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Pham LA, Clark PJ, Macdonald GA, Thomas JA, Dalais C, Fonda A, Kendall BJ, Thrift AP. Colorectal cancer screening participation in First Nations populations worldwide: a systematic review and data synthesis. EClinicalMedicine 2024; 73:102666. [PMID: 38828132 PMCID: PMC11139771 DOI: 10.1016/j.eclinm.2024.102666] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2023] [Revised: 05/07/2024] [Accepted: 05/10/2024] [Indexed: 06/05/2024] Open
Abstract
Background First Nations populations have poorer colorectal cancer (CRC) survival compared to non-First Nations populations. Whilst First Nations populations across the world are distinct, shared experiences of discrimination and oppression contribute to persistent health inequities. CRC screening improves survival, however screening rates in First Nations populations are poorly described. This study seeks to define participation rates in CRC screening in First Nations populations worldwide. Methods A systematic literature search was conducted of PubMed, Embase, Cochrane Library, CINAHL, MEDLINE, grey literature, national registries and ClinicalTrials.gov. All sources were searched from their inception date to 18 February 2024. Studies were included if they reported CRC screening rates in adult (≥18 years) First Nations populations. We aimed to undertake a meta-analysis if there were sufficient data. Quality of papers were assessed using the Joanna Briggs Institute (JBI) appraisal tool. The study was registered with PROSPERO, CRD42020210181. Findings The literature search identified 1723 potentially eligible published studies. After review, 57 studies were included, 50 from the United States (US), with the remaining studies from Australia, Aotearoa New Zealand (NZ), Canada, Dominica and Guatemala. Additionally, eleven non-indexed reports from national programs in Australia and NZ were included. There were insufficient data to undertake meta-analysis, therefore a systematic review and narrative synthesis were conducted. CRC screening definitions varied, and included stool-based screening, sigmoidoscopy and colonoscopy. US First Nations screening rates ranged between 4.0 and 79.2%, Australia reported 10.6-35.2%, NZ 18.4-49%, Canada 22.4-53.4%, Guatemala 2.2% and Dominica 4.2%. Fifty-five studies were assessed as moderate or high quality and two as low quality. Interpretation Our findings suggested that there is wide variation in CRC screening participation rates across First Nations populations. Screening data are lacking in direct comparator groups and longitudinal outcomes. Disaggregation of screening data are required to better understand and address First Nations CRC outcome inequities. Funding None.
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Affiliation(s)
- Lily A. Pham
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Paul J. Clark
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Graeme A. Macdonald
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - James A. Thomas
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Christine Dalais
- University of Queensland Library, The University of Queensland, Brisbane, Australia
| | - Annie Fonda
- Southern Queensland Centre of Excellence in Aboriginal and Torres Strait Islander Primary Health Care, Queensland Health, Brisbane, Australia
| | - Bradley J. Kendall
- Faculty of Medicine, University of Queensland, Brisbane, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Brisbane, Australia
| | - Aaron P. Thrift
- Section of Epidemiology and Population Sciences, Baylor College of Medicine, Houston, United States
- Dan L Duncan Comprehensive Cancer Center, Baylor College of Medicine, Houston, United States
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Bonnefin A, Balafas A, Simone L, Bedford K, Voukelatos A, Hyde-Page A, Dalao A, Lyons R, Coe D, Wen LM. Pivot to prevent bowel cancer: Reflections on adapting an Aboriginal bowel cancer screening awareness program to a digital call to action-A commentary. Health Promot J Austr 2024; 35:824-828. [PMID: 37675497 DOI: 10.1002/hpja.804] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Revised: 08/01/2023] [Accepted: 08/28/2023] [Indexed: 09/08/2023] Open
Abstract
ISSUE ADDRESSED The Sydney Local Health District (SLHD) Health Promotion Unit was awarded a Cancer Institute NSW grant to raise awareness of bowel cancer and promote the National Bowel Cancer Screening Program (NBCSP) among Aboriginal communities in SLHD. The COVID-19 pandemic thwarted initial plans for face-to-face workshops and plans pivoted to digital products and dissemination of messages on a range of communication platforms. DISCUSSION The coronavirus (COVID-19) pandemic provided staff with the freedom, flexibility, and ability to be creative in ways not possible prior to the pandemic and ultimately ended up with a superior product with a reach further than anticipated. A more comprehensive suite of digital resources addressing barriers to bowel cancer screening in the Aboriginal community was produced that is able to be used more broadly. These resources have reached a much larger population group through websites, social media, as well as TV and radio advertisements, and have the potential to be used and adapted in other local health districts and states across Australia. CONCLUSION Adapting an Aboriginal bowel cancer screening awareness program to a digital platform is a promising approach. SO WHAT?: COVID-19 provided an opportunity to create new long-lasting partnerships and to be creative beyond the scope of the original grant. This in turn produced a product with a reach further than anticipated that can also be built on and sustained.
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Affiliation(s)
- Amy Bonnefin
- Health Promotion Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Angela Balafas
- Health Promotion Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Lisa Simone
- Health Promotion Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Karen Bedford
- Health Promotion Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Alexander Voukelatos
- Health Promotion Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
- School of Population Health, UNSW, Sydney, New South Wales, Australia
| | - Alexander Hyde-Page
- Health Promotion Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Albert Dalao
- Direct Access Colonoscopy, Royal Prince Alfred Hospital, Camperdown, New South Wales, Australia
| | - Ricky Lyons
- Aboriginal Health Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Daniel Coe
- Health Promotion Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
| | - Li Ming Wen
- Health Promotion Unit, Sydney Local Health District, Camperdown, New South Wales, Australia
- University of Sydney School of Public Health, Sydney, New South Wales, Australia
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Han E(F, Srinivasa S, Gurney J, Koea J. Cancer Screening Services: What Do Indigenous Communities Want? A Systematic Review. JCO Glob Oncol 2024; 10:e2300035. [PMID: 38359371 PMCID: PMC10881110 DOI: 10.1200/go.23.00035] [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: 03/06/2023] [Revised: 11/04/2023] [Accepted: 11/14/2023] [Indexed: 02/17/2024] Open
Abstract
PURPOSE Indigenous communities experience worse cancer outcomes compared with the general population partly because of lower cancer screening access. One-size-fits-all screening programs are unsuitable for reaching Indigenous communities. In this review, we summarize available evidence on the perspectives of these communities; with a view to informing the improvement of cancer screening services to achieve equitable access. METHODS We undertook a systematic review according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, using the databases MEDLINE, Scopus, PubMed, and Google Scholar. The search terms used were "Indigenous community or Indigenous communities," "cancer screening," and "facilitators, enablers, desires, or needs." Qualitative studies published up to the August 30, 2022 investigating the perspectives of Indigenous communities on factors encouraging screening participation were included in the study. The included studies were reviewed and analyzed inductively by two independent reviewers, and key themes regarding indigenous access to cancer screening were then extracted. RESULTS A total of 204 unique articles were identified from the search. The title and abstracts of these studies were screened, and 164 were excluded on the basis of the exclusion and inclusion criteria. The full texts of the remaining 40 studies were examined and 18 were included in the review. Four key themes were identified pertaining to culturally tailored education and information dissemination, community involvement, positive relationships with health care providers, and individual empowerment and autonomy. CONCLUSION Improvements, on the basis of the key themes identified from this review, must be made at all levels of the health care system to achieve equitable screening participation in Indigenous communities. However, we recommend an investigation into the perspectives of the local Indigenous communities before the initiation of cancer screening programs.
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Affiliation(s)
| | - Sanket Srinivasa
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
| | - Jason Gurney
- Department of Public Health, University of Otago, Wellington, New Zealand
| | - Jonathan Koea
- Department of Surgery, North Shore Hospital, Auckland, New Zealand
- Department of Surgery, The University of Auckland, Auckland, New Zealand
- Te Kupenga Hauora Māori, University of Auckland, Auckland, New Zealand
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Taylor EV, Dugdale S, Connors CM, Garvey G, Thompson SC. "A Huge Gap": Health Care Provider Perspectives on Cancer Screening for Aboriginal and Torres Strait Islander People in the Northern Territory. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2024; 21:141. [PMID: 38397632 PMCID: PMC10887611 DOI: 10.3390/ijerph21020141] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/19/2023] [Revised: 01/23/2024] [Accepted: 01/26/2024] [Indexed: 02/25/2024]
Abstract
Cancer is one of the leading causes of death for Aboriginal and Torres Strait Islander people in the Northern Territory (NT). Accessible and culturally appropriate cancer screening programs are a vital component in reducing the burden of cancer. Primary health care plays a pivotal role in facilitating the uptake of cancer screening in the NT, due to the significant challenges caused by large distances, limited resources, and cultural differences. This paper analyses health care provider perspectives and approaches to the provision of cancer screening to Aboriginal people in the NT that were collected as part of a larger study. Semi-structured interviews were conducted with 50 staff from 15 health services, including 8 regional, remote, and very remote primary health care (PHC) clinics, 3 hospitals, a cancer centre, and 3 cancer support services. Transcripts were thematically analysed. Cancer screening by remote and very remote PHC clinics in the NT is variable, with some staff seeing cancer screening as a "huge gap", while others see it as lower priority compared to other conditions due to a lack of resourcing and the overwhelming burden of acute and chronic disease. Conversely, some clinics see screening as an area where they are performing well, with systematic screening, targeted programs, and high screening rates. There was a large variation in perceptions of the breast screening and cervical screening programs. However, participants universally reported that the bowel screening kit was complicated and not culturally appropriate for their Aboriginal patients, which led to low uptake. System-level improvements are required, including increased funding and resourcing for screening programs, and for PHC clinics in the NT. Being appropriately resourced would assist PHC clinics to incorporate a greater emphasis on cancer screening into adult health checks and would support PHCs to work with local communities to co-design targeted cancer screening programs and culturally relevant education activities. Addressing these issues are vital for NT PHC clinics to address the existing cancer screening gaps and achieving the Australian Government pledge to be the first nation in the world to eliminate cervical cancer as a public health problem by 2035. The implementation of the National Lung Cancer Screening Program in 2025 also presents an opportunity to deliver greater benefits to Aboriginal communities and reduce the cancer burden.
