus on ways to foster GPs' integration in cancer care and evaluate if this can be reached by incorporating GPs in formal cooperation structures such as tumour boards.
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Affiliation(s)
- J Engler
- Institute of General Practice, University of Frankfurt/Main, Frankfurt am Main, Germany.,Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - C Güthlin
- Institute of General Practice, University of Frankfurt/Main, Frankfurt am Main, Germany
| | - A Dahlhaus
- Institute of General Practice, University of Frankfurt/Main, Frankfurt am Main, Germany.,German Cancer Research Center (DKFZ), Heidelberg, Germany.,German Cancer Consortium (DKTK), Heidelberg, Germany
| | - E Kojima
- Institute of General Practice, University of Frankfurt/Main, Frankfurt am Main, Germany
| | - J Müller-Nordhorn
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - L Weißbach
- Foundation of Men's Health, Berlin, Germany
| | - C Holmberg
- Institute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany
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22
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Weller D. Screening, resilience, patient navigation and information needs--key areas in cancer control. Eur J Cancer Care (Engl) 2017; 25:3-5. [PMID: 26768700 DOI: 10.1111/ecc.12439] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/07/2015] [Indexed: 12/31/2022]
Affiliation(s)
- D Weller
- Centre for Population Health Sciences, University of Edinburgh, Edinburgh, UK
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23
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Dalton ARH. Incomplete diagnostic follow-up after a positive colorectal cancer screening test: a systematic review. J Public Health (Oxf) 2017; 40:e46-e58. [DOI: 10.1093/pubmed/fdw147] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2016] [Accepted: 12/20/2016] [Indexed: 12/19/2022] Open
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24
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Peterson EB, Ostroff JS, DuHamel KN, D'Agostino TA, Hernandez M, Canzona MR, Bylund CL. Impact of provider-patient communication on cancer screening adherence: A systematic review. Prev Med 2016; 93:96-105. [PMID: 27687535 PMCID: PMC5518612 DOI: 10.1016/j.ypmed.2016.09.034] [Citation(s) in RCA: 168] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/29/2016] [Revised: 09/17/2016] [Accepted: 09/25/2016] [Indexed: 12/18/2022]
Abstract
Cancer screening is critical for early detection and a lack of screening is associated with late-stage diagnosis and lower survival rates. The goal of this review was to analyze studies that focused on the role of provider-patient communication in screening behavior for cervical, breast, and colorectal cancer. A comprehensive search was conducted in four online databases between 1992 and 2016. Studies were included when the provider being studied was a primary care provider and the communication was face-to-face. The search resulted in 3252 records for review and 35 articles were included in the review. Studies were divided into three categories: studies comparing recommendation status to screening compliance; studies examining the relationship between communication quality and screening behavior; and intervention studies that used provider communication to improve screening behavior. There is overwhelming evidence that provider recommendation significantly improves screening rates. Studies examining quality of communication are heterogeneous in method, operationalization and results, but suggest giving information and shared decision making had a significant relationship with screening behavior. Intervention studies were similarly heterogeneous and showed positive results of communication interventions on screening behavior. Overall, results suggest that provider recommendation is necessary but not sufficient for optimal adherence to cancer screening guidelines. Quality studies suggest that provider-patient communication is more nuanced than just a simple recommendation. Discussions surrounding the recommendation may have an important bearing on a person's decision to get screened. Research needs to move beyond studies examining recommendations and adherence and focus more on the relationship between communication quality and screening adherence.
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Affiliation(s)
- Emily B Peterson
- George Mason University, 4400 University Drive, MSN 3D6, Fairfax, VA 22031, United States.
| | - Jamie S Ostroff
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Katherine N DuHamel
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Thomas A D'Agostino
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Marisol Hernandez
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States
| | - Mollie R Canzona
- Wake Forest University, P.O. Box 7347, Winston-Salem, NC 27109, United States; Wake Forest University School of Medicine, Medical Center Blvd, Winston-Salem, NC 27157, United States
| | - Carma L Bylund
- Memorial Sloan Kettering Cancer Center, 641 Lexington Ave, 7th Floor, New York, NY 10022, United States; Hamad Medical Corporation, Doha, Qatar; Weill Cornell Medicine, Doha, Qatar
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