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Drysdale H, Marlow LAV, Lim A, Waller J. Experiences of Self-Sampling and Future Screening Preferences in Non-Attenders Who Returned an HPV Vaginal Self-Sample in the YouScreen Study: Findings From a Cross-Sectional Questionnaire. Health Expect 2024; 27:e14118. [PMID: 38953514 DOI: 10.1111/hex.14118] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2024] [Revised: 04/25/2024] [Accepted: 06/01/2024] [Indexed: 07/04/2024] Open
Abstract
BACKGROUND We assessed experiences of human papillomavirus (HPV) vaginal self-sampling and future screening preferences in an ethnically and socio-economically diverse group of women overdue for cervical screening. SETTING AND PARTICIPANTS A postal questionnaire was embedded in the YouScreen self-sampling trial in England: 32.5% (2712/8338) of kit completers returned the survey. Kit non-completers were encouraged to return a questionnaire, but no responses were received. Participants were ethnically diverse (40.3% came from ethnic minority backgrounds), and 59.1% came from the two most deprived quintiles. Differences in confidence in kit completion, trust in the test results and intention to attend a follow-up test if HPV-positive were evaluated using Pearson's χ2 analyses. Binary logistic regression models explored predictors of a future screening choice and preferences for urine versus vaginal self-sampling. RESULTS Most kit-completers reported high confidence in self-sampling (82.6%) and high trust in the results (79.9%), but experiences varied by ethnicity and screening status. Most free-text comments were positive but some reported difficulties using the device, pain or discomfort. Most women would opt for self-sampling in the future (71.3% vs. 10.4% for a clinician-taken test) and it was more often preferred by ethnic minority groups, overdue screeners and never attenders. Urine self-tests were preferred to vaginal tests (41.9% vs. 15.4%), especially among women from Asian, Black or Other Ethnic backgrounds. CONCLUSIONS Kit-completers were confident, found the test easy to complete, and trusted the self-sample results. However, experiences varied by ethnic group and some women highlighted difficulties with the kit. Most women would prefer self-sampling in the future, but it was not a universal preference, so offering a choice will be important. PATIENT OR PUBLIC CONTRIBUTION We did not have direct patient and public involvement and engagement (PPIE) in the questionnaire design. However, patients and public representatives did input into the design of the YouScreen trial and reviewed the wider study materials (e.g. participant information sheet). TRIAL REGISTRATION This questionnaire study was embedded in the YouScreen trial. The protocol for the YouScreen trial is available at https://www.isrctn.com/ISRCTN12759467. The National Institute for Health Research 43 Clinical Research Network (NIHR CRN) Central Portfolio Management System (CPMS) ID is 4441934.
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Affiliation(s)
- Hannah Drysdale
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
| | - Laura A V Marlow
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
- Centre for Cancer Prevention, Screening and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Anita Lim
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
| | - Jo Waller
- Cancer Prevention Group, School of Cancer and Pharmaceutical Sciences, King's College, Faculty of Life Sciences and Medicine, London, UK
- Centre for Cancer Prevention, Screening and Early Diagnosis, Wolfson Institute of Population Health, Faculty of Medicine and Dentistry, Queen Mary University of London, London, UK
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Anderson LE, Collins KE, Myers L, Ireland MJ, Omar M, Drummond A, Goodwin BC. Decisions and prompts to screen for cervical, bowel, and breast cancer. PATIENT EDUCATION AND COUNSELING 2024; 122:108174. [PMID: 38295667 DOI: 10.1016/j.pec.2024.108174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/21/2023] [Revised: 01/17/2024] [Accepted: 01/23/2024] [Indexed: 02/25/2024]
Abstract
OBJECTIVES To investigate what makes Australians decide to screen and follow through for breast, cervical, and bowel cancer population screening programs. METHODS A convenience sample (N = 962) answered open-text questions about their decision to screen and what prompted them to act in an online survey. Open text responses were coded based on shared meaning using content analysis. Frequencies of each code were calculated. RESULTS For breast and cervical screening, decisions were commonly based on screening being routine (32.58%breast and 35.19%cervical) or receiving a reminder (20.53% breast 13.07% cervical), and similarly, common prompts were receiving a reminder (40.68% breast and 29.13% cervical), screening being routine (22.05% breast and 18.65% cervical). Participants reported deciding to screen for bowel cancer due to arrival of home screening test kit (40.50%) or the experience of loved one's cancer (13.57%) and were prompted by arrival of home test kit (23.58%), and convenience (15.72%). CONCLUSIONS Findings can inform the development of interventions targeting non-participants of cancer screening programs. PRACTICE IMPLICATIONS Messages to encourage breast and cervical cancer screening should frame screening as part of regular healthcare routine. Messages to encourage bowel cancer screening should encourage immediate use of the screening kit upon arrival.
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Affiliation(s)
- Laura E Anderson
- National Centre for Youth Substance Use, The University of Queensland, St Lucia, QLD, Australia; Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia.
| | - Katelyn E Collins
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia; School of Psychology and Wellbeing, University of Southern Queensland, Springfield, QLD, Australia
| | - Larry Myers
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia; School of Psychology and Wellbeing, University of Southern Queensland, Springfield, QLD, Australia
| | - Michael J Ireland
- Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia; School of Psychology and Wellbeing, University of Southern Queensland, Springfield, QLD, Australia
| | - Mariam Omar
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia
| | - Allanah Drummond
- School of Psychology and Wellbeing, University of Southern Queensland, Springfield, QLD, Australia
| | - Belinda C Goodwin
- Viertel Cancer Research Centre, Cancer Council Queensland, Fortitude Valley, QLD, Australia; Centre for Health Research, University of Southern Queensland, Springfield, QLD, Australia; Melbourne School of Population and Global Health, University of Melbourne, Melbourne, VIC, Australia
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Ngo O, Chloupková R, Cibula D, Sláma J, Mandelová L, Hejduk K, Hajdúch M, Minka P, Koudeláková V, Jaworek H, Trnková M, Vaněk P, Dvořák V, Dušek L, Májek O. Direct mailing of HPV self-sampling kits to women aged 50-65 non-participating in cervical screening in the Czech Republic. Eur J Public Health 2024; 34:361-367. [PMID: 38224266 PMCID: PMC10990530 DOI: 10.1093/eurpub/ckad229] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2024] Open
Abstract
BACKGROUND A population-based cervical cancer screening programme is implemented in the Czech Republic. However, participation is insufficient among women over 50 years. This study aimed to estimate the potential improvement in participation through directly mailed HPV self-sampling kits (HPVssk) compared with standard invitation letters in women aged 50-65 non-participating in screening. METHODS The study recruited 1564 eligible women (no cervical cancer screening in the last 3 years or more, no previous treatment associated with cervical lesions or cervical cancer). Eight hundred women were mailed with an HPVssk (HPVssk group), and 764 women were sent a standard invitation letter (control group) inviting them to a routine screening (Pap test). The primary outcome was a comparison of the overall participation rate between study groups using a binominal regression model. RESULTS The participation rate in the HPVssk group was 13.4% [95% confidence interval (CI) 11.2-15.9%; 7.4% of women returned the HPVssk and 6.0% attended gynaecological examination] and 5.0% (95% CI 3.6-6.8%) in the control group. Using the binominal regression model, the difference between the groups was estimated as 7.6% (95% CI 5.0-10.2%; P < 0.001). In the HPVssk group, 22% of women who returned HPVssk had a positive result and 70% of them underwent a follow-up examination. CONCLUSIONS Compared with traditional invitation letters, the direct mailing of the HPVssk achieved a significantly higher participation rate, along with a notable HPV positivity rate among HPVssk responders. This approach offers a potentially viable method for engaging women who have not yet attended a cervical screening programme.
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Affiliation(s)
- Ondřej Ngo
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Renata Chloupková
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - David Cibula
- Department of Obstetrics, Gynaecology and Neonatology, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Jiří Sláma
- Department of Obstetrics, Gynaecology and Neonatology, General University Hospital and 1st Faculty of Medicine, Charles University, Prague, Czech Republic
| | - Lucie Mandelová
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
| | - Karel Hejduk
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Marián Hajdúch
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- Laboratory of Experimental Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Petr Minka
- RBP, Health Insurance Company, Ostrava, Czech Republic
| | - Vladimíra Koudeláková
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- Laboratory of Experimental Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | - Hana Jaworek
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
- Laboratory of Experimental Medicine, University Hospital Olomouc, Olomouc, Czech Republic
| | | | - Peter Vaněk
- Institute of Molecular and Translational Medicine, Faculty of Medicine and Dentistry, Palacky University, Olomouc, Czech Republic
| | - Vladimír Dvořák
- Centre of Outpatient Gynaecology and Primary Care, Brno, Czech Republic
| | - Ladislav Dušek
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
| | - Ondřej Májek
- Institute of Health Information and Statistics of the Czech Republic, Prague, Czech Republic
- Institute of Biostatistics and Analyses, Faculty of Medicine, Masaryk University, Brno, Czech Republic
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McIntosh JG, Jenkins M, Wood A, Chondros P, Campbell T, Wenkart E, O'Reilly C, Dixon I, Toner J, Martinez-Gutierrez J, Govan L, Emery JD. Increasing bowel cancer screening using SMS in general practice: the SMARTscreen cluster randomised trial. Br J Gen Pract 2024; 74:BJGP.2023.0230. [PMID: 38164588 PMCID: PMC10962502 DOI: 10.3399/bjgp.2023.0230] [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: 05/16/2023] [Accepted: 12/11/2023] [Indexed: 01/03/2024] Open
Abstract
BACKGROUND Australia has one of the highest incidences of colorectal cancer (CRC) worldwide. The Australian National Bowel Cancer Screening Program (NBCSP) is a best-practice, organised screening programme, but uptake is low (40.9%) and increasing participation could reduce morbidity and mortality associated with CRC. Endorsement by GPs is strongly associated with increasing screening uptake. AIM This study (SMARTscreen) aimed to test whether a multi-intervention short message service (SMS) sent by general practices to 50-60-year-old patients who were due to receive the NBCSP kit would increase NBCSP uptake, by comparing it with usual care. DESIGN AND SETTING A stratified cluster randomised controlled trial was undertaken, involving 21 Australian general practices in Western Victoria, Australia. METHOD For intervention practices, people due to receive the NBCSP kit within a 6-month study period were sent an SMS just before receiving the kit. The SMS included a personalised message from the person's general practice endorsing the kit, a motivational narrative video, an instructional video, and a link to more information. Control practices continued with usual care, comprising at-home testing with a faecal immunochemical test (FIT) through the NBCSP. The primary outcome was the between-arm percentage difference in uptake of FIT screening within 12 months from randomisation, which was estimated using generalised linear model regression. RESULTS In total, 39.2% (1143/2914) of people in 11 intervention practices and 23.0% (583/2537) of people in 10 control practices had a FIT result in their electronic health records - a difference of 16.5% (95% confidence interval = 2.02 to 30.9). CONCLUSION The SMS intervention increased NBCSP kit return in 50-60-year-old patients in general practice. This finding informed a larger trial - SMARTERscreen - to test this intervention in a broader Australian population.
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Affiliation(s)
- Jennifer G McIntosh
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne
| | - Mark Jenkins
- Centre for Epidemiology and Biostatistics, University of Melbourne, Melbourne
| | - Anna Wood
- Department of General Practice and Primary Care, University of Melbourne, Melbourne
| | - Patty Chondros
- Department of General Practice and Primary Care, University of Melbourne, Melbourne
| | | | | | - Clare O'Reilly
- Workforce Development, Screening Early Detection and Immunisation, Cancer Council Victoria, Melbourne, and executive manager, Chronic Health, Population Health Unit, VACCHO, Melbourne
| | | | | | | | - Linda Govan
- Ballarat Goldfields/Wimmera Grampians, Western Victoria Primary Health Network, Ballarat
| | - Jon D Emery
- Department of General Practice and Primary Care, University of Melbourne, Melbourne
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Beal EW, McNamara M, Owen M, McAlearney AS, Tsung A. Interventions to Improve Surveillance for Hepatocellular Carcinoma in High-Risk Patients: A Scoping Review. J Gastrointest Cancer 2024; 55:1-14. [PMID: 37328730 DOI: 10.1007/s12029-023-00944-1] [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] [Accepted: 05/09/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) is most often a sequela of chronic liver disease or chronic hepatitis B infection. Among high-risk patients, surveillance for HCC every 6 months is recommended by international guidelines. However, rates of HCC surveillance are suboptimal (11-64%). Barriers at the patient, provider, and healthcare delivery system levels have been identified. METHODS We performed a systemic scoping review to identify and characterize interventions to improve HCC surveillance that has previously been evaluated. Searches using key terms in PubMed and Embase were performed to identify studies examining interventions designed to improve the surveillance rate for HCC in patients with cirrhosis or chronic liver disease that were published in English between January 1990 and September 2021. RESULTS Included studies (14) had the following study designs: (1) randomized clinical trials (3, 21.4%), (2) quasi-experimental (2, 14.3%), (3) prospective cohort (6, 42.8%), and (4) retrospective cohort (3, 21.4%). Interventions included mailed outreach invitations, nursing outreach, patient education with or without printed materials, provider education, patient navigation, chronic disease management programs, nursing-led protocols for image ordering, automated reminders to physicians and nurses, web-based clinical management tools, HCC surveillance databases, provider compliance reports, radiology-led surveillance programs, subsidized HCC surveillance, and the use of oral medications. It was found that HCC surveillance rates increased after intervention implementation in all studies. CONCLUSION Despite improvements in HCC surveillance rates with intervention, compliance remained suboptimal. Further analysis of which interventions yield the greatest increases in HCC surveillance, design of multi-pronged strategies, and improved implementation are needed.
