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Kirkøen B, Berstad P, Botteri E, Åvitsland TL, Ossum AM, de Lange T, Hoff G, Bernklev T. Do no harm: no psychological harm from colorectal cancer screening. Br J Cancer 2016; 114:497-504. [PMID: 26867161 PMCID: PMC4782205 DOI: 10.1038/bjc.2016.14] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2015] [Revised: 12/21/2015] [Accepted: 01/11/2016] [Indexed: 12/13/2022] Open
Abstract
Background: Participation in cancer screening programmes might cause worries in the population outweighting the benefits of reduced mortality. The present study aimed to investigate possible psychological harm of participation in a colorectal cancer (CRC) screening pilot in Norway. Methods: In a prospective, randomised trial participants (aged 50–74 years) were invited to either flexible sigmoidoscopy (FS) screening, faecal immunochemical test (FIT), or no screening (the control group; 1 : 1: 1). Three thousand two hundred and thirteen screening participants (42% of screened individuals) completed the Hospital Anxiety and Depression Scale questionnaire as well as the SF-12—a health-related quality of life (HRQOL) questionnaire when invited to screening and when receiving the screening result. A control group was invited to complete the questionnaires only. Two thousand six hundred and eighteen control participants (35% of invited individuals) completed the questionnaire. Results: A positive screening result did not increase participants' level of anxiety or depression, or decrease participants' level of HRQOL. Participants who received a negative result reported decreased anxiety and improvement on some HRQOL dimensions. However, no change was considered to be of clinical relevance. Conclusion: The current study showed no clinically relevant psychological harm of receiving a positive CRC screening result or of participating in FS or FIT screening, in a Norwegian population.
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Affiliation(s)
- Benedicte Kirkøen
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, P.O. box 1171 Blindern, 0318 Oslo, Norway
| | - Paula Berstad
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, 3710 Skien, Norway
| | - Edoardo Botteri
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Division of Epidemiology and Biostatistics, European Institute of Oncology, Via Ripamonti 435, 20141 Milan, Italy
| | - Tone Lise Åvitsland
- Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, P.O. box 800, 3004 Drammen, Norway
| | - Alvilde Maria Ossum
- Department of Gastroenterology, Østfold Hospital Trust, P.O. box 300, 1714 Grålum, Norway
| | - Thomas de Lange
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Department of Internal Medicine, Vestre Viken Hospital Trust, Bærum Hospital, P.O. box 800, 3004 Drammen, Norway
| | - Geir Hoff
- Department of Colorectal Cancer Screening, Cancer Registry of Norway, P.O. box 5313 Majorstuen, 0304 Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, 3710 Skien, Norway.,Department of Health Management and Health Economics, Institute of Health and Society, University of Oslo, P.O. box 1089 Blindern, 0318 Oslo, Norway
| | - Tomm Bernklev
- Institute of Clinical Medicine, University of Oslo, P.O. box 1171 Blindern, 0318 Oslo, Norway.,Department of Research and Development, Telemark Hospital Trust, 3710 Skien, Norway
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Abstract
Background In the UK there has been an effort, through the National Awareness and Early Diagnosis Initiative (NAEDI), to increase early stage diagnoses and ultimately cancer survival. Encouraging early symptom presentation through awareness-raising activities in primary care is one method to achieve this goal. Understanding GPs’ views about this type of activity, however, is crucial prior to implementation. Aim To describe GPs’ attitudes to raising public awareness of gynaecological cancers, and their views about the potential impact on primary care services. Design and setting An online survey with a convenience sample recruited from 1860 UK general practices. Method An invitation was emailed to GPs via practice managers and included a weblink to a draft education leaflet and an online survey about the impact of sending a leaflet giving information about symptoms associated with gynaecological cancers to all women on GPs’ lists. Participants could offer additional free text comments which were coded using content analysis. Results A total of 621 GPs participated. Most (77%, 477) felt that raising awareness of cancers was important. Only half (50%, 308), however, indicated that they would distribute such a leaflet from their practice. Barriers to implementation included concerns about financial costs; emotional impact on patients; increased demand for appointments and diagnostic services, such as ultrasound. Conclusions GPs were generally positive about an intervention to improve patients’ awareness of gynaecological cancers, but had concerns about increasing rates of presentation. There is a need for research quantifying the benefits of earlier diagnosis against resource costs such as increased consultations, investigations, and referrals.
