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Gezels E, Van Roy K, Arbyn M, Coursier P, Devroey D, Martens P, Simoens C, Vaes B, Van Herck K, Vankrunkelsven P, Verhoeven V, Willems S. The ESSAG-trial protocol: A randomized controlled trial evaluating the efficacy of offering a self-sampling kit by the GP to reach women underscreened in the routine cervical cancer screening program. Contemp Clin Trials 2024; 144:107617. [PMID: 38977179 DOI: 10.1016/j.cct.2024.107617] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2024] [Revised: 06/13/2024] [Accepted: 07/03/2024] [Indexed: 07/10/2024]
Abstract
BACKGROUND In Flanders (Belgium), women not screened for cervical cancer (CC) within the last three years receive an invitation letter from the regional screening organization, the Centre for Cancer Detection (CCD), encouraging them to have a cervical specimen taken by their general practitioner (GP) or gynecologist. However, the coverage for CC screening remains suboptimal (63%). The offer of a self-sampling kit (SSK, for HPV testing) by a GP may trigger participation among women who do not attend regular screening. METHODS The ESSAG-trial is a cluster-randomized controlled trial with three arms, each including 1125 women aged 31-64 years, who were not screened for CC in the last 6 years. In arm A, GPs offer a SSK when eligible women consult for any reason. In arm B, women receive a personal GP signed invitation letter including an SSK at their home address. In the control arm, women receive the standard invitation letter from the CCD. The primary outcome is the response rate at three months after inclusion. Secondary outcomes are: screen test positivity; compliance with foreseen follow-up among screen-positives; costs per invited and per screened women; as well as contrasts between trial arms and between socio-demographic categories. CONCLUSION The ESSAG-trial will assess the effect of GP-based interventions using SSKs on CC screening participation among hard-to-reach populations. Findings will inform policymakers about feasible strategies on increasing CC screening that may be rolled-out throughout the whole region. TRIAL REGISTRATION ClinicalTrials.gov: NCT05656976.
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Affiliation(s)
- Eva Gezels
- Department of Public Health and Primary Care, Ghent University, C Heymanslaan 10, 9000 Ghent, Belgium.
| | - Kaatje Van Roy
- Department of Public Health and Primary Care, Ghent University, C Heymanslaan 10, 9000 Ghent, Belgium
| | - Marc Arbyn
- Unit of Cancer Epidemiology, Belgian Cancer Center, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Patrick Coursier
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 7001, 3000 Leuven, Belgium
| | - Dirk Devroey
- Department of Family Medicine, Vrije Universiteit Brussel (VUB), Laarbeeklaan 103, 1090 Jette, Belgium
| | - Patrick Martens
- Center for Cancer Detection, Ruddershove 4, 8000 Bruges, Belgium
| | - Cindy Simoens
- Unit of Cancer Epidemiology, Belgian Cancer Center, Sciensano, Juliette Wytsmanstraat 14, 1050 Brussels, Belgium
| | - Bert Vaes
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 7001, 3000 Leuven, Belgium
| | - Koen Van Herck
- Belgian Cancer Registry, Koningsstraat 215/7, 1210 Brussels, Belgium
| | - Patrick Vankrunkelsven
- Department of Public Health and Primary Care, KU Leuven, Kapucijnenvoer 35 7001, 3000 Leuven, Belgium
| | - Veronique Verhoeven
- Family Medicine and Population Health, University of Antwerp, Doornstraat 331, 2610 Wilrijk, Belgium
| | - Sara Willems
- Department of Public Health and Primary Care, Ghent University, C Heymanslaan 10, 9000 Ghent, Belgium
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Mon HM, Robb KA, Demou E. Effectiveness of workplace cancer screening interventions: a systematic review. BMC Cancer 2024; 24:999. [PMID: 39134945 PMCID: PMC11321184 DOI: 10.1186/s12885-024-12649-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 07/16/2024] [Indexed: 08/15/2024] Open
Abstract
INTRODUCTION Cancer cases are rising globally, with a noticeable rise in younger adults. Screening and early detection are effective in decreasing mortality. Workplaces can play a role in promoting cancer screening uptake. This systematic review investigated the effectiveness of workplace breast, lung, colorectal, and cervical cancer screening interventions, and the factors impacting their effectiveness. METHODOLOGY Six databases (Embase, Medline, Web of Science, CINAHL, Cochrane Library, Scopus) were searched, and cancer screening promotion and cancer screening uptake was analysed using effect direction plots. Magnitude of effectiveness (i.e., change in knowledge or screening rate) was also evaluated. RESULTS In total, 13,426 articles were identified. After screening and applying the eligibility criteria, 21 articles were included in the analysis. A positive effect direction was seen for all workplace cancer screening promotion interventions. Magnitude of effectiveness for cancer screening promotion interventions resulted in a > 30% change in knowledge or screening uptake in 4/7 of breast cancer, in 3/4 of cervical cancer and 1/3 colorectal cancer screening promotion interventions. For workplace cancer screening uptake interventions, a positive effect direction was observed for the majority (18/22). Cancer screening uptake interventions showed a > 30% change in magnitude of screening rate in 4/7 breast cancer, 5/10 colorectal cancer and in 1/5 cervical cancer workplace interventions. No studies for lung cancer were eligible. Factors positively influencing effectiveness included an interest in health and previous healthcare use, while fear of cancer and embarrassment of screening negatively influenced effectiveness. CONCLUSION Workplace cancer screening promotion and uptake interventions can effectively improve cancer screening knowledge and increase uptake of screening tests.
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Affiliation(s)
- Hsu Myat Mon
- College of Social Sciences, University of Glasgow, G12 8QQ, Glasgow, Scotland
- Department of Preventive and Social Medicine, Faculty of Medicine, Chulalongkorn University, 1873 Rama IV Road, Khwaeng Pathum Wan, Khet Pathum Wan, Krung Thep Maha Nakhon, Bangkok, 10330, Thailand
| | - Kathryn A Robb
- School of Health and Wellbeing, University of Glasgow, G12 8QQ, Glasgow, Scotland
| | - Evangelia Demou
- MRC/CSO Social and Public Health Sciences Unit, School of Health and Wellbeing, University of Glasgow, G12 8QQ, Glasgow, Scotland.
