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Gao W, Zhang Q, Wang D, Li X, Zhang L, Xu M, Han J. The role expectations of young women as wives after breast cancer treatment: A qualitative study. Int J Nurs Sci 2024; 11:366-373. [PMID: 39156686 PMCID: PMC11329045 DOI: 10.1016/j.ijnss.2024.05.001] [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: 02/03/2024] [Revised: 05/06/2024] [Accepted: 05/29/2024] [Indexed: 08/20/2024] Open
Abstract
Objectives Through the reflection of young breast cancer women on their selves and identities, we explored expectations of the wife role that they need to fulfill to return to their families, aimed to provide a reference basis for medical professionals to develop interventions related to cancer family rehabilitation. Methods Descriptive phenomenological methods and purposive sampling were used. Young breast cancer patients and their spouses were selected for semi-structured face-to-face interviews in the study from March to April 2023 at the department of breast surgery and oncology center of a Class A tertiary hospital in Xuzhou City, China. The interviews were transcribed verbatim and analyzed using Colaizzi's phenomenological approach. Results Twenty patients and six spouses were interviewed. The mean patient age was (35.95 ± 3.36) years, and the mean spouse was (37.67 ± 5.28) years. Young breast cancer patients were concerned about three main wife expectations during their treatment and rehabilitation: preserving self-love and self-esteem (paying attention to physical health, embracing the disease, and regaining confidence in female characters); adjustment of conjugal relationships (harmonious and effective couple communication, providing support for marriage and love, and creating a beautiful married life together); assisting in family recovery (relieving stress on spouses from caregiving and finances, and management of daily household chores). Conclusions The wife role expectations of young breast cancer women and their spouses encompass three core aspects: self, couple, and family. Self-esteem and self-love are the most fundamental expectations of the wife role, while adjusting the couple's relationship and assistance in family rehabilitation represent higher expectations. This study can help healthcare professionals and cancer families gain a more comprehensive understanding of the wife role expectations for young cancer women, thereby enabling the development of couple-centered interventions to promote patient recovery and enhance the resilience of marriages and families.
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Affiliation(s)
- Wenjuan Gao
- School of Nursing, Xuzhou Medical University, Jiangsu, China
| | - Qian Zhang
- School of Nursing, Xuzhou Medical University, Jiangsu, China
| | - Dan Wang
- Department of Oncology Center, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Xiaoxu Li
- Department of Nail and Breast Surgery, Affiliated Hospital of Xuzhou Medical University, Jiangsu, China
| | - Linping Zhang
- School of Nursing, Xuzhou Medical University, Jiangsu, China
| | - Mengjiao Xu
- School of Nursing, Xuzhou Medical University, Jiangsu, China
| | - Jing Han
- School of Nursing, Xuzhou Medical University, Jiangsu, China
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2
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Archer S. Exploring the barriers to and facilitators of implementing CanRisk in primary care: a qualitative thematic framework analysis. Br J Gen Pract 2023; 73:e586-e596. [PMID: 37308304 PMCID: PMC10285688 DOI: 10.3399/bjgp.2022.0643] [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: 12/21/2022] [Revised: 01/27/2023] [Accepted: 02/28/2023] [Indexed: 06/14/2023] Open
Abstract
BACKGROUND The CanRisk tool enables the collection of risk factor information and calculation of estimated future breast cancer risks based on the multifactorial Breast and Ovarian Analysis of Disease Incidence and Carrier Estimation Algorithm (BOADICEA) model. Despite BOADICEA being recommended in National Institute for Health and Care Excellence (NICE) guidelines and CanRisk being freely available for use, the CanRisk tool has not yet been widely implemented in primary care. AIM To explore the barriers to and facilitators of the implementation of the CanRisk tool in primary care. DESIGN AND SETTING A multi-methods study was conducted with primary care practitioners (PCPs) in the East of England. METHOD Participants used the CanRisk tool to complete two vignette-based case studies; semi-structured interviews gained feedback about the tool; and questionnaires collected demographic details and information about the structural characteristics of the practices. RESULTS Sixteen PCPs (eight GPs and eight nurses) completed the study. The main barriers to implementation included: time needed to complete the tool; competing priorities; IT infrastructure; and PCPs' lack of confidence and knowledge to use the tool. Main facilitators included: easy navigation of the tool; its potential clinical impact; and the increasing availability of and expectation to use risk prediction tools. CONCLUSION There is now a greater understanding of the barriers and facilitators that exist when using CanRisk in primary care. The study has highlighted that future implementation activities should focus on reducing the time needed to complete a CanRisk calculation, integrating the CanRisk tool into existing IT infrastructure, and identifying appropriate contexts in which to conduct a CanRisk calculation. PCPs may also benefit from information about cancer risk assessment and CanRisk-specific training.