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Affiliation(s)
- Emma V Taylor
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia
| | - Sarah Dugdale
- Health Statistics and Informatics, NT Health, Darwin, NT 0800, Australia
| | | | - Gail Garvey
- The School of Public Health, Faculty of Medicine, The University of Queensland, Herston, QLD 4006, Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, The University of Western Australia, Geraldton, WA 6530, Australia
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Baum S. Spatial variability in socio-demographic factors affecting participation in the Australian national bowel cancer screening program. PUBLIC HEALTH IN PRACTICE 2023; 6:100452. [PMID: 38099090 PMCID: PMC10719410 DOI: 10.1016/j.puhip.2023.100452] [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: 07/19/2023] [Revised: 10/29/2023] [Accepted: 11/15/2023] [Indexed: 12/17/2023] Open
Abstract
Objectives The objective of this paper is to analyse the socio-demographic and spatial patterns associated with bowel cancer screening in Australia. Despite the importance of screening in reducing mortality via early intervention, it remains the case that overall screening rates are uneven between different socio-demographic groups and geographic regions. Notwithstanding this, there is limited knowledge in Australia regarding the interplay between socio-demographics and geography in relation to bowel cancer screening. Thus, this paper explores the socio-demographic and spatial patterns of screening participation across Australian regions to better inform public health policy and programs. Study design This is a nationwide ecological study based on aggregate spatial data. Methods An ecological study is conducted using bowel cancer screening rates and selected socio-demographic data measured at the Statistical Area 3 level. Geographically weighted regression software is used to conduct global and spatial regression analysis. Results The global regression results show that higher rates of screening participation were associated with employment/education disengagement and volunteering while in contrast, lower rates of participation were associated with higher rates of indigenous populations, people with chronic health conditions, and people with poor English skills. Considering the spatial analysis, the analysis shows that once the spatial non-stationarity in the data is considered the influence of the variables shown to be significant in the global model, has significant spatial variability. Conclusion From a public health perspective, addressing shortfalls in bowel cancer screening participation is an important priority. In order to understand differences in participation rates it is important to consider both socio-demographic factors as well as the geographic or spatial distribution of these factors.
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Affiliation(s)
- Scott Baum
- School of Environment and Built Environment, Griffith University, Nathan, Queensland, Australia
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Krahe MA, Hall KK, Anderson PJ, Shannon C. Mapping the knowledge structure and trends in Australian Indigenous health and wellbeing research from 2003 to 2022: a scientometric analysis. FRONTIERS IN SOCIOLOGY 2023; 8:1290322. [PMID: 38098755 PMCID: PMC10720666 DOI: 10.3389/fsoc.2023.1290322] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 09/07/2023] [Accepted: 11/09/2023] [Indexed: 12/17/2023]
Abstract
The health and wellbeing of Australian Indigenous peoples is a nationally sanctioned priority, but despite this, few studies have comprehensively analyzed the features and characteristics of the research in the field. In this regard, a comprehensive scientometric analysis and knowledge mapping to systematically summarize and discuss the current state of research, research trends, and emerging areas of research were conducted. Original articles and reviews published between 2003 and 2022 were obtained from the Web of Science Core Collection. CiteSpace and VOSviewer software were used to perform scientometric analysis and knowledge mapping. An examination of document and citation trends, authors, institutions, countries/regions, journals, and keywords was untaken, while co-citation, co-occurrence, and burst analysis provide insights and future development in this area. A total of 2,468 documents in this field were retrieved. A gradual increase in the number of documents over the past two decades is observed, with the number of documents doubling every ~7.5 years. Author Thompson SC and Charles Darwin University published the most documents, and 85.6% were affiliated with only Australian-based researchers. The Australian and New Zealand Journal of Public Health is the most prominent journal publishing in the field. The most commonly co-occurring keyword was "health," and the keyword "risk" had the longest citation burst. Five keyword clusters were identified; "cultural safety" was the largest. This study articulates the knowledge structure of the research, revealing a shift from population-level and data-driven studies to more applied research that informs Indigenous peoples health and wellbeing. Based on this review, we anticipate emergent research areas to (1) reflect a more comprehensive understanding of the multidimensional factors that shape Indigenous health and wellbeing; (2) move beyond a deficit-based perspective; (3) respect cultural protocols and protect the rights and privacy of Indigenous participants; (4) address racism and discrimination within the healthcare system; (5) foster respectful, equitable, and collaborative research practices with Indigenous peoples; (6) provide culturally appropriate and effective interventions for prevention, early intervention, and treatment; and (7) ensure equitable change in systems to enhance access, quality, and outcomes in health and wellbeing.
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Affiliation(s)
- Michelle A. Krahe
- Office of the Deputy Vice Chancellor (Indigenous, Diversity and Inclusion), Griffith University, Meadowbrook, QLD, Australia
- College of Medicine and Dentistry, James Cook University, Cairns, QLD, Australia
| | - Kerry K. Hall
- Office of the Deputy Vice Chancellor (Indigenous, Diversity and Inclusion), Griffith University, Meadowbrook, QLD, Australia
| | - Peter J. Anderson
- Office of the Deputy Vice Chancellor (Indigenous, Diversity and Inclusion), Griffith University, Meadowbrook, QLD, Australia
| | - Cindy Shannon
- Office of the Deputy Vice Chancellor (Indigenous, Diversity and Inclusion), Griffith University, Meadowbrook, QLD, Australia
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Worthington J, Lew J, He E, Broun K, D'Onise K, Grogan P, Canfell K, Feletto E. The 'hot zone policy' for colorectal cancer screening presents unique risks and opportunities for rural Australia. Aust J Rural Health 2023; 31:580-586. [PMID: 36912762 PMCID: PMC10947086 DOI: 10.1111/ajr.12977] [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: 12/15/2022] [Revised: 02/19/2023] [Accepted: 02/27/2023] [Indexed: 03/14/2023] Open
Abstract
OBJECTIVE Colorectal cancer has geographic inequities in Australia, with higher mortality rates and lower participation in the National Bowel Cancer Screening Program (NBCSP) in remote and rural areas. The at-home kit is temperature-sensitive, necessitating a 'hot zone policy' (HZP); kits are not sent when an area's average monthly temperature is above 30°C. Australians in HZP areas are susceptible to potential screening disruptions but may benefit from well-timed interventions to improve participation. This study describes the demographics of HZP areas and estimates the impacts of potential screening changes. METHODS The number of individuals in HZP areas was estimated, as well as correlations with remoteness, socio-economic and Indigenous status. The potential impacts of screening changes were estimated. RESULTS Over a million eligible Australians live in HZP areas, which are more likely to be remote/rural, have lower socio-economic status and higher Indigenous populations. Predictive modelling estimates that any 3-month screening disruption would increase CRC mortality rates up to 4.1 times more in HZP areas vs unaffected areas, while targeted intervention could decrease mortality rates 3.4 times more in HZP areas. CONCLUSION People living in affected areas would be negatively impacted by any NBCSP disruption, compounding existing inequities. However, well-timed health promotion could have a stronger impact.
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Affiliation(s)
- Joachim Worthington
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Jie‐Bin Lew
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Emily He
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Kate Broun
- Cancer Council VictoriaMelbourneVictoriaAustralia
| | - Katina D'Onise
- School of Public HealthUniversity of AdelaideAdelaideSouth AustraliaAustralia
- Prevention and Population Health, Wellbeing SAAdelaideSouth AustraliaAustralia
| | - Paul Grogan
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Karen Canfell
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
| | - Eleonora Feletto
- The Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNew South WalesAustralia
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Nightingale C, Bavor C, Stone E, Rankin NM. Lung Cancer Screening: Implementation Challenges and Health Equity Considerations For the Western Pacific Region. JCO Glob Oncol 2023; 9:e2200329. [PMID: 36749907 PMCID: PMC10166439 DOI: 10.1200/go.22.00329] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Affiliation(s)
- Claire Nightingale
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Claire Bavor
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia
| | - Emily Stone
- Department of Lung Transplantation and Thoracic Medicine, St Vincent's Hospital Sydney, Darlinghurst, Australia.,Faculty of Medicine, University of New South Wales, Kensington, Australia
| | - Nicole M Rankin
- Center for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Australia.,Sydney School of Public Health, The University of Sydney, Camperdown, Australia
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Improving Access to Cancer Treatment Services in Australia’s Northern Territory—History and Progress. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137705. [PMID: 35805361 PMCID: PMC9265828 DOI: 10.3390/ijerph19137705] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/05/2022] [Revised: 06/14/2022] [Accepted: 06/21/2022] [Indexed: 12/28/2022]
Abstract
Cancer is the leading cause of death in the Northern Territory (NT), Australia’s most sparsely populated jurisdiction with the highest proportion of Aboriginal people. Providing cancer care to the NT’s diverse population has significant challenges, particularly related to large distances, limited resources and cultural differences. This paper describes the developments to improve cancer treatment services, screening and end-of-life care in the NT over the past two decades, with a particular focus on what this means for the NT’s Indigenous peoples. This overview of NT cancer services was collated from peer-reviewed literature, government reports, cabinet papers and personal communication with health service providers. The establishment of the Alan Walker Cancer Care Centre (AWCCC), which provides radiotherapy, chemotherapy and other specialist cancer services at Royal Darwin Hospital, and recent investment in a PET Scanner have reduced patients’ need to travel interstate for cancer diagnosis and treatment. The new chemotherapy day units at Alice Springs Hospital and Katherine Hospital and the rapid expansion of tele-oncology have also reduced patient travel within the NT. Access to palliative care facilities has also improved, with end-of-life care now available in Darwin, Alice Springs and Katherine. However, future efforts in the NT should focus on increasing and improving travel assistance and support and increasing the availability of appropriate accommodation; ongoing implementation of strategies to improve recruitment and retention of health professionals working in cancer care, particularly Indigenous health professionals; and expanding the use of telehealth as a means of delivering cancer care and treatment.
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Lew JB, Feletto E, Worthington J, Roder D, Canuto K, Miller C, D’Onise K, Canfell K. The potential for tailored screening to reduce bowel cancer mortality for Aboriginal and Torres Strait Islander peoples in Australia: modelling study. J Cancer Policy 2022; 32:100325. [DOI: 10.1016/j.jcpo.2022.100325] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2021] [Revised: 01/28/2022] [Accepted: 02/06/2022] [Indexed: 12/13/2022]
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Protani MM, Jordan SJ, Kendall BJ, Siskind D, Lawrence D, Sara G, Brophy L, Kisely S. Colorectal cancer Outcomes in people with Severe Mental Illness Cohort (COSMIC): a protocol for an Australian retrospective cohort using linked administrative data. BMJ Open 2021; 11:e044737. [PMID: 34103315 PMCID: PMC8190058 DOI: 10.1136/bmjopen-2020-044737] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2020] [Accepted: 05/21/2021] [Indexed: 12/05/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) mortality is significantly higher in those with severe mental illness (SMI) compared with the general population, despite similar incidence rates, suggesting that barriers to optimal screening and cancer care may contribute to disparities in CRC mortality in those with SMI. This study aims to compare participation in Australia's National Bowel Cancer Screening Programme (NBCSP) in those with SMI and those in the general population. We will also investigate treatment pathways after diagnosis to determine whether treatment variations could explain differences in CRC mortality. METHODS AND ANALYSIS We will undertake a retrospective cohort study of Australians using linked administrative data to assess differences in screening and cancer care between those with and without SMI, aged 50-74 years on or after 1 January 2006. People with SMI will be defined using antipsychotic medication prescription data. The comparison group will be people enrolled in Medicare (Australia's universal healthcare system) who have not been prescribed antipsychotic medication. Data on outcomes (NBCSP participation, follow-up colonoscopy, CRC incidence and CRC-cause and all-cause mortality) and confounders will be obtained from national-based and state-based administrative health datasets. All people in New South Wales, aged 50-74 with a new diagnosis of CRC on or after 1 January 2006, will be ascertained to examine stage at diagnosis and cancer treatment in those with and without SMI. Poisson regression will be used to calculate incidence rates and rate ratios for each outcome. ETHICS AND DISSEMINATION Ethics approval has been obtained from the University of Queensland Human Research Ethics Committee, the Australian Institute of Health and Welfare Ethics Committee and data custodians from every Australian State/Territory. Findings will be disseminated via publications in peer-reviewed journals and presented at appropriate conferences. TRIAL REGISTRATION NUMBER ACTRN12620000781943.