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Kim S, Shin DW, Yang HK, Kim SY, Ko YJ, Cho B, Lee YS, Lee D, Park K, Park JH. Public Perceptions on Cancer Incidence and Survival: A Nation-wide Survey in Korea. Cancer Res Treat 2015; 48:775-88. [PMID: 26044162 PMCID: PMC4843741 DOI: 10.4143/crt.2014.369] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2014] [Accepted: 04/13/2015] [Indexed: 12/24/2022] Open
Abstract
PURPOSE The aim of this study was to compare the public perceptions of the incidence rates and survival rates for common cancers with the actual rates from epidemiologic data. MATERIALS AND METHODS We conducted a survey of Korean adults without history of cancer (n=2,000). The survey consisted of questions about their perceptions regarding lifetime incidence rates and 5-year survival rates for total cancer, as well as those of eight site-specific cancers. To investigate associated factors, we included questions about cancer worry (Lerman's Cancer Worry Scale) or cared for a family member or friend with cancer as a caregiver. RESULTS Only 19% of Korean adults had an accurate perception of incidence rates compared with the epidemiologic data on total cancer. For specific cancers, most of the respondents overestimated the incidence rates and 10%-30% of men and 6%-18% of women had an accurate perception. A high score in "cancer worry" was associated with higher estimates of incidence rates in total and specific cancers. In cancers with high actual 5-year survival rates (e.g., breast and thyroid), the majority of respondents underestimated survival rates. However, about 50% of respondents overestimated survival rates in cancers with low actual survival rates (e.g., lung and liver). There was no factor consistently associated with perceived survival rates. CONCLUSION Widespread discrepancies were observed between perceived probability and actual epidemiological data. In order to reduce cancer worry and to increase health literacy, communication and patient education on appropriate risk is needed.
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Affiliation(s)
- Soyeun Kim
- Department of Family Medicine, Korean Cancer Center Hospital, Seoul, Korea
| | - Dong Wook Shin
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea.,Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Hyung Kook Yang
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - So Young Kim
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Regional Cardiocerebrovascular Center, Chungbuk National University, Cheongju, Korea
| | - Young-Jin Ko
- Department of Family Medicine, Korean Cancer Center Hospital, Seoul, Korea
| | - BeLong Cho
- Department of Family Medicine, Seoul National University Hospital, Seoul, Korea.,Cancer Survivorship Clinic, Seoul National University Cancer Hospital, Seoul, Korea.,Laboratory of Health Promotion and Health Behavior, Biomedical Research Institute, Seoul National University Hospital, Seoul, Korea
| | - Young Sung Lee
- Department of Health Informatics and Management, College of Medicine, Chungbuk National University, Cheongju, Korea
| | - Dukhyoung Lee
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Keeho Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea
| | - Jong Hyock Park
- National Cancer Control Institute, National Cancer Center, Goyang, Korea.,Department of Health Informatics and Management, College of Medicine, Chungbuk National University, Cheongju, Korea.,Graduate School of Health Science Business Convergence, Chungbuk National University, Cheongju, Korea
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Greenwood NW, Dreyfus D, Wilkinson J. More than just a mammogram: breast cancer screening perspectives of relatives of women with intellectual disability. INTELLECTUAL AND DEVELOPMENTAL DISABILITIES 2014; 52:444-455. [PMID: 25409131 DOI: 10.1352/1934-9556-52.6.444] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Women with intellectual disability (ID) have similar rates of breast cancer as the general public, but higher breast cancer mortality and lower rates of regular screening mammography. Screening rates are lowest among women who live with their families. Though women with ID often make decisions in partnership with their relatives, we lack research related to family member perspectives on mammography. We conducted a qualitative study of family members of women with ID, with an interview guide focused on health care decision making and experiences, and breast cancer screening barriers, facilitators, and beliefs as related to their loved ones. Sixteen family members underwent semistructured interviews. Important themes included mammography as a reference point for other social and cultural concerns, such as their loved one's sexuality or what it means to be an adult woman; fear of having to make hard decisions were cancer to be diagnosed acting as a barrier to screening; a focus on quality of life; and desire for quality health care for their loved one, though quality care did not always equate to regular cancer screening. Adults with ID are valued members of their families, and their relatives are invested in their well-being. However, families fear the potentially complicated decisions associated with a cancer diagnosis and may choose to forgo screening due to misinformation and a focus on quality of life. Effective interventions to address disparities in mammography should focus on adults with ID and their families together, and incorporate the family context.