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Dennison RA, Clune RJ, Morris S, Thomas C, Usher‐Smith JA. Understanding the Preferences and Considerations of the Public Towards Risk-Stratified Screening for Colorectal Cancer: Insights From Think-Aloud Interviews Based on a Discrete Choice Experiment. Health Expect 2024; 27:e14153. [PMID: 39030943 PMCID: PMC11258464 DOI: 10.1111/hex.14153] [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: 04/26/2024] [Revised: 07/02/2024] [Accepted: 07/08/2024] [Indexed: 07/22/2024] Open
Abstract
CONTEXT Risk stratification has been suggested as a strategy for improving cancer screening. Any changes to existing programmes must be acceptable to the public. OBJECTIVE This study aimed to explore the preferences and considerations of individuals relating to the introduction of different risk-based strategies to determine eligibility for colorectal cancer (CRC) screening. STUDY DESIGN Participants completed a discrete choice experiment (DCE) within online interviews. Nine conjoint-analysis tasks were created, each with two potential CRC screening programmes. The attributes included personal risk of CRC, screening invitation strategy and impact. Participants chose between programmes while thinking aloud and sharing their thoughts. Transcripts were analysed using codebook thematic analysis. PARTICIPANTS Twenty participants based in England aged 40-79 years without previous cancer history or medical expertise. RESULTS When choosing between programmes, participants first and primarily looked to prioritise saving lives. The harms associated with screening were viewed as a surprise but also felt by most to be inevitable; the benefits frequently outweighed, therefore, harms were considered less important. Risk stratification using individual characteristics was considered a nuanced approach to healthcare, which tended to be preferred over the age-alone model. Detailed personal risk information could be taken more seriously than non-personalised information to motivate behaviour change. Although it had minimal impact on decision-making, not diverting resources for screening from elsewhere was valued. Individuals who chose not to provide health information were considered irresponsible, while it was important that those with no information to provide should not lose out. CONCLUSION Risk-stratified CRC screening is generally aligned with public preferences, with decisions between possible stratification strategies dominated by saving lives. Even if attributes including risk factors, risk stratification strategy and risk communication contributed less to the overall decision to select certain programmes, some levels more clearly fulfilled public values; therefore, all these factors should be taken into consideration when redesigning and communicating CRC screening programmes. PATIENT OR PUBLIC CONTRIBUTION The primary data source for this study is interviews with 20 members of the public (current, past or future CRC screening invitees). Two public representatives contributed to planning this study, particularly the DCE.
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Affiliation(s)
- Rebecca A. Dennison
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Reanna J. Clune
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Stephen Morris
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Chloe Thomas
- Sheffield Centre for Health and Related Research, School of Medicine and Population HealthUniversity of SheffieldSheffieldUK
| | - Juliet A. Usher‐Smith
- Primary Care Unit, Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
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Dunsmore VJ, Neupert SD. Social isolation, coping efficacy, and social well-being over time in patients with lung cancer. J Behav Med 2024:10.1007/s10865-024-00508-z. [PMID: 39078571 DOI: 10.1007/s10865-024-00508-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2023] [Accepted: 07/09/2024] [Indexed: 07/31/2024]
Abstract
BACKGROUND Little work has examined how coping efficacy and lung cancer-related social isolation relate to social well-being in the context of a patient's computed tomography (CT) scan. Researchers tested the cross-sectional relationship of social isolation and social well-being, and the longitudinal relationship between coping efficacy and social well-being before CT scans. METHOD 25 patients with lung cancer, within 6 months of their upcoming CT scan, participated. Baseline surveys collected clinical information, demographics, and social isolation; repeated monthly surveys collected coping efficacy and social well-being every 30 days until one's scan. RESULTS [Cross-sectional] High levels of social isolation were associated with low levels of social well-being. [Longitudinal] On months patients reported high coping efficacy, they also reported increases in social well-being. CONCLUSIONS Social interventions may improve well-being among those with lung cancer as our work shows that getting and receiving support are strongly related to well-being in the time surrounding a scan.
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Affiliation(s)
- Victoria J Dunsmore
- Department of Psychology, North Carolina State University, Raleigh, USA.
- UNC Chapel Hill, Lineberger Comprehensive Cancer Center, Chapel Hill, USA.
| | - Shevaun D Neupert
- Department of Psychology, North Carolina State University, Raleigh, USA
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Helgestad ADL, Andersen B, Njor SH, Larsen MB. The association of demographic and socioeconomic variables with cancer screening participation: A national cross-sectional study of three cancer screening programs in Denmark. Heliyon 2024; 10:e31163. [PMID: 39044972 PMCID: PMC11263647 DOI: 10.1016/j.heliyon.2024.e31163] [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: 05/06/2024] [Accepted: 05/10/2024] [Indexed: 07/25/2024] Open
Abstract
Objective To analyze the demographic and socioeconomic determinants of non-participation in cervical, colorectal and breast cancer screening programs in Denmark. Study design and setting We conducted a cross-sectional study involving all women aged 53-65 years residing in Denmark on March 31, 2018, utilizing comprehensive individual data from population registries. Logistic regression models were employed to assess associations between demographic and socioeconomic factors and non-participation compared with participating in one, two, and three cancer screening programs, presenting odds ratios (ORs) with 95 % confidence intervals (CIs). Both unadjusted and adjusted models were applied for each level of screening participation. Results Significant associations with non-participation in the three cancer screening programs were observed across all demographic and socioeconomic covariates considered. Women with low incomes demonstrated the highest likelihood of non-participation (none vs. three programs attended, OR: 2.95, 95 % CI: 2.82-3.08). Similarly, increased odds of non-participation were noted among immigrants (Western immigrants: OR: 2.08, 95 % CI: 1.96-2.21; non-Western immigrants OR 1.26 95 % CI: 1.20-1.32), women living alone (OR: 2.08, 95 % CI: 2.02-2.14), women outside the labor force (OR: 1.92, 95 % CI: 1.86-1.99), and women with lower educational levels (OR: 1.44, 95 % CI: 1.39-1.50) in the model comparing non-participation to participating in three screening programs. A progressive intensification of the association with non-participation was noted with each incremental increase in screening participation (from one to two to three programs). Conclusions Demographic and socioeconomic variables are significantly associated with non-participation in all three Danish cancer screening programs, particularly affecting women from vulnerable demographic and socioeconomic backgrounds. Future research should prioritize strategies to enhance participation within this subgroup, aiming to alleviate social inequities in cancer screening.