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Affiliation(s)
- Melinda M Protani
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
| | - Susan J Jordan
- School of Public Health, The University of Queensland, Herston, Queensland, Australia
- Population Health Department, QIMR Berghofer Medical Research Institute, Herston, Queensland, Australia
| | - Bradley J Kendall
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Department of Gastroenterology and Hepatology, Princess Alexandra Hospital, Woolloongabba, Queensland, Australia
| | - Dan Siskind
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
| | - David Lawrence
- Graduate School of Education, University of Western Australia, Perth, Western Australia, Australia
| | - Grant Sara
- InforMH, System Information and Analytics Branch, NSW Ministry of Health, North Ryde, New South Wales, Australia
- Northern Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
| | - Lisa Brophy
- School of Allied Health, Human Services and Sport, La Trobe University, Melbourne, Victoria, Australia
- Centre for Mental Health, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, Victoria, Australia
| | - Steve Kisely
- School of Clinical Medicine, The University of Queensland, Brisbane, Queensland, Australia
- Metro South Addiction and Mental Health Service, Brisbane, Queensland, Australia
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Donachie M, Bhat S, Whiley T, MacFater W, Bissett IP, Lill M. Equity of colonoscopy provision and quality in Māori and New Zealand Europeans: a comparative retrospective study. ANZ J Surg 2021; 91:1575-1581. [PMID: 33590655 DOI: 10.1111/ans.16636] [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: 11/13/2020] [Revised: 12/09/2020] [Accepted: 01/14/2021] [Indexed: 11/29/2022]
Abstract
BACKGROUND High-quality colonoscopy is essential for investigating suspected colorectal cancer and relies on endoscopists meeting key performance indicator (KPI) targets. The rising demand for colonoscopy raises concerns that Māori populations could be under-served. This study aimed to compare rates of colonoscopy provision and colonoscopy KPIs between Māori and New Zealand (NZ) European patients. METHODS This retrospective comparative study was conducted at Whanganui Hospital (NZ). Consecutive colonoscopies performed between September 2016 and March 2020 were included. Primary outcome was the rate of colonoscopy provision for the population. Secondary outcomes were the colonoscopy completion rate (CCR), colonoscope withdrawal time (CWT), polyp detection rate (PDR) and adenoma detection rate (ADR). Subgroup analysis of ADR in index symptomatic colonoscopies was also performed. RESULTS A total of 2962 colonoscopies were analysed (385 Māori; 2577 NZ European). Rates of colonoscopy provision in participants aged ≥40 were significantly lower among Māori (6.1% versus 9.1%; P < 0.0001). The CCR (P = 1.00), CWT (P = 0.28) and PDR (P = 0.24) were similar. Whilst the ADR in the overall cohort was significantly lower in Māori (32.7% versus 40.0%; P = 0.028), this was not observed when stratified by 10-year age cohorts. The ADR was similar on subgroup analysis of index symptomatic colonoscopies (P = 0.42). CONCLUSIONS This study found inequities in access to colonoscopy services for Māori compared to NZ European patients. Among those that did receive colonoscopy, there were no differences in colonoscopy quality after age stratification. Improving equity will require the addition of colonoscopy provision rates to other mandatory KPIs and reporting these by ethnicity in all endoscopy units.
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Affiliation(s)
- Matthew Donachie
- Department of Surgery, Whanganui Hospital, Whanganui District Health Board, Gonville, New Zealand
| | - Sameer Bhat
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Grafton, New Zealand
| | - Teri Whiley
- Department of Surgery, Whanganui Hospital, Whanganui District Health Board, Gonville, New Zealand
| | - Wiremu MacFater
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Grafton, New Zealand
| | - Ian P Bissett
- Department of Surgery, Faculty of Medical and Health Sciences, The University of Auckland, Grafton, New Zealand
| | - Marianne Lill
- Department of Surgery, Whanganui Hospital, Whanganui District Health Board, Gonville, New Zealand
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Smith HA, Scarffe AD, Brunet N, Champion C, Kandola K, Tessier A, Boushey R, Kuziemsky C. Impact of colorectal cancer screening participation in remote northern Canada: A retrospective cohort study. World J Gastroenterol 2020; 26:7652-7663. [PMID: 33505142 PMCID: PMC7789056 DOI: 10.3748/wjg.v26.i48.7652] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/05/2020] [Revised: 10/15/2020] [Accepted: 11/21/2020] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Screening provides earlier colorectal cancer (CRC) detection and improves outcomes. It remains poorly understood if these benefits are realized with screening guidelines in remote northern populations of Canada where CRC rates are nearly twice the national average and access to colonoscopy is limited.
AIM To evaluate the participation and impact of CRC screening guidelines in a remote northern population.
METHODS This retrospective cohort study included residents of the Northwest Territories, a northern region of Canada, age 50-74 who underwent CRC screening by a fecal immunohistochemical test (FIT) between January 1, 2014 to March 30, 2019. To assess impact, individuals with a screen-detected CRC were compared to clinically-detected CRC cases for stage and location of CRC between 2014-2016. To assess participation, we conducted subgroup analyses of FIT positive individuals exploring the relationships between signs and symptoms of CRC at the time of screening, wait-times for colonoscopy, and screening outcomes. Two sample Welch t-test was used for normally distributed continuous variables, Mann-Whitney-Wilcoxon Tests for data without normal distribution, and Chi-square goodness of fit test for categorical variables. A P value of < 0.05 was considered to be statistically significant.
RESULTS 6817 fecal tests were completed, meaning an annual average screening rate of 25.04%, 843 (12.37%) were positive, 629 individuals underwent a follow-up colonoscopy, of which, 24.48% had advanced neoplasia (AN), 5.41% had CRC. There were no significant differences in stage, pathology, or location between screen-detected cancers and clinically-detected cancers. In assessing participation and screening outcomes, we observed 49.51% of individuals referred for colonoscopy after FIT were ineligible for CRC screening, most often due to signs and symptoms of CRC. Individuals were more likely to have AN if they had signs and symptoms of cancer at the time of screening, waited over 180 d for colonoscopy, or were indigenous [respectively, estimated RR 1.18 95%CI of RR (0.89-1.59)]; RR 1.523 (CI: 1.035, 2.240); RR 1.722 (CI: 1.165, 2.547)].
CONCLUSION Screening did not facilitate early cancer detection but facilitated higher than anticipated AN detection. Signs and symptoms of CRC at screening, and long colonoscopy wait-times appear contributory.
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Affiliation(s)
- Heather A Smith
- Department of Surgery, University of Ottawa, Ottawa K1Y4E9, Ontario, Canada
- Telfer School of Management, University of Ottawa, Ottawa K1N6N5, Ontario, Canada
| | - Andrew D Scarffe
- Telfer School of Management, University of Ottawa, Ottawa K1N6N5, Ontario, Canada
| | - Nicole Brunet
- Faculty of Medicine, University of Ottawa, Ottawa K1Y4E9, Ontario, Canada
| | - Cait Champion
- Department of Surgery, Northern Ontario School of Medicine, Sudbury P3E2C6, Ontario, Canada
| | - Kami Kandola
- Department of Health and Social Services, Government of the Northwest Territories, Yellowknife X1A1P5, Northwest Territories, Canada
| | - Alisha Tessier
- Department of Surgery, Stanton Territorial Health Authority, Yellowknife X1A0H1, Northwest Territories, Canada
| | - Robin Boushey
- Division of General Surgery, University of Ottawa, Ottawa K1H 8L6, Ontario, Canada
| | - Craig Kuziemsky
- Office of Research Services, MacEwan University, Edmonton T5J4S2, Alberta, Canada
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Vather R, Petrushnko W, Chapman D, Sammour T, Mor I, Warner R. Factors predictive of an advanced stage of colorectal cancer at presentation - a bi-national study. Colorectal Dis 2020; 22:1538-1544. [PMID: 32421899 DOI: 10.1111/codi.15137] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2020] [Accepted: 04/08/2020] [Indexed: 02/08/2023]
Abstract
AIM Identifying elements associated with advanced colorectal cancer (CRC) stage may inform understanding of whether advanced disease is a corollary of access to healthcare or tumour biology and in turn allow the use of targeted screening and awareness programmes. The aim of this study was to identify factors that predict advanced stage of CRC at presentation in Australia and New Zealand. METHOD This was a cross-sectional registry study sourced from the prospectively maintained Binational Colorectal Cancer Audit database of Australia and New Zealand. The primary outcome was stage as defined by the TNM system with associations drawn to demographic and perioperative variables. RESULTS In total, 25 282 separate cancers were included. Univariate analysis found younger age, treatment at a public facility, increasing American Society of Anesthesiologists (ASA) grade, more distal tumours, and less recent year of surgery to all be associated with more advanced disease; sex and presentation at a rural vs urban hospital had no bearing on this outcome. Logistic regression identified younger age (< 60 years vs > 80 years: OR 1.96; 95% CI 1.80-2.14; P = 0.002), treatment at a public vs private hospital (OR 1.21; 95% CI 1.14-1.28; P < 0.001), increasing ASA grade (ASA4 vs ASA1: OR 1.37; 95% CI 1.17-1.59, P < 0.001) and more distal tumours (mid-low rectal vs right colon tumours: OR 1.52; 95% CI 1.41-1.64; P < 0.001) to be independent predictors of nodal or metastatic disease at presentation. CONCLUSION Younger age, increasing ASA grade, more distal tumours, and treatment at a public rather than private facility are independently associated with the presence of nodal or distant CRC metastases at diagnosis.