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Evans RE, Beeken RJ, Steptoe A, Wardle J. Cancer information and anxiety: applying the extended parallel process model. J Health Psychol 2011; 17:579-89. [PMID: 21914768 DOI: 10.1177/1359105311421046] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
There is concern that public education about testicular cancer (TC) may cause unnecessary anxiety. Psychological theory suggests that if threat (eg, TC) information is accompanied with threat control strategies (eg, testicular self-examination; TSE) anxiety is less likely. Male students (N=443) were randomized to either a TC or TC +TSE information group or a no information control group, and assessed at three time points. Anxiety levels did not differ between the groups and exposure to TC+TSE resulted in greater perceived message benefit, increased intention to self-examine and lower message denigration. This suggests TC information is not anxiogenic, but inclusion of TSE information may improve acceptance of disease awareness information.
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Collins RE, Lopez LM, Marteau TM. Emotional impact of screening: a systematic review and meta-analysis. BMC Public Health 2011; 11:603. [PMID: 21798046 PMCID: PMC3223929 DOI: 10.1186/1471-2458-11-603] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/10/2010] [Accepted: 07/28/2011] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND There is a widely held expectation that screening for disease has adverse emotional impacts. The aim of the current review is to estimate the short (< 4 weeks) and longer term (> 4 weeks) emotional impact of such screening. METHODS Studies selected for inclusion were (a) randomised controlled trials in which (b) participants in one arm underwent screening and received test results, and those in a control arm did not, and (c) emotional outcomes were assessed in both arms. MEDLINE via PubMed (1950 to present), EMBASE (1980 to present), PsycINFO (1985 to present) using OVID SP, and CINAHL (1982 to present) via EBSCO were searched, using strategies developed with keywords and medical subject headings. Data were extracted on emotional outcomes, type of screening test and test results. RESULTS Of the 12 studies that met the inclusion criteria, six involved screening for cancer, two for diabetes, and one each for abdominal aortic aneurysms, peptic ulcer, coronary heart disease and osteoporosis. Five studies reported data on anxiety, five [corrected] on depression, two on general distress and eight on quality of life assessed between one week and 13 years after screening (median = 1.3 years).Meta-analyses revealed no significant impact of screening on longer term anxiety (pooled SMD 0.01, 95% CI -0.10, 0.11), depression (pooled SMD -0.04, 95% CI -.12, 0.20), or quality of life subscales (mental and self-assessed health pooled SMDs, respectively: 0.03; -0.01, (95% CI -.02, 0.04; 0.00, 95% CI -.04, 0.03). CONCLUSION Screening does not appear to have adverse emotional impacts in the longer term (> 4 weeks). Too few studies assessed outcomes before four weeks to comment on the shorter term emotional impact of screening.
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Affiliation(s)
- Ruth E Collins
- Department of Psychology (at Guy's), Kings College London, Health Psychology Section, 5th Floor Bermondsey Wing, Guy's Campus, London, SE1 9RT, UK
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Evans REC, Simon AE, Wardle J. Public perceptions of the harms and benefits of testicular cancer education: a qualitative study. Cancer Epidemiol 2010; 34:212-9. [PMID: 20060797 DOI: 10.1016/j.canep.2009.12.008] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2009] [Revised: 12/03/2009] [Accepted: 12/09/2009] [Indexed: 12/12/2022]
Abstract
BACKGROUND The value of testicular cancer (TC) education, and in particular advice on testicular self-examination (TSE), has been widely debated by health professionals. One concern centres on its potential to cause unnecessary anxiety among the target population. Views outside the health professional community about TC education's potential benefits and harms have not previously been described. The objective of this study was to investigate the range of views expressed by specific groups thought to have an interest in provision of TC education. METHODS One-to-one, in-depth interviews with 37 men and women were completed. Participants included TC patients, men with no prior diagnosis of TC, and parents and teachers of adolescent boys. Verbatim transcripts were analysed using the Framework approach to produce a thematic description of views expressed. RESULTS Participants were unanimously in favour of TC education. Key perceived benefits included earlier cancer detection through increasing knowledge of symptoms leading to better treatment outcomes, and motivating help-seeking by reducing emotional barriers such as fear of cancer or embarrassment. Anxiety was acknowledged as a possible harm but was not expected to be widespread or serious. CONCLUSION TC education is viewed favourably by members of the public likely to be interested in its provision. Education's potential to cause anxiety was not considered a disincentive to promoting disease awareness.