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3
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Calanzani N, Pannebakker MM, Tagg MJ, Walford H, Holloway P, de Wit N, Hamilton W, Walter FM. Who are the patients being offered the faecal immunochemical test in routine English general practice, and for what symptoms? A prospective descriptive study. BMJ Open 2022; 12:e066051. [PMID: 36123111 PMCID: PMC9486301 DOI: 10.1136/bmjopen-2022-066051] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES The faecal immunochemical test (FIT) was introduced to triage patients with lower-risk symptoms of colorectal cancer (CRC) in English primary care in 2018. While there is growing evidence on its utility to triage patients in this setting, evidence is still limited on how official FIT guidance is being used, for which patients and for what symptoms. We aimed to investigate the use of FIT in primary care practice for lower-risk patients who did not immediately meet criteria for urgent referral. DESIGN A prospective, descriptive study of symptomatic patients offered a FIT in primary care between January and June 2020. SETTING East of England general practices. PARTICIPANTS Consenting patients (aged ≥40 years) who were seen by their general practitioners (GPs) with symptoms of possible CRC for whom a FIT was requested. We excluded patients receiving a FIT for asymptomatic screening purposes, or patients deemed by GPs as lacking capacity for informed consent. Data were obtained via patient questionnaire, medical and laboratory records. PRIMARY AND SECONDARY OUTCOME MEASURES FIT results (10 µg Hb/g faeces defined a positive result); patient sociodemographic and clinical characteristics; patient-reported and GP-recorded symptoms, symptom severity and symptom agreement between patient and GP (% and kappa statistics). RESULTS Complete data were available for 310 patients, median age 70 (IQR 61-77) years, 53% female and 23% FIT positive. Patients most commonly reported change in bowel habit (69%) and fatigue (57%), while GPs most commonly recorded abdominal pain (25%) and change in bowel habit (24%). Symptom agreement ranged from 44% (fatigue) to 80% (unexplained weight loss). Kappa agreement was universally low across symptoms. CONCLUSION Almost a quarter of this primary care cohort of symptomatic patients with FIT testing were found to be positive. However, there was low agreement between patient-reported and GP-recorded symptoms. This may impact cancer risk assessment and optimal patient management in primary care.
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Affiliation(s)
- Natalia Calanzani
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Merel M Pannebakker
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Max J Tagg
- School of Clinical Medicine, Addenbrooke's Hospital, University of Cambridge, Cambridge, UK
| | - Hugo Walford
- School of Clinical Medicine, University College London, London, UK
| | | | - Niek de Wit
- Julius Center for Health Sciences and Primary Care, University Medical Center, Utrecht University, Utrecht, The Netherlands
| | - Willie Hamilton
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
- Wolfson Institute of Population Health, Queen Mary University of London, London, UK
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4
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Dineen M, Sidaway-Lee K, Pereira Gray D, Evans PH. Family history recording in UK general practice: the lIFeLONG study. Fam Pract 2022; 39:610-615. [PMID: 34568898 PMCID: PMC9295608 DOI: 10.1093/fampra/cmab117] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In order to integrate genomic medicine into routine patient care and stratify personal risk, it is increasingly important to record family history (FH) information in general/family practice records. This is true for classic genetic disease as well as multifactorial conditions. Research suggests that FH recording is currently inadequate. OBJECTIVES To provide an up-to-date analysis of the frequency, quality, and accuracy of FH recording in UK general/family practice. METHODS An exploratory study, based at St Leonard's Practice, Exeter-a suburban UK general/family practice. Selected adult patients registered for over 1 year were contacted by post and asked to complete a written FH questionnaire. The reported information was compared with the patients' electronic medical record (EMR). Each EMR was assessed for its frequency (how often information was recorded), quality (the level of detail included), and accuracy (how closely the information matched the patient report) of FH recording. RESULTS Two hundred and forty-one patients were approached, 65 (27.0%) responded and 62 (25.7%) were eligible to participate. Forty-three (69.4%) EMRs contained FH information. The most commonly recorded conditions were bowel cancer, breast cancer, diabetes, and heart disease. The mean quality score was 3.64 (out of 5). There was little negative recording. 83.2% of patient-reported FH information was inaccurately recorded or missing from the EMRs. CONCLUSION FH information in general/family practice records should be better prepared for the genomic era. Whilst some conditions are well recorded, there is a need for more frequent, higher quality recording with greater accuracy, especially for multifactorial conditions.