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Affiliation(s)
- Anne Dorte Lerche Helgestad
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus N, Denmark
| | - Berit Andersen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus N, Denmark
| | - Sisse Helle Njor
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus N, Denmark
- Department of Data, Innovation and Research, Lillebaelt Hospital, Vejle, Beriderbakken 4, 7100, Vejle, Denmark
| | - Mette Bach Larsen
- University Research Clinic for Cancer Screening, Department of Public Health Programmes, Randers Regional Hospital, Skovlyvej 15, 8930, Randers NO, Denmark
- Department of Clinical Medicine, Aarhus University, Palle Juul-Jensens Blvd. 82, 8200, Aarhus N, Denmark
- Research Unit, Horsens Regional Hospital, Sundvej 30, 8700, Horsens, Denmark
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Kelley Jones C, Scott S, Pashayan N, Morris S, Okan Y, Waller J. Risk-Adapted Breast Screening for Women at Low Predicted Risk of Breast Cancer: An Online Discrete Choice Experiment. Med Decis Making 2024; 44:586-600. [PMID: 38828503 PMCID: PMC11283735 DOI: 10.1177/0272989x241254828] [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: 04/14/2023] [Accepted: 04/08/2024] [Indexed: 06/05/2024]
Abstract
BACKGROUND A risk-stratified breast screening program could offer low-risk women less screening than is currently offered by the National Health Service. The acceptability of this approach may be enhanced if it corresponds to UK women's screening preferences and values. OBJECTIVES To elicit and quantify preferences for low-risk screening options. METHODS Women aged 40 to 70 y with no history of breast cancer took part in an online discrete choice experiment. We generated 32 hypothetical low-risk screening programs defined by 5 attributes (start age, end age, screening interval, risk of dying from breast cancer, and risk of overdiagnosis), the levels of which were systematically varied between the programs. Respondents were presented with 8 choice sets and asked to choose between 2 screening alternatives or no screening. Preference data were analyzed using conditional logit regression models. The relative importance of attributes and the mean predicted probability of choosing each program were estimated. RESULTS Participants (N = 502) preferred all screening programs over no screening. An older starting age of screening, younger end age of screening, longer intervals between screening, and increased risk of dying had a negative impact on support for screening programs (P < 0.01). Although the risk of overdiagnosis was of low relative importance, a decreased risk of this harm had a small positive impact on screening choices. The mean predicted probabilities that risk-adapted screening programs would be supported relative to current guidelines were low (range, 0.18 to 0.52). CONCLUSIONS A deintensified screening pathway for women at low risk of breast cancer, especially one that recommends a later screening start age, would run counter to women's breast screening preferences. Further research is needed to enhance the acceptability of offering less screening to those at low risk of breast cancer. HIGHLIGHTS Risk-based breast screening may involve the deintensification of screening for women at low risk of breast cancer.Low-risk screening pathways run counter to women's screening preferences and values.Longer screening intervals may be preferable to a later start age.Work is needed to enhance the acceptability of a low-risk screening pathway.
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Affiliation(s)
| | - Suzanne Scott
- Professor of Health Psychology, Queen Mary University London, London, UK
| | - Nora Pashayan
- Professor of Applied Cancer Research, Centre for Cancer Genetic Epidemiology, University of Cambridge, Cambridge, UK
| | - Stephen Morris
- Rand Professor of Health Services Research, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Yasmina Okan
- Department of Communication, Pompeu Fabra University, Barcelona, Spain
- Centre for Decision Research, Leeds University Business School, Leeds, UK
| | - Jo Waller
- Professor of Cancer Behavioural Science, Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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Kıran Ş, Sevim F, Ürek D, Şenol O. Factors affecting cancer screening perception in Turkish women: the role of health literacy. Health Promot Int 2024; 39:daae053. [PMID: 38842148 DOI: 10.1093/heapro/daae053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/07/2024] Open
Abstract
It is suggested that individuals with limited health literacy have less awareness about cancer and screening methods. However, there is a paucity of evidence regarding the relationship between cancer screening perception and health literacy levels among women. This study investigates the determinants of cancer screening perceptions in Turkish women, with a particular emphasis on the influence of health literacy. Employing a cross-sectional design, the study involved 428 women aged 18-69. Data were collected via online questionnaires. Hierarchical regression analysis was utilized to assess the effects of distinct variables on cancer screening perceptions. Exploratory and confirmatory factor analyses were employed to validate and ensure reliability. The results indicated that the constructed hierarchical regression model explicated around 10% of the variance in cancer screening perceptions. Among the various factors examined, health literacy emerged as the most potent predictor of screening perceptions. Individuals possessing higher health literacy demonstrated more favorable attitudes toward cancer screening. Additionally, age surfaced as another notable determinant, with advanced age correlating positively with awareness and receptiveness to screening. This research reveals the pivotal role of health literacy in shaping how Turkish women perceive cancer screening. While a few factors have an impact, the study highlights the urgent need to elevate health literacy levels to foster heightened awareness and engagement in cancer screening programs. The study's findings offer valuable guidance for devising targeted interventions to address disparities in cancer screening perception and participation, particularly among women in low- to middle-income countries such as Turkey.