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Affiliation(s)
- Ruth E C Evans
- Department of Epidemiology and Public Health, University College London, Gower Street, London WC1E 6BT, United Kingdom
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8
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Lewis CL. Colorectal cancer: screening. BMJ CLINICAL EVIDENCE 2007; 2007:0414. [PMID: 19454089 PMCID: PMC2943786] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Subscribe] [Scholar Register] [Indexed: 05/27/2023]
Abstract
INTRODUCTION Nearly two thirds of colorectal cancers occur in the rectum or sigmoid colon. It is the third most common cancer in resource-rich countries, accounting for about 20,000 deaths each year in the UK, and 60,000 each year in the USA. METHODS AND OUTCOMES We conducted a systematic review and aimed to answer the following clinical question: What are the effects of screening for colorectal cancer? We searched: Medline, Embase, The Cochrane Library and other important databases up to November 2006 (BMJ Clinical evidence reviews are updated periodically, please check our website for the most up-to-date version of this review). We included harms alerts from relevant organisations such as the US Food and Drug Administration (FDA) and the UK Medicines and Healthcare products Regulatory Agency (MHRA). RESULTS We found 19 systematic reviews, RCTs, or observational studies that met our inclusion criteria. We performed a GRADE evaluation of the quality of evidence for interventions. CONCLUSIONS In this systematic review we present information relating to the effectiveness and safety of the following interventions: colonoscopy, computed tomography colography, double contrast barium enema, faecal occult blood testing, flexible sigmoidoscopy.
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Andersen MR, Drescher CW, Zheng Y, Bowen DJ, Wilson S, Young A, McIntosh M, Mahony BS, Lowe KA, Urban N. Changes in cancer worry associated with participation in ovarian cancer screening. Psychooncology 2007; 16:814-20. [PMID: 17225260 DOI: 10.1002/pon.1151] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
While ovarian cancer is rare and screening is not recommended for most women, it is being studied as a way to reduce ovarian cancer mortality. As effective strategies for screening emerge it will be important to understand the quality of life (QOL) effects of participation in ovarian cancer screening. In this study, we examined the effects of participation in an ovarian cancer screening program on worry about cancer risk and QOL. A randomized controlled clinical trial (n = 592) was conducted. Women without a family history suggestive of a BRCA1/2 mutation were randomly assigned to screening and risk counseling, separately and in combination. Results were compared to women randomized to usual care alone. Levels of cancer worry fell for all study groups and QOL was unaffected; no statistically significant differences were found between groups. Increased levels of worry about ovarian cancer at 2-year follow-up were found among participants in screening receiving abnormal test results. For those who receive abnormal results, screening may have long-term effects and increase worry about cancer risk. Further research will be required to examine the possibility that screening reduces worry when women receive only normal, presumably reassuring, results.
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Affiliation(s)
- M Robyn Andersen
- Fred Hutchinson Cancer Research Center, Seattle, WA 98109-1024, USA.
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10
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Abstract
Bowel cancer is a major cause of morbidity and death and is a high cost to health care systems. Screening currently offers the best chance of improving outcomes from bowel cancer. When introducing screening, the problems encountered in other cancers need to be avoided to maximize benefits and minimize harms.
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Affiliation(s)
- Michael R Thompson
- Department of Surgery, Queen Alexandra Hospital, Portsmouth, PO6 3LY, Hampshire, United Kingdom.