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Affiliation(s)
- Molly Dineen
- College of Medicine and Health, University of Exeter, Exeter, Devon, United Kingdom.,St Leonard's Practice, Exeter, Devon, United Kingdom
| | | | - Denis Pereira Gray
- College of Medicine and Health, University of Exeter, Exeter, Devon, United Kingdom.,St Leonard's Practice, Exeter, Devon, United Kingdom
| | - Philip H Evans
- College of Medicine and Health, University of Exeter, Exeter, Devon, United Kingdom.,St Leonard's Practice, Exeter, Devon, United Kingdom
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5
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Miroševič Š, Klemenc-Ketiš Z, Peterlin B. Family history tools for primary care: A systematic review. Eur J Gen Pract 2022; 28:75-86. [PMID: 35510897 PMCID: PMC9090347 DOI: 10.1080/13814788.2022.2061457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
Background Many medical family history (FH) tools are available for various settings. Although FH tools can be a powerful health screening tool in primary care (PC), they are currently underused. Objectives This review explores the FH tools currently available for PC and evaluates their clinical performance. Methods Five databases were systematically searched until May 2021. Identified tools were evaluated on the following criteria: time-to-complete, integration with electronic health record (EMR) systems, patient administration, risk-assessment ability, evidence-based management recommendations, analytical and clinical validity and clinical utility. Results We identified 26 PC FH tools. Analytical and clinical validity was poorly reported and agreement between FH and gold standard was commonly inadequately reported and assessed. Sensitivity was acceptable; specificity was found in half of the reviewed tools to be poor. Most reviewed tools showed a capacity to successfully identify individuals with increased risk of disease (6.2–84.6% of high and/or moderate or increased risk individuals). Conclusion Despite the potential of FH tools to improve risk stratification of patients in PC, clinical performance of current tools remains limited as well as their integration in EMR systems. Twenty-one FH tools are designed to be self-administered by patients.
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Affiliation(s)
- Špela Miroševič
- Department of Family Medicine, Medical Faculty Ljubljana, Ljubljana, Slovenia
| | - Zalika Klemenc-Ketiš
- Department of Family Medicine, Medical Faculty Ljubljana, Ljubljana, Slovenia.,Department of Family Medicine, Faculty of Medicine, University of Maribor, Maribor, Slovenia.,Community Health Centre Ljubljana, Ljubljana, Slovenia
| | - Borut Peterlin
- Clinical Institute for Medical Genetics, University Medical Centre Ljubljana, Ljubljana, Slovenia
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6
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Genetics in primary care: validating a tool to pre-symptomatically assess common disease risk using an Australian questionnaire on family history. Clin Transl Med 2019; 8:17. [PMID: 31044318 PMCID: PMC6494887 DOI: 10.1186/s40169-019-0233-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2019] [Accepted: 04/11/2019] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND A positive family history for diabetes, cardiovascular diseases or various types of cancer increases the relative risk for these diseases by 2 to 5 times compared to people without a positive family history. Taking a family history in daily general practice is useful for early, pre-symptomatic risk assessment, but at the moment no standardized family history questionnaire is available in the Dutch language. In this study we used a 9-item questionnaire, previously developed and applied in an Australian study, to probe family history for 7 specific conditions. The aim of the present qualitative study was to test face and content validity of the Australian family history questionnaire in Dutch general practice and to advance the standardization of intake information at an international level. We conducted 10 cognitive interviews with patients over 4 rounds, using the verbal probing technique. This approach allows the collection of data through a series of probe questions, with the aim of obtaining detailed information. After each interview round we modified the questionnaire based on the answers of the interviewees. We also performed 10 semi-structured interviews with general practitioners (GPs) to get their opinion on the content and usability of the questionnaire in practice. RESULTS Patients varied in age and gender, and 4 patients were known to have a genetic disorder. The GPs varied in age, gender, clinical experience, type of practice and location. In the first round, seven problems were identified in the questionnaire in the categories Comprehension (1), Recall (2), Judgement (0), Response process (2) and Completeness, (2); by the fourth and final round no problems remained. The content and usability of the questionnaire were assessed positively. CONCLUSIONS When translated for everyday use in Dutch general practice, the Australian family history questionnaire showed a strong face and content validity, and GPs were positive regarding feasibility. Validation of this family history questionnaire could aid in the standardized integration of genetically relevant information in the electronic health record and clinical research. Conspicuous questionnaire information might alert the GP regarding specific conditions and enable detection of disease at an earlier stage. Additional questionnaire requirements needed however are accurate patient information and consistent, accessible locations in the electronic health record with a possibility to be automatically registered. By deriving a Dutch family history questionnaire convenient for GPs, we adapted a template that might also prove useful for other countries and other medical professionals. This development could make the rapid operationalization of readily available genetic knowledge feasible in daily practice and clinical research, leading to improved medical care.