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Affiliation(s)
- Eliza W Beal
- Departments of Surgery and Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R, Mailcode: HW04HO, Detroit, MI, 48201, USA.
| | - Molly McNamara
- The Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Mackenzie Owen
- The Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University College of Medicine, Columbus, OH, 43210, USA
- Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Allan Tsung
- Department of Surgery, Division of Surgical Oncology, University of Virginia, Charlottsville, VA, 22908, USA
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6
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Scobie H, Robb KA, Macdonald S, Harrow S, Sullivan F. Optimising recruitment to a lung cancer screening trial: A comparison of general practitioner and community-based recruitment. J Med Screen 2024; 31:46-52. [PMID: 37525582 PMCID: PMC10878003 DOI: 10.1177/09691413231190785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/03/2023] [Revised: 06/07/2023] [Accepted: 07/11/2023] [Indexed: 08/02/2023]
Abstract
OBJECTIVES Pre-trial focus groups of the Early detection of Cancer of the Lung Scotland (ECLS) trial indicated that those at high risk of lung cancer are more likely to engage with community-based recruitment methods. The current study aimed to understand if general practitioner (GP) and community-based recruitment might attract different groups of people, and to quantitatively explore the demographic and psychosocial differences between people responding to GP or community-based recruitment. DESIGN Secondary data analysis of ECLS trial baseline data. METHODS Adults (n = 11,164) aged 50 to 75 years completed a baseline questionnaire as part of their participation in the ECLS trial. The questionnaire assessed smoking behaviour, health state, health anxiety and illness perception. Alongside demographic characteristics, how participants were made aware of the study/participant recruitment method (GP recruitment/community recruitment) was also obtained via trial records. RESULTS The likelihood of being recruited via community-based methods increased as deprivation level decreased. Those recruited via the community had higher levels of perceived personal control of developing lung cancer and were more likely to understand their own risk of developing lung cancer, compared to those who were recruited to the trial via their GP. Health state and health anxiety did not predict recruitment methods in multivariable analysis. CONCLUSIONS Community and opportunistic screening invitations were associated with uptake in people from less-deprived backgrounds, and therefore might not be the optimal method to reach those at high risk of lung cancer and living in more deprived areas.
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Affiliation(s)
- Hannah Scobie
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Kathryn A Robb
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Sara Macdonald
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Stephen Harrow
- Edinburgh Cancer Centre, Western General Hospital, NHS Lothian, Edinburgh, UK
| | - Frank Sullivan
- School of Medicine, University of St Andrews, St Andrews, Fife, UK
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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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Goossens MM, Kellen E, Broeders MJM, Vandemaele E, Jacobs B, Martens P. The effect of a pre-scheduled appointment on attendance in a population-based mammography screening programme. Eur J Public Health 2023; 33:1122-1127. [PMID: 37555832 PMCID: PMC10710327 DOI: 10.1093/eurpub/ckad137] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/10/2023] Open
Abstract
BACKGROUND Pre-scheduled appointments can increase attendance in breast cancer screening programmes compared to 'open invitations' but relatively few randomized controlled trials exist. We investigated the effect of a pre-scheduled appointment on uptake in the Flemish population-based mammography screening programme. METHODS Between September and December 2022, a total of 4798 women were randomly assigned to receive either a pre-scheduled appointment or open invitation. The difference in attendance was compared with Poisson regression analysis for the primary endpoint (attendance ≤92 days after date of invitation), yielding relative risks (RRs). This was done separately for three groups: women invited to a mobile unit and a history of nonattendance (group M-NA); women invited to a hospital-based unit and a history of nonattendance (group HB-NA); women invited to a hospital-based unit and a history of irregular attendance (group HB-IA). There were no women invited to a mobile unit and a history of irregular attendance. RESULTS The RRs in favour of the pre-scheduled appointment were 2.3 [95% confidence interval (CI) 1.80-2.88], 1.8 (95% CI 1.07-2.97) and 1.8 (95% CI 1.43-2.39), for groups M-NA, HB-NA and HB-IA, respectively. We found no statistically significant difference between the various RRs. The respective absolute gains in attendance between pre-scheduled appointment and open invitation were 8.3%, 4.4% and 15.8%. CONCLUSIONS Sending an invitation with a pre-scheduled appointment is an effective tool to increase screening attendance in both mobile and hospital-based screening units. The pre-scheduled appointment is associated with a considerable absolute gain in attendance which varies depending on the screening history.
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Affiliation(s)
- Mathijs M Goossens
- Department of Radiology, Vrije Universiteit Brussel, Brussels, Belgium
- Centrum voor Kankeropsporing (Centre for Cancer Detection), Brugge, Belgium
| | - Eliane Kellen
- Centrum voor Kankeropsporing (Centre for Cancer Detection), Brugge, Belgium
- Department of Radiology, University Hospital Leuven, Campus St. Rafael, Leuven, Belgium
| | - Mireille J M Broeders
- Department for Health Evidence, Radboud University Medical Center, Nijmegen, The Netherlands
- Dutch Expert Centre for Screening, Nijmegen, The Netherlands
| | - Els Vandemaele
- Centrum voor Kankeropsporing (Centre for Cancer Detection), Brugge, Belgium
| | - Brenda Jacobs
- Department of Radiology, Vrije Universiteit Brussel, Brussels, Belgium
- Centrum voor Kankeropsporing (Centre for Cancer Detection), Brugge, Belgium
| | - Patrick Martens
- Centrum voor Kankeropsporing (Centre for Cancer Detection), Brugge, Belgium
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McIntosh JG, Emery JD, Wood A, Chondros P, Goodwin BC, Trevena J, Wilson C, Chang S, Hocking J, Campbell T, Macrae F, Milley K, Lew JB, Nightingale C, Dixon I, Castelli M, Lee N, Innes L, Jolley T, Fletcher S, Buchanan L, Doncovio S, Broun K, Austin G, Jiang J, Jenkins MA. SMARTERscreen protocol: a three-arm cluster randomised controlled trial of patient SMS messaging in general practice to increase participation in the Australian National Bowel Cancer Screening Program. Trials 2023; 24:723. [PMID: 37957680 PMCID: PMC10642038 DOI: 10.1186/s13063-023-07756-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2023] [Accepted: 10/20/2023] [Indexed: 11/15/2023] Open
Abstract
BACKGROUND Australia persistently has one of the highest rates of colorectal cancer (CRC) in the world. Australia's National Bowel Cancer Screening Program (NBCSP) sends a biennial Faecal Immunochemical Test (FIT)-the 'NBCSP kit'-to everyone eligible for the programme between 50 and 74 years old; however, participation in the programme is low, especially in the 50- to 60-year-old age group. Our previous efficacy trial ('SMARTscreen') demonstrated an absolute increase in uptake of 16.5% (95% confidence interval = 2.02-30.9%) for people sent an SMS with motivational and instructional videos, from their general practice prior to receiving their NBCSP kit, compared to those receiving usual care. Building on the strengths of the SMARTscreen trial and addressing limitations, the 'SMARTERscreen' trial will test the effect on participation in the NBCSP of sending either an SMS only or an SMS with online video material to general practice patients due to receive their NBCSP compared to 'usual care'. METHODS SMARTERscreen is a three-arm stratified cluster randomised controlled trial involving 63 general practices in two states in Australia. Eligible patients are patients who are aged 49-60 years and due to receive their NBCSP kit within the next 2 weeks during the intervention period. General practices will be equally randomised to three trial arms (21:21:21, estimated average 260 patients/practice). The two interventions include (i) an SMS with an encouraging message from their general practice or (ii) the same SMS with weblinks to additional motivational and instructional videos. The control arm will receive 'usual care'. Using the intention-to-treat approach, primary analysis will estimate the three pair-wise between-arm differences in the proportion of eligible patients who participate in the NBCSP within 6 months of when their kit is sent, utilising screening data from the Australian National Cancer Screening Register (NCSR). Patient intervention adherence to the interventions will also be evaluated. Findings will be incorporated into the Policy1-Bowel microsimulation model to estimate the long-term health benefits and cost-effectiveness of the interventions. DISCUSSION SMARTERscreen will provide high-level evidence determining whether an SMS or an SMS with web-based material sent to general practice patients prior to receiving their NBCSP kit increases participation in bowel cancer screening. TRIAL REGISTRATION Australian New Zealand Clinical Trials Registry ACTRN12623000036617. Registered on 13 January 2023. Trial URL: https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=385119&isClinicalTrial=False.
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Affiliation(s)
- Jennifer G McIntosh
- Centre for Cancer Research, University of Melbourne, Parkville, Australia.
- Department of General Practice and Primary Care, University of Melbourne, Parkville, Australia.
- Centre for Epidemiology and Biostatistics, University of Melbourne Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia.
| | - Jon D Emery
- Centre for Cancer Research, University of Melbourne, Parkville, Australia
- Department of General Practice and Primary Care, University of Melbourne, Parkville, Australia
| | - Anna Wood
- Centre for Cancer Research, University of Melbourne, Parkville, Australia
- Department of General Practice and Primary Care, University of Melbourne, Parkville, Australia
| | - Patty Chondros
- Department of General Practice and Primary Care, University of Melbourne, Parkville, Australia
| | - Belinda C Goodwin
- Centre for Epidemiology and Biostatistics, University of Melbourne Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
- Centre for Health Research, University of Southern Queensland, Springfield, Australia
| | - Judy Trevena
- Department of General Practice and Primary Care, University of Melbourne, Parkville, Australia
| | - Carlene Wilson
- Centre for Epidemiology and Biostatistics, University of Melbourne Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Shanton Chang
- School of Computing and Information Systems, The University of Melbourne, Parkville, Australia
| | - Jane Hocking
- Centre for Epidemiology and Biostatistics, University of Melbourne Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | | | - Finlay Macrae
- Colorectal Medicine and Genetics, The Royal Melbourne Hospital, Parkville, Australia
- Department of Medicine, University of Melbourne, Melbourne, Australia
| | - Kristi Milley
- Centre for Cancer Research, University of Melbourne, Parkville, Australia
- Department of General Practice and Primary Care, University of Melbourne, Parkville, Australia
- Primary Care Collaborative Cancer Clinical Trials Group (PC4), Melbourne, Australia
| | - Jie-Bin Lew
- The Daffodil Centre, a joint venture between Cancer Council NSW and the University of Sydney, Sydney, Australia
| | - Claire Nightingale
- Centre for Epidemiology and Biostatistics, University of Melbourne Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | - Ian Dixon
- , Consumer Representative, Melbourne, Australia
| | | | | | | | - Tamara Jolley
- Cancer Council Queensland, Fortitude Valley, QLD, Australia
| | | | - Lyn Buchanan
- Centre for Epidemiology and Biostatistics, University of Melbourne Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
| | | | - Kate Broun
- Cancer Council Victoria, Melbourne, Australia
| | | | - Joyce Jiang
- Centre for Epidemiology and Biostatistics, University of Melbourne Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
- Multicultural Centre for Women's Health, Melbourne, Australia
| | - Mark A Jenkins
- Centre for Cancer Research, University of Melbourne, Parkville, Australia
- Centre for Epidemiology and Biostatistics, University of Melbourne Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, University of Melbourne, Parkville, Australia
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10
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Reilly M, Ali A, Doyle PF, Cotter S, Heavey L, Brain PK, Rankin PN, Mccutchan G, Redmond PP. Co-designing a recruitment strategy for lung cancer screening in high-risk individuals: protocol for a mixed-methods study. HRB Open Res 2023; 6:64. [PMID: 38911612 PMCID: PMC11190654 DOI: 10.12688/hrbopenres.13793.1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/17/2023] [Indexed: 06/25/2024] Open
Abstract
Background Lung cancer is a significant cause of cancer-related mortality globally, with early detection through screening critical to improving patient outcomes. However, recruiting high-risk individuals, particularly in deprived populations, for screening remains a considerable challenge. This study aims to co-design a targeted recruitment strategy for lung cancer screening, tailored to the specific needs and experiences of high-risk individuals, in collaboration with a Patient and Public Involvement (PPI) panel and expert stakeholders in Ireland. Methods We will employ a mixed-methods design guided by the Medical Research Council (MRC) framework for developing complex interventions. Our approach will integrate systematic review findings on screening participation interventions, evaluation of the recruitment strategy's feasibility in an Irish context, and the application of behavioural science frameworks. The target population includes individuals over 55 years, either current smokers or those who quit within the last year, who reside in highly deprived areas. Conclusion This co-designed recruitment strategy will combine evidence-based research, local context understanding, and stakeholder input to develop a solution that is both scientifically robust and tailored to the target population's needs. This patient-centred approach aims to increase the potential for successful implementation of lung cancer screening programs, thereby improving early detection and patient outcomes.
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Affiliation(s)
- Maeve Reilly
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Ahmeda Ali
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Prof Frank Doyle
- Department of Health Psychology, School of Population Health, Royal College of Surgeons Ireland, Dublin, Ireland
| | - Seamus Cotter
- Patient and Public Involvement (PPI), Irish Lung Cancer Community, Dublin, Ireland
| | - Laura Heavey
- National Screening Service, Health Service Executive (HSE), Dublin, Ireland
| | - Prof Kate Brain
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Prof Nicole Rankin
- School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Grace Mccutchan
- Division of Population Medicine, Cardiff University, Cardiff, UK
| | - Prof Patrick Redmond
- Department of General Practice, Royal College of Surgeons Ireland, Dublin, Ireland
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11
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Djuric O, Venturelli F, Bassi MC, Gorini G, Paci E, Mantellini P, Giorgi Rossi P. Recruitment strategies and interventions to increase participation in lung cancer screening programmes: a systematic review protocol. BMJ Open 2023; 13:e074140. [PMID: 37907293 PMCID: PMC10618983 DOI: 10.1136/bmjopen-2023-074140] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Accepted: 10/16/2023] [Indexed: 11/02/2023] Open
Abstract
INTRODUCTION Despite strong evidence for the efficacy of low-radiation dose CT (LDCT) in reducing lung cancer (LC) mortality, implementing LC screening (LCS) programmes remains a challenge. We aim to systematically review the evidence on the strategies used to recruit the adult population at risk of LC to LDCT within LCS programmes and to estimate the effectiveness of interventions identified, used to reach the potentially eligible population, increase participation and informed choice, and ensure equitable access. METHODS AND ANALYSIS This sequential systematic literature review will consist of three steps: (1) a scoping review of existing strategies and organisational models for LCS; (2) selecting papers reporting relevant outcomes (test coverage, screening participation and informed choice) and comparing results among different models; (3) a systematic review of interventions implemented to increase participation in LCS programmes. Each step will follow the methodological guidelines provided by the Cochrane Collaboration and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Data sources include electronic databases such as Medline (PubMed version), Embase, CINAHL (Ebsco version), Scopus and Cochrane CENTRAL. The search will be limited to studies published from January 2000 to March 2023 in English, Italian, French, Spanish, Serbian and Croatian language. Findings will be synthesised quantitatively and qualitatively as appropriate. Risk of bias assessment will be only applied to studies selected in the second and third steps. The quality of evidence will be summarised for each outcome using the Grading Recommendation Assessment, Development and Evaluation methodology. ETHICS AND DISSEMINATION Given that this is a review of existing literature, ethics approval is not required. The results will be published in peer-reviewed scientific journals and presented at relevant conferences. The findings of this review will help guide health authorities in organising LCS programmes and developing recommendations, policies, and actions at national and regional levels. PROSPERO REGISTRATION NUMBER CRD42023408357.