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Castells A, Marzo M, Bellas B, Amador FJ, Lanas A, Mascort JJ, Ferrándiz J, Alonso P, Piñol V, Fernández M, Bonfill X, Piqué JM. [Clinical guidelines for the prevention of colorectal cancer]. GASTROENTEROLOGIA Y HEPATOLOGIA 2005; 27:573-634. [PMID: 15574281 DOI: 10.1016/s0210-5705(03)70535-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Clavarino AM, Janda M, Hughes KL, Del Mar C, Tong S, Stanton WR, Aitken JF, Leggett BA, Newman B. The view from two sides: a qualitative study of community and medical perspectives on screening for colorectal cancer using FOBT. Prev Med 2004; 39:482-90. [PMID: 15313087 DOI: 10.1016/j.ypmed.2004.05.015] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022]
Abstract
BACKGROUND Population-wide screening for people at average risk of colorectal cancer (CRC) by faecal occult blood test (FOBT) is under consideration in Australia. METHODS Qualitative methods were used to examine the views of community members who did (n = 18) or did not (n = 12) participate in a pilot program of FOBT screening. In addition, views were obtained from general practitioners (GPs) and specialist gastroenterologists directly involved in the implementation of the program. Two focus group sessions were conducted with screening participants and interviews were conducted with nonparticipants, GPs and gastroenterologists. RESULTS The findings suggest that CRC screening by FOBT distributed to households by mail was well accepted by the community and by the medical practitioners involved in its implementation. The trial had little negative effect on general practice. Both medical practitioners and consumers raised concerns about the efficacy of FOBT screening. Medical practitioners were also concerned about the potential burden mass screening could place on the public (government-funded) health care sector. CONCLUSIONS It would seem that CRC screening using FOBT will not enjoy unqualified support from the community or from medical practitioners involved in the continuum of screening. Information about the objectives of screening programs, in general, and the efficacy of FOBT screening in particular, needs to be provided to the community to ensure informed individual choice.
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Robb KA, Miles A, Wardle J. Demographic and Psychosocial Factors Associated with Perceived Risk for Colorectal Cancer. Cancer Epidemiol Biomarkers Prev 2004. [DOI: 10.1158/1055-9965.366.13.3] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
Abstract
Objective: The objective of this study was to investigate demographic and psychosocial predictors of perceptions of risk for colorectal cancer (CRC) in a population-based sample. Method: The study was a cross-sectional survey of 18,447 men and women aged 55–64 years. A mailed questionnaire assessed perceived comparative risk for CRC along with demographic characteristics (age, gender, ethnicity, marital status, and socioeconomic status), health-related factors (family history, subjective health and bowel symptoms, and health behaviors), and emotional state (anxiety). Results: Being male and older were associated with lower perceived risk. Having a family history of CRC, poorer subjective health, more symptoms, and higher levels of anxiety were all associated with increased perceived risk of CRC. Smokers and nonexercisers perceived their risk as higher. Conclusion: Misperceptions surrounding the effects of age and gender on CRC risk, as well as the genetic link and pathogenesis of CRC, need to be addressed in risk communications.
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Affiliation(s)
- Kathryn A. Robb
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Anne Miles
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, United Kingdom
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Donovan RJ, Jalleh G, Jones SC. The word 'cancer': reframing the context to reduce anxiety arousal. Aust N Z J Public Health 2004; 27:291-3. [PMID: 14705284 DOI: 10.1111/j.1467-842x.2003.tb00397.x] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
This study investigated reaction to the word 'cancer' versus the phrase 'a cancer' in two ways: (1) assessing associations to the spoken words 'cancer' or 'a cancer'; and (2) presenting participants with a situation where one person says to another in print. 'I have cancer' or 'I have a cancer'. The participants were a convenience sample of 112 adults (i.e. aged 18 years or over), 55 males and 57 females, recruited via a mall intercept survey in the Perth (Western Australia) central business district. Participants were randomly assigned to either the 'cancer' condition or the 'a cancer' condition. Both methods confirmed that cancer arouses primarily negative affective responses in the vast majority of people. It was hypothesised that using 'a cancer' might lead to less negative affect associations than just the word 'cancer'. This was found to be the case for the spoken word association technique, but not for the printed cartoon technique.
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Affiliation(s)
- Robert J Donovan
- Centre for Behavioural Research in Cancer Control, Curtin University, GPO Box U1987, Perth, Western Australia 6845.
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15
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Hoff G. CRC screening: review of the evidence and suggestions on when and how to move on from randomized trials to screening programmes. Scand J Gastroenterol 2004; 39:99-103. [PMID: 15000269 DOI: 10.1080/00365520410004488] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Affiliation(s)
- G Hoff
- Cancer Registry of Norway, Montebello, Oslo.
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Mladen DM, Dragoslav MP, Sanja Z, Bozidar B, Snezana D. Problems in screening colorectal cancer in the elderly. World J Gastroenterol 2003; 9:2335-7. [PMID: 14562405 PMCID: PMC4656490 DOI: 10.3748/wjg.v9.i10.2335] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the problems in the screening of colorectal carcinoma in the elderly.