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Little MP, Fang M, Liu JJ, Weideman AM, Linet MS. Inflammatory disease and C-reactive protein in relation to therapeutic ionising radiation exposure in the US Radiologic Technologists. Sci Rep 2019; 9:4891. [PMID: 30894578 PMCID: PMC6426979 DOI: 10.1038/s41598-019-41129-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2018] [Accepted: 02/21/2019] [Indexed: 12/12/2022] Open
Abstract
Chronic inflammation underlies many autoimmune diseases, including hypothyroidism, hyperthyroidism, and rheumatoid arthritis, also type-2 diabetes and osteoarthritis. Associations have been suggested of high-dose ionising radiation exposure with type-2 diabetes and elevated levels of C-reactive protein, a marker of chronic inflammation. In this analysis we used a proportional hazards model to assess effects of radiotherapy on risks of subsequent inflammatory disease morbidity in 110,368 US radiologic technologists followed from a baseline survey (1983–1989/1994–1998) through 2008. We used a linear model to assess log-transformed C-reactive protein concentration following radiotherapy in 1326 technologists. Relative risk of diabetes increased following radiotherapy (p < 0.001), and there was a borderline significant increasing trend per treatment (p = 0.092). For osteoarthritis there was increased relative risk associated with prior radiotherapy on all questionnaires (p = 0.005), and a significant increasing trend per previous treatment (p = 0.024). No consistent increases were observed for other types of inflammatory disease (hypothyroidism, hyperthyroidism, rheumatoid arthritis) associated with radiotherapy. There was a borderline significant (p = 0.059) increasing trend with dose for C-reactive protein with numbers of prior radiotherapy treatments. Our results suggest that radiotherapy is associated with subsequent increased risk of certain inflammatory conditions, which is reinforced by our finding of elevated levels of C-reactive protein.
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Affiliation(s)
- Mark P Little
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9778, USA.
| | - Michelle Fang
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9778, USA
| | - Jason J Liu
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9778, USA
| | - Ann Marie Weideman
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9778, USA
| | - Martha S Linet
- Radiation Epidemiology Branch, Division of Cancer Epidemiology and Genetics, National Cancer Institute, Bethesda, MD, 20892-9778, USA
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8
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Genetic cancer risk assessment in general practice: systematic review of tools available, clinician attitudes, and patient outcomes. Br J Gen Pract 2018; 69:e97-e105. [PMID: 30510097 DOI: 10.3399/bjgp18x700265] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/26/2018] [Accepted: 05/18/2018] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND A growing demand for cancer genetic services has led to suggestions for the involvement of GPs. How, and in which conditions, they can be involved, and whether there are important barriers to implementation should be ascertained. AIM To review the tools available, clinician attitudes and experiences, and the effects on patients of genetic cancer risk assessment in general practice. DESIGN AND SETTING Systematic review of papers published worldwide between 1996 and 2017. METHOD The MEDLINE (via Ovid), EMBASE, Cochrane Library, CINAHL, and PsycINFO databases and grey literature were searched for entries dating from January 1996 to December 2017. Study quality was assessed with relevant Critical Appraisal Skills Programme tool checklists and a narrative synthesis of findings was conducted. RESULTS In total, 40 studies were included in the review. A variety of testing and screening tools were available for genetic cancer risk assessment in general practice, principally for breast, breast-ovarian, and colorectal cancer risk. GPs often reported low knowledge and confidence to engage with genetic cancer risk assessment; however, despite time pressures and concerns about confidentiality and the impact of results on family members, some recognised the potential importance relating to such a development of the GP's role. Studies found few reported benefits for patients. Concerns about negative impacts on patient anxiety and cancer worries were largely not borne out. CONCLUSION GPs may have a potential role in identifying patients at risk of hereditary cancer that can be facilitated by family-history tools. There is currently insufficient evidence to support the implementation of population-wide screening for genetic cancer risk, especially given the competing demands of general practice.