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Affiliation(s)
- R Vather
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia
| | - W Petrushnko
- Colorectal Unit, Department of Surgery, Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - D Chapman
- Department of Surgery, University of Auckland, Auckland, New Zealand
| | - T Sammour
- Colorectal Unit, Department of Surgery, Royal Adelaide Hospital, Adelaide, South Australia, Australia.,Discipline of Surgery, Faculty of Health and Medical Science, School of Medicine, University of Adelaide, Adelaide, South Australia, Australia
| | - I Mor
- Colorectal Unit, Department of Surgery, Tweed Hospital, Tweed Heads, New South Wales, Australia
| | - R Warner
- Colorectal Unit, Department of Surgery, Tweed Hospital, Tweed Heads, New South Wales, Australia
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15
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D'Onise K, Iacobini ET, Canuto KJ. Colorectal cancer screening using faecal occult blood tests for Indigenous adults: A systematic literature review of barriers, enablers and implemented strategies. Prev Med 2020; 134:106018. [PMID: 32057956 DOI: 10.1016/j.ypmed.2020.106018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2019] [Revised: 02/02/2020] [Accepted: 02/07/2020] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Colorectal cancer (CRC) screening using a Faecal Occult Blood Test (FOBT) is a well-established population intervention to reduce mortality and morbidity of CRC. As Indigenous people are not fully benefiting from the screening programs, a greater understanding of barriers and enablers affecting participation is needed. METHODS Searches were carried out in PubMed, Embase, Sociological Abstracts, Scopus, CINAHL, and selected websites. Both qualitative and quantitative studies related to Indigenous populations of Canada, New Zealand, Australia and the United States of America were assessed for quality and data related to FOBT were extracted and synthetised. RESULTS A total of 375 publications were identified and screened against the inclusion/exclusion criteria. Thirty-four studies were included in the review. The barriers for participation in CRC screening included the lack of culturally competent health service access, particularly access to Indigenous health service providers. Medical discrimination, long-standing distrust in Western medicine and/or health staff and screening tests were all identified as barriers for Indigenous people. There were a small number of promising interventions to improve participation, which could be considered on a broader scale to increase overall participation by Indigenous people in CRC screening. CONCLUSIONS The review identified barriers and possible enablers for Indigenous participation in the CRC screening program, some which appear to be unique to Indigenous people. Further intervention studies conducted in partnership with Indigenous communities are needed to improve participation.
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Affiliation(s)
- Katina D'Onise
- Prevention and Population Health Directorate, Wellbeing SA, Citi Centre Building, 11 Hindmarsh Square, Adelaide, South Australia, Australia. Katina.D'
| | | | - Karla Joy Canuto
- South Australian Health and Medical Research Institute, North Terrace, Adelaide, South Australia, Australia.
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16
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Amitay EL, Cuk K, Niedermaier T, Weigl K, Brenner H. Factors associated with false‐positive fecal immunochemical tests in a large German colorectal cancer screening study. Int J Cancer 2019; 144:2419-2427. [DOI: 10.1002/ijc.31972] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 10/15/2018] [Accepted: 10/26/2018] [Indexed: 12/12/2022]
Affiliation(s)
- Efrat L. Amitay
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ) Heidelberg Germany
| | - Katarina Cuk
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ) Heidelberg Germany
| | - Tobias Niedermaier
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ) Heidelberg Germany
- Heidelberg Medical FacultyHeidelberg University Heidelberg Germany
| | - Korbinian Weigl
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ) Heidelberg Germany
- Heidelberg Medical FacultyHeidelberg University Heidelberg Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Heidelberg Germany
| | - Hermann Brenner
- Division of Clinical Epidemiology and Aging ResearchGerman Cancer Research Center (DKFZ) Heidelberg Germany
- German Cancer Consortium (DKTK), German Cancer Research Center (DKFZ) Heidelberg Germany
- Division of Preventive Oncology, German Cancer Research Center (DKFZ) and National Center for Tumor Diseases (NCT) Heidelberg Germany
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17
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Kopczynska M, Smits S, Hopps R, Ramaraj R, Warren N, Goddard S, Ye X, Dolwani S. Assessment of technical parameters and skills training to inform a simulation-based training program for semi-automated robotic colonoscopy. Endosc Int Open 2019; 7:E9-E14. [PMID: 30648134 PMCID: PMC6327751 DOI: 10.1055/a-0774-4554] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2018] [Accepted: 04/25/2018] [Indexed: 12/16/2022] Open
Abstract
Background and study aims Video-colonoscopy, despite being the gold-standard for diagnosis of colorectal lesions, has limitations including patient discomfort and risk of complications. This study assessed training characteristics and acceptability in operators of a new robotic colonoscope (RC). Materials and methods Participants (n = 9) with varying degrees of skill and background knowledge in colonoscopy performed colonoscopies with a RC on a simulation-based training model. Quantitative procedure-related and qualitative operator-related parameters were recorded. Results Polyp detection rate was highest in the novice group (91.67 %) followed by experts (86.11 %), then equally, trainees and video gamers (79.17 %). Four participants repeated the procedure at a follow-up session. Each participant improved cecal intubation time and had the same or higher polyp detection rate. The potential role for RC was identified for an out-of-hospital environment and as a novel diagnostic tool. Conclusions Results from this pilot suggest that operators at all skill levels found the RC acceptable and potentially useful as a diagnostic tool. Acquisition of skills with RC seems to improve rapidly to a clinically relevant level with simulation-based training.
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Affiliation(s)
| | | | - Rebecca Hopps
- Cardiff and Vale University Health Board, Penarth, Cardiff, Wales
| | | | - Neil Warren
- Welsh Institute for Minimal Access Therapy (WIMAT), Cardiff University, Cardiff, Wales
| | - Stuart Goddard
- Welsh Institute for Minimal Access Therapy (WIMAT), Cardiff University, Cardiff, Wales
| | - Xujiong Ye
- University of Lincoln, School of Computer Science, London, UK
| | - Sunil Dolwani
- Cardiff University School of Medicine, Cardiff, Wales
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18
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Collins JH, Bowie D, Shannon G. A descriptive analysis of health practices, barriers to healthcare and the unmet need for cervical cancer screening in the Lower Napo River region of the Peruvian Amazon. WOMEN'S HEALTH (LONDON, ENGLAND) 2019; 15:1745506519890969. [PMID: 31840562 PMCID: PMC6918491 DOI: 10.1177/1745506519890969] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 11/20/2018] [Revised: 08/05/2019] [Accepted: 10/31/2019] [Indexed: 01/17/2023]
Abstract
OBJECTIVES To undertake an descriptive analysis of the health needs, healthcare practices and barriers to accessing healthcare faced by women in Lower Napo River Region, Peru, and to understand health literacy regarding cervical cancer and the need for more effective cervical cancer screening services. METHODS We performed a community-based needs assessment adapting Demographic and Health survey methodology with additional questions determining female health literacy on cervical cancer and assessing the availability and need for cervical cancer screening services. We surveyed women (N = 121) across all households in six communities along the Lower Napo River, Loreto, Peru, in May 2015. Data were collected as part of the larger Amazon Community Based Participation Cervical Cancer Screen-and-Treat Programme. Survey data were compared to national results from ENDES 2014. RESULTS Comparison between our findings and the ENDES 2014 survey highlighted considerable inequality between indigenous or mixed indigenous, rural populations in Loreto, Peru, and national population data averages over level of formal education, literacy, barriers to accessing healthcare and maternal and sexual health. Even though only 5.9% (N = 7/117) of women had no formal health insurance coverage, money was reported as the leading barrier accessing healthcare (N = 88/117, 75.2%). Health literacy regarding cervical and breast cancer was poor. A high proportion of women highlighted fear of screening processes (70.8%, N = 80/113) and lack of available services (53.6%, N = 60/112) as barriers to cervical cancer screening. CONCLUSION Although progress has been made in improving healthcare access in Peru, such gains have not been experienced equitably and women living in remote communities face persistent marginalization regarding their health. There is a significant need for education related to and screening for cervical cancer in this region that is tailored to the reality of women's lives in remote communities in Loreto.
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Affiliation(s)
- Joseph H Collins
- Institute for Global Health, University College London, London, UK
| | | | - Geordan Shannon
- Institute for Global Health, University College London, London, UK
- DB Peru, Miraflores, Lima, Peru
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19
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Sandiford P, Buckley A, Holdsworth D, Tozer G, Scott N. Reducing ethnic inequalities in bowel screening participation in New Zealand: A randomised controlled trial of telephone follow-up for non-respondents. J Med Screen 2018; 26:139-146. [PMID: 30522405 DOI: 10.1177/0969141318815719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Objective To test whether a telephone follow-up service for high-needs ethnic groups increases bowel screening participation in non-responders to postal invitations. Methods Māori, Pacific, and Asian ethnicity individuals who failed to return a bowel screening test kit within four weeks of it being posted were randomly allocated (1:1) to a telephone active follow-up service or a control group. The active follow-up service made multiple attempts to contact the invitee and provide support. Participation rates at eight weeks’ post-randomisation were compared, and the effect of the intervention on overall participation rates was imputed. Results A total of 3828 eligible individuals were allocated to active follow-up and 3773 to the control group. The imputed potential overall increase in participation in the active follow-up group was 2.0% (95% CI = 0.6%–3.4%); however, the impact of follow-up varied significantly by ethnicity and deprivation. The imputed increase in participation was significant for Māori (5.2; CI = 1.8%–8.5%) and Pacific (3.6%; CI = 0.7%–6.4%), but not for Asian ethnicities (0.7%; CI=−1.1%–2.4%). In addition, the imputed increase was significant among high deprivation participants (3.9%; CI = 2.0%–5.9%), but not among low deprivation participants (0.3%; CI=−1.6%–2.2%). Conclusions Active follow-up led to higher bowel screening participation in Māori and Pacific but not in Asian ethnicities and was more effective in high deprivation subjects. Active follow-up significantly reduced but did not eliminate ethnic inequalities in bowel screening participation.