METHODS: Three models of colorectal cancer prevention were examined: standard screening, active check-up of suspected cases and summons to have endoscopic check-up for previously diagnosed colorectal polyps. The study was performed among three groups of elderly individuals: Group 1 (167 cases), hospitalized asymptomatic individuals without symptoms in large intestines. Group 2 (612 cases): old individuals at home for the aged, out of which 32 showed symptoms of colon disorders; Group 3 (44 cases): elderly people with diagnosed polyps. As a result of 1788 rectosigmoidoscopies, we identified 61 individuals with polyps, out of which 44 patients were over 65 years old. However, only 9 of these 44 individuals agreed to have the endoscopy performed again.
RESULTS: One cancer and 13 polyps were detected in Group 1, and two polyps in Group 2. However, it should be noted that only eleven individuals from Group 2 agreed to have the endoscopy. In Group 3, there were no relapses of the polyps among the nine individuals who came back for the endoscopy.
CONCLUSION: Poor understanding of the screening procedures is one of the greatest problems in early detection of the cancer in the aged. Paradoxically, the cooperation is better with hospitalized patients, than with “successfully old” persons.
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Affiliation(s)
- Davidović M Mladen
- Center of Geriatric Medicine, 11050 Beograd, Rifata Burdzevica 31, Yugoslavia.
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Humphris GM, Field EA. The immediate effect on knowledge, attitudes and intentions in primary care attenders of a patient information leaflet: a randomized control trial replication and extension. Br Dent J 2003; 194:683-8; discussion 675. [PMID: 12830193 DOI: 10.1038/sj.bdj.4810283] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2002] [Accepted: 02/12/2003] [Indexed: 11/09/2022]
Abstract
AIM To determine whether the influence of a leaflet on mouth cancer improves knowledge, related attitudes and intention to accept a mouth screen. DESIGN Randomized controlled trial. SETTING Dental and medical waiting rooms in the North West of England. SAMPLE Nine hundred and forty nine patients from 16 practices were invited to participate. MEASURES Standardized multi-item scales of six outcome measures including knowledge, beliefs and intention to accept an oral cancer screen. PROCEDURE A patient information leaflet was given to a randomized intervention group of patients. A single sheet questionnaire was completed by both groups of patients (immediately following leaflet administration in the intervention arm of study). STATISTICAL ANALYSIS t tests were used to compare outcome variables between patients with and without access to the leaflet with Boneferroni correction. RESULTS Participation rate was high (91%). Knowledge (P <0.001) and intentions (P = 0.003) benefited from patient access to leaflet. Anxiety was not raised with leaflet exposure. Some beliefs about the screening procedure appeared to be slightly improved by reading the leaflet (p <0.05). CONCLUSION This study supports previous findings of an immediate positive effect of an information leaflet on patients' knowledge of oral cancer and willingness to accept an oral cancer screen.
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Affiliation(s)
- G M Humphris
- Division of Clinical Psychology, School of Psychiatry and Behavioural Sciences, University of Manchester, Rawnsley Building, Manchester Royal Infirmary, Oxford Road, Manchester, M13 9WL.
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McCaffery K, Wardle J, Waller J. Knowledge, attitudes, and behavioral intentions in relation to the early detection of colorectal cancer in the United Kingdom. Prev Med 2003; 36:525-35. [PMID: 12689797 DOI: 10.1016/s0091-7435(03)00016-1] [Citation(s) in RCA: 181] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) mortality is high. Understanding the social, psychological, and cognitive predictors of early detection practices such as screening may help improve CRC outcomes. This study examined knowledge of CRC and the relationship between knowledge, attitudes to cancer, and intentions to engage in early detection behaviors for CRC in a national representative population sample. METHOD An interview-based survey was carried out in a British population sample of adults ages 16 to 74 years (n = 1637), assessing knowledge, attitudes, and intention with regard to colorectal cancer. RESULTS Knowledge levels were very low; 58% (n = 995) of respondents could not list any colorectal cancer risk factors and 24% (n = 393) were unable to identify any warning signs for cancer. Knowledge was lower among men (chi(2)[2] = 52.8, P < 0.0001), younger respondents (chi(2)[10] = 79.9, P <.0001), and those with less education (chi(2)[4] = 73.9, P < 0.0001). Attitudes to cancer were more negative among women (chi(2) [2] = 7.4, P = 0.025), younger participants (chi(2)[10] = 22.4, P = 0.013), and those with less education (chi(2) [4] = 75.0, P < 0.0001). Low knowledge was associated with negative attitudes (P < 0.0001) and both factors were associated with lower intentions to participate in colorectal cancer screening (P < 0.0001). Multivariate analysis indicated that attitudes partially mediated the effect of knowledge on screening intentions. CONCLUSIONS Increasing knowledge may reduce negative public perceptions of cancer which may impact positively on intentions to participate in screening.
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Affiliation(s)
- Kirsten McCaffery
- Health Behaviour Unit, Cancer Research UK, Department of Epidemiology and Public Health, Royal Free and University College Medical School, London, England, UK
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Wardle J, Williamson S, Sutton S, Biran A, McCaffery K, Cuzick J, Atkin W. Psychological impact of colorectal cancer screening. Health Psychol 2003; 22:54-9. [PMID: 12558202 DOI: 10.1037/0278-6133.22.1.54] [Citation(s) in RCA: 34] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
This article examines the psychological impact of participating in sigmoidoscopy screening for colorectal cancer prevention. The 1st study examined psychological well-being at 3 months, in relation to screening outcome, in 4,153 individuals. The 2nd study used longitudinal data to examine changes in psychological functioning from before to after screening in relation both to screening outcome and baseline indicators of vulnerability. There were few psychological differences between those who had received negative results or had polyps detected. These findings were confirmed in the longitudinal study, which also found no evidence for vulnerability to adverse effects among those who were initially most anxious or who perceived their risk of cancer to be higher. The longitudinal data suggested that screening might produce transient positive effects.
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Affiliation(s)
- Jane Wardle
- Cancer Research UK, Health Behaviour Unit, Department of Epidemiology and Public Health, University College London, 2-16 Torrington Place, London WC1E 6BT, England.
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Dailey YM, Humphris GM, Lennon MA. Reducing patients' state anxiety in general dental practice: a randomized controlled trial. J Dent Res 2002; 81:319-22. [PMID: 12097444 DOI: 10.1177/154405910208100506] [Citation(s) in RCA: 67] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Anxiety assessment by questionnaire provides information for the dentist and may also confer a psychological benefit on patients. This study tested the hypothesis that informing dentists about patients' dental anxiety prior to commencement of treatment reduces patients' state anxiety. A randomized controlled trial was conducted involving eight General Dental Practitioners in North Wales. Participants included patients attending their first session of dental treatment, and accumulating a score of 19 or above, or scoring 5 on any one question, of the Modified Dental Anxiety Scale (MDAS). Patients (n = 119) completed Spielberger's state anxiety inventory (STAI-S) pre- and post-treatment and were randomly allocated to intervention (dentist informed of MDAS score) and control (dentist not informed) groups. Intervention patients showed greater reduction in mean change STAI-S scores (F[1,119] = 8.74, P < 0.0001). Providing the dentist with information of the high level of a patient's dental anxiety prior to treatment, and involving the patient in this, reduced the patient's state anxiety.
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Affiliation(s)
- Y-M Dailey
- Department of Clinical Dental Sciences, The University of Liverpool, School of Dentistry, Liverpool, L69 3GN UK.
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Colorectal Cancer Screening in Great Britain. J Psychosoc Oncol 2001. [DOI: 10.1300/j077v19n03_04] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
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Chew GK, Cruickshank ME. Human papillomavirus as a form of risk assessment. Best Pract Res Clin Obstet Gynaecol 2001; 15:759-68. [PMID: 11563871 DOI: 10.1053/beog.2001.0218] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
There is a huge amount of interest in the use of human papillomavirus testing to improve both the sensitivity and specificity of cervical screening. Although oncogenic human papillomavirus subtypes are recognized to be the most important factor in the development of cervical disease, only a minority of such infections results in invasive cancer. Given our current, albeit limited, knowledge of the natural history of human papillomavirus infection and the development of cervical intra-epithelial neoplasia, it may be possible to identify well-defined high-risk groups of women. Such groups may benefit from intensive surveillance, or indeed new developments in immunoprophylaxis, while allowing low-risk women less screening intervention. Known high-risk groups include those with chronic immunosuppression and previous treatment for high-grade cervical intra-epithelial neoplasia. Lowering the upper age limit for cervical screening is already under consideration because of the low incidence of both human papillomavirus infection and cervical intra-epithelial neoplasia in older women, and human papillomavirus testing could rationalize the screening programme.