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9
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Cleophat JE, Nabi H, Pelletier S, Bouchard K, Dorval M. What characterizes cancer family history collection tools? A critical literature review. ACTA ACUST UNITED AC 2018; 25:e335-e350. [PMID: 30111980 DOI: 10.3747/co.25.4042] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Background Many tools have been developed for the standardized collection of cancer family history (fh). However, it remains unclear which tools have the potential to help health professionals overcome traditional barriers to collecting such histories. In this review, we describe the characteristics, validation process, and performance of existing tools and appraise the extent to which those tools can support health professionals in identifying and managing at-risk individuals. Methods Studies were identified through searches of the medline, embase, and Cochrane central databases from October 2015 to September 2016. Articles were included if they described a cancer fh collection tool, its use, and its validation process. Results Based on seventy-nine articles published between February 1978 and September 2016, 62 tools were identified. Most of the tools were paper-based and designed to be self-administered by lay individuals. One quarter of the tools could automatically produce pedigrees, provide cancer-risk assessment, and deliver evidence-based recommendations. One third of the tools were validated against a standard reference for collected fh quality and cancer-risk assessment. Only 3 tools were integrated into an electronic health records system. Conclusions In the present review, we found no tool with characteristics that might make it an efficient clinical support for health care providers in cancer-risk identification and management. Adequately validated tools that are connected to electronic health records are needed to encourage the systematic identification of individuals at increased risk of cancer.
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Affiliation(s)
- J E Cleophat
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Université Laval, Faculté de pharmacie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC
| | - H Nabi
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC.,inserm, U1018, Centre de recherche en épidémiologie et santé des populations, Villejuif, France
| | - S Pelletier
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC
| | - K Bouchard
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC
| | - M Dorval
- Centre de recherche du chu de Québec, Axe Oncologie, Quebec City, QC.,Université Laval, Faculté de pharmacie, Quebec City, QC.,Centre de recherche sur le cancer, Quebec City, QC.,Centre de recherche du cisss Chaudière-Appalaches, Lévis, QC
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10
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Walker JG, Macrae F, Winship I, Oberoi J, Saya S, Milton S, Bickerstaffe A, Dowty JG, De Abreu Lourenço R, Clark M, Galloway L, Fishman G, Walter FM, Flander L, Chondros P, Ait Ouakrim D, Pirotta M, Trevena L, Jenkins MA, Emery JD. The use of a risk assessment and decision support tool (CRISP) compared with usual care in general practice to increase risk-stratified colorectal cancer screening: study protocol for a randomised controlled trial. Trials 2018; 19:397. [PMID: 30045764 PMCID: PMC6060496 DOI: 10.1186/s13063-018-2764-7] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2018] [Accepted: 06/25/2018] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Australia and New Zealand have the highest incidence rates of colorectal cancer worldwide. In Australia there is significant unwarranted variation in colorectal cancer screening due to low uptake of the immunochemical faecal occult blood test, poor identification of individuals at increased risk of colorectal cancer, and over-referral of individuals at average risk for colonoscopy. Our pre-trial research has developed a novel Colorectal cancer RISk Prediction (CRISP) tool, which could be used to implement precision screening in primary care. This paper describes the protocol for a phase II multi-site individually randomised controlled trial of the CRISP tool in primary care. METHODS This trial aims to test whether a standardised consultation using the CRISP tool in general practice (the CRISP intervention) increases risk-appropriate colorectal cancer screening compared to control participants who receive standardised information on cancer prevention. Patients between 50 and 74 years old, attending an appointment with their general practitioner for any reason, will be invited into the trial. A total of 732 participants will be randomised to intervention or control arms using a computer-generated allocation sequence stratified by general practice. The primary outcome (risk-appropriate screening at 12 months) will be measured using baseline data for colorectal cancer risk and objective health service data to measure screening behaviour. Secondary outcomes will include participant cancer risk perception, anxiety, cancer worry, screening intentions and health service utilisation measured at 1, 6 and 12 months post randomisation. DISCUSSION This trial tests a systematic approach to implementing risk-stratified colorectal cancer screening in primary care, based on an individual's absolute risk, using a state-of-the-art risk assessment tool. Trial results will be reported in 2020. TRIAL REGISTRATION Australian and New Zealand Clinical Trial Registry, ACTRN12616001573448p . Registered on 14 November 2016.