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Affiliation(s)
- P Sandiford
- 1 Auckland and Waitemata District Health Boards - Planning Funding and Outcomes, Auckland, New Zealand.,2 School of Population Health, University of Auckland, Auckland, New Zealand
| | - A Buckley
- 3 Surgical and Ambulatory Department, Waitemata District Health Board, Auckland, New Zealand
| | - D Holdsworth
- 1 Auckland and Waitemata District Health Boards - Planning Funding and Outcomes, Auckland, New Zealand
| | - G Tozer
- 3 Surgical and Ambulatory Department, Waitemata District Health Board, Auckland, New Zealand
| | - N Scott
- 4 Waikato District Health Board, Hamilton, New Zealand
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20
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Sun J, March S, Ireland MJ, Crawford-Williams F, Goodwin B, Hyde MK, Chambers SK, Aitken JF, Dunn J. Socio-demographic factors drive regional differences in participation in the National Bowel Cancer Screening Program - An ecological analysis. Aust N Z J Public Health 2017; 42:92-97. [DOI: 10.1111/1753-6405.12722] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2017] [Revised: 06/01/2017] [Accepted: 07/01/2017] [Indexed: 11/29/2022] Open
Affiliation(s)
- Jiandong Sun
- Institute for Resilient Regions; University of Southern Queensland
- School of Public Health and Social Work; Queensland University of Technology
| | - Sonja March
- Institute for Resilient Regions; University of Southern Queensland
- School of Psychology and Counselling; University of Southern Queensland
| | - Michael J. Ireland
- Institute for Resilient Regions; University of Southern Queensland
- School of Psychology and Counselling; University of Southern Queensland
| | - Fiona Crawford-Williams
- Institute for Resilient Regions; University of Southern Queensland
- School of Psychology and Counselling; University of Southern Queensland
| | - Belinda Goodwin
- Institute for Resilient Regions; University of Southern Queensland
| | - Melissa K. Hyde
- Cancer Research Centre; Cancer Council Queensland
- Menzies Health Institute Queensland; Griffith University; Queensland
| | - Suzanne K. Chambers
- Institute for Resilient Regions; University of Southern Queensland
- Cancer Research Centre; Cancer Council Queensland
- Menzies Health Institute Queensland; Griffith University; Queensland
| | - Joanne F. Aitken
- Institute for Resilient Regions; University of Southern Queensland
- School of Public Health and Social Work; Queensland University of Technology
- Cancer Research Centre; Cancer Council Queensland
| | - Jeff Dunn
- Institute for Resilient Regions; University of Southern Queensland
- Cancer Research Centre; Cancer Council Queensland
- School of Social Science; University of Queensland
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21
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Durey A, Halkett G, Berg M, Lester L, Kickett M. Does one workshop on respecting cultural differences increase health professionals' confidence to improve the care of Australian Aboriginal patients with cancer? An evaluation. BMC Health Serv Res 2017; 17:660. [PMID: 28915810 PMCID: PMC5603013 DOI: 10.1186/s12913-017-2599-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2016] [Accepted: 09/06/2017] [Indexed: 11/20/2022] Open
Abstract
BACKGROUND Aboriginal Australians have worse cancer survival rates than other Australians. Reasons include fear of a cancer diagnosis, reluctance to attend mainstream health services and discrimination from health professionals. Offering health professionals education in care focusing on Aboriginal patients' needs is important. The aim of this paper was to evaluate whether participating in a workshop improved the confidence of radiation oncology health professionals in their knowledge, communication and ability to offer culturally safe healthcare to Aboriginal Australians with cancer. METHODS Mixed methods using pre and post workshop online surveys, and one delivered 2 months later, were evaluated. Statistical analysis determined the relative proportion of participants who changed from not at all/a little confident at baseline to fairly/extremely confident immediately and 2 months after the workshop. Factor analysis identified underlying dimensions in the items and nonparametric tests recorded changes in mean dimension scores over and between times. Qualitative data was analysed for emerging themes. RESULTS Fifty-nine participants attended the workshops, 39 (66% response rate) completed pre-workshop surveys, 32 (82% of study participants) completed post-workshop surveys and 25 (64% of study participants) completed surveys 2 months later. A significant increase in the proportion of attendees who reported fair/extreme confidence within 2 days of the workshop was found in nine of 14 items, which was sustained for all but one item 2 months later. Two additional items had a significant increase in the proportion of fair/extremely confident attendees 2 months post workshop compared to baseline. An exploratory factor analysis identified three dimensions: communication; relationships; and awareness. All dimensions' mean scores significantly improved within 2 days (p < 0.005) and persisted to 2 months. The workshop raised awareness about barriers and enablers to delivering services respectful of cultural differences, led to a willingness to reflect on pre-existing beliefs and assumptions about Aboriginal Australians that in some cases resulted in improved care. CONCLUSION Single workshops co-delivered by an Aboriginal and non-Aboriginal presenter can be effective in building health professionals' confidence and translating into practice knowledge of respectful care of Aboriginal patients with cancer. Sustaining improvements may require integrating this approach into ongoing professional development.
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Affiliation(s)
- Angela Durey
- UWA Dental School, University of Western Australia, 35 Stirling Highway, Perth, Western Australia 6009 Australia
- Centre for Aboriginal Studies, Curtin University, Kent Street, Bentley, Perth, 6102 Western Australia Australia
| | - Georgia Halkett
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley, Perth, 6102 Western Australia Australia
| | - Melissa Berg
- School of Nursing, Midwifery and Paramedicine, Curtin University, Kent Street, Bentley, Perth, 6102 Western Australia Australia
| | - Leanne Lester
- Health Promotion and Evaluation Unit, University of Western Australia, 35 Stirling Highway, Perth, 6009 Western Australia Australia
| | - Marion Kickett
- Centre for Aboriginal Studies, Curtin University, Kent Street, Bentley, Perth, 6102 Western Australia Australia
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22
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McLeod M, Kvizhinadze G, Boyd M, Barendregt J, Sarfati D, Wilson N, Blakely T. Colorectal Cancer Screening: How Health Gains and Cost-Effectiveness Vary by Ethnic Group, the Impact on Health Inequalities, and the Optimal Age Range to Screen. Cancer Epidemiol Biomarkers Prev 2017. [DOI: 10.1158/1055-9965.epi-17-0150] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
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23
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Tervonen HE, Walton R, You H, Baker D, Roder D, Currow D, Aranda S. After accounting for competing causes of death and more advanced stage, do Aboriginal and Torres Strait Islander peoples with cancer still have worse survival? A population-based cohort study in New South Wales. BMC Cancer 2017; 17:398. [PMID: 28577351 PMCID: PMC5457659 DOI: 10.1186/s12885-017-3374-6] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2015] [Accepted: 05/18/2017] [Indexed: 01/07/2023] Open
Abstract
Background Aboriginal and Torres Strait Islander peoples in Australia have been found to have poorer cancer survival than non-Aboriginal people. However, use of conventional relative survival analyses is limited due to a lack of life tables. This cohort study examined whether poorer survival persist after accounting for competing risks of death from other causes and disparities in cancer stage at diagnosis, for all cancers collectively and by cancer site. Methods People diagnosed in 2000–2008 were extracted from the population-based New South Wales Cancer Registry. Aboriginal status was multiply imputed for people with missing information (12.9%). Logistic regression models were used to compute odds ratios (ORs) with 95% confidence intervals (CIs) for ‘advanced stage’ at diagnosis (separately for distant and distant/regional stage). Survival was examined using competing risk regression to compute subhazard ratios (SHRs) with 95%CIs. Results Of the 301,356 cases, 2517 (0.84%) identified as Aboriginal (0.94% after imputation). After adjusting for age, sex, year of diagnosis, socio-economic status, remoteness, and cancer site Aboriginal peoples were more likely to be diagnosed with distant (OR 1.30, 95%CI 1.17–1.44) or distant/regional stage (OR 1.29, 95%CI 1.18–1.40) for all cancers collectively. This applied to cancers of the female breast, uterus, prostate, kidney, others (those not included in other categories) and cervix (when analyses were restricted to cases with known stages/known Aboriginal status). Aboriginal peoples had a higher hazard of death than non-Aboriginal people after accounting for competing risks from other causes of death, socio-demographic factors, stage and cancer site (SHR 1.40, 95%CI 1.31–1.50 for all cancers collectively). Consistent results applied to colorectal, lung, breast, prostate and other cancers. Conclusions Aboriginal peoples with cancer have an elevated hazard of cancer death compared with non-Aboriginal people, after accounting for more advanced stage and competing causes of death. Further research is needed to determine reasons, including any contribution of co-morbidity, lifestyle factors and differentials in service access to help explain disparities.
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Affiliation(s)
- Hanna E Tervonen
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.
| | - Richard Walton
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Hui You
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Deborah Baker
- Information Analysis Unit, Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - David Roder
- School of Health Sciences, Centre for Population Health Research, University of South Australia, GPO Box 2471, Adelaide, SA, 5001, Australia.,Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - David Currow
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
| | - Sanchia Aranda
- Cancer Institute NSW, GPO Box 41, Alexandria, Sydney, NSW, 1435, Australia
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Ward PR. Improving Access to, Use of, and Outcomes from Public Health Programs: The Importance of Building and Maintaining Trust with Patients/Clients. Front Public Health 2017; 5:22. [PMID: 28337430 PMCID: PMC5340761 DOI: 10.3389/fpubh.2017.00022] [Citation(s) in RCA: 59] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2016] [Accepted: 02/02/2017] [Indexed: 12/05/2022] Open
Abstract
The central argument in this paper is that "public trust" is critical for developing and maintaining the health and wellbeing of individuals, communities, and societies. I argue that public health practitioners and policy makers need to take "public trust" seriously if they intend to improve both the public's health and the engagement between members of the public and public health systems. Public health practitioners implement a range of services and interventions aimed at improving health but implicit a requirement for individuals to trust the practitioners and the services/interventions, before they engage with them. I then go on to provide an overview of the theory of trust within sociology and show why it is important to understand this theory in order to promote trust in public health services. I then draw on literature in three classic areas of public health-hospitals, cancer screening, and childhood immunization-to show why trust is vital in terms of understanding and potentially improving uptake of services. The case studies in this paper reveal that public health practitioners need to understand the centrality of building and maintaining trusting relationships with patients/clients because people who distrust public health services are less likely to use them, less likely to follow advice or recommendations, and more likely to have poorer health outcomes.
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Affiliation(s)
- Paul Russell Ward
- Discipline of Public Health, Flinders University, Adelaide, SA, Australia
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Brown A, Roder D, Yerrell P, Cargo M, Reilly R, Banham D, Micklem J, Morey K, Stewart H. Cancer Data and Aboriginal Disparities Project (CanDAD)--an overdue cancer control initiative. Eur J Cancer Care (Engl) 2017; 25:208-13. [PMID: 26918683 DOI: 10.1111/ecc.12466] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/18/2016] [Indexed: 11/30/2022]
Affiliation(s)
- A Brown
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - D Roder
- Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - P Yerrell
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - M Cargo
- Centre for Population Health Research, University of South Australia, Adelaide, SA, Australia
| | - R Reilly
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - D Banham
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - J Micklem
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - K Morey
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
| | - H Stewart
- Wardliparingga Aboriginal Research Unit, South Australian Health and Medical Research Institute, Adelaide, SA
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Haigh M, Shahid S, O'Connor K, Thompson SC. Talking about the not talked about: use of, and reactions to, a DVD promoting bowel cancer screening to Aboriginal people. Aust N Z J Public Health 2016; 40:548-552. [PMID: 27524679 DOI: 10.1111/1753-6405.12565] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2015] [Revised: 03/01/2015] [Accepted: 04/01/2015] [Indexed: 11/26/2022] Open
Abstract
OBJECTIVE To examine a) the implementation and use of a DVD developed to educate Aboriginal people about bowel cancer and bowel cancer screening; and b) broader aspects of Aboriginal participation in the National Bowel Cancer Screening Program. METHODS Qualitative methods and descriptive approaches were used. Data were collected using face-to-face and telephone interviews and focus group discussions. There were 67 participants, including those involved in the development and distribution of the DVD, health professionals and Aboriginal community members. RESULTS Although the DVD received a positive reaction from participants, fewer than half the DVDs had been distributed. Furthermore, the small number of DVDs that had been distributed were under-utilised. CONCLUSION The weaknesses do not appear to lie with the resource itself but can be attributed partly to poor distribution and promotion. This may have been compounded by the structure of the National Bowel Cancer Screening Program, which limited the engagement of Aboriginal community members and health providers whose focus is largely directed towards more pressing health care issues. IMPLICATIONS Interest in the resource may increase once the Aboriginal component of the screening program is more closely linked with primary care.
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Affiliation(s)
- Margaret Haigh
- Western Australian Centre for Rural Health, University of Western Australia
| | - Shaouli Shahid
- Centre for Aboriginal Studies, Curtin University, Western Australia
| | - Kathleen O'Connor
- Bowel Cancer Screening Implementation Team, WA Cancer & Palliative Care Network, Department of Health Western Australia
| | - Sandra C Thompson
- Western Australian Centre for Rural Health, University of Western Australia
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Moore SP, Green AC, Bray F, Coory M, Garvey G, Sabesan S, Valery PC. Colorectal cancer among Indigenous and non-Indigenous people in Queensland, Australia: Toward survival equality. Asia Pac J Clin Oncol 2016; 12:e209-14. [PMID: 24571285 DOI: 10.1111/ajco.12164] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/04/2013] [Indexed: 12/13/2022]
Abstract
AIM While Indigenous people in Queensland have lower colorectal cancer (CRC) incidence and mortality than the rest of the population, CRC remains the third most frequent cancer among Australian Indigenous people overall. This study aimed to investigate patterns of care and survival between Indigenous and non-Indigenous Australians with CRC. METHODS Through a matched-cohort design we compared 80 Indigenous and 85 non-Indigenous people all diagnosed with CRC and treated in Queensland public hospitals during 1998-2004 (frequency matched on age, sex, geographical remoteness). We compared clinical and treatment data (Pearson's chi-square) and all-cause and cancer survival (Cox regression analysis). RESULTS Indigenous patients with CRC were not significantly more likely to have comorbidity, advanced disease at diagnosis or less treatment than non-Indigenous people. There was also no statistically significant difference in all-cause survival (HR 1.14, 95% CI 0.69, 1.89) or cancer survival (HR 1.01, 95% CI 0.60, 1.69) between the two groups. CONCLUSIONS Similar CRC mortality among Indigenous and other Australians may reflect both the lower incidence and adequate management. Increasing life expectancy and exposures to risk factors suggests that Indigenous people are vulnerable to a growing burden of CRC. Primary prevention and early detection will be of paramount importance to future CRC control among Indigenous Australians. Current CRC management must be maintained and include prevention measures to ensure that predicted increases in CRC burden are minimized.
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Affiliation(s)
- Suzanne P Moore
- Queensland Institute of Medical Research, Brisbane
- International Agency for Research on Cancer, Lyon, France
| | - Adèle C Green
- Queensland Institute of Medical Research, Brisbane
- University of Manchester, Manchester Academic Health Science Centre, Manchester, UK
| | - Freddie Bray
- International Agency for Research on Cancer, Lyon, France
| | - Michael Coory
- Murdoch Childrens Research Institute, Parkville, Victoria
| | - Gail Garvey
- Cancer Epidemiology, Menzies School of Health Research, Darwin, Northern Territory, Australia
| | | | - Patricia C Valery
- Cancer Epidemiology, Menzies School of Health Research, Darwin, Northern Territory, Australia
- International Agency for Research on Cancer, Lyon, France
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Abstract
Colonoscopy is a frequently performed diagnostic and therapeutic test and the primary screening tool in several nationalized bowel cancer screening programs. There has been a considerable focus on maximizing the utility of colonoscopy. This has occurred in four key areas: Optimizing patient selection to reduce unnecessary or low yield colonoscopy has offered cost-benefit improvements in population screening. Improving quality assurance, through the development of widely accepted quality metrics for use in individual practice and the research setting, has offered measurable improvements in colonoscopic yield. Significant improvements have been demonstrated in colonoscopic technique, from the administration of preparation to the techniques employed during withdrawal of the colonoscope. Improved techniques to avoid post-procedural complications have also been developed-further maximizing the utility of colonoscopy. The aim of this review is to summarize the recent evidence-based advances in colonoscopic practice that contribute to the optimal practice of colonoscopy.
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Affiliation(s)
- Crispin J Corte
- Department of Gastroenterology, Concord Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
| | - Rupert W Leong
- Department of Gastroenterology, Concord Hospital, Sydney, Australia.,Faculty of Medicine, University of New South Wales, Sydney, Australia
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Ward PR, Coffey C, Javanparast S, Wilson C, Meyer SB. Institutional (mis)trust in colorectal cancer screening: a qualitative study with Greek, Iranian, Anglo-Australian and Indigenous groups. Health Expect 2015; 18:2915-27. [PMID: 25271975 PMCID: PMC5810636 DOI: 10.1111/hex.12276] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/05/2014] [Indexed: 11/28/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) has the second highest cancer mortality rate in Australia. The Australian National Bowel Cancer Screening Program (NBCSP) aims to increase early detection of CRC by offering free Faecal Occult Blood Testing (FOBT), although uptake is low for culturally and linguistically diverse (CALD) groups. AIM OF PAPER To present data on trust and mistrust in the NBCSP by population groups with low uptake and thus to highlight areas in need of policy change. METHODS A qualitative study was undertaken in South Australia, involving interviews with 94 people from four CALD groups: Greek, Iranian, Anglo-Australian, and Indigenous peoples. RESULTS Our study highlights the complexities of institutional trust, which involves considerations of trust at interpersonal, local and national levels. In addition, trust and mistrust was found in more abstract systems such as the medical knowledge of doctors to diagnose or treat cancer or the scientific procedures in laboratories to test the FOBTs. The object of institutional (mis)trust differed between cultural groups - Anglo-Australian and Iranian groups indicated a high level of trust in the government, whereas Indigenous participants were much less trusting. CONCLUSION The level and nature of trust in the screening process varied between the CALD groups. Addressing program misconceptions, clarifying the FOBT capabilities and involving medical services in collecting and transporting the samples may increase trust in the NBCSP. However, broader and more enduring mistrust in services and institutions may need to be dealt with in order to increase trust and participation.
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Affiliation(s)
- Paul R Ward
- Discipline of Public Health, Flinders University, Adalaide, SA, Australia
| | - Cushla Coffey
- Discipline of Public Health, Flinders University, Adalaide, SA, Australia
| | - Sara Javanparast
- South Australian Community Health Research Unit, Flinders University, Adalaide, SA, Australia
| | - Carlene Wilson
- School of Medicine, Flinders University, Adalaide, SA, Australia
| | - Samantha B Meyer
- Public Health and Health Systems, University of Waterloo, Waterloo, ON, Canada
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Ward PR, Coffey C, Meyer S. Trust, choice and obligation: a qualitative study of enablers of colorectal cancer screening in South Australia. SOCIOLOGY OF HEALTH & ILLNESS 2015; 37:988-1006. [PMID: 25912247 DOI: 10.1111/1467-9566.12280] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
Colorectal cancer (CRC) has the second highest cancer prevalence and mortality rates in Australia. The Australian National Bowel Cancer Screening Program (NBCSP) aims to increase early detection of CRC by offering free faecal occult blood testing. The NBCSP aims to offer choice to consumers about whether or not to participate in screening. This article presents data on trust, choice and perceived obligation to participate in the NBCSP by population groups with low uptake. A qualitative study was undertaken in South Australia. We interviewed 94 people from four culturally distinct groups: Greek, Iranian, Anglo-Australian and Indigenous peoples. This article demonstrates the complexity of factors shaping the choice, or lack thereof, to participate in the NBCSP. Informed choice is based on adequate knowledge, although this varied among our participants, highlighting the need for more health education in appropriate languages. An obligation to participate was found in the Iranian and Anglo-Australian groups and resulted from an established personal relationship with the doctor, a sense of duty, the acknowledgement of government investment and appreciation. Overall, this article makes a link between trust, choice and obligation, adding to literature on the sociology of trust and medical screening and highlighting important issues in the need of a policy and practice to improve CRC screening rates.
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Affiliation(s)
- Paul R Ward
- Discipline of Public Health, Flinders University, Australia
| | - Cushla Coffey
- Discipline of Public Health, Flinders University, Australia
| | - Samantha Meyer
- School of Public Health and Health Systems, Waterloo University, Canada
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Feletto E, Sitas F. Quantifying disparities in cancer incidence and mortality of Australian residents of New South Wales (NSW) by place of birth: an ecological study. BMC Public Health 2015; 15:823. [PMID: 26306859 PMCID: PMC4548689 DOI: 10.1186/s12889-015-2141-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/21/2015] [Accepted: 08/11/2015] [Indexed: 12/12/2022] Open
Abstract
Background In 2013, about 32 % of the Australian population over 15 years of age was born overseas. Previous cancer-related immigrant health studies identified differences in mortality and incidence between immigrants and Australian-born people. To identify groups that may require targeted interventions, we describe by region of birth: 1. the highest cancer incidence and mortality rates for NSW residents, Australia’s most populous state; and 2. mortality to incidence ratios (MIR) for all cancers. Methods Cancer incidence and mortality data were obtained from NSW residents for 2004–2008 (averaged) by sex, region of birth and 10 year age groups. Age standardised incidence and mortality rates were calculated with 95 % confidence intervals (per 100,000), using the world standard population. In the place of 5-year survival rates, we used age standardised MIRs (=M/I) as a simple proxy indicator of cancer survival. Results All-cancer incidence only exceeded Australian born people (308.5) for New Zealand born (322). The highest reported incidence rates for cancers from all regions were prostate and breast cancers. All-cancer mortality exceeded Australian-born (105.3) in people born in Western Europe (110.9), Oceania (108.2) and UK and Ireland (106.4). For Australian-born residents, the MIR was 34 cancer deaths per 100 cases compared to residents from Central Europe at 38 deaths per 100 cases and lowest at 28 deaths per 100 cases for residents from Central and Southern Asia. Conclusion Some disparities between Australian-born NSW residents and immigrants were identified in prostate, breast and lung cancer mortality rates. While on average most immigrant groups have similar cancer characteristics for the top cancers, areas for improvement to inform strategies to alleviate cancer disparities are required. This analysis suggests that NSW residents could benefit from specific prevention programmes on healthy eating and smoking cessation, especially people from Central Europe, UK and Ireland and Western Europe. Rising immigration rates encourage us to continue to address the areas indicated for improvement. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2141-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Eleonora Feletto
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW, 2011, Australia.
| | - Freddy Sitas
- Cancer Research Division, Cancer Council NSW, 153 Dowling St, Woolloomooloo, NSW, 2011, Australia. .,University of Sydney, School of Public Health, Sydney, Australia. .,University of NSW, School of Public Health and Community Medicine, Sydney, Australia.
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Noble NE, Paul CL, Turner N, Blunden SV, Oldmeadow C, Turon HE. A cross-sectional survey and latent class analysis of the prevalence and clustering of health risk factors among people attending an Aboriginal Community Controlled Health Service. BMC Public Health 2015; 15:666. [PMID: 26173908 PMCID: PMC4502927 DOI: 10.1186/s12889-015-2015-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2014] [Accepted: 07/02/2015] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Indigenous Australians are a socially disadvantaged group who experience significantly poorer health and a higher prevalence of modifiable health behaviours than other Australians. Little is known about the clustering of health risks among Indigenous Australians. The aims of this study were to describe the clustering of key health risk factors, such as smoking, physical inactivity and alcohol consumption, and socio-demographics associated with clusters, among a predominantly Aboriginal sample. METHODS Participants (n = 377) attending an Aboriginal Community Controlled Health Service (ACCHS) in regional/rural New South Wales, Australia, in 2012-2013 completed a self-report touch screen health risk survey. Clusters were identified using latent class analysis. RESULTS Cluster 1 ('low fruit/vegetable intake, lower risk'; 51%) consisted of older men and women; Cluster 2 ('risk taking'; 22%) included younger unemployed males with a high prevalence of smoking, risky alcohol, and illicit drug use. Cluster 3 ('inactive, overweight, depressed'; 28%) was characterised by younger to mid aged women likely to have experienced emotional or physical violence. CONCLUSIONS If future research identifies similar stable clusters of health behaviours for this population, intervention approaches targeting these clusters of risk factors should be developed and tested for Aboriginal and Torres Strait Islander Australians.
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Affiliation(s)
- Natasha E Noble
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Level 4 West HMRI Building, Callaghan, NSW, 2308, Australia.
| | - Christine L Paul
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Level 4 West HMRI Building, Callaghan, NSW, 2308, Australia.
| | - Nicole Turner
- School of Medicine and Public Health & Department of Rural Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Stephen V Blunden
- Casino Aboriginal Medical Service, 43 Johnson Street, Casino, NSW, 2470, Australia.
| | - Christopher Oldmeadow
- Hunter Medical Research Institute and Faculty of Health, University of Newcastle, Callaghan, NSW, 2308, Australia.
| | - Heidi E Turon
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, University of Newcastle, Level 4 West HMRI Building, Callaghan, NSW, 2308, Australia.
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Barbaro B, Brotherton JML. Measuring HPV vaccination coverage in Australia: comparing two alternative population-based denominators. Aust N Z J Public Health 2015; 39:326-30. [PMID: 26094817 DOI: 10.1111/1753-6405.12372] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2014] [Accepted: 01/01/2015] [Indexed: 12/16/2022] Open
Abstract
OBJECTIVE To compare the use of two alternative population-based denominators in calculating HPV vaccine coverage in Australia by age groups, jurisdiction and remoteness areas. METHOD Data from the National HPV Vaccination Program Register (NHVPR) were analysed at Local Government Area (LGA) level, by state/territory and by the Australian Standard Geographical Classification Remoteness Structure. The proportion of females vaccinated was calculated using both the ABS ERP and Medicare enrolments as the denominator. RESULTS HPV vaccine coverage estimates were slightly higher using Medicare enrolments than using the ABS estimated resident population nationally (70.8% compared with 70.4% for 12 to 17-year-old females, and 33.3% compared with 31.9% for 18 to 26-year-old females, respectively.) The greatest differences in coverage were found in the remote areas of Australia. CONCLUSION There is minimal difference between coverage estimates made using the two denominators except in Remote and Very Remote areas where small residential populations make interpretation more difficult. Adoption of Medicare enrolments for the denominator in the ongoing program would make minimal, if any, difference to routine coverage estimates.
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Affiliation(s)
- Bianca Barbaro
- Australian Workplace Innovation and Social Research Centre, University of Adelaide, South Australia
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Kolahdooz F, Jang SL, Corriveau A, Gotay C, Johnston N, Sharma S. Knowledge, attitudes, and behaviours towards cancer screening in indigenous populations: a systematic review. Lancet Oncol 2015; 15:e504-16. [PMID: 25281469 DOI: 10.1016/s1470-2045(14)70508-x] [Citation(s) in RCA: 48] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Cancer mortality among indigenous peoples is increasing, but these populations commonly under use cancer-screening services. This systematic review explores knowledge, attitudes, and behaviours towards cancer screening among indigenous peoples worldwide. Searches of major bibliographic databases identified primary studies published in English up to March, 2014; of 33 eligible studies, three were cohort studies, 27 cross-sectional, and three case-control. Knowledge of and participation in screening was greater for breast cancer than for other cancers. Indigenous peoples tended to have less knowledge, less favourable attitudes, and a higher propensity to refuse screening than non-indigenous populations. The most common factors affecting knowledge, attitudes, and behaviours towards cancer screening included access to screening, knowledge about cancer and screening, educational attainment, perceived necessity of screening, and age. Greater understanding of knowledge, attitudes, and behaviours towards cancer screening in diverse indigenous cultures is needed so that culturally appropriate cancer prevention programmes can be provided.
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Affiliation(s)
- Fariba Kolahdooz
- Aboriginal and Global Health Research Group, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - Se Lim Jang
- Aboriginal and Global Health Research Group, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada
| | - André Corriveau
- Office of the Chief Public Health Officer, Department of Health and Social Services, Government of the Northwest Territories, Yellowknife, NT, Canada
| | - Carolyn Gotay
- Faculty of Medicine, School of Population and Public Health, University of British Columbia, Vancouver, BC, Canada
| | - Nora Johnston
- Alberta Centre for Active Living, Faculty of Physical Education and Recreation, University of Alberta, Edmonton, AB, Canada
| | - Sangita Sharma
- Aboriginal and Global Health Research Group, Department of Medicine, Faculty of Medicine and Dentistry, University of Alberta, Edmonton, AB, Canada.
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Varlow M, Stacey I, Dunlop S, Young J, Kite J, Dessaix A, McAulay C. Self-reported participation and beliefs about bowel cancer screening in New South Wales, Australia. Health Promot J Austr 2014; 25:97-103. [PMID: 25017447 DOI: 10.1071/he13102] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/14/2013] [Accepted: 04/11/2014] [Indexed: 12/28/2022] Open
Abstract
ISSUE ADDRESSED To describe self-reported bowel cancer screening participation, beliefs and attitudes in a sample of New South Wales (NSW) adults, and to identify beliefs and demographic factors associated with self-reported bowel cancer screening participation. METHODS This study used data from the International Cancer Benchmarking Partnership Module 2, a representative population-based telephone survey. Self-reported participation in and beliefs about bowel cancer screening were measured using the Awareness and Beliefs about Cancer survey of people aged 50 years and over living in NSW, Australia (n=2001). Logistic regression modelling was used to identify explanatory variables associated with bowel cancer screening participation. RESULTS Half of all women (54.1%, 95% CI: 50.8-57.4%) and two-thirds of men (65.7%, 95% CI: 61.5-69.9%) reported screening for bowel cancer within the previous 5 years. Believing that screening was only necessary when experiencing symptoms was more likely to be endorsed by people aged 65 years and over (25.5%, 95% CI: 22.2-28.7%) rather than younger (50-64 years; 16.7%, 95% CI: 13.8-19.7%), non-English-speaking migrants (35.4%, 95% CI: 26.7-44.1%) versus others (18.6%, 95% CI: 16.4-20.7%), and people in metropolitan (23.3%, 95% CI: 20.4-26.1%) versus non-metropolitan areas (16.4%, 95% CI: 12.8-20%). People who disagreed that screening was only necessary when experiencing symptoms were four times more likely to report screening participation (OR 3.96, 95% CI: 3.11-5.03). CONCLUSIONS Community education about bowel cancer screening is needed to correct misperceptions regarding screening in the absence of symptoms. Tailored strategies for older, migrant and urban communities may be beneficial. SO WHAT? Education strategies that promote the need for screening in the absence of symptoms and correct misconceptions about bowel cancer screening amongst subgroups of the NSW population may improve screening rates and decrease the burden of bowel cancer in NSW.
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Affiliation(s)
- Megan Varlow
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Ingrid Stacey
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Sally Dunlop
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Jane Young
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - James Kite
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Anita Dessaix
- Cancer Institute NSW, PO Box 41, Alexandria, NSW 1435, Australia
| | - Claire McAulay
- Sydney School of Public Health, The University of Sydney, Edward Ford Building (A27), NSW 2006, Australia
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Weber MF, Chiew M, Feletto E, Kahn C, Sitas F, Webster L. Cancer Screening among immigrants living in urban and regional Australia: results from the 45 and up study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2014; 11:8251-66. [PMID: 25153460 PMCID: PMC4143860 DOI: 10.3390/ijerph110808251] [Citation(s) in RCA: 62] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2014] [Revised: 07/30/2014] [Accepted: 08/06/2014] [Indexed: 12/23/2022]
Abstract
Over 25% of the Australian population are immigrants, and are less active participants in cancer screening programmes. Most immigrants live in urban areas of Australia, but a significant proportion (~20%), live in regional areas. This study explored differences in cancer screening participation by place of birth and residence. Self-reported use of mammogram, faecal occult blood test (FOBT), and/or prostate specific antigen (PSA) tests was obtained from 48,642 immigrants and 141,275 Australian-born participants aged 50 years or older in the 45 and Up Study (New South Wales, Australia 2006-2010). Poisson regression was used to estimate relative risks of test use, adjusting for key socio-demographic characteristics. Overall, immigrants from Asia and Europe were less likely to have had any of the tests in the previous two years than Australian-born participants. Regional Australian-born participants were more likely to have had any of the tests than those living in urban areas. Regional immigrant participants were more likely to have had an FOBT or PSA test than those living in urban areas, but there were no differences in mammograms. This report identifies key immigrant groups in urban and regional areas that policymakers and healthcare providers should target with culturally appropriate information to promote cancer screening.
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Affiliation(s)
- Marianne F Weber
- Cancer Research Division, Cancer Council NSW, P.O. Box 572 Kings Cross, NSW 1340, Australia.
| | - May Chiew
- Cancer Research Division, Cancer Council NSW, P.O. Box 572 Kings Cross, NSW 1340, Australia.
| | - Eleonora Feletto
- Cancer Research Division, Cancer Council NSW, P.O. Box 572 Kings Cross, NSW 1340, Australia.
| | - Clare Kahn
- Cancer Research Division, Cancer Council NSW, P.O. Box 572 Kings Cross, NSW 1340, Australia.
| | - Freddy Sitas
- Cancer Research Division, Cancer Council NSW, P.O. Box 572 Kings Cross, NSW 1340, Australia.
| | - Lucy Webster
- School of Biomedical Sciences, Charles Sturt University, Boorooma Street, Wagga Wagga, NSW 2650, Australia.
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Determinants of cervical screening services uptake among 18-49 year old women seeking services at the Jaramogi Oginga Odinga Teaching and Referral Hospital, Kisumu, Kenya. BMC Health Serv Res 2014; 14:335. [PMID: 25100298 PMCID: PMC4271847 DOI: 10.1186/1472-6963-14-335] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 07/30/2014] [Indexed: 11/30/2022] Open
Abstract
Background Kenyan women aged ≥15 years are at risk of developing cervical cancer. Currently, cervical cytology reduces cervical cancer incidence, since it allows for early diagnosis and treatment. Uptake of cervical screening services is a priority research area in Kenya. Central to the success of any screening programme is its ability to identify, reach out and screen the defined target population. Cervical screening coverage in Kenya is currently at 3.2%. In Jaramogi Oginga Odinga Teaching and Referral Hospital (JOOTRH) in Nyanza, the number screened for cervical cancer is low (averagely 3/day). Thus the current study sought to identify factors influencing uptake of cervical screening services at the facility. Methods In a cross-sectional study, knowledge, perceptions and cues for action associated with self-reported cervical screening uptake were explored. The targeted population (n = 424), purposively selected were women of child-bearing age (18–49 years) visiting JOOTRH. Data on socio-demographic status (age, level of education, marital status, job status, income level), knowledge of cervical cancer, perceptions on severity and susceptibility to the disease were collected using self-administered structured questionnaires. Statistical significance of differences in proportions were determined by chi-square analyses while logistic regression analyses were used to identify determinants of self-reported uptake of the service. Results Self-reported screening uptake was 17.5%. There was a strong positive association between age (P < 0.0001), level of education (P < 0.0001) and income levels (P = 0.005) with the uptake of the service. Knowledge level on the signs and symptoms of cervical cancer was an important determinant for being screened for cervical cancer (P < 0.0001). Furthermore, those who said they didn’t know about the disease (OR, 26.84, 95% CI, 6.07-118.61, P < 0.0001) or were not aware about susceptibility to it (OR, 2.37, 95% CI, 1.10-5.08, P = 0.02) had a higher likelihood of not being screened. On cues for action, those who attended the child welfare clinic were more likely to be screened (OR, 2.31, 95% CI, 1.17-3.93, P = 0.03). Conclusion Knowledge, perception of higher susceptibility and attending child welfare clinic are key determinants of self-reported uptake of cervical screening. Increasing knowledge, enhancing health education and providing free services may increase uptake among women population in such settings. Electronic supplementary material The online version of this article (doi:10.1186/1472-6963-14-335) contains supplementary material, which is available to authorized users.
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Noble NE, Paul CL, Carey ML, Sanson-Fisher RW, Blunden SV, Stewart JM, Conigrave KM. A cross-sectional survey assessing the acceptability and feasibility of self-report electronic data collection about health risks from patients attending an Aboriginal Community Controlled Health Service. BMC Med Inform Decis Mak 2014; 14:34. [PMID: 24739205 PMCID: PMC4005463 DOI: 10.1186/1472-6947-14-34] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/02/2013] [Accepted: 04/11/2014] [Indexed: 12/19/2022] Open
Abstract
BACKGROUND Aboriginal Australians experience significantly worse health and a higher burden of chronic disease than non-Aboriginal Australians. Electronic self-report data collection is a systematic means of collecting data about health risk factors which could help to overcome screening barriers and assist in the provision of preventive health care. Yet this approach has not been tested in an Aboriginal health care setting. Therefore, the aim of this study was to examine the acceptability and feasibility of a health risk questionnaire administered on a touch screen laptop computer for patients attending an Aboriginal Community Controlled Health Service (ACCHS). METHODS In 2012, consecutive adult patients attending an ACCHS in rural New South Wales, Australia, were asked to complete a health risk survey on a touch screen computer. Health risk factors assessed in the questionnaire included smoking status, body mass index, and level of physical activity. The questionnaire included visual cues to improve accuracy and minimise literacy barriers and was completed while participants were waiting for their appointment. RESULTS A total of 188 participants completed the questionnaire, with a consent rate of 71%. The mean time taken to complete the questionnaire was less than 12 minutes. Over 90% of participants agreed that: the questionnaire instructions were easy to follow; the touch screen computer was easy to use; they had enough privacy; the questions were easy to understand; they felt comfortable answering all the questions. CONCLUSIONS Results indicate that the use of a touch screen questionnaire to collect information from patients about health risk factors affecting Aboriginal Australians is feasible and acceptable in the ACCHS setting. This approach has potential to improve identification and management of at-risk individuals, therein providing significant opportunities to reduce the burden of disease among Aboriginal Australians.
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Affiliation(s)
- Natasha E Noble
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Christine L Paul
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Mariko L Carey
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | - Robert W Sanson-Fisher
- Priority Research Centre for Health Behaviour, School of Medicine and Public Health, The University of Newcastle, Callaghan, NSW, Australia
| | | | - Jessica M Stewart
- National Health Performance Authority, Level 9, Oxford St, Sydney NSW 2001, Australia
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Christou A, Thompson SC. Missed opportunities in educating Aboriginal Australians about bowel cancer screening: whose job is it anyway? Contemp Nurse 2013. [DOI: 10.5172/conu.2013.4084] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Potter MB. Strategies and resources to address colorectal cancer screening rates and disparities in the United States and globally. Annu Rev Public Health 2013; 34:413-29. [PMID: 23297661 DOI: 10.1146/annurev-publhealth-031912-114436] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
Abstract
Colorectal cancer is a significant cause of mortality in the United States and globally. In the United States, increased access to screening and effective treatment has contributed to a reduction in colorectal cancer incidence and mortality for the general population, though significant disparities persist. Worldwide, the disparities are even more pronounced, with vastly different colorectal cancer mortality rates and trends among nations. Newly organized colorectal cancer screening programs in economically developed countries with a high burden of colorectal cancer may provide pathways to reduce these disparities over time. This article provides an overview of colorectal cancer incidence, mortality, screening, and disparities in the United States and other world populations. Promising strategies and resources are identified to address colorectal cancer screening rates and disparities in the United States and worldwide.
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Affiliation(s)
- Michael B Potter
- Department of Family and Community Medicine, University of California, San Francisco, California 94143, USA.
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Flitcroft KL, Irwig LM, Carter SM, Salkeld GP, Gillespie JA. Colorectal cancer screening: why immunochemical fecal occult blood tests may be the best option. BMC Gastroenterol 2012; 12:183. [PMID: 23272939 PMCID: PMC3548714 DOI: 10.1186/1471-230x-12-183] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2012] [Accepted: 12/14/2012] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND There are many test options available for colorectal cancer screening. The choice of test relates to the objectives of those offering or considering screening. DISCUSSION While all screening programs aim to detect disease early in order to improve the length and/or quality of life for the individual, some organizations and individuals prefer screening tests that offer the opportunity for cancer prevention. Others favor maximizing participation or the opportunity for shared decision-making, including discussion of information on test quality and availability. We propose three additional objectives for screening: minimizing harms, optimizing economic efficiency and maximizing equity of access to screening. SUMMARY Applying these objectives to colorectal cancer screening, we advocate the use of immunochemical FOBTs as the preferred screening strategy, as it satisfies all three of these important objectives.
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Affiliation(s)
- Kathy L Flitcroft
- Sydney School of Public Health, Edward Ford Building, A28 University of Sydney, 2006, Sydney, NSW, Australia
| | - Les M Irwig
- Sydney School of Public Health, Edward Ford Building, A28 University of Sydney, 2006, Sydney, NSW, Australia
| | - Stacy M Carter
- Sydney School of Public Health, Edward Ford Building, A28 University of Sydney, 2006, Sydney, NSW, Australia
| | - Glenn P Salkeld
- Sydney School of Public Health, Edward Ford Building, A28 University of Sydney, 2006, Sydney, NSW, Australia
| | - James A Gillespie
- Sydney School of Public Health, Edward Ford Building, A28 University of Sydney, 2006, Sydney, NSW, Australia
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Whynes DK. Screening for colorectal cancer: how can we maximize uptake? COLORECTAL CANCER 2012. [DOI: 10.2217/crc.12.64] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
Abstract
SUMMARY Screening for colorectal cancer is being introduced in a number of countries, yet uptake remains low. The rationalistic model of screening participation explains low uptake in terms of deficient knowledge and high cost. There is evidence to support this view and remedial actions produce anticipated effects up to a point. However, differential uptake among specific groups suggests that the individual decision to participate in screening is idiosyncratic, and understanding decisions requires interpretation in terms of message framing, reference points, the use of simplifying heuristics and affective or emotional reaction. As these aspects of decisions originate from fundamental personal characteristics, they may be difficult to combat. When decision determinants, such as fear and herding, are manipulated, consequences for uptake can be contradictory.
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Affiliation(s)
- David K Whynes
- School of Economics, University of Nottingham, Nottingham NG7 2RD, UK
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Christou A, Thompson SC. Colorectal cancer screening knowledge, attitudes and behavioural intention among Indigenous Western Australians. BMC Public Health 2012; 12:528. [PMID: 22809457 PMCID: PMC3481427 DOI: 10.1186/1471-2458-12-528] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2011] [Accepted: 06/26/2012] [Indexed: 12/31/2022] Open
Abstract
Background Indigenous Australians are significantly less likely to participate in colorectal cancer (CRC) screening compared to non-Indigenous people. This study aimed to identify important factors influencing the decision to undertake screening using Faecal Occult Blood Testing (FOBT) among Indigenous Australians. Very little evidence exists to guide interventions and programmatic approaches for facilitating screening uptake in this population in order to reduce the disparity in colorectal cancer outcomes. Methods Interviewer-administered surveys were carried out with a convenience sample (n = 93) of Indigenous Western Australians between November 2009-March 2010 to assess knowledge, awareness, attitudes and behavioural intent in regard to CRC and CRC screening. Results Awareness and knowledge of CRC and screening were low, although both were significantly associated with exposure to media advertising (p = 0.008; p < 0.0001). Nearly two-thirds (63%; 58/92) of respondents reported intending to participate in screening, while a greater proportion (84%; 77/92) said they would participate on a doctor’s recommendation. Multivariate analysis with logistic regression demonstrated that independent predictors of screening intention were, greater perceived self-efficacy (OR = 19.8, 95% CI = 5.5-71.8), a history of cancer screening participation (OR = 6.8, 95% CI = 2.0-23.3) and being aged 45 years or more (OR = 4.5, 95% CI = 1.2-16.5). A higher CRC knowledge score (medium vs. low: OR = 9.9, 95% CI = 2.4-41.3; high vs. low: 13.6, 95% CI = 3.4-54.0) and being married or in a de-facto relationship (OR = 6.9, 95% CI = 2.1-22.5) were also identified as predictors of intention to screen with FOBT. Conclusions Improving CRC related knowledge and confidence to carry out the FOBT self-screening test through education and greater promotion of screening has the potential to enhance Indigenous participation in CRC screening. These findings should guide the development of interventions to encourage screening uptake and reduce bowel cancer related deaths among Indigenous Australians.
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Affiliation(s)
- Aliki Christou
- Centre for International Health, Curtin University, GPO Box U1987, Perth, Western Australia.
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