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Affiliation(s)
- Olivera Djuric
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
- Department of Biomedical, Metabolic and Neural Sciences, Centre for Environmental, Nutritional and Genetic Epidemiology (CREAGEN), Public Health Unit, University of Modena and Reggio Emilia, Reggio Emilia, Italy
| | - Francesco Venturelli
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Maria Chiara Bassi
- Scientific Library, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
| | - Giuseppe Gorini
- Division of Epidemiology and Clinical Governance, Institute for Study, Prevention and network in Oncology (ISPRO), Florence, Italy
| | - Eugenio Paci
- Italian League against Cancer (LILT), Florence, Italy
| | - Paola Mantellini
- Division of Screening, Institute for Study, Prevention and Network in Oncology (ISPRO), Florence, Italy
| | - Paolo Giorgi Rossi
- Epidemiology Unit, Azienda Unità Sanitaria Locale-IRCCS di Reggio Emilia, Reggio Emilia, Italy
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12
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Patel P, Bradley SH, McCutchan G, Brain K, Redmond P. What should the role of primary care be in lung cancer screening? Br J Gen Pract 2023; 73:340-341. [PMID: 37500469 PMCID: PMC10405969 DOI: 10.3399/bjgp23x734397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/29/2023] Open
Affiliation(s)
- Priya Patel
- GKT School of Medical Education, King's College London, London, UK
| | - Stephen H Bradley
- GP and National Institute for Health and Care Research Academic Clinical Lecturer, Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Kate Brain
- School of Medicine, Cardiff University, Cardiff, UK
| | - Patrick Redmond
- Department of General Practice, Royal College of Surgeons in Ireland, Dublin, Ireland
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13
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Breedlove SR, McCraney P, Chalmers S. A patient reminder to improve colorectal cancer screenings. J Am Assoc Nurse Pract 2023; 35:386-391. [PMID: 36857537 DOI: 10.1097/jxx.0000000000000840] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2022] [Accepted: 01/06/2023] [Indexed: 03/03/2023]
Abstract
BACKGROUND Colorectal cancer screenings detect the early, treatable, and often curable stages of the disease. Screenings are now recommended beginning at 45 years of age. Health care providers are expected to have patient's complete screenings, and reimbursement rates can be affected if results are not documented. LOCAL PROBLEM An independent review of expected organizational core measures revealed inadequate colorectal cancer screenings completed and no formal patient outreach program for patients who had not completed ordered screenings. The lack of a formal reminder to patients resulted in a cumulative completion rate of 19%. METHODS A phone call intervention was designed to notify patients of the need to complete colorectal cancer screenings. A preimplementation and postimplementation design was used to compare completed colorectal cancer screenings. INTERVENTION Patients with ordered colorectal cancer screenings received one reminder phone call to complete the screening. Preintervention and postintervention completion rates were evaluated using data from the electronic medical record. RESULTS Results revealed a colorectal cancer screening rate of 19% preimplementation and 43% postimplementation and reflected a 61.9% increase in cumulative completion rates over a 12-week intervention period. CONCLUSION The colorectal cancer patient reminder intervention showed clinical significance in improving completion rates of colorectal cancer screenings. The intervention was a successful method to improve patient compliance with the expected screening and helped improve provider core measure expectations.
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Affiliation(s)
- Shirley Rene' Breedlove
- Department of Nursing, University of North Georgia, Dahlonega, Georgia, Piedmont Healthcare, Commerce and Homer, Georgia
| | - Paige McCraney
- Department of Nursing, University of North Georgia, Dahlonega, Georgia, Rising Medical Solutions, Care Management, Chicago, Illinois
| | - Sharon Chalmers
- Department of Nursing, University of North Georgia, Dahlonega, Georgia
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14
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Hudson SM, Binysh K, Duffy SW. Did the use of open invitations in place of timed appointment invitations reduce the uptake of breast screening in the London region during the COVID-19 recovery? J Med Screen 2023; 30:87-91. [PMID: 36220103 PMCID: PMC9554567 DOI: 10.1177/09691413221127583] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2022] [Revised: 08/26/2022] [Accepted: 08/26/2022] [Indexed: 11/22/2022]
Abstract
OBJECTIVE The Covid-19 pandemic created a backlog of women awaiting an invitation for breast screening in the UK. To recover in a timely fashion, the National Health Service programme opted to issue open invitations (OI) to women rather than the standard pre-booked timed appointments (TA). Historically, OIs have been shown to result in lower uptake. The aim of this study was to make use of a natural experiment to compare uptake in groups sent an OI with those sent a TA during a period when both invitation methods were in use. METHODS Women invited for routine screening at one of the six London breast screening services from September 2020 to March 2021 were included and grouped according to the type of invitation they had received (TA or OI). The outcome was attendance within 6 months of opening the screening episode. Data were analysed by logistic regression. RESULTS During the period of the study, 78,192 (32.5%) women received a TA and 162,680 (67.5%) received an OI. In the TA group, 47,391 (60.6%) attended within six months of offered appointment and in the OI group 86,430 (53.1%) attended. This difference was significant (p < 0.001). The odds ratio (95% CI) for the attended outcome was 1.44 (1.33-1.55) adjusted for differences in deprivation and for invitation category (first invitation or subsequent invitation). CONCLUSIONS This study supports the view that TA delivers a higher uptake than OI. It suggests that during this period over 12,000 women in London, who would have been expected to attend if given the standard TA, did not attend their appointment having received an OI.
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Affiliation(s)
| | - Kathie Binysh
- Head of Screening, NHS England & Improvement (London), London, UK
| | - Stephen W Duffy
- Centre for Prevention, Detection and Diagnosis, Wolfson Institute of Population Health, London, UK
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15
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Robb KA, Kotzur M, Young B, McCowan C, Hollands GJ, Irvine A, Macdonald S, McConnachie A, O'Carroll RE, O'Connor RC, Steele RJC. Increasing uptake of FIT colorectal screening: protocol for the TEMPO randomised controlled trial testing a suggested deadline and a planning tool. BMJ Open 2023; 13:e066136. [PMID: 37202130 PMCID: PMC10201271 DOI: 10.1136/bmjopen-2022-066136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2022] [Accepted: 04/28/2023] [Indexed: 05/20/2023] Open
Abstract
INTRODUCTION Screening can reduce deaths from colorectal cancer (CRC). Despite high levels of public enthusiasm, participation rates in population CRC screening programmes internationally remain persistently below target levels. Simple behavioural interventions such as completion goals and planning tools may support participation among those inclined to be screened but who fail to act on their intentions. This study aims to evaluate the impact of: (a) a suggested deadline for return of the test; (b) a planning tool and (c) the combination of a deadline and planning tool on return of faecal immunochemical tests (FITs) for CRC screening. METHODS AND ANALYSIS A randomised controlled trial of 40 000 adults invited to participate in the Scottish Bowel Screening Programme will assess the individual and combined impact of the interventions. Trial delivery will be integrated into the existing CRC screening process. The Scottish Bowel Screening Programme mails FITs to people aged 50-74 with brief instructions for completion and return. Participants will be randomised to one of eight groups: (1) no intervention; (2) suggested deadline (1 week); (3) suggested deadline (2 weeks); (4) suggested deadline (4 weeks); (5) planning tool; (6) planning tool plus suggested deadline (1 week); (7) planning tool plus suggested deadline (2 weeks); (8) planning tool plus suggested deadline (4 weeks). The primary outcome is return of the correctly completed FIT at 3 months. To understand the cognitive and behavioural mechanisms and to explore the acceptability of both interventions, we will survey (n=2000) and interview (n=40) a subgroup of trial participants. ETHICS AND DISSEMINATION The study has been approved by the National Health Service South Central-Hampshire B Research Ethics Committee (ref. 19/SC/0369). The findings will be disseminated through conference presentations and publication in peer-reviewed journals. Participants can request a summary of the results. TRIAL REGISTRATION NUMBER clinicaltrials.govNCT05408169.
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Affiliation(s)
- Kathyrn A Robb
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Marie Kotzur
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Ben Young
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Colin McCowan
- School of Medicine, University of St. Andrews, St Andrews, UK
| | - Gareth J Hollands
- EPPI Centre, UCL Social Research Institute, University College London, London, UK
| | - Audrey Irvine
- Scottish Bowel Screening Centre, NHS Tayside, Dundee, Dundee, UK
| | - Sara Macdonald
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | - Alex McConnachie
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Rory C O'Connor
- School of Health and Wellbeing, University of Glasgow, Glasgow, UK
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16
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Gascoyne C, Broun K, Morley B, Wyatt K, Feletto E, Durkin SJ. Engaging lower screening groups: a field experiment to evaluate the impact of a multiwave national campaign on participation in the National Bowel Cancer Screening Program. BMJ Open 2023; 13:e065124. [PMID: 36921953 PMCID: PMC10030563 DOI: 10.1136/bmjopen-2022-065124] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/17/2023] Open
Abstract
OBJECTIVES This field study evaluated a multiwave media campaign that aired in 2019 to promote participation in the Australian National Bowel Cancer Screening Program (NBCSP), which provides free biennial mailed-out immunochemical faecal occult blood test (iFOBT) kits to Australians aged 50-74 years. DESIGN Adjusted negative binomial regression models determined rate ratios of iFOBT kits returned during and following three campaign waves compared with 2018 (baseline). Interaction terms determined whether effects differed by gender×age group, socioeconomic status (SES) and previous participation. SETTING Australia. PARTICIPANTS All Australians eligible for the NBCSP (men and women aged 50-74 years) who returned an iFOBT kit between 1 January 2018 and 30 October 2019. INTERVENTIONS A multiwave national integrated media campaign to promote participation in the NBCSP. MAIN OUTCOME MEASURES iFOBT kit return rate and number of iFOBT kits returned during and immediately following campaign activity overall and within historically lower screening groups (men, 50-59 years old; lower SES; never participants). RESULTS The rate of iFOBT kits returned increased significantly during all three campaign waves, with evidence of carry-over effects of the second wave coinciding with a general practitioner mail-out strategy (all p<0.001). At each wave, effects were observed among men and women in the younger (50-59 years old) age group, but were less consistent for the older age group. Each SES group and both never and previous participants had increased return rates at each wave, but increases were stronger among mid-higher SES and those who had never participated. An estimated 93 075 extra iFOBT kits were returned due to the campaign. CONCLUSIONS The campaign increased participation, especially among those who were younger and never previously screened-key groups to recruit given reparticipation rates of over 80%. Ongoing investment in national integrated media campaigns of sufficient duration and intensity can increase bowel cancer screening and ultimately save lives.
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Affiliation(s)
- Claudia Gascoyne
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Kate Broun
- Prevention Division, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Belinda Morley
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Kerryann Wyatt
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
| | - Eleonora Feletto
- Cancer Research Division, Cancer Council New South Wales, Woolloomooloo, New South Wales, Australia
- School of Public Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Sarah J Durkin
- Centre for Behavioural Research in Cancer, Cancer Council Victoria, Melbourne, Victoria, Australia
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17
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Gershfeld-Litvin A, Halabi S, Bellizzi KM. Stigma related to breast cancer among women and men: The case of the Druze minority in Israel. J Health Psychol 2023; 28:189-199. [PMID: 35894170 PMCID: PMC9936445 DOI: 10.1177/13591053221115619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022] Open
Abstract
The objective of this study was to explore stigma related to breast cancer among Druze women and men and identify factors associated with low screening rates among Druze women. A sample of 270 Druze women and men completed an online questionnaire adapted to detect breast cancer stigma and internalized breast cancer stigma. Independent samples t-test results showed higher scores for men compared to women, at a significant level, on four of the Breast Cancer Stigma scales: awkwardness, avoidance, policy opposition, and personal responsibility. Independent samples t-test results also showed higher scores for men compared to women, at a significant level, on two of the Internalized Breast Cancer Stigma scales: stereotype endorsement and discrimination experience. These results suggest a need for psychoeducation about breast cancer screening for minority groups such as the Druze, with male partners of women who are diagnosed with breast cancer being the main target recipients.
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Affiliation(s)
- Avital Gershfeld-Litvin
- The Academic College of Tel Aviv-Yaffo, Israel,Avital Gershfeld-Litvin, School of Behavioral Sciences, The Academic College of Tel Aviv-Yaffo, Rabenu Yeruham 2, Yaffo 6818211, Israel.
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18
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Dickson JL, Hall H, Horst C, Tisi S, Verghese P, Mullin AM, Teague J, Farrelly L, Bowyer V, Gyertson K, Bojang F, Levermore C, Anastasiadis T, McCabe J, Navani N, Nair A, Devaraj A, Hackshaw A, Quaife SL, Janes SM. Uptake of invitations to a lung health check offering low-dose CT lung cancer screening among an ethnically and socioeconomically diverse population at risk of lung cancer in the UK (SUMMIT): a prospective, longitudinal cohort study. Lancet Public Health 2023; 8:e130-e140. [PMID: 36709053 PMCID: PMC7615156 DOI: 10.1016/s2468-2667(22)00258-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Revised: 09/12/2022] [Accepted: 09/27/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Lung cancer screening with low-dose CT reduces lung cancer mortality, but screening requires equitable uptake from candidates at high risk of lung cancer across ethnic and socioeconomic groups that are under-represented in clinical studies. We aimed to assess the uptake of invitations to a lung health check offering low-dose CT lung cancer screening in an ethnically and socioeconomically diverse cohort at high risk of lung cancer. METHODS In this multicentre, prospective, longitudinal cohort study (SUMMIT), individuals aged 55-77 years with a history of smoking in the past 20 years were identified via National Health Service England primary care records at practices in northeast and north-central London, UK, using electronic searches. Eligible individuals were invited by letter to a lung health check offering lung cancer screening at one of four hospital sites, with non-responders re-invited after 4 months. Individuals were excluded if they had dementia or metastatic cancer, were receiving palliative care or were housebound, or declined research participation. The proportion of individuals invited who responded to the lung health check invitation by telephone was used to measure uptake. We used univariable and multivariable logistic regression analyses to estimate associations between uptake of a lung health check invitation and re-invitation of non-responders, adjusted for sex, age, ethnicity, smoking, and deprivation score. This study was registered prospectively with ClinicalTrials.gov, NCT03934866. FINDINGS Between March 20 and Dec 12, 2019, the records of 2 333 488 individuals from 251 primary care practices across northeast and north-central London were screened for eligibility; 1 974 919 (84·6%) individuals were outside the eligible age range, 7578 (2·1%) had pre-existing medical conditions, and 11 962 (3·3%) had opted out of particpation in research and thus were not invited. 95 297 individuals were eligible for invitation, of whom 29 545 (31·0%) responded. Due to the COVID-19 pandemic, re-invitation letters were sent to only a subsample of 4594 non-responders, of whom 642 (14·0%) responded. Overall, uptake was lower among men than among women (odds ratio [OR] 0·91 [95% CI 0·88-0·94]; p<0·0001), and higher among older age groups (1·48 [1·42-1·54] among those aged 65-69 years vs those aged 55-59 years; p<0·0001), groups with less deprivation (1·89 [1·76-2·04] for the most vs the least deprived areas; p<0·0001), individuals of Asian ethnicity (1·14 [1·09-1·20] vs White ethnicity; p<0·0001), and individuals who were former smokers (1·89 [1·83-1·95] vs current smokers; p<0·0001). When ethnicity was subdivided into 16 groups, uptake was lower among individuals of other White ethnicity than among those with White British ethnicity (0·86 [0·83-0·90]), whereas uptake was higher among Chinese, Indian, and other Asian ethnicities than among those with White British ethnicity (1·33 [1·13-1·56] for Chinese ethnicity; 1·29 [1·19-1·40] for Indian ethnicity; and 1·19 [1·08-1·31] for other Asian ethnicity). INTERPRETATION Inviting eligible adults for lung health checks in areas of socioeconomic and ethnic diversity should achieve favourable participation in lung cancer screening overall, but inequalities by smoking, deprivation, and ethnicity persist. Reminder and re-invitation strategies should be used to increase uptake and the equity of response. FUNDING GRAIL.
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Affiliation(s)
- Jennifer L Dickson
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Helen Hall
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Carolyn Horst
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Sophie Tisi
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Priyam Verghese
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Anne-Marie Mullin
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Jon Teague
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Laura Farrelly
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Vicky Bowyer
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Kylie Gyertson
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Fanta Bojang
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Claire Levermore
- University College London Hospitals NHS Foundation Trust, London, UK
| | | | - John McCabe
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK; University College London Hospitals NHS Foundation Trust, London, UK
| | - Arjun Nair
- University College London Hospitals NHS Foundation Trust, London, UK
| | - Anand Devaraj
- Royal Brompton and Harefield NHS Trust, London, UK; National Heart and Lung Institute, Imperial College London, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, University College London, London, UK
| | - Samantha L Quaife
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sam M Janes
- Lungs for Living Research Centre, UCL Respiratory, University College London, London, UK.
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19
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Stoffel ST, Hvalica Coldwell A, von Wagner C, Herrmann B. Testing temporal frames of colorectal cancer risks: evidence from randomized online experiments. PSYCHOL HEALTH MED 2023; 28:375-389. [PMID: 35635266 DOI: 10.1080/13548506.2022.2061716] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
Low perceived risk of is associated with a low probability of engaging in risk preventive behaviours. Temporal framing has been suggested to make the risk seem higher, as narrower time frames appear to increase perceived risk and intentions to engage in risk-preventive behaviours. In two online experiments, we tested how manipulating risk information about colorectal cancer (CRC) influenced risk perception and preventive behaviours. 902 men and women aged 45-54 were recruited from an English online panel. Study 1 (N = 132) investigated how communicating CRC mortality instead of incidence rates influences risk perception, using both yearly and daily frames. In study 2 (N = 770), CRC incidence was described as occurring yearly, daily or hourly. The primary outcome measures were risk perception, intention to engage in preventive behaviours and whether participants chose to read information about ways to reduce CRC risk or skip it to finish the survey. Study 1 did not find a difference in intentions based on information about the risk of developing vs the risk of dying of CRC. Study 2 found that, while communicating CRC incidence occurring as every day increased information-seeking behaviour compared to every year and every hour (57.4% vs 45.9% vs 45.6%, p = 0.012), individuals in the daily condition were less likely to get all comprehension questions right (69.9% vs 78.2% vs 85.0%, respectively, p = 0.015). Temporal framing had no impact on perceived risk or intentions to engage in risk-reducing behaviours. While manipulating risk information in terms of temporal framing did not increase perceived risk, it may influence people's decision to engage with the information in the first place.
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Affiliation(s)
- Sandro T Stoffel
- European Commission, Joint Research Centre (JRC), Ispra, Italy.,Research Department of Behavioural Science and Health, University College London, London, UK.,Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | - Ana Hvalica Coldwell
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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20
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Balata H, Quaife SL, Craig C, Ryan DJ, Bradley P, Crosbie PAJ, Murray RL, Evison M. Early Diagnosis and Lung Cancer Screening. Clin Oncol (R Coll Radiol) 2022; 34:708-715. [PMID: 36175244 DOI: 10.1016/j.clon.2022.08.036] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 08/19/2022] [Accepted: 08/31/2022] [Indexed: 01/31/2023]
Abstract
Lung cancer remains the most significant cause of cancer death, accounting for about 20% of all cancer-related mortality. A significant reason for this is delayed diagnosis, either due to lack of symptoms in early-stage disease or presentation with non-specific symptoms common with a broad range of alternative diagnoses. More is needed in terms of increasing public awareness, providing adequate healthcare professional education and implementing clinical pathways that improve the earlier diagnosis of symptomatic lung cancer. Low-dose computed tomography screening of high-risk, asymptomatic populations has been shown to reduce lung cancer mortality, with focus now shifting towards how best to implement lung cancer screening on a wider scale in a safe, efficient and cost-effective manner. For maximum benefit, efforts must be made to optimise uptake, especially among high-risk populations with significant socioeconomic deprivation, as well as successfully incorporate tobacco-dependency treatment. Quality assured programme management will be critical to minimising screening-related harms and adequately managing incidental findings. By undertaking the above, there can be optimism that lung cancer outcomes can be improved significantly in the near future.
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Affiliation(s)
- H Balata
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK.
| | - S L Quaife
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - C Craig
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
| | - D J Ryan
- Department of Respiratory Medicine, Beaumont Hospital, Dublin, Ireland
| | - P Bradley
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - P A J Crosbie
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK; Division of Infection, Immunity and Respiratory Medicine, Faculty of Biology, Medicine and Health, University of Manchester, Manchester, UK
| | - R L Murray
- Academic Unit of Lifespan and Population Health, Faculty of Medicine & Health Sciences, University of Nottingham, Clinical Sciences Building, City Hospital, Nottingham, UK
| | - M Evison
- Manchester Thoracic Oncology Centre, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Manchester, UK
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21
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Jørgensen MD, Mikkelsen EM, Erichsen R, Thomsen MK. Mental illness and participation in colorectal cancer screening: a scoping review. Scand J Gastroenterol 2022; 57:1216-1226. [PMID: 35639472 DOI: 10.1080/00365521.2022.2073185] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
INTRODUCTION Compared with the background population, persons with mental illness have increased colorectal cancer (CRC) mortality. Screening has the potential to alleviate the increased cancer mortality due to mental illness, but the extent to which persons with mental illness participate in CRC screening programs is uncertain. This scoping review aims to summarize the literature on CRC screening participation among persons with mental illness. MATERIALS AND METHODS We searched four databases (PubMed, PsychInfo, Embase, and the Cochrane Library) to identify published literature on mental illness and participation in CRC screening programs. We included full-text papers available in English, published before February 2021, and excluded papers on dementia, intellectual disabilities, and developmental disabilities. RESULTS In total, we included 17 studies and categorized the findings according to severity of mental illness. Across varying study designs, the studies found that persons with severe mental illness, e.g. schizophrenia, participate less in CRC screening compared with the background population. The results were ambiguous for common mental illness, such as depression and anxiety. In general, studies were small or lacked comparison groups and the estimates were imprecise. CONCLUSION This is the first scoping review to evaluate participation in CRC screening programs among persons with mental illness. Overall, the existing literature lacks high quality evidence from large population-based studies and comparison groups based on organized screening programs.
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Affiliation(s)
- Marie D Jørgensen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Ellen M Mikkelsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
| | - Rune Erichsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark.,Department of Surgery, Randers Regional Hospital, Randers NØ, Denmark
| | - Mette K Thomsen
- Department of Clinical Epidemiology, Aarhus University and Aarhus University Hospital, Aarhus N, Denmark
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22
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McWilliams L, Evans DG, Payne K, Harrison F, Howell A, Howell SJ, French DP. Implementing Risk-Stratified Breast Screening in England: An Agenda Setting Meeting. Cancers (Basel) 2022; 14:cancers14194636. [PMID: 36230559 PMCID: PMC9563640 DOI: 10.3390/cancers14194636] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Revised: 09/20/2022] [Accepted: 09/21/2022] [Indexed: 11/16/2022] Open
Abstract
It is now possible to accurately assess breast cancer risk at routine NHS Breast Screening Programme (NHSBSP) appointments, provide risk feedback and offer risk management strategies to women at higher risk. These strategies include National Institute for Health and Care Excellence (NICE) approved additional breast screening and risk-reducing medication. However, the NHSBSP invites nearly all women three-yearly, regardless of risk. In March 2022, a one-day agenda setting meeting took place in Manchester to discuss the feasibility and desirability of implementation of risk-stratified screening in the NHSBSP. Fifty-eight individuals participated (38 face-to-face, 20 virtual) with relevant expertise from academic, clinical and/or policy-making perspectives. Key findings were presented from the PROCAS2 NIHR programme grant regarding feasibility of risk-stratified screening in the NHSBSP. Participants discussed key uncertainties in seven groups, followed by a plenary session. Discussions were audio-recorded and thematically analysed to produce descriptive themes. Five themes were developed: (i) risk and health economic modelling; (ii) health inequalities and communication with women; (iii); extending screening intervals for low-risk women; (iv) integration with existing NHSBSP; and (v) potential new service models. Most attendees expected some form of risk-stratified breast screening to be implemented in England and collectively identified key issues to be resolved to facilitate this.
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Affiliation(s)
- Lorna McWilliams
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester M13 9WU, UK
- Correspondence:
| | - D. Gareth Evans
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester M13 9WU, UK
- Genomic Medicine, Division of Evolution and Genomic Sciences, School of Biological Sciences, Faculty of Biology, Medicine and Health, University of Manchester, St Mary’s Hospital, Manchester University NHS Foundation Trust, Oxford Road, Manchester M13 9WL, UK
- Nightingale & Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, 55 Wilmslow Road, Manchester M20 4GJ, UK
| | - Katherine Payne
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester M13 9WU, UK
- Manchester Centre for Health Economics, School of Health Sciences, Faculty of Biology Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | | | - Anthony Howell
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester M13 9WU, UK
- Nightingale & Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, 55 Wilmslow Road, Manchester M20 4GJ, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - Sacha J. Howell
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester M13 9WU, UK
- Nightingale & Prevent Breast Cancer Research Unit, Wythenshawe Hospital, Manchester University NHS Foundation Trust, Southmoor Road, Wythenshawe, Manchester M23 9LT, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, 55 Wilmslow Road, Manchester M20 4GJ, UK
- Division of Cancer Sciences, School of Medical Sciences, Faculty of Biology, Medicine & Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
| | - David P. French
- Manchester Centre for Health Psychology, Division of Psychology & Mental Health, School of Health Sciences, Faculty of Biology, Medicine and Health, University of Manchester, Oxford Road, Manchester M13 9PL, UK
- NIHR Manchester Biomedical Research Centre, Manchester Academic Health Science Centre, Manchester University NHS Foundation Trust, Manchester M13 9WU, UK
- Manchester Breast Centre, Manchester Cancer Research Centre, University of Manchester, 55 Wilmslow Road, Manchester M20 4GJ, UK
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23
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Helgestad ADL, Larsen MB, Njor S, Tranberg M, Petersen LK, Andersen B. Three birds with one stone: a protocol for a randomised intervention study to increase participation in cervical and colorectal cancer screening among women attending breast cancer screening. BMJ Open 2022; 12:e062824. [PMID: 36137619 PMCID: PMC9511607 DOI: 10.1136/bmjopen-2022-062824] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION The participation rate is higher in breast cancer screening than in cervical cancer (CCU) and colorectal cancer (CRC) screening. In this cluster-randomised study, we aim to evaluate an intervention offering home-based CCU and CRC screening to women when attending breast cancer screening if they are overdue for CCU and/or CRC screening. METHODS AND ANALYSIS On intervention days, one of the five breast cancer screening units in the Central Denmark Region will be randomly allocated to intervention, whereas the remaining units will serve as control. Women attending breast cancer screening in the intervention unit will be offered information regarding their CCU and CRC screening history, and, if overdue, they will be offered self-sampling screening kits. For CCU screening, women aged 50-64 years will be offered a vaginal self-sampling kit for human papillomavirus testing. For CRC screening, women aged 50-69 years will be offered a kit to obtain a faecal immunochemical test. Women attending the control units will receive only standard care.After the intervention, a survey will be sent to all women in the intervention and control group, asking about their experience while attending breast cancer screening.Primary outcomes will be difference in the coverage in CCU and CRC screening 6 months after intervention between the intervention and the control group, and difference in participation rates 6 months after intervention for those who were overdue for CCU and/or CRC screening at the time of the intervention. ETHICS AND DISSEMINATION The project is listed in the record of processing activities for research projects in the Central Denmark Region (R. No.: 1-16-02-217-21). According to the Danish Consolidation Act on Research Ethics Review of Health Research Project, this study was not notifiable to the Committee (R. No.: 1-10-72-1-21). The findings will be disseminated in peer-reviewed scientific journals. TRIAL REGISTRATION NUMBER NCT05022511.
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Affiliation(s)
- Anne Dorte Lerche Helgestad
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Sisse Njor
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
| | - Mette Tranberg
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
| | - Lone Kjeld Petersen
- Department of Obstetrics and Gynecology, Odense University Hospital, Odense, Denmark
- Open Patient data Explorative Network (OPEN), Department of Clinical Medicine, University of Southern Denmark, Odense, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Randers, Denmark
- Department of Clinical Medicine, Aarhus University, Aarhus, Denmark
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24
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Shuldiner J, Shah N, Reis C, Chalmers I, Ivers N, Nathan P. Developing a Provincial Surveillance and Support System for Childhood Cancer Survivors: Multiphase User-Centered Design Study. JMIR Hum Factors 2022; 9:e37606. [PMID: 36099013 PMCID: PMC9516377 DOI: 10.2196/37606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/21/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Survivors of childhood cancer are at lifelong risk of morbidity (such as new cancers or heart failure) and premature mortality due to their cancer treatment. These are termed late effects. Therefore, they require lifelong, risk-tailored surveillance. However, most adult survivors of childhood cancer do not complete recommended surveillance tests such as mammograms or echocardiograms. Objective In partnership with survivors, family physicians, and health system partners, we are designing a provincial support system for high-priority tests informed by principles of implementation science, behavioral science, and design thinking. Methods Our multiphase process was structured as follows. Step 1 consisted of a qualitative study to explore intervention components essential to accessing surveillance tests. Step 2 comprised a workshop with childhood cancer survivors, family physicians, and health system stakeholders that used the Step 1 findings and “personas” (a series of fictional but data-informed characters) to develop and tailor the intervention for different survivor groups. Step 3 consisted of intervention prototype development, and Step 4 involved iterative user testing. Results The qualitative study of 30 survivors and 7 family physicians found a high desire for information on surveillance for late effects. Respondents indicated that the intervention should help patients book appointments when they are due in addition to providing personalized information. Insights from the workshop included the importance of partnering with both family physicians and survivorship clinics and providing emotional support for survivors who may experience distress upon learning of their risk for late effects. In our user-testing process, prototypes went through iterations that incorporated feedback from users regarding acceptability, usability, and functionality. We sought to address the needs of survivors and physicians while balancing the capacity and infrastructure available for a lifelong intervention via our health system partners. Conclusions In partnership with childhood cancer survivors, family physicians, and health system partners, we elucidated the barriers and enablers to accessing guideline-recommended surveillance tests and designed a multifaceted solution that will support survivors and their family physicians. The next step is to evaluate the intervention in a pragmatic randomized controlled trial.
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Affiliation(s)
- Jennifer Shuldiner
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Nida Shah
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Catherine Reis
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | | | - Noah Ivers
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Nathan
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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25
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Luckett KL. Implementing a standardized protocol to improve cervical cancer screening rates in primary care. J Am Assoc Nurse Pract 2022; 34:1077-1082. [PMID: 35916764 DOI: 10.1097/jxx.0000000000000758] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2022] [Accepted: 06/13/2022] [Indexed: 11/25/2022]
Abstract
BACKGROUND Routine cervical cancer screening for women aged 21-65 is a recommended standard practice. Early identification and treatment of cervical cancer improves patient outcomes. LOCAL PROBLEM Cervical cancer screening rates at the primary care project site were 51%, well below the national benchmark of 87%. The purpose of this quality improvement project was to increase cervical cancer screening rates by implementing a standardized eligibility assessment protocol. METHODS This initiative took place at an outpatient family practice site over 7.5 months and included 2,018 eligible patients. INTERVENTIONS Evidence-based interventions included a standardized process change that shifted eligibility assessment from an opportunistic screening by providers to a proactive screening by clinical staff. Using a system reminder prompt, clinical staff began assessing all eligible patients during rooming and proactively scheduling future Pap appointments in office or placing OBGYN referrals, per patient preference. RESULTS A statistically significant increase in cervical cancer screening rates occurred, 33% ( p < .001). The rate of scheduled Pap appointments increased by 124% ( p < .001), the rate of OBGYN referrals increased by 300% ( p < .001), and the rate of completed Pap tests in office increased by 280% ( p < .001). CONCLUSION The results suggest that implementing a proactive, standardized screening process can increase cervical cancer screening rates in primary care.
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26
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Thomas C, Mandrik O, Whyte S. Modelling cost-effective strategies for minimising socioeconomic inequalities in colorectal cancer screening outcomes in England. Prev Med 2022; 162:107131. [PMID: 35803353 DOI: 10.1016/j.ypmed.2022.107131] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 06/17/2022] [Accepted: 06/27/2022] [Indexed: 11/18/2022]
Abstract
Colorectal cancer (CRC) incidence and mortality is higher in socioeconomically deprived groups for a variety of reasons, but is exacerbated by poorer screening uptake. However, many strategies for improving screening participation exist. This analysis aimed to model the impact of screening on CRC inequalities in England and then compare different strategies for increasing participation, to determine the most cost-effective methods for reducing screening-induced inequalities. An existing health economic model, Microsimulation Model in Cancer of the Bowel was adapted. Screening-eligible individuals were simulated to investigate the impact of screening on CRC inequalities. Following this, four strategies for promoting screening participation were compared: 1) annual re-invitation of screening non-participants; 2) a national media advertising campaign; 3) text message reminders for non-participants; 4) health promotion in deprived populations. Cost-effectiveness, CRC outcomes, resource impacts and effects on CRC inequalities were assessed. Inequalities analysis was based on age-standardised CRC mortality by socioeconomic group. Screening was found to be highly cost-effective but CRC inequalities increased as screening effectiveness improved. Annual re-invitation of non-participants was most cost-effective for promoting particiption (incremental cost-effectiveness ratio = £4404 per quality-adjusted life-year), reducing CRC mortality (11,129 deaths averted), and reducing screening-induced inequality (slope of inequalities reduced from 20.80 to 19.38), although it required 42% more screening kits to be sent out. Other strategies were cost-effective compared with screening alone, and improved CRC outcomes, but had varying impacts on inequalities. Whilst bowel cancer screening increases socioeconomic inequalities in CRC mortality, effective and cost-effective strategies are available for mitigating screening-induced inequalities.
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Affiliation(s)
- Chloe Thomas
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield S1 4DA, United Kingdom.
| | - Olena Mandrik
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield S1 4DA, United Kingdom
| | - Sophie Whyte
- School of Health and Related Research, University of Sheffield, Regent Court, Sheffield S1 4DA, United Kingdom
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27
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Schliemann D, Tan MM, Hoe WMK, Mohan D, Taib NA, Donnelly M, Su TT. mHealth Interventions to Improve Cancer Screening and Early Detection: Scoping Review of Reviews. J Med Internet Res 2022; 24:e36316. [PMID: 35969450 PMCID: PMC9425170 DOI: 10.2196/36316] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/13/2022] [Revised: 06/14/2022] [Accepted: 06/16/2022] [Indexed: 12/24/2022] Open
Abstract
BACKGROUND Cancer screening provision in resource-constrained settings tends to be opportunistic, and uptake tends to be low, leading to delayed presentation and treatment and poor survival. OBJECTIVE The aim of this study was to identify, review, map, and summarize findings from different types of literature reviews on the use of mobile health (mHealth) technologies to improve the uptake of cancer screening. METHODS The review methodology was guided by the PRISMA-ScR (Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews). Ovid MEDLINE, PyscINFO, and Embase were searched from inception to May 2021. The eligible criteria included reviews that focused on studies of interventions that used mobile phone devices to promote and deliver cancer screening and described the effectiveness or implementation of mHealth intervention outcomes. Key data fields such as study aims, types of cancer, mHealth formats, and outcomes were extracted, and the data were analyzed to address the objective of the review. RESULTS Our initial search identified 1981 titles, of which 12 (0.61%) reviews met the inclusion criteria (systematic reviews: n=6, 50%; scoping reviews: n=4, 33%; rapid reviews: n=1, 8%; narrative reviews: n=1, 8%). Most (57/67, 85%) of the interventions targeted breast and cervical cancer awareness and screening uptake. The most commonly used mHealth technologies for increasing cancer screening uptake were SMS text messages and telephone calls. Overall, mHealth interventions increased knowledge about screening and had high acceptance among participants. The likelihood of achieving improved uptake-related outcomes increased when interventions used >1 mode of communication (telephone reminders, physical invitation letters, and educational pamphlets) together with mHealth. CONCLUSIONS mHealth interventions increase cancer screening uptake, although multiple modes used in combination seem to be more effective.
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Affiliation(s)
- Désirée Schliemann
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Min Min Tan
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Subang Jaya, Malaysia.,Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Wilfred Mok Kok Hoe
- South East Asia Community Observatory (SEACO), Monash University Malaysia, Subang Jaya, Malaysia.,Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Devi Mohan
- Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
| | - Nur Aishah Taib
- Department of Surgery, Faculty of Medicine, University Malaya Cancer Research Institute, University of Malaya, Kuala Lumpur, Malaysia
| | - Michael Donnelly
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom
| | - Tin Tin Su
- Centre for Public Health, Queen's University Belfast, Belfast, United Kingdom.,South East Asia Community Observatory (SEACO), Monash University Malaysia, Subang Jaya, Malaysia.,Global Public Health, Jeffrey Cheah School of Medicine and Health Sciences, Monash University Malaysia, Subang Jaya, Malaysia
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28
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Verbunt E, Boyd L, Creagh N, Milley K, Emery J, Nightingale C, Kelaher M. Health care system factors influencing primary healthcare workers' engagement in national cancer screening programs: a qualitative study. Aust N Z J Public Health 2022; 46:858-864. [PMID: 35735902 DOI: 10.1111/1753-6405.13272] [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: 07/01/2021] [Revised: 03/01/2022] [Accepted: 05/01/2022] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE This study aimed to explore factors across the environment, organisation and care team levels of the health care system that influence the engagement of primary healthcare workers (PHCWs) in Australia's national cancer screening programs. METHODS A cross-sectional qualitative study involving semi-structured interviews with PHCWs - general practitioners (n=10), practices nurses (n=10), and practice managers (n=10) from settings across Australia. Transcripts were analysed using the Framework Method. RESULTS Two environment-level factors were found to influence several organisation and care team level factors. Firstly, the financial structure of primary health care, impacting on practitioner: time, practice culture, screening knowledge and opportunistic conversations. Secondly, the structure of screening programs had flow-on effects for: access to patient screening records, recall and reminder systems, and sense of program ownership. CONCLUSIONS Encouraging more effective PHCW engagement in the screening programs requires the consideration and mitigation of overarching financial and structural barriers. Up-to-date and easy-to-use recall and reminder systems, whole-of-practice approaches which optimise the role of each PHCW and the identification of a 'champion' to drive implementation should be considered. IMPLICATIONS FOR PUBLIC HEALTH This study offers insights into what elements practice and practitioner targeted initiatives in Australia should incorporate, potentially leading to improved engagement of PHCWs and increased cancer screening participation rates.
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Affiliation(s)
- Ebony Verbunt
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Victoria
| | - Lucy Boyd
- Centre for Cancer Research, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria
| | - Nicola Creagh
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Victoria
| | - Kristi Milley
- Centre for Cancer Research, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria
| | - Jon Emery
- Centre for Cancer Research, Department of General Practice, Faculty of Medicine, Dentistry and Health Sciences, The University of Melbourne, Victoria
| | - Claire Nightingale
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Victoria
| | - Margaret Kelaher
- Centre for Health Policy, Melbourne School of Population and Global Health, The University of Melbourne, Victoria
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Bosch G, Posso M, Louro J, Roman M, Porta M, Castells X, Macià F. Impact of the COVID-19 pandemic on breast cancer screening indicators in a Spanish population-based program: a cohort study. eLife 2022; 11:77434. [PMID: 35686727 PMCID: PMC9212994 DOI: 10.7554/elife.77434] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2022] [Accepted: 06/09/2022] [Indexed: 12/23/2022] Open
Abstract
Background: To assess the effect of the COVID-19 pandemic on performance indicators in the population-based breast cancer screening program of Parc de Salut Mar (PSMAR), Barcelona, Spain. Methods: We conducted a before-and-after, study to evaluate participation, recall, false positives, the cancer detection rate, and cancer characteristics in our screening population from March 2020 to March 2021 compared with the four previous rounds (2012–2019). Using multilevel logistic regression models, we estimated the adjusted odds ratios (aORs) of each of the performance indicators for the COVID-19 period, controlling by type of screening (prevalent or incident), socioeconomic index, family history of breast cancer, and menopausal status. We analyzed 144,779 invitations from 47,571women. Results: During the COVID-19 period, the odds of participation were lower in first-time invitees (aOR = 0.90 [95% CI = 0.84–0.96]) and in those who had previously participated regularly and irregularly (aOR = 0.63 [95% CI = 0.59–0.67] and aOR = 0.95 [95% CI = 0.86–1.05], respectively). Participation showed a modest increase in women not attending any of the previous rounds (aOR = 1.10 [95% CI = 1.01–1.20]). The recall rate decreased in both prevalent and incident screening (aOR = 0.74 [95% CI = 0.56–0.99] and aOR = 0.80 [95% CI = 0.68–0.95], respectively). False positives also decreased in both groups (prevalent aOR = 0.92 [95% CI = 0.66–1.28] and incident aOR = 0.72 [95% CI = 0.59–0.88]). No significant differences were observed in compliance with recall (OR = 1.26, 95% CI = 0.76–2.23), cancer detection rate (aOR = 0.91 [95% CI = 0.69–1.18]), or cancer stages. Conclusions: The COVID-19 pandemic negatively affected screening attendance, especially in previous participants and newcomers. We found a reduction in recall and false positives and no marked differences in cancer detection, indicating the robustness of the program. There is a need for further evaluations of interval cancers and potential diagnostic delays. Funding: This study has received funding by grants PI19/00007 and PI21/00058, funded by Instituto de Salud Carlos III (ISCIII) and cofunded by the European Union and Grant RD21/0016/0020 funded by Instituto de Salud Carlos III and by the European Union NextGenerationEU, Mecanismo para la Recuperación y la Resiliencia (MRR).
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Affiliation(s)
- Guillermo Bosch
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Preventive Medicine and Public Health Training Unit PSMar-ASPB-UPF, Barcelona, Spain
| | - Margarita Posso
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Javier Louro
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Marta Roman
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
| | - Miquel Porta
- Universitat Autònoma de Barcelona, Barcelona, Spain.,Hospital del Mar Institute of Medical Research (IMIM PSMar), Barcelona, Spain.,Spanish Consortium for Research on Epidemiology and Public Health (CIBERESP), Madrid, Spain
| | - Xavier Castells
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain.,Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Francesc Macià
- Department of Epidemiology and Evaluation,IMIM (Hospital del Mar Medical Research Institute), Barcelona, Spain.,Research Network on Chronicity, Primary Care and Health Promotion (RICAPPS), Barcelona, Spain
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Delon C, Brown KF, Payne NWS, Kotrotsios Y, Vernon S, Shelton J. Differences in cancer incidence by broad ethnic group in England, 2013-2017. Br J Cancer 2022; 126:1765-1773. [PMID: 35233092 PMCID: PMC9174248 DOI: 10.1038/s41416-022-01718-5] [Citation(s) in RCA: 32] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2021] [Revised: 01/05/2022] [Accepted: 01/25/2022] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Cancer incidence variation between population groups can inform public health and cancer services. Previous studies have shown cancer incidence rates vary by ethnic group in England. Since their publication, the completeness of ethnicity recording in cancer data has improved, and relevant inequalities (e.g. risk factor prevalence and healthcare access) may have changed. METHODS Age-standardised incidence rates were calculated for Asian, Black, Mixed/Multiple and White ethnic groups in England in 2013-2017, using almost 3 million diagnoses across 31 cancer sites. Rate ratios were calculated with the White ethnic group as reference. Sensitivity analyses used imputed ethnicity for cases with missing data and perturbed population estimates. RESULTS Incidence rates for most cancer sites and ethnic group and sex combinations were lower in non-White minority ethnic groups compared with the corresponding White group, with particularly low rate ratios (below 0.5) for melanoma skin cancer and some smoking-related cancers (lung, bladder and oesophageal cancers). Exceptions included prostate cancer (2.1 times higher in males of Black ethnicity), myeloma (2.7-3.0 times higher in people of Black ethnicity), several gastrointestinal cancers (1.1-1.9 times higher in people of Black ethnicity, 1.4-2.2 times higher in people of Asian ethnicity), Hodgkin lymphoma (1.1 times higher in males of Asian ethnicity, 1.3 times higher in males of Black ethnicity) and thyroid cancers (1.4 times higher in people of Asian ethnicity, 1.2 times higher in people of Black ethnicity). Sensitivity analyses did not materially alter these results (rate ratios changed by a maximum of 12 percentage points, the direction and significance of results were unchanged in all but two cancer site/sex/ethnic group combinations). CONCLUSIONS People of non-White minority ethnicity in England generally have lower cancer risk than the White population, though there are a number of notable exceptions. These results should galvanise efforts to better understand the reasons for this variation, and the possible impact on cancer services, patient experiences and outcomes.
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Affiliation(s)
- Christine Delon
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK.
| | - Katrina F Brown
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Nick W S Payne
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Yannis Kotrotsios
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
| | - Sally Vernon
- National Disease Registration Service, NHS Digital, 7 and 8 Wellington Place, Leeds, LS1 4AP, UK
| | - Jon Shelton
- Cancer Intelligence Team, Cancer Research UK, 2 Redman Place, London, E20 1JQ, UK
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31
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Thy JE, Vigeland E, Larsen M, Hofvind S. Participation and cancer detection after reminders versus ordinary invitations in BreastScreen Norway. J Med Screen 2022; 29:178-184. [PMID: 35502849 DOI: 10.1177/09691413221098839] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVES To compare attendance, recall and cancer detection as well as histopathological tumor characteristics among women attending BreastScreen Norway after a reminder versus an ordinary invitation. SETTING This study was conducted on data from a population-based screening program inviting women aged 50-69 to biennial two-view mammography. METHODS We used de-identified data from 883,020 women invited to BreastScreen Norway, 2004-2020, to analyze invitations, participation, recalls, biopsies, cancer detection, and histopathological tumor characteristics. All results were stratified by reminders and ordinary invitations. Early screening outcomes after reminders versus ordinary invitations were compared using bivariate tests and multivariable logistic regression. RESULTS Reminders increased overall participation rate by 5.0%. The recall rate was 4.3% for reminded women and 3.3% for the ordinary invited. For reminded women, the rate of screen-detected cancer was 7.3 per 1000 screening examinations compared to 5.8 per 1000 for ordinary attenders. The interval cancer rates were 1.9 and 1.7 per 1000 for reminded and ordinary invited women, respectively. Median tumor diameter was 14 mm (interquartile range (IQR): 10-16) for screen-detected cancers (SDC) among reminded women and 13 mm (IQR: 10-16) for ordinary invited. A higher percentage of histological grade III cancers was observed among the reminded: 25.2% versus 21.7% for the ordinary invited. We also found a higher proportion of lymph node positive cases in those reminded: 23.6% versus 20.9%. CONCLUSIONS Postponing screening examinations affects early screening outcomes, including cancer detection and histopathological tumor characteristics. Women should be encouraged to attend screening at regularly intervals to avoid delays in diagnosis.
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Affiliation(s)
- Jonas E Thy
- 11315Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
| | - Einar Vigeland
- Department of Radiology, 60512Vestfold Hospital, Tønsberg, Norway
| | - Marthe Larsen
- 11315Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway
| | - Solveig Hofvind
- 11315Section for Breast Screening, Cancer Registry of Norway, Oslo, Norway.,Department of Health and Care Sciences, 8016The Arctic University of Norway, Tromsø, Norway
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Teixeira C, Antão C, Anes E, Gomes MJ, Versos A, Tomé C. Use of Cervical Cancer Screening among Patients of Primary Healthcare Services: Northeast Portugal. PORTUGUESE JOURNAL OF PUBLIC HEALTH 2022. [DOI: 10.1159/000522666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
<b><i>Background:</i></b> Understanding the overuse and underuse of cervical cancer (CC) screening plays a role in preventing such behaviours, allowing to maximize the CC screening uptake. <b><i>Aim:</i></b> To assess the predictors of being over-screened and never/under-screened in CC screening in Northeast Portugal. <b><i>Methods:</i></b> This is a part of a larger cross-sectional survey carried out in two public health centres in Northeast Portugal (October 2017 to June 2018). Data collection was based on a face-to-face interview. This analysis included 764 women (aged 25–60 years) classified according to the use of CC screening into guideline-consistent screened, over-screened and unscreened/under-screened. Multivariate logistic regression models were conducted to assess predictors of being over-screened and never/under-screened. Adjusted odds ratio (OR) and respective 95% confidence interval (95% CI) were obtained. <b><i>Results:</i></b> One-fourth (<i>n</i> = 197) of participants were unscreened/under-screened and 50.0% (<i>n</i> = 382) of them were classified as over-screened. Regular visits with primary care physicians (OR = 0.44; 95% CI: 0.26–0.76) and higher age (OR = 0.98; 95% CI: 0.96–1.00) reduced the odds of being unscreened/under-screened. Women who received prescription/recommendation for CC screening from primary care physician (OR = 1.89; 95% CI: 1.09–3.29) or both primary care physician and nurse (OR = 2.62; 95% CI: 1.10–6.22) were more likely to be over-screened. Higher level of CC health literacy decreases the odds of being over-screened (OR = 0.95; 95% CI: 0.90–1.00) and unscreened/under-screened (OR = 0.87; 95% CI: 0.82–0.92). The majority of over-screened (52.2%) and of under-screened (44.2%) women reported that their screening frequency was based on healthcare provider prescription. Among never-screened women, 60.2% reported that no one prescribed screening. <b><i>Conclusion:</i></b> The increase in CC health literacy can maximize CC screening uptake. Primary healthcare providers could play a role in preventing the overuse and underuse of CC screening.
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Stoffel ST, McGregor L, Hirst Y, Hanif S, Morris L, von Wagner C. Evaluation of the Call for a Kit intervention to increase bowel cancer screening uptake in Lancashire, England. J Med Screen 2022; 29:166-171. [PMID: 35410541 PMCID: PMC9381688 DOI: 10.1177/09691413221089184] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
OBJECTIVE To evaluate the 'Call for a Kit' health promotion intervention that was initiated in Lancashire, England to improve bowel cancer screening uptake. METHODS Within the intervention, screening non-responders are called and invited to attend a consultation with a health promotion team member at their primary care practice. In this audit, we analysed the proportion of those contacted who attended the in-person clinic versus those who received a phone consultation, the number returning a test kit from in-person versus phone consultations, and the extent to which test kit return was moderated by sociodemographic characteristics. RESULTS In 2019, 68 practices participated in the intervention which led to 10,772 individuals being contacted; 2464 accepted the invitation to an in-person consultation, of whom 1943 attended. A further 1065 agreed to and attended a consultation over the phone. The 3008 consultations resulted in 2890 test kits being ordered, of which 1608 (55.6%) were returned. The intervention therefore yielded a 14.9% response rate in the total cohort; 71.5% of test kits came from individuals attending the in-person consultation. Women and those registered with a practice in socioeconomically deprived areas were less likely to return the test kit. Individuals with a black, mixed or a non-Indian/Pakistani Asian ethnic background were significantly more likely to accept the offer of an in-person consultation and return the test kit. CONCLUSION Our analysis demonstrated the strong likelihood of people returning a test kit after an in-person appointment but also the usefulness of using phone consultations as a safety net for people unable or unwilling to attend in-person clinics.
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Affiliation(s)
- Sandro T Stoffel
- Research Department of Behavioural Science and Health, University College London, London, UK.,Institute for Pharmaceutical Medicine, 27209University of Basel, Basel, Switzerland
| | - Lesley McGregor
- Division of Psychology, Faculty of Natural Sciences, 7622University of Stirling, Stirling, UK
| | - Yasemin Hirst
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Sahida Hanif
- 1756Blackpool Teaching Hospitals, NHS Foundation Trust, Blackpool, UK
| | - Lorraine Morris
- 1756Blackpool Teaching Hospitals, NHS Foundation Trust, Blackpool, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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Implementing lung cancer screening in Europe: taking a systems approach. JTO Clin Res Rep 2022; 3:100329. [PMID: 35601926 PMCID: PMC9121320 DOI: 10.1016/j.jtocrr.2022.100329] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2022] [Revised: 03/30/2022] [Accepted: 04/14/2022] [Indexed: 12/05/2022] Open
Abstract
Lung cancer is the leading cause of cancer death in Europe. Screening by means of low-dose computed tomography (LDCT) can shift detection to an earlier stage and reduce lung cancer mortality in high-risk individuals. However, to date, Poland, Croatia, Italy, and Romania are the only European countries to commit to large-scale implementation of targeted LDCT screening. Using a health systems approach, this article evaluates key factors needed to enable the successful implementation of screening programs across Europe. Recent literature on LDCT screening was reviewed for 10 countries (Belgium, Croatia, France, Germany, Italy, the Netherlands, Poland, Spain, Sweden, and United Kingdom) and complemented by 17 semistructured interviews with local experts. Research findings were mapped against a health systems framework adapted for lung cancer screening. The European policy landscape is highly variable, but potential barriers to implementation are similar across countries and consistent with those reported for other cancer screening programs. While consistent quality and safety of screening must be ensured across all screening centers, system factors are also important. These include appropriate data infrastructure, targeted recruitment methods that ensure equity in participation, sufficient capacity and workforce training, full integration of screening with multidisciplinary care pathways, and smoking cessation programs. Stigma and underlying perceptions of lung cancer as a self-inflicted condition are also important considerations. Building on decades of implementation research, governments now have a unique opportunity to establish effective, efficient, and equitable lung cancer screening programs adapted to their health systems, curbing the impact of lung cancer on their populations.
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35
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Taylor LC, Kerrison RS, Herrmann B, Stoffel ST. Effectiveness of behavioural economics-based interventions to improve colorectal cancer screening participation: A rapid systematic review of randomised controlled trials. Prev Med Rep 2022; 26:101747. [PMID: 35284211 PMCID: PMC8914541 DOI: 10.1016/j.pmedr.2022.101747] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 02/18/2022] [Accepted: 02/26/2022] [Indexed: 12/22/2022] Open
Abstract
We searched PubMed, PsycInfo and EconLit for RCTs that evaluated BE interventions in CRC screening. We identified 1027 papers for title and abstract review. 30 studies were eligible for the review. The most frequently tested BE intervention was incentives, followed by default principle and salience. Default-based interventions were most likely to be effective. Incentives had mixed evidence. BE remains a promising field of interest in relation to influencing CRC screening behaviours.
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Affiliation(s)
- Lily C. Taylor
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, UK
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Robert S. Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
- School of Health Sciences, University of Surrey, Surrey, UK
| | | | - Sandro T. Stoffel
- Research Department of Behavioural Science and Health, University College London, London, UK
- European Commission, Joint Research Centre (JRC), Ispra, Italy
- Institute for Pharmaceutical Medicine, University of Basel, Basel, Switzerland
- Corresponding author at: Research Department of Behavioural Science and Health, University College London, London, UK.
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36
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Duffy SW, Hudson S, Vulkan D, Duffy TE, Binysh K. Recovery of the breast screening programme following pandemic-related delays: Should we focus on round length or uptake? J Med Screen 2022; 29:99-103. [PMID: 35119338 PMCID: PMC9087308 DOI: 10.1177/09691413211066476] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES The NHS Breast Screening programme is recovering from the hiatus in screening in 2020 due to the COVID-19 pandemic. Currently, open rather than timed invitations are issued, which leads to lower uptake but more rapid coverage of the eligible population by invitation and therefore closer adherence to a round length of 3 years. We aimed to estimate the likely effect on numbers of cancers detected at incident screens of a range of round lengths and uptake rates. METHODS We assumed exponential distributions of time to incidence of preclinical screen-detectable cancer and of time to progression thereafter to symptomatic clinical disease. We derived numerical values of these, along with screening sensitivity, from published research results and statistics from the NHS Breast Screening programme. These were used to calculate numbers of cancers detected at incident screens at ages 51-70 by round length and uptake rates. RESULTS We found that in a homogeneous population of cancers, a 4-year round length with uptake of 62%, as observed with timed appointments in London before the pandemic, would result in 295 cancers screen detected per 10,000 invited, compared to 222 cancers with a 3-year round and uptake of 46%, as observed in London during the recovery period. Similar results were found when we posited two populations, one of rapidly progressing and one of slowly progressing cancers. CONCLUSIONS It may be more productive in terms of early detection to focus on uptake rather than round length in the programme's recovery from the pandemic.
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Affiliation(s)
- Stephen W Duffy
- 105714Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Sue Hudson
- Peel & Schriek Consulting Limited, London, UK
| | - Daniel Vulkan
- 105714Wolfson Institute of Population Health, Queen Mary University of London, London, UK
| | - Thomas E Duffy
- Research Department of Behavioural Science and Health, 4919University College London, London, UK
| | - Kathie Binysh
- Head of Screening, 53249NHS England & Improvement (London), London, UK
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37
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Deng Q, Liu W. The Effect of Social Norms on Physicians’ Intentions to Use Liver Cancer Screening: A Cross-Sectional Study Using Extended Theory of Planned Behavior. Healthc Policy 2022; 15:179-191. [PMID: 35173496 PMCID: PMC8841539 DOI: 10.2147/rmhp.s349387] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2021] [Accepted: 01/27/2022] [Indexed: 11/25/2022] Open
Abstract
Background Liver cancer is a globally acknowledged threat to public health, and there is a critical and urgent need to determine factors associated with the use of liver cancer screening and to further promote its use. Purpose To examine whether the extended theory of planned behavior (TPB) incorporating social norms predicts physicians’ intentions to use liver cancer screening and to identify the associated factors quantitatively, using contrast-enhanced ultrasound (CEUS) as an example. Methods A research framework was established by adding social norms to the TPB, based on which the questionnaire for this study was developed. Through multistage random sampling, a cross-sectional questionnaire survey was conducted among 292 physicians in Fujian and Jiangxi provinces. Due to the multicollinearity problem of the data, ridge regression was applied to determine the influencing factors of physicians’ intentions to use CEUS. Results Most participants (87.30%) reported that they were willing to use liver cancer screening in their clinical practice. The scores of TPB variables were generally higher than those of social norms variables. Ridge regression results indicated that the proposed model was explanatory, which has accounted for 73.5% of the total variance in physicians’ intentions. Analyses also illustrated the significant role of TPB variables (attitude and perceived behavioral control) and social norms variables (personal norms, organizational norms, and industrial norms) on physicians’ intentions to use CEUS. Conclusion The study extended the TPB by including the concepts of social norms, which is not only conducive to expanding the knowledge of factors associated with physicians’ intentions to use liver cancer screening, but also provides implications for developing strategies to promote the use of certain health services or products, such as playing the role of core members, holding panel meetings, and establishing information push systems.
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Affiliation(s)
- Qingwen Deng
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
- School of Public Health, Fudan University, Shanghai, 200032, People’s Republic of China
| | - Wenbin Liu
- Department of Health Management, School of Public Health, Fujian Medical University, Fuzhou, 350122, People’s Republic of China
- Correspondence: Wenbin Liu, Tel +86 13799983766, Email
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Patients' and physicians' experiences with remote consultations in primary care, during the covid-19 pandemic: a multi-method rapid review of the literature. BJGP Open 2022; 6:BJGPO.2021.0192. [PMID: 35031558 PMCID: PMC9447321 DOI: 10.3399/bjgpo.2021.0192] [Citation(s) in RCA: 22] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2021] [Accepted: 11/22/2021] [Indexed: 11/03/2022] Open
Abstract
BACKGROUND During the COVID-19 pandemic, many countries implemented remote consultations in primary care to protect patients and staff from infection. AIM The aim of this review was to synthesise the literature exploring patients' and physicians' experiences with remote consultations in primary care, during the pandemic, with the further aim of informing their future delivery. DESIGN & SETTING Rapid literature review. METHOD We searched PubMed and PsychInfo for studies that explored patients' and physicians' experiences with remote consultations in primary care. To determine the eligibility of studies, we reviewed their titles and abstracts, prior to the full paper. We then extracted qualitative and quantitative data from those that were eligible, and synthesised the data using thematic and descriptive synthesis. RESULTS A total of twenty-four studies were eligible for inclusion in the review. Most were performed in the United States of America (n=7, 29%) or Europe (n=7, 29%). Patient and physician experiences were categorised into perceived 'advantages' and 'issues'. Key advantages experienced by patients and physicians included: 'Reduced risk of COVID-19' and 'Increased convenience', while key issues included: 'a lack of confidence in / access to required technology' and a 'loss of non-verbal communication', which exacerbated clinical decision making. CONCLUSION This review identified a number of advantages and issues experienced by patients and physicians using remote consultations in primary care. The results suggest that, while remote consultations are more convenient, and protect patients and staff against COVID-19, they result in the loss of valuable non-verbal communication, and are not accessible to all.
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Landy R, Hollingworth T, Waller J, Marlow LA, Rigney J, Round T, Sasieni PD, Lim AW. Non-speculum sampling approaches for cervical screening in older women: randomised controlled trial. Br J Gen Pract 2022; 72:e26-e33. [PMID: 34972808 PMCID: PMC8714504 DOI: 10.3399/bjgp.2021.0350] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2021] [Accepted: 08/25/2021] [Indexed: 01/10/2023] Open
Abstract
BACKGROUND Cervical cancer disproportionately affects women ≥65 years, especially those not screened regularly. Speculum use is a key barrier. AIM To assess if offering non-speculum clinician-taken sampling and self-sampling increases uptake for lapsed attenders aged 50-64 years. DESIGN AND SETTING Pragmatic randomised control trial conducted at 10 general practices in East London, UK. METHOD Participants were 784 women aged 50-64 years, last screened 6-15 years before randomisation. Intervention participants received a letter offering the choice of non-speculum clinician- or self-sampling. Control participants received usual care. The main outcome measure was uptake within 4 months. RESULTS Screening uptake 4 months after randomisation was significantly higher in the intervention arm: 20.4% (n = 80/393) versus 4.9% in the control arm (n = 19/391, absolute difference 15.5%, 95% confidence interval [CI] = 11.0% to 20.0%, P<0.001). This was maintained at 12 months: intervention 30.5% (n = 120/393) versus control 13.6% (n = 53/391) (absolute difference 17.0%, 95% CI = 11.3% to 22.7%, P<0.001). Conventional screening attendance within 12 months was very similar for both intervention 12.7% (n = 50/393) and control 13.6% (n = 53/391) arms. Ethnic differences were seen in screening modality preference. More White women opted for self-sampling (50.7%, n = 38/75), whereas most Asian and Black women and those from other ethnic backgrounds opted for conventional screening. CONCLUSION Offering non-speculum clinician-taken sampling and self-sampling substantially increases uptake in older lapsed attendee women. Non-speculum clinician sampling appeals to women who dislike the speculum but still prefer a clinician to take their sample. Providing a choice of screening modality may be important for optimising cervical screening uptake.
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Affiliation(s)
- Rebecca Landy
- Division of Cancer Epidemiology and Genetics, National Cancer Institute, National Institutes of Health, Department of Health and Human Services, Bethesda, Maryland, US
| | | | - Jo Waller
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Laura Av Marlow
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Jane Rigney
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Thomas Round
- School of Population Health and Environmental Sciences, King's College London, London and National Cancer Analysis and Registration Service, Public Health England
| | - Peter D Sasieni
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
| | - Anita Ww Lim
- Comprehensive Cancer Centre, School of Cancer and Pharmaceutical Sciences, Faculty of Life Sciences and Medicine, King's College London, London
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40
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North F, Nelson EM, Buss RJ, Majerus RJ, Thompson MC, Crum BA. The Effect of Automated Mammogram Orders Paired With Electronic Invitations to Self-schedule on Mammogram Scheduling Outcomes: Observational Cohort Comparison. JMIR Med Inform 2021; 9:e27072. [PMID: 34878997 PMCID: PMC8693199 DOI: 10.2196/27072] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Revised: 04/03/2021] [Accepted: 11/15/2021] [Indexed: 01/15/2023] Open
Abstract
Background Screening mammography is recommended for the early detection of breast cancer. The processes for ordering screening mammography often rely on a health care provider order and a scheduler to arrange the time and location of breast imaging. Self-scheduling after automated ordering of screening mammograms may offer a more efficient and convenient way to schedule screening mammograms. Objective The aim of this study was to determine the use, outcomes, and efficiency of an automated mammogram ordering and invitation process paired with self-scheduling. Methods We examined appointment data from 12 months of scheduled mammogram appointments, starting in September 2019 when a web and mobile app self-scheduling process for screening mammograms was made available for the Mayo Clinic primary care practice. Patients registered to the Mayo Clinic Patient Online Services could view the schedules and book their mammogram appointment via the web or a mobile app. Self-scheduling required no telephone calls or staff appointment schedulers. We examined uptake (count and percentage of patients utilizing self-scheduling), number of appointment actions taken by self-schedulers and by those using staff schedulers, no-show outcomes, scheduling efficiency, and weekend and after-hours use of self-scheduling. Results For patients who were registered to patient online services and had screening mammogram appointment activity, 15.3% (14,387/93,901) used the web or mobile app to do either some mammogram self-scheduling or self-cancelling appointment actions. Approximately 24.4% (3285/13,454) of self-scheduling occurred after normal business hours/on weekends. Approximately 9.3% (8736/93,901) of the patients used self-scheduling/cancelling exclusively. For self-scheduled mammograms, there were 5.7% (536/9433) no-shows compared to 4.6% (3590/77,531) no-shows in staff-scheduled mammograms (unadjusted odds ratio 1.24, 95% CI 1.13-1.36; P<.001). The odds ratio of no-shows for self-scheduled mammograms to staff-scheduled mammograms decreased to 1.12 (95% CI 1.02-1.23; P=.02) when adjusted for age, race, and ethnicity. On average, since there were only 0.197 staff-scheduler actions for each finalized self-scheduled appointment, staff schedulers were rarely used to redo or “clean up” self-scheduled appointments. Exclusively self-scheduled appointments were significantly more efficient than staff-scheduled appointments. Self-schedulers experienced a single appointment step process (one and done) for 93.5% (7553/8079) of their finalized appointments; only 74.5% (52,804/70,839) of staff-scheduled finalized appointments had a similar one-step appointment process (P<.001). For staff-scheduled appointments, 25.5% (18,035/70,839) of the finalized appointments took multiple appointment steps. For finalized appointments that were exclusively self-scheduled, only 6.5% (526/8079) took multiple appointment steps. The staff-scheduled to self-scheduled odds ratio of taking multiple steps for a finalized screening mammogram appointment was 4.9 (95% CI 4.48-5.37; P<.001). Conclusions Screening mammograms can be efficiently self-scheduled but may be associated with a slight increase in no-shows. Self-scheduling can decrease staff scheduler work and can be convenient for patients who want to manage their appointment scheduling activity after business hours or on weekends.
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Affiliation(s)
- Frederick North
- Division of Community Internal Medicine, Department of Internal Medicine, Mayo Clinic, Rochester, MN, United States
| | - Elissa M Nelson
- Enterprise Office of Access Management, Mayo Clinic, Rochester, MN, United States
| | - Rebecca J Buss
- Enterprise Office of Access Management, Mayo Clinic, Rochester, MN, United States
| | - Rebecca J Majerus
- Enterprise Office of Access Management, Mayo Clinic, Rochester, MN, United States
| | - Matthew C Thompson
- Enterprise Office of Access Management, Mayo Clinic, Rochester, MN, United States
| | - Brian A Crum
- Department of Neurology, Mayo Clinic, Rochester, MN, United States
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Cross AJ, Myles J, Greliak P, Hackshaw A, Halloran S, Benton SC, Addison C, Chapman C, Djedovic N, Smith S, Wagner CV, Duffy SW, Raine R. Including a general practice endorsement letter with the testing kit in the Bowel Cancer Screening Programme: Results of a cluster randomised trial. J Med Screen 2021; 28:419-425. [PMID: 33645308 DOI: 10.1177/0969141321997480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
OBJECTIVES To evaluate the effect of general practitioner endorsement accompanying the screening kit rather than with the invitation letter on participation in the NHS Bowel Cancer Screening Programme and on the socioeconomic gradient in participation in the Programme. METHODS The NHS Bowel Cancer Screening Programme in England is delivered via five regional hubs. In early 2016, we carried out a cluster-randomised trial, with hub-day of invitation as the randomisation unit. We randomised 150 hub-days of invitation to the intervention group, GP endorsement on the letter accompanying the guaiac faecal occult blood testing kit (75 hub-days, 197,366 individuals) or control, usual letter (75 hub-days, 197,476 individuals). The endpoint was participation, defined as return of a valid kit within 18 weeks of initial invitation. Because of the cluster randomisation, data were analysed by a hierarchical logistic regression, allowing a random effect for date of invitation. Socioeconomic status was represented by the index of multiple deprivation. RESULTS Participation was 59.4% in the intervention group and 58.7% in the control group, a significant difference (p = 0.04). There was no heterogeneity of the effect of intervention by index of multiple deprivation. We found that there was some confounding between date and screening episode order (first or subsequent screen). This in turn may have induced confounding with age and slightly diluted the result. CONCLUSIONS General practitioner endorsement induces a modest increase in participation in bowel cancer screening, but does not affect the socioeconomic gradient. When considering cluster randomisation as a research method, careful scrutiny of potential confounding is indicated in advance if possible and in analysis otherwise.
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Affiliation(s)
- Amanda J Cross
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Jonathan Myles
- Wolfson Institute for Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Paul Greliak
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Allan Hackshaw
- Cancer Research UK and UCL Cancer Trials Centre, Cancer Institute, University College London, London, UK
| | - Stephen Halloran
- Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, Guildford, UK
- Department of Biomedical Sciences, University of Surrey, Guildford, UK
| | - Sally C Benton
- Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, Guildford, UK
- Berkshire and Surrey Pathology Services, Royal Surrey County Hospital, Guildford, UK
| | - Caroline Addison
- Bowel Cancer Screening North East Programme Hub, Queen Elizabeth Hospital, Gateshead, UK
| | - Caroline Chapman
- Bowel Cancer Screening Eastern Programme Hub, University of Nottingham, Nottingham, UK
| | - Natasha Djedovic
- Bowel Cancer Screening London Programme Hub, Northwick Park & St Mark's Hospitals, Harrow, UK
| | - Stephen Smith
- Bowel Cancer Screening Midlands & North West Programme Hub, Hospital of St Cross, Rugby, UK
| | | | - Stephen W Duffy
- Wolfson Institute for Preventive Medicine, Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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42
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Stoffel S, Kioupi S, Ioannou D, Kerrison RS, von Wagner C, Herrmann B. Testing messages from behavioral economics to improve participation in a population-based colorectal cancer screening program in Cyprus: Results from two randomized controlled trials. Prev Med Rep 2021; 24:101499. [PMID: 34430189 PMCID: PMC8371188 DOI: 10.1016/j.pmedr.2021.101499] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2021] [Revised: 06/17/2021] [Accepted: 07/13/2021] [Indexed: 11/04/2022] Open
Abstract
•Behavioral economic-based interventions have been suggested to increase uptake in CRC screening programmes.•This study tested the effectiveness of six behavioral economic-based messages in two field trials.•None of the messages increased screening participation.
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Affiliation(s)
- Sandro Stoffel
- Joint Research Centre, European Commission, Ispra, Italy
- Research Department of Behavioural Science and Health, University College London, London, UK
- Institute of Pharmaceutical Medicine, University of Basel, Basel, Switzerland
| | - Stala Kioupi
- Ministry of Health, Government of the Republic of Cyprus, Nicosia, Cyprus
| | - Despina Ioannou
- Ministry of Health, Government of the Republic of Cyprus, Nicosia, Cyprus
| | - Robert S. Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
- School of Health Science, University of Surrey, Surrey, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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43
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Acharya A, Sounderajah V, Ashrafian H, Darzi A, Judah G. A systematic review of interventions to improve breast cancer screening health behaviours. Prev Med 2021; 153:106828. [PMID: 34624390 DOI: 10.1016/j.ypmed.2021.106828] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/10/2021] [Revised: 09/27/2021] [Accepted: 10/03/2021] [Indexed: 12/17/2022]
Abstract
Whilst breast cancer screening has been implemented in many countries, uptake is often suboptimal. Consequently, several interventions targeting non-attendance behaviour have been developed. This systematic review aims to appraise the successes of interventions, identifying and comparing the specific techniques they use to modify health behaviours. A literature search (PROSPERO CRD42020212090) between January 2005 and December 2020 using PubMed, Medline, PsycInfo, EMBASE and Google Scholar was conducted. Studies which investigated patient-facing interventions to increase attendance at breast cancer screening appointments were included. Details regarding the intervention delivery, theoretical background, and contents were extracted, as was quantitative data on the impact on attendance rates, compared to control measures. Interventions were also coded using the Behavioural Change Techniques (BCT) Taxonomy. In total fifty-four studies, detailing eighty interventions, met the inclusion criteria. Only 50% of interventions reported a significant impact on screening attendance. Thirty-two different BCTs were used, with 'prompts/cues' the most commonly incorporated (77.5%), however techniques from the group 'covert learning' had the greatest pooled effect size 0.12 (95% CI 0.05-0.19, P < 0·01, I2 = 91.5%). 'Problem solving' was used in the highest proportion of interventions that significantly increased screening attendance (69.0%). 70% of the interventions were developed using behavioural theories. These results show interventions aimed at increasing screening uptake are often unsuccessful. Commonly used approaches which focus upon explaining the consequences of not attending mammograms were often ineffective. Problem solving, however, has shown promise. These techniques should be investigated further, as should emerging technologies which can enable interventions to be feasibly translated at a population-level.
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Affiliation(s)
- Amish Acharya
- Institute of Global Health Innovation, Imperial College London, London W2 1NY, United Kingdom; Imperial Patient Safety and Translational Research Centre, Imperial College London, W2 1NY, United Kingdom
| | - Viknesh Sounderajah
- Institute of Global Health Innovation, Imperial College London, London W2 1NY, United Kingdom
| | - Hutan Ashrafian
- Institute of Global Health Innovation, Imperial College London, London W2 1NY, United Kingdom.
| | - Ara Darzi
- Institute of Global Health Innovation, Imperial College London, London W2 1NY, United Kingdom; Imperial Patient Safety and Translational Research Centre, Imperial College London, W2 1NY, United Kingdom
| | - Gaby Judah
- Imperial Patient Safety and Translational Research Centre, Imperial College London, W2 1NY, United Kingdom
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Young B, Robb KA. Understanding patient factors to increase uptake of cancer screening: a review. Future Oncol 2021; 17:3757-3775. [PMID: 34378403 DOI: 10.2217/fon-2020-1078] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Early detection of cancer through organized screening is a central component of population-level strategies to reduce cancer mortality. For screening programs to be effective, it is important that those invited to screening participate. However, uptake rates are suboptimal in many populations and vary between screening programs, indicating a complex combination of patient factors that require elucidation to develop evidence-based strategies to increase participation. In this review, the authors summarize individual-level (sociodemographic and psychosocial) factors associated with cancer screening uptake and evidence for the effectiveness of behavioral interventions to increase uptake. The authors reflect on current trends and future directions for behavioral cancer screening research to overcome challenges and address unmet needs in reducing cancer mortality.
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Affiliation(s)
- Ben Young
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
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45
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Transient elastography in patients at risk of liver fibrosis in primary care: a follow-up study over 54 months. BJGP Open 2021; 5:BJGPO.2021.0145. [PMID: 34580065 PMCID: PMC9447304 DOI: 10.3399/bjgpo.2021.0145] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2021] [Accepted: 09/17/2021] [Indexed: 11/08/2022] Open
Abstract
Background Liver fibrosis assessment services using transient elastography are growing in primary care. These services identify patients requiring specialist referral for liver fibrosis, and provide an opportunity for recommending lifestyle change. However, there are uncertainties regarding service design, effectiveness of advice given, and frequency of follow-up. Aim To assess the following: (a) effectiveness of standard care lifestyle advice for weight management and alcohol consumption; (b) uptake for liver rescan; and (c) usefulness of a 4.5-year time interval of rescanning in monitoring progression of liver fibrosis. Design & setting Analysis of patient outcomes 4.5 years after the first ‘liver service’ attendance that included transient elastography in five GP practices in Southampton, UK. Method Outcomes included weight, alcohol consumption, rescan uptake, time interval between scans, and change in liver fibrosis stage. Results A total of 401 participants were recontacted. Mean standard deviation (± SD) weight loss was 1.2 kg±8.4 kg (P = 0.005); Alcohol Use Disorders Identification Test (AUDIT) grade increased by 7.8% (P ≤0.001). A total of n = 116/401 participants were eligible for liver rescanning and n = 59/116 (50.9%) agreed to undergo rescanning. Mean ± SD time interval between scans was 53.6±3.4 months. Liver fibrosis progressed from mild (≥6.0 kPa–8.1 kPa) to significant fibrosis (8.2 kPa–9.6 kPa) in 3.4% of patients; from mild to advanced fibrosis (9.7 kPa–13.5 kPa) and cirrhosis (≥13.6 kPa) in 15.3% of patients, and did not progress in 81.3%. No baseline factors were independently associated with liver fibrosis progression at follow-up. Conclusion Rescan recall attendance and adherence to lifestyle changes needs improving. Optimum time interval between scans remains uncertain. After a mean interval of 53.6 months between scans, and with no specific predictors indicated, a substantial minority (18.7%) experienced a deterioration in fibrosis grade.
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46
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Chan TKC, Tan LWL, van Dam RM, Seow WJ. Cancer Screening Knowledge and Behavior in a Multi-Ethnic Asian Population: The Singapore Community Health Study. Front Oncol 2021; 11:684917. [PMID: 34476210 PMCID: PMC8406849 DOI: 10.3389/fonc.2021.684917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022] Open
Abstract
Background Cancer has become the leading cause of mortality in Singapore and among other Asian populations worldwide. Despite the presence of National Cancer Screening programmes in Singapore, less than half of the population has had timely screening according to guidelines. The underlying factors of poor cancer screening rates and health outcomes among Asian ethnic groups remain poorly understood. We therefore examined cancer screening participation rates and screening behavior in a multi-ethnic Singapore population. Methods We collected data from 7,125 respondents of the 2015–2016 Singapore Community Health Study. Factors associated with cervical, breast, and colorectal cancer screening were evaluated using modified Poisson regression. Adjusted prevalence ratios were computed with 95% confidence intervals after adjusting for confounders. Results The mean age of the respondents was 57.7 ± 10.9 years; 58.9% were female and were predominately Chinese (73.0%), followed by Malay (14.2%), and Indian (10.9%). Less than half of the respondents in the recommended age groups had undergone cancer screening (cervical, 43%; breast, 35.1%; colorectal, 27.3%). Malay respondents were significantly less likely to screen as recommended for cervical (aPR = 0.75, CI = 0.65–0.86, p < 0.001), breast (aPR = 0.83, CI = 0.68–0.99, p = 0.045), and colorectal cancer (aPR = 0.55, CI = 0.44–0.68, p < 0.001), as compared to Chinese respondents. Respondents who had obtained lower secondary level education were 42% more likely to screen for cervical cancer (aPR = 1.42, CI = 1.23–1.64, p < 0.001), and 22% more likely to screen for breast cancer (aPR = 1.22, CI = 1.02–1.46, p = 0.032), compared to those with primary level education and below. Respondents with a household income ≥S$10,000/month were 71% more likely to screen for breast cancer (aPR = 1.71, CI = 1.37–2.13, p < 0.001), as compared with <$2,000/month. Conclusions Ethnicity and socio-economic status were significantly associated with lower uptake of cancer screening tests in Singapore. To improve the screening uptake among disadvantaged groups, a multi-faceted approach is needed that addresses the barriers to screening such as the adequacy of subsidy schemes and ethnic differences.
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Affiliation(s)
| | - Linda Wei Lin Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Wei Jie Seow
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
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47
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Robb KA. The integrated screening action model (I-SAM): A theory-based approach to inform intervention development. Prev Med Rep 2021; 23:101427. [PMID: 34189020 PMCID: PMC8220376 DOI: 10.1016/j.pmedr.2021.101427] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2021] [Revised: 05/13/2021] [Accepted: 05/25/2021] [Indexed: 12/12/2022] Open
Abstract
Screening can reduce deaths if the people invited participate. However, good uptake is hard to achieve, and our current approaches are failing to engage the most vulnerable. A coherent model of screening behaviour to guide our understanding and intervention development is yet to be established. The present aim was to propose an Integrated Screening Action Model (I-SAM) to improve screening access. The I-SAM synthesises existing models of health behaviour and empirical evidence. The I-SAM was developed following: i) an appraisal of the predominant models used within the screening literature; ii) the integration of the latest knowledge on behaviour change; with iii) the empirical literature, to inform the development of a theory-based approach to intervention development. There are three key aspects to the I-SAM: i) a sequence of stages that people pass through in engaging in screening behaviour (based on the Precaution Adoption Process Model); ii) screening behaviour is shaped by the interaction between participant and environmental influences (drawing from the Access Framework); and iii) targets for intervention should focus on the sources of behaviour - 'capability', 'opportunity', and 'motivation' (based on the COM-B Model). The I-SAM proposes an integrated model to support our understanding of screening behaviour and to identify targets for intervention. It will be an iterative process to test and refine the I-SAM and establish its value in supporting effective interventions to improve screening for all.
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Affiliation(s)
- Kathryn A. Robb
- Institute of Health and Wellbeing, University of Glasgow, Glasgow G12 0XH, United Kingdom
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48
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Moore CM. An important step towards smarter screening for prostate cancer. Lancet Oncol 2021; 22:1201-1202. [PMID: 34391507 DOI: 10.1016/s1470-2045(21)00449-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/11/2021] [Accepted: 07/12/2021] [Indexed: 11/26/2022]
Affiliation(s)
- Caroline M Moore
- Division of Surgical and Interventional Science, University College London, London WC1E 6BT, UK.
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49
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Scott SE, Rauf B, Waller J. "Whilst you are here…" Acceptability of providing advice about screening and early detection of other cancers as part of the breast cancer screening programme. Health Expect 2021; 24:1868-1878. [PMID: 34369071 PMCID: PMC8483189 DOI: 10.1111/hex.13330] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2021] [Revised: 07/02/2021] [Accepted: 07/14/2021] [Indexed: 12/13/2022] Open
Abstract
Objectives This research aimed to assess women's willingness to receive advice about cervical and bowel cancer screening participation and advice on cancer symptom awareness when attending breast cancer screening. Methods Women (n = 322) aged 60–64 years, living in the United Kingdom, who had previously taken part in breast cancer screening were recruited via a market research panel. They completed an online survey assessing willingness to receive advice, the potential impact of advice on breast screening participation, prospective acceptability and preferences for mode and timing of advice. Results Most women would be willing to receive information about cervical (86%) and bowel cancer screening (90%) and early symptoms of other cancers (92%) at a breast cancer screening appointment. Those who were not up to date with cervical cancer screening were less willing. Prospective acceptability was high for all three forms of advice and was associated with willingness to receive advice. Women would prefer to receive advice through a leaflet (41%) or discussion with the mammographer (30%) either before the appointment (27%), at the appointment (44%) or with their results (22%). Conclusions While there is high willingness and high acceptability towards using breast cancer screening as a teachable moment for advice about prevention and early detection of other cancers, some women find it unacceptable and this may reduce their likelihood of attending a breast screening appointment. Patient or Public Contribution This study focused on gaining women's insights into potential future initiatives to encourage screening and early diagnosis of cancer. Members of the public were also involved in piloting the questionnaire.
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Affiliation(s)
- Suzanne E Scott
- Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Betul Rauf
- Centre for Oral, Clinical and Translational Sciences, Faculty of Dentistry, Oral and Craniofacial Sciences, King's College London, London, UK
| | - Jo Waller
- School of Cancer & Pharmaceutical Sciences, Cancer Prevention Group, King's College London, London, UK
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50
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Jäntti M, Heinävaara S, Malila N, Sarkeala T. Sociodemographic features and patterns of non-participation in colorectal cancer screening in Finland. Eur J Public Health 2021; 31:890-894. [PMID: 34347069 DOI: 10.1093/eurpub/ckab074] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening was run as a randomized health services programme in Finland between 2004 and 2016. This study evaluates sociodemographic features and patterns of non-participation among men and women invited to be screened. METHODS The study population in this register-based study includes 233 211 men and women invited to guaiac faecal occult blood test screening on consecutive screening rounds (n = 708 621 invitations). A generalized estimating equation (GEE) was used to estimate incidence rate ratios (IRR) between sociodemographic features and non-participation. RESULTS The overall proportion of non-participation was 31.6% and was higher in men (38.8%) than in women (24.6%). Birth cohort, education, marital status and country of birth were associated with non-participation. The birth cohort of 1950-54 was less likely to participate than the birth cohort of 1940-44. Men and women with primary education were more likely non-participants (IRR 1.26, CI 1.23-1.29 and IRR 1.22, CI 1.18-1.26, respectively) than men or women with tertiary education. Further, unmarried persons and immigrants had an increased risk of non-participation. Initial non-participation predicted subsequent behaviour, since, e.g. ∼80% of first-round non-participants also remained non-participants in the second round. CONCLUSION Education, gender and marital status had a significant effect on non-participation in the CRC screening programme. As high and comprehensive participation is essential for a successful screening programme, attention should be paid in ensuring participation of all sociodemographic groups. Special efforts should be invested in those not participating in the first invitational round, since initial non-participation predicts non-participation to subsequent invitations.
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Affiliation(s)
- Maija Jäntti
- Finnish Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, Helsinki 00130, Finland
| | - Sirpa Heinävaara
- Finnish Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, Helsinki 00130, Finland
| | - Nea Malila
- Finnish Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, Helsinki 00130, Finland
| | - Tytti Sarkeala
- Finnish Mass Screening Registry, Finnish Cancer Registry, Unioninkatu 22, Helsinki 00130, Finland
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