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Affiliation(s)
- Jennifer G. Walker
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
| | - Finlay Macrae
- Department of Medicine, The University of Melbourne, Melbourne, VIC Australia
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, VIC Australia
- Colorectal Medicine and Genetics, Royal Melbourne Hospital, Melbourne, VIC Australia
| | - Ingrid Winship
- Department of Medicine, The University of Melbourne, Melbourne, VIC Australia
- Genetic Medicine and Family Cancer Clinic, Royal Melbourne Hospital, Melbourne, VIC Australia
| | - Jasmeen Oberoi
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
| | - Sibel Saya
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
| | - Shakira Milton
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
| | - Adrian Bickerstaffe
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - James G. Dowty
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Richard De Abreu Lourenço
- Centre for Health Economics Research and Evaluation, University of Technology Sydney, Sydney, NSW Australia
| | - Malcolm Clark
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
- IPN Medical Centres, Camberwell, VIC Australia
| | - Louise Galloway
- Department of Health and Human Services, Victorian Government, Melbourne, VIC Australia
| | - George Fishman
- Joint Consumer Advisory Group, Primary Care Collaborative Cancer Clinical Trials Group, Carlton, Australia
| | - Fiona M. Walter
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
| | - Louisa Flander
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Patty Chondros
- Department of General Practice, The University of Melbourne, Melbourne, VIC Australia
| | - Driss Ait Ouakrim
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Marie Pirotta
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
| | - Lyndal Trevena
- School of Public Health, The University of Sydney, Sydney, NSW Australia
| | - Mark A. Jenkins
- Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Melbourne, VIC Australia
| | - Jon D. Emery
- Centre for Cancer Research, Department of General Practice, Victorian Comprehensive Cancer Centre, The University of Melbourne, Carlton, VIC Australia
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, UK
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Online self-test identifies women at high familial breast cancer risk in population-based breast cancer screening without inducing anxiety or distress. Eur J Cancer 2017; 78:45-52. [PMID: 28412588 DOI: 10.1016/j.ejca.2017.03.014] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2017] [Revised: 03/02/2017] [Accepted: 03/13/2017] [Indexed: 01/07/2023]
Abstract
INTRODUCTION Identifying high familial breast cancer (FBC) risk improves detection of yet unknown BRCA1/2-mutation carriers, for whom BC risk is both highly likely and potentially preventable. We assessed whether a new online self-test could identify women at high FBC risk in population-based BC screening without inducing anxiety or distress. METHODS After their visit for screening mammography, women were invited by email to take an online self-test for identifying highly increased FBC risk-based on Dutch guidelines. Exclusion criteria were previously diagnosed as increased FBC risk or a personal history of BC. Anxiety (State-Trait Anxiety Inventory Dutch Version), distress (Hospital Anxiety Depression Scale) and BC risk perception were assessed using questionnaires, which were completed immediately before and after taking the online self-test and 2 weeks later. RESULTS Of the 562 women invited by email, 406 (72%) completed the online self-test while 304 also completed questionnaires (response rate 54%). After exclusion criteria, 287 (51%) were included for data analysis. Median age was 56 years (range 50-74). A high or moderate FBC risk was identified in 12 (4%) and three (1%) women, respectively. After completion of the online self-test, anxiety and BC risk perception were decreased while distress scores remained unchanged. Levels were below clinical relevance. Most women (85%) would recommend the self-test; few (3%) would not. CONCLUSION The online self-test identified previously unknown women at high FBC risk (4%), who may carry a BRCA1/2-mutation, without inducing anxiety or distress. We therefore recommend offering this self-test to women who attend population-based screening mammography for the first time.