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Affiliation(s)
- Şafak Kıran
- Department of Health Management, Karadeniz Technical University, Ortahisar, Trabzon 61080, Turkey
| | - Ferit Sevim
- Department of Health Management, Karadeniz Technical University, Ortahisar, Trabzon 61080, Turkey
| | - Duygu Ürek
- Department of Health Management, Karadeniz Technical University, Ortahisar, Trabzon 61080, Turkey
| | - Osman Şenol
- Department of Health Management, Karadeniz Technical University, Ortahisar, Trabzon 61080, Turkey
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Smittenaar R, Quaife SL, von Wagner C, Higgins T, Hubbell E, Lee L. Impact of screening participation on modelled mortality benefits of a multi-cancer early detection test by socioeconomic group in England. J Epidemiol Community Health 2024; 78:345-353. [PMID: 38429085 PMCID: PMC11103338 DOI: 10.1136/jech-2023-220834] [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: 05/11/2023] [Accepted: 02/10/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Cancer burden is higher and cancer screening participation is lower among individuals living in more socioeconomically deprived areas of England, contributing to worse health outcomes and shorter life expectancy. Owing to higher multi-cancer early detection (MCED) test sensitivity for poor-prognosis cancers and greater cancer burden in groups experiencing greater deprivation, MCED screening programmes may have greater relative benefits in these groups. We modelled potential differential benefits of MCED screening between deprivation groups in England at different levels of screening participation. METHODS We applied the interception multi-cancer screening model to cancer incidence and survival data made available by the National Cancer Registration and Analysis Service in England to estimate reductions in late-stage diagnoses and cancer mortality from an MCED screening programme by deprivation group across 24 cancer types. We assessed the impact of varying the proportion of people who participated in annual screening in each deprivation group on these estimates. RESULTS The modelled benefits of an MCED screening programme were substantial: reductions in late-stage diagnoses were 160 and 274 per 100 000 persons in the least and most deprived groups, respectively. Reductions in cancer mortality were 60 and 99 per 100 000 persons in the least and most deprived groups, respectively. Benefits were greatest in the most deprived group at every participation level and were attenuated with lower screening participation. CONCLUSIONS For the greatest possible population benefit and to decrease health inequalities, an MCED implementation strategy should focus on enhancing equitable, informed participation, enabling equal participation across all socioeconomic deprivation groups. TRIAL REGISTRATION NUMBER NCT05611632.
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Affiliation(s)
| | | | | | - Thomas Higgins
- National Cancer Registration and Analysis Service, Leeds, UK
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Hoare S, Thomas GPA, Powell A, Armstrong N, Mant J, Burt J. Why do people choose not to take part in screening? Qualitative interview study of atrial fibrillation screening nonparticipation. Health Expect 2023; 26:2216-2227. [PMID: 37452480 PMCID: PMC10632648 DOI: 10.1111/hex.13819] [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: 02/14/2023] [Revised: 06/30/2023] [Accepted: 07/01/2023] [Indexed: 07/18/2023] Open
Abstract
INTRODUCTION While screening uptake is variable, many individuals feel they 'ought' to participate in screening programmes to aid the detection of conditions amenable to early treatment. Those not taking part in screening are often presented as either hindered by practical or social barriers or personally at fault. Why some people choose not to participate receives less consideration. METHODS We explored screening nonparticipation by examining the accounts of participants who chose not to participate in screening offered by a national research trial of atrial fibrillation (AF) screening in England (SAFER: Screening for Atrial Fibrillation with ECG to Reduce stroke). AF is a heart arrhythmia that increases in prevalence with age and increases the risk of stroke. Systematic screening for AF is not a nationally adopted programme within the United Kingdom; it provides a unique opportunity to explore screening nonparticipation outside of the norms and values attached to existing population-based screening programmes. We interviewed people aged over 65 (n = 50) who declined an invitation from SAFER and analysed their accounts thematically. RESULTS Beyond practical reasons for nonparticipation, interviewees challenged the utility of identifying and managing AF earlier. Many questioned the benefits of screening at their age. The trial's presentation of the screening as research made it feel voluntary-something they could legitimately decline. CONCLUSION Nonparticipants were not resistant to engaging in health-promoting behaviours, uninformed about screening or unsupportive of its potential benefits. Instead, their consideration of the perceived necessity, legitimacy and utility of this screening shaped their decision not to take part. PATIENT OR PUBLIC CONTRIBUTION The SAFER programme is guided by four patient and carer representatives. The representatives are embedded within the team (e.g., one is a co-applicant, another sits on the programme steering committee) and by participating in regular meetings advise on all aspects of the design, management and delivery of the programme, including engaging with interpreting and disseminating the findings. For the qualitative workstream, we established a supplementary patient and public involvement group with whom we regularly consult about research design questions.
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Affiliation(s)
- Sarah Hoare
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Gwilym P. A. Thomas
- The Guildhall and Barrow SurgeryBury St EdmundsUK
- Primary Care Unit, Department of Public Health and Primary CareStrangeways Research Laboratory, University of Cambridge School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Alison Powell
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
| | - Natalie Armstrong
- SAPPHIRE Research Group, Department of Population Health SciencesUniversity of LeicesterLeicesterUK
| | - Jonathan Mant
- Primary Care Unit, Department of Public Health and Primary CareStrangeways Research Laboratory, University of Cambridge School of Clinical MedicineUniversity of CambridgeCambridgeUK
| | - Jenni Burt
- The Healthcare Improvement Studies Institute (THIS Institute), Department of Public Health and Primary CareUniversity of CambridgeCambridgeUK
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Andrzejczak A, Rucińska M, Żarłok E, Osowiecka K. Health care system and patient-related factors affecting low cancer screening participation in Poland. Prev Med Rep 2023; 36:102442. [PMID: 37822981 PMCID: PMC10562866 DOI: 10.1016/j.pmedr.2023.102442] [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: 05/20/2023] [Revised: 09/21/2023] [Accepted: 09/22/2023] [Indexed: 10/13/2023] Open
Abstract
The level of participation in cancer screening is low in the Polish population. The aim of this study was to assess the opinions of centers providing cancer screening as to the reasons for the low frequency of cancer screening in Poland and possible methods to increase participation. In July 2020 433 centers in Poland carried out breast and/or cervical cancer screening. Of these, 136 centers decided to participate in the study. The study was conducted using an original questionnaire. The questions were addressed to opinion of centers about: reasons for the low frequency of cancer screening in Poland, methods to increase the frequency of cancer screening, pricing and motivating factors for providing cancer screening. Among opinions as to possible reasons for the low frequency of cancer screening in Poland related to the care-system, lack of encouragement from general practitioners, lack of invitations for cancer screening and lack of proper social advertising were most prevalent; whereas among reasons related to patients, a low awareness of cancer screening and fear of cancer diagnosis. The main methods that could potentially increase screening participation are considered to be the inclusion of cancer screening in mandatory periodic employee examinations, more activity by general practitioners, better promotion of screening by central institutions, and sending personal invitations. In conclude some interventions should be carried out to motivate people to break down barriers.
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Affiliation(s)
- A. Andrzejczak
- Fundacja Onkologia 2025, Al. gen. Sikorskiego 9B lok 12D, Warszawa, Poland
| | - M. Rucińska
- Department of Oncology, Collegium Medicum University of Warmia and Mazury in Olsztyn, Wojska Polskiego 37, 10-228 Olsztyn, Poland
| | - E. Żarłok
- Fundacja Onkologia 2025, Al. gen. Sikorskiego 9B lok 12D, Warszawa, Poland
| | - K. Osowiecka
- Department of Psychology and Sociology of Health and Public Health, School of Public Health, University of Warmia and Mazury in Olsztyn, Warszawska 30, 10-082 Olsztyn, Poland
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Myers RE, Hallman MH, Shimada A, DiCarlo M, Davis K, Leach WT, Jackson H, Indictor A, Chambers CV. Primary Care Patient Interest in Multi-Cancer Early Detection for Cancer Screening. J Pers Med 2023; 13:1613. [PMID: 38003928 PMCID: PMC10671850 DOI: 10.3390/jpm13111613] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2023] [Revised: 10/27/2023] [Accepted: 11/14/2023] [Indexed: 11/26/2023] Open
Abstract
Multi-cancer early detection (MCED) tests are being developed, but little is known about patient receptivity to their use for cancer screening. The current study assessed patient interest in such testing. Our team conducted a prospective, observational study among primary care patients in a large, urban health system. They were asked to complete a telephone survey that briefly described a new blood test in development to identify multiple types of cancer, but was not currently recommended or covered by insurance. The survey included items to assess respondent background characteristics, perceptions about MCED testing, and interest in having such an MCED test. We also used multivariable analyses to identify factors associated with patient interest in test use. In 2023, we surveyed 159 (32%) of 500 identified patients. Among respondents, 125 (79%) reported a high level of interest in having an MCED test. Interest was not associated with personal background characteristics, but was positively associated with the following expectations: testing would be recommended for cancer screening, be convenient, and be effective in finding early-stage disease (OR = 11.70, 95% CI: 4.02, 34.04, p < 0.001). Research is needed to assess patient interest and actual uptake when detailed information on testing is presented in routine care.
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Affiliation(s)
- Ronald E. Myers
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Mie H. Hallman
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Ayako Shimada
- Division of Biostatistics, Department of Pharmacology, Physiology, and Cancer Biology, Thomas Jefferson University, Philadelphia, PA 19107, USA;
| | - Melissa DiCarlo
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Kaitlyn Davis
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (K.D.); (W.T.L.); (C.V.C.)
| | - William T. Leach
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (K.D.); (W.T.L.); (C.V.C.)
| | - Hattie Jackson
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Amanda Indictor
- Division of Population Science, Department of Medical Oncology, Thomas Jefferson University, Philadelphia, PA 19107, USA (M.D.); (H.J.); (A.I.)
| | - Christopher V. Chambers
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA; (K.D.); (W.T.L.); (C.V.C.)
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12
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Poon C, Wilsdon T, Sarwar I, Roediger A, Yuan M. Why is the screening rate in lung cancer still low? A seven-country analysis of the factors affecting adoption. Front Public Health 2023; 11:1264342. [PMID: 38026274 PMCID: PMC10666168 DOI: 10.3389/fpubh.2023.1264342] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2023] [Accepted: 10/12/2023] [Indexed: 12/01/2023] Open
Abstract
Strong evidence of lung cancer screening's effectiveness in mortality reduction, as demonstrated in the National Lung Screening Trial (NLST) in the US and the Dutch-Belgian Randomized Lung Cancer Screening Trial (NELSON), has prompted countries to implement formal lung cancer screening programs. However, adoption rates remain largely low. This study aims to understand how lung cancer screening programs are currently performing. It also identifies the barriers and enablers contributing to adoption of lung cancer screening across 10 case study countries: Canada, China, Croatia, Japan, Poland, South Korea and the United States. Adoption rates vary significantly across studied countries. We find five main factors impacting adoption: (1) political prioritization of lung cancer (2) financial incentives/cost sharing and hidden ancillary costs (3) infrastructure to support provision of screening services (4) awareness around lung cancer screening and risk factors and (5) cultural views and stigma around lung cancer. Although these factors have application across the countries, the weighting of each factor on driving or hindering adoption varies by country. The five areas set out by this research should be factored into policy making and implementation to maximize effectiveness and outreach of lung cancer screening programs.
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Affiliation(s)
| | - Tim Wilsdon
- Charles River Associates, London, United Kingdom
| | - Iqra Sarwar
- Charles River Associates, London, United Kingdom
| | | | - Megan Yuan
- Merck & Co., Inc., Kenilworth, NJ, United States
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13
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Philipson TJ, Durie T, Cong Z, Fendrick AM. The aggregate value of cancer screenings in the United States: full potential value and value considering adherence. BMC Health Serv Res 2023; 23:829. [PMID: 37550686 PMCID: PMC10405449 DOI: 10.1186/s12913-023-09738-4] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/22/2023] [Indexed: 08/09/2023] Open
Abstract
BACKGROUND Although cancer mortality has been decreasing since 1991, many cancers are still not detected until later stages with poorer outcomes. Screening for early-stage cancer can save lives because treatments are generally more effective at earlier than later stages of disease. Evidence of the aggregate benefits of guideline-recommended single-site cancer screenings has been limited. This article assesses the benefits in terms of life-years gained and associated value from major cancer screening technologies in the United States. METHODS A mathematical model was built to estimate the aggregate benefits of screenings for breast, colorectal, cervical, and lung cancer over time since the start of US Preventive Services Task Force (USPSTF) recommendations. For each type, the full potential benefits under perfect adherence and the benefits considering reported adherence rates were estimated. The effectiveness of each screening technology was abstracted from published literature on the life-years gained per screened individual. The number of individuals eligible for screening per year was estimated using US Census data matched to the USPSTF recommendations, which changed over time. Adherence rates to screening protocols were based on the National Health Interview Survey results with extrapolation. RESULTS Since initial USPSTF recommendations, up to 417 million people were eligible for cancer screening. Assuming perfect adherence to screening recommendations, the life-years gained from screenings are estimated to be 15.5-21.3 million (2.2-4.9, 1.4-3.6, 11.4-12.3, and 0.5 million for breast, colorectal, cervical, and lung cancer, respectively). At reported adherence rates, combined screening has saved 12.2-16.2 million life-years since the introduction of USPSTF recommendations, ~ 75% of potential with perfect adherence. These benefits translate into a value of $8.2-$11.3 trillion at full potential and $6.5-$8.6 trillion considering current adherence. Therefore, single-site screening could have saved an additional 3.2-5.1 million life-years, equating to $1.7-$2.7 trillion, with perfect adherence. CONCLUSIONS Although gaps persist between the full potential benefit and benefits considering adherence, existing cancer screening technologies have offered significant value to the US population. Technologies and policy interventions that can improve adherence and/or expand the number of cancer types tested will provide significantly more value and save significantly more patient lives.
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Affiliation(s)
| | | | - Ze Cong
- GRAIL, LLC, a subsidiary of Illumina, Inc., currently held separate from Illumina Inc., under the terms of the Interim Measures Order of the European Commission dated 29 October 2021, Menlo Park, CA, USA.
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14
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Bongaerts THG, Büchner FL, de Munck L, Elferink MAG, Guicherit OR, Numans ME. Attendance characteristics of the breast and colorectal cancer screening programmes in a highly urbanised region of the Netherlands: a retrospective observational study. BMJ Open 2023; 13:e071354. [PMID: 37355264 PMCID: PMC10314424 DOI: 10.1136/bmjopen-2022-071354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/13/2023] [Indexed: 06/26/2023] Open
Abstract
OBJECTIVES Throughout Europe, many countries offer population-based cancer screening programmes (CSPs). In the Netherlands, two implemented CSPs are targeting people of 50 years and older, aiming at breast cancer (BC) and colorectal cancer (CRC). In order for a CSP to be (cost-)effective, high participation rates and outreach to the populations at risk are essential. People living in highly urbanised areas and big cities are known to participate less in CSPs. The aim of this study was to gain further insight into the participation patterns of a screening-eligible population of 50 years and over, living in a highly urbanised region, over a longer time period. DESIGN A retrospective observational study. SETTING Participation data of the regional screening organisation, linked to the cancer incidence data derived from the Netherlands Cancer Registry, concerning the city of The Hague, between 2005 and 2019. Attendance groups were defined as attenders (attending >50% of the invitations) and non-attenders (attending ≤50% of the invitations), and were mutually compared. RESULTS The databases contained 106 377 unique individuals on the BC screening programme (SP) and 73 669 on the CRC-SP. Non-attendance at both CSPs was associated with living in a lower socioeconomic status (SES) neighbourhood and as a counter effect, also associated with a more unfavourable, relatively late-stage, tumour diagnosis. When combining the results of the two CSPs, our results imply high screening adherence over time. Women who did not participate in both CSPs were older, and more often lived in neighbourhoods with a lower SES score. CONCLUSIONS Since low screening uptake is one of the factors that contribute to increasing inequalities in cancer survival, future outreach strategies should be focused on engaging specific non-attending subgroups.
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Affiliation(s)
- Thomas H G Bongaerts
- Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Frederike L Büchner
- Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Linda de Munck
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Marloes A G Elferink
- Department of Research and Development, Netherlands Comprehensive Cancer Organisation, Utrecht, The Netherlands
| | - Onno R Guicherit
- University Cancer Center Leiden | The Hague, Haaglanden Medical Center, The Hague, The Netherlands
| | - Mattijs E Numans
- Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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15
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Sijben J, Peters Y, Bas S, Siersema P, Rainey L, Broeders M. Dutch individuals' views of screening for oesophageal cancer: a focus group study. BMJ Open Gastroenterol 2023; 10:e001136. [PMID: 37257920 PMCID: PMC10254588 DOI: 10.1136/bmjgast-2023-001136] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Accepted: 05/16/2023] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVE Screening for early oesophageal adenocarcinoma (OAC), including its precursor Barrett's oesophagus (BO), can potentially reduce OAC-related morbidity and mortality. This study explores Dutch at-risk individuals' views of screening an at-risk population for BO/OAC. DESIGN We invited 372 individuals with risk factors for OAC from primary care practices, 73 individuals with surveillance experience, and 221 participants of previous studies (BO/OAC screening trial or survey) to participate in focus groups. Transcripts were inductively and thematically analysed by two independent researchers. RESULTS A total of 50 individuals (42% with gastro-oesophageal reflux symptoms) of 50-75 years participated. Themes that were raised included: theme 1 'screening intentions' describing participants' motivation to be screened (eg, early diagnosis, potential reassurance, physician recommendation, and knowing someone with cancer) or decline screening (eg, anticipated discomfort or suboptimal accuracy of the test); theme 2 'risk-based eligibility' describing the tension between effectiveness (eg, targeting high-risk individuals) and inclusivity (eg, making screening available for everyone); theme 3 'distributive justice', in which the pressure of a potential new screening programme on healthcare resources was discussed; and theme 4 'information needs' describing the perceived lack of information access and individuals' preference to discuss screening with their general practitioner. CONCLUSION Individuals not only expressed high willingness to be screened but also voiced the concern that a new screening programme may pressure limited healthcare resources. If implemented, it is crucial to develop educational materials that meet the public's information needs and explain the test procedures and eligibility criteria while avoiding stigmatising language.
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Affiliation(s)
- Jasmijn Sijben
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Yonne Peters
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Sharell Bas
- Department for Health Evidence, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Peter Siersema
- Department of Gastroenterology and Hepatology, Radboudumc, Nijmegen, Gelderland, The Netherlands
- Department of Gastroenterology and Hepatology, Erasmus MC, Rotterdam, Zuid-Holland, The Netherlands
| | - Linda Rainey
- Department for Health Evidence, Radboudumc, Nijmegen, Gelderland, The Netherlands
| | - Mireille Broeders
- Department for Health Evidence, Radboudumc, Nijmegen, Gelderland, The Netherlands
- Dutch Expert Centre for Screening, Nijmegen, The Netherlands
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16
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Sinopoli A, Baccolini V, Di Rosa E. Killing Two Birds with One Stone: Is the COVID-19 Vaccination Campaign an Opportunity to Improve Adherence to Cancer Screening Programmes? The Challenge of a Pilot Project in a Large Local Health Authority in Rome. Vaccines (Basel) 2023; 11:vaccines11030523. [PMID: 36992105 DOI: 10.3390/vaccines11030523] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Revised: 02/17/2023] [Accepted: 02/20/2023] [Indexed: 02/25/2023] Open
Abstract
The COVID-19 pandemic has affected health services worldwide. The suspension of cancer screening programs during the lockdown period, coupled with the other measures taken to limit the SARS-CoV-2 spread, contributed to the idea that cancer preventive interventions are deferrable. In this opinion paper, we present some data on cancer screening coverage in one of the largest Local Health Authorities in Italy in recent years. Within this context, we introduce the benefits of a pilot project in which we took advantage of the great attention on the COVID-19 vaccination campaign to improve screening uptake. In this project, we offered men and women eligible for cancer screening the opportunity to book appointments while waiting to be vaccinated. In addition, trained healthcare personnel were available on-site to discuss any barriers to participation with the attendees. Despite the project having only just started, preliminary results are encouraging, with positive feedback from the attendees. In conclusion, we advocate for the need to adopt a comprehensive approach when it comes to population health, and we use this project as an example to discuss how it is possible to contribute to minimizing the long-term impact of the COVID-19 pandemic with resources already in place.
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Affiliation(s)
- Alessandra Sinopoli
- Department of Prevention, Local Health Authority Roma 1, 00193 Rome, Italy
- Department of Experimental Medicine, University of Rome "Tor Vergata", 00133 Rome, Italy
| | - Valentina Baccolini
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, 00185 Rome, Italy
| | - Enrico Di Rosa
- Department of Prevention, Local Health Authority Roma 1, 00193 Rome, Italy
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17
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Bongaerts THG, Büchner FL, Crone MR, van Exel J, Guicherit OR, Numans ME, Nierkens V. Perspectives on cancer screening participation in a highly urbanized region: a Q-methodology study in The Hague, the Netherlands. BMC Public Health 2022; 22:1925. [PMID: 36243684 PMCID: PMC9571478 DOI: 10.1186/s12889-022-14312-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 10/04/2022] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Netherlands hosts, as many other European countries, three population-based cancer screening programmes (CSPs). The overall uptake among these CSPs is high, but has decreased over recent years. Especially in highly urbanized regions the uptake rates tend to fall below the minimal effective rate of 70% set by the World Health Organization. Understanding the reasons underlying the decision of citizens to partake in a CPS are essential in order to optimize the current screening participation rates. The aim of this study was to explore the various perspectives concerning cancer screening among inhabitants of The Hague, a highly urbanized region of the Netherlands. METHODS A Q-methodology study was conducted to provide insight in the prevailing perspectives on partaking in CSPs. All respondents were inhabitants of the city of The Hague, the Netherlands. In an online application they ranked a set of 31 statements, based on the current available literature and clustered by the Integrated Change model, into a 9-column forced ranking grid according to level of agreement, followed by a short survey. Respondents were asked to participate in a subsequent interview to explain their ranking. By-person factor analysis was used to identify distinct perspectives, which were interpreted using data from the rankings and interviews. RESULTS Three distinct perspectives were identified: 1). "Positive about participation", 2). "Thoughtful about participation", and 3). "Fear drives participation". These perspectives provide insight into how potential respondents, living in an urbanized region in the Netherlands, decide upon partaking in CSPs. CONCLUSIONS Since CSPs will only be effective when participation rates are sufficiently high, it is essential to have insight into the different perspectives among potential respondents concerning partaking in a CSP. This study adds new insights concerning these perspectives and suggests several ideas for future optimization of the CSPs.
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Affiliation(s)
- Thomas H G Bongaerts
- Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands. .,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands.
| | - Frederike L Büchner
- Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Matty R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Job van Exel
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands.,Erasmus Centre for Health Economics Research, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Onno R Guicherit
- University Cancer Center Leiden - The Hague, at Haaglanden Medical Center, The Hague, The Netherlands
| | - Mattijs E Numans
- Health Campus The Hague, Leiden University Medical Center, The Hague, The Netherlands.,Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
| | - Vera Nierkens
- Department of Public Health and Primary Care, Leiden University Medical Center, Leiden, The Netherlands
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18
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Kotzur M, Macdonald S, O'Carroll RE, O'Connor RC, Irvine A, Steele RJC, Robb KA. What are common barriers and helpful solutions to colorectal cancer screening? A cross-sectional survey to develop intervention content for a planning support tool. BMJ Open 2022; 12:e062738. [PMID: 36691140 PMCID: PMC9445780 DOI: 10.1136/bmjopen-2022-062738] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 08/05/2022] [Indexed: 02/01/2023] Open
Abstract
OBJECTIVE Colorectal screening using faecal immunochemical tests (FITs) can save lives if the people invited participate. In Scotland, most people intend to complete a FIT but this is not reflected in uptake rates. Planning interventions can bridge this intention-behaviour gap. To develop a tool supporting people willing to do colorectal screening with planning to complete a FIT, this study aimed to identify frequently experienced barriers and solutions to these barriers. DESIGN This is a cross-sectional study. SETTING Participants were recruited through the Scottish Bowel Screening Programme to complete a mailed questionnaire. PARTICIPANTS The study included 2387 participants who had completed a FIT (mean age 65 years, 40% female) and 359 participants who had not completed a FIT but were inclined to do so (mean age 63 years, 39% female). OUTCOME MEASURES The questionnaire assessed frequency of endorsement of colorectal screening barriers and solutions. RESULTS Participants who had not completed a FIT endorsed significantly more barriers than those who had completed a FIT, when demographic, health and behavioural covariates were held constant (F(1,2053)=13.40, p<0.001, partial η2=0.01). Participants who completed a FIT endorsed significantly more solutions than those who did not (U=301 585.50, z=-3.21, p<0.001, r=0.06). This difference became insignificant when covariates were controlled. Participants agreed on the most common barriers and solutions regardless of screening history. Barriers included procrastination, forgetting, fear of the test result, screening anxiety, disgust and low self-efficacy. Solutions included hand-washing, doing the FIT in private, reading the FIT instructions, benefit of early detection, feelings of responsibility, high self-efficacy and seeing oneself as a person who looks after one's health. CONCLUSION This survey identified six barriers and seven solutions as key content to include in the development of a planning tool for colorectal screening using the FIT. Participatory research is required to codesign an engaging and accessible planning tool.
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Affiliation(s)
- Marie Kotzur
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | - Sara Macdonald
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | | | - Rory C O'Connor
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
| | | | | | - Kathryn A Robb
- School of Health & Wellbeing, University of Glasgow, Glasgow, UK
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19
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Marlow LAV, Schmeising-Barnes N, Brain K, Duncombe S, Robb KA, Round T, Sanderson SC, Waller J. Multi-cancer early detection tests for cancer screening: a behavioural science perspective. Lancet Oncol 2022; 23:837-839. [DOI: 10.1016/s1470-2045(22)00161-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2022] [Accepted: 03/10/2022] [Indexed: 11/29/2022]
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20
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Shimoda A, Saito Y, Kondo N. Postal reminder with reduced burden of clinic information seeking for equitable participation in general health check-ups: A randomized controlled trial. Prev Med 2022; 157:107009. [PMID: 35248681 DOI: 10.1016/j.ypmed.2022.107009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/16/2021] [Revised: 02/18/2022] [Accepted: 02/26/2022] [Indexed: 11/15/2022]
Abstract
High participation rate and low inequality in participation are key to the program success of general health check-ups in Japan. This study examined the effectiveness of a postal reminder including nearest clinic information, compared to the standard postal reminder including details of all local clinics, on participation rate and income-based participation rate in general health checks. This was a single-blind, two-arm, prospective, randomized controlled study conducted at the Fukuoka Branch of Japan Health Insurance Association. Dependents (family members) of insured persons aged 40-69 years were randomly assigned (1:1) to the intervention group that received a tailored postal reminder intervention (showing information on the nearest clinic from each participant's address) or to the control group that received an original template postal reminder (containing just the URL of the website listing all available clinics). Allocation was concealed from participants and service providers of general health check-up. The primary outcome was participation in general health check-ups within 1 month of intervention. Between February 1 and February 10, 2017, 21,017 were randomly assigned to the intervention (n = 10,474) or control (n = 10,543) group. The participation rate in the intervention group was higher than control group (3.2% vs. 2.1%; OR: 1.55, 95% CI: 1.31-1.85, P < 0.001). The intervention effect was estimated to decrease as the income category increased (P for interaction = 0.037). Tailored postal reminders with information on the nearest clinic were able to improve the overall participation rate and reduce income-based inequality in participation for general health check-ups in Japan. Trial registration: UMIN-CTR, UMIN000042509, Registered 26 November 2020 - Retrospectively registered.
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Affiliation(s)
- Akihiro Shimoda
- Department of Social Epidemiology and Global Health, Graduate School of Medicine and School of Public Health, Kyoto University, Yoshida-honmachi, Sakyo-ku, Kyoto 606-8501, Japan
| | - Yoshiyuki Saito
- Department of Health Economics & Outcomes Research, Graduate School of Pharmaceutical Sciences, the University of Tokyo, 7-3-1, Hongo, Bunkyo-ku, Tokyo 113-0033, Japan
| | - Naoki Kondo
- Department of Social Epidemiology and Global Health, Graduate School of Medicine and School of Public Health, Kyoto University, Yoshida-honmachi, Sakyo-ku, Kyoto 606-8501, Japan.
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21
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Gautier LJ, Shkak L. Past, present and Future Oncology: welcome to volume 18. Future Oncol 2021; 18:1-5. [PMID: 34856836 DOI: 10.2217/fon-2021-1338] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
Affiliation(s)
| | - Lana Shkak
- Future Medicine Ltd., Unitec House, London, N3 1QB, UK
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22
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Collyar DE, Gautier LJ. The importance and value of engaging patients in cancer research. Future Oncol 2021; 17:3663-3666. [PMID: 34505795 DOI: 10.2217/fon-2021-0856] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Affiliation(s)
- Deborah E Collyar
- Patient Advocates in Research (PAIR), Danville, CA, USA.,Patient Author
| | - Louis J Gautier
- Future Medicine Ltd, Unitec House, 2 Albert Place, London N3 1QB, UK
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