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Affiliation(s)
- G K Chew
- Department of Obstetrics and Gynaecology, Aberdeen Maternity Hospital, Foresterhill, Aberdeen AB24 1ZD, UK
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Humphris GM, Ireland RS, Field EA. Randomised trial of the psychological effect of information about oral cancer in primary care settings. Oral Oncol 2001; 37:548-52. [PMID: 11564574 DOI: 10.1016/s1368-8375(01)00017-3] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
AIM To determine the immediate influence of a validated patient information leaflet (PIL) on patient anxiety and intention to have a screen for oral cancer in primary care attenders. PARTICIPANTS Patients (n=800) attending their primary health care provider. SETTING Fourteen general practices (eight dental and six medical) in the northwest of England. DESIGN Randomised controlled trial with two arms: leaflets provided in information group, leaflet was absent in control group. MEASURES Single item ratings of (1) intention to have an oral cancer screen, and (2) anxiety towards a screen, (3) perceived risk of oral cancer. Knowledge of oral cancer, self-reported dental service attendance history and demographic variables were also collected. RESULTS Patients who had read the oral cancer PIL demonstrated an increase in their intention to have a screen (Mann Whitney U test: z=-3.67, P<0.001) and reduced anxiety (Mann Whitney U test: z=-2.07, P<0.05). Subjective risk was not elevated by the extra information. Intention to have a screen was predicted by knowledge level and anxiety (odds ratios: 1.10 and 0.70 respectively, both P's<0.001). CONCLUSION The influence of an information leaflet appeared to have a positive effect on anxiety level and intentions to agree to receive an oral cancer screen.
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Affiliation(s)
- G M Humphris
- Department of Clinical Psychology, School of Health Sciences, Whelan Building, The University of Liverpool, Liverpool L69 3GB, UK.
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Zisman A, Leibovici D, Kleinmann J, Siegel YI, Lindner A. The impact of prostate biopsy on patient well-being: a prospective study of pain, anxiety and erectile dysfunction. J Urol 2001; 165:445-54. [PMID: 11176394 DOI: 10.1097/00005392-200102000-00023] [Citation(s) in RCA: 145] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE We prospectively studied the impact of transrectal ultrasound guided prostate biopsy on patient well-being. MATERIALS AND METHODS We enrolled 211 consecutive men who underwent a total of 218 biopsy events in a questionnaire based survey focusing on pain, anxiety and erectile dysfunction risk factors. Surveys were administered before, and immediately, 1 week and 1 month after biopsy. Quantitative information on the intensity of symptoms and signs was obtained using a uniform grading system. RESULTS Intraoperative pain considered severe in 20% of the biopsy events was associated with pain in the first 24 hours postoperatively, leading to analgesic use in 10%. Inflammatory infiltrate in the biopsy core and younger patient age correlated with persistent pain on days 2 and 7 after biopsy, respectively. Preoperative anxiety was reported in 64% of biopsy events and predictive of intraoperative pain. Anxiety peaked before result disclosure. Erectile dysfunction attributed to anxiety in anticipation of biopsy was reported in 7% of cases. At days 7 and 30, 15% of previously potent patients reported erectile dysfunction. CONCLUSIONS The impact of prostate biopsy on patient well-being begins while waiting for the scheduled procedure. Shortening the anticipation period before results are disclosed and administering pre-biopsy anxiety decreasing measures may benefit patients. Analgesic therapy is recommended in younger patients, those reporting moderate to severe intraoperative pain and those with known prostatic inflammatory infiltrate. The risk of acute erectile dysfunction should be discussed cautiously with patients who are potent before biopsy.
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Affiliation(s)
- A Zisman
- Department of Urology, Assaf-Harofeh Medical Center, Sackler Faculty of Medicine, Tel-Aviv University, Zerifin, Israel
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Affiliation(s)
- M J Dalrymple-Hay
- Wessex Cardiothoracic Centre, Mailpoint 46, Southampton General Hospital, Tremona Road, Southampton SO16 6YD, UK.
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