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Carroll JC, Campbell-Scherer D, Permaul JA, Myers J, Manca DP, Meaney C, Moineddin R, Grunfeld E. Assessing family history of chronic disease in primary care: Prevalence, documentation, and appropriate screening. CANADIAN FAMILY PHYSICIAN MEDECIN DE FAMILLE CANADIEN 2017; 63:e58-e67. [PMID: 28115461 PMCID: PMC5257240] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
Abstract
OBJECTIVE To assess the proportion of primary care patients who report a family history (FH) of type 2 diabetes, coronary artery disease, breast cancer, or colorectal cancer (CRC); assess concordance of FH information derived from the electronic medical record (EMR) compared with patient-completed health questionnaires; and assess whether appropriate screening was informed by risk based solely on FH. DESIGN Data from the BETTER (Building on Existing Tools to Improve Chronic Disease Prevention and Screening in Primary Care) trial were used. Patients were mailed questionnaires. Baseline FH and screening data were obtained for enrolled patients from the EMR and health questionnaires. SETTING Ontario and Alberta. PARTICIPANTS Randomly selected patients from 8 family practices. MAIN OUTCOME MEASURES Agreement on FH between the EMR and questionnaire was determined; logistic regression was used to assess significant predictors of screening. RESULTS In total, 775 of 789 (98%) patients completed the health questionnaire. The mean age of participants was 52.5 years and 72% were female. A minimum of 12% of patients (range 12% to 36%) had a reported FH of 1 of 4 chronic diseases. Among patients with positive FH, the following proportions of patients had that FH recorded in the EMR compared with the questionnaire: diabetes, 24% in the EMR versus 36% on the questionnaire, κ = 0.466; coronary artery disease, 35% in the EMR versus 22% on the questionnaire, κ = 0.225; breast cancer, 21% in the EMR versus 22% on the questionnaire, κ = 0.241; and CRC, 12% in the EMR versus 14% on the questionnaire, κ = 0.510. There was moderate agreement for diabetes and CRC. The presence of FH was a significant predictor of CRC screening (odds ratio 1.9, 95% CI 1.1 to 3.1). CONCLUSION A moderate prevalence of FH was found for 4 conditions for which screening recommendations vary with risk based on FH. Having patients self-complete an FH was thought to be feasible; however, questions about FH accuracy and completeness from both self-report and EMR remain. Work is needed to determine how to facilitate the adoption of FH tools into practice as well as strategies linking familial risk to appropriate screening.Trial registration number ISRCTN07170460 (ISRCTN Registry).
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Affiliation(s)
- June C Carroll
- Professor and Sydney G. Frankfort Chair in the Department of Family and Community Medicine of the Sinai Health System at the University of Toronto in Ontario.
| | - Denise Campbell-Scherer
- Associate Professor in the Department of Family Medicine at the University of Alberta in Edmonton
| | - Joanne A Permaul
- Research associate in the Ray D. Wolfe Department of Family Medicine in the Sinai Health System
| | - Jesse Myers
- Second-year family medicine resident at Women's College Hospital at the University of Toronto
| | - Donna P Manca
- Director of Research in the Department of Family Medicine Research Program at the University of Alberta
| | - Christopher Meaney
- Biostatistician in the Department of Family and Community Medicine at the University of Toronto
| | - Rahim Moineddin
- Biostatistician in the Department of Family and Community Medicine at the University of Toronto
| | - Eva Grunfeld
- Giblon Professor and Vice Chair of Research in the Department of Family and Community Medicine at the University of Toronto and Director of Knowledge Translation Research in the Health Services Research Program at the Ontario Institute for Cancer Research
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Robertson DS, Prevost AT, Bowden J. Correcting for bias in the selection and validation of informative diagnostic tests. Stat Med 2015; 34:1417-37. [PMID: 25645331 PMCID: PMC4415464 DOI: 10.1002/sim.6413] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2014] [Revised: 12/16/2014] [Accepted: 12/17/2014] [Indexed: 12/02/2022]
Abstract
When developing a new diagnostic test for a disease, there are often multiple candidate classifiers to choose from, and it is unclear if any will offer an improvement in performance compared with current technology. A two-stage design can be used to select a promising classifier (if one exists) in stage one for definitive validation in stage two. However, estimating the true properties of the chosen classifier is complicated by the first stage selection rules. In particular, the usual maximum likelihood estimator (MLE) that combines data from both stages will be biased high. Consequently, confidence intervals and p-values flowing from the MLE will also be incorrect. Building on the results of Pepe et al. (SIM 28:762–779), we derive the most efficient conditionally unbiased estimator and exact confidence intervals for a classifier's sensitivity in a two-stage design with arbitrary selection rules; the condition being that the trial proceeds to the validation stage. We apply our estimation strategy to data from a recent family history screening tool validation study by Walter et al. (BJGP 63:393–400) and are able to identify and successfully adjust for bias in the tool's estimated sensitivity to detect those at higher risk of breast cancer. © 2015 The Authors. Statistics in Medicine published by John Wiley & Sons Ltd.
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A Qualitative Evaluation of the Psychosocial Impact of Family History Screening in Australian Primary Care. J Genet Couns 2014; 24:312-24. [DOI: 10.1007/s10897-014-9772-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2013] [Accepted: 09/09/2014] [Indexed: 12/20/2022]
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Birt L, Emery JD, Prevost AT, Sutton S, Walter FM. Psychological impact of family history risk assessment in primary care: a mixed methods study. Fam Pract 2014; 31:409-18. [PMID: 24728773 PMCID: PMC5926455 DOI: 10.1093/fampra/cmu012] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/21/2023] Open
Abstract
BACKGROUND Routine family history risk assessment for chronic diseases could enable primary care practitioners to efficiently identify at-risk patients and promote preventive management strategies. OBJECTIVES To investigate patients' understanding and responses to family history risk assessment in primary care. METHOD A mixed methods study set in 10 Eastern England general practices. Participants in a family history questionnaire validation study were triaged into population or increased risk for four chronic diseases (type 2 diabetes, cardiovascular disease, breast cancer, colorectal cancer). Questionnaires completed immediately prior to the family history consultation (baseline) and 4 weeks later (follow-up) assessed the psychological impact, including State-Trait Anxiety Inventory scores. Semi-structured interviews explored the meaning participants gave to their personal familial disease risk. RESULTS Four hundred and fifty-three participants completed both baseline and follow-up questionnaires and 30 were interviewed. At follow-up, there was no increase in anxiety among either group, or differences between the groups [difference in mean change 0.02, 95% confidence interval -2.04, 2.08, P = 0.98]. There were no significant changes over time in self-rated health in either group. At follow-up, participants at increased risk (n = 153) were more likely to have recent changes to behaviour and they had stronger intentions to make changes to diet (P = 0.001), physical activity (P = 0.006) and to seek further information in the future than those at population risk (n = 300; P < 0.001). Using qualitative analysis, five themes were developed representing ways in which participants gave meaning to familial disease risk ('Being reassured', 'Controlling risk', 'Dealing with it later', 'Beyond my control', 'Disbelieving the risk'). The meanings they attributed to increased risk appeared to shape their intention to undertake behaviour change. CONCLUSION Routine assessment for familial risk of chronic diseases may be undertaken in primary care without causing anxiety or reducing self-rated health. Patient responses to family history risk assessment may inform promotion of preventive management strategies.
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Affiliation(s)
- Linda Birt
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK,
| | - Jon D Emery
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK, General Practice and Primary Care Academic Centre, University of Melbourne, Parkville VIC 3010, Australia, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley WA 6009, Australia
| | - A Toby Prevost
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK, King's College London, Department of Primary Care and Public Health Sciences, Capital House, London, UK and
| | - Stephen Sutton
- Behavioural Science Group, Primary Care Unit, Department of Public Health and Primary Care, University of Cambridge, Cambridge, CB2 0SR
| | - Fiona M Walter
- The Primary Care Unit, Department of Public Health & Primary Care, University of Cambridge, Cambridge, CB2 0SR, UK, General Practice and Primary Care Academic Centre, University of Melbourne, Parkville VIC 3010, Australia, School of Primary Aboriginal and Rural Health Care, University of Western Australia, Crawley WA 6009, Australia
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Emery JD, Reid G, Prevost AT, Ravine D, Walter FM. Development and validation of a family history screening questionnaire in Australian primary care. Ann Fam Med 2014; 12:241-9. [PMID: 24821895 PMCID: PMC4018372 DOI: 10.1370/afm.1617] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
PURPOSE We aimed to validate a family history screening questionnaire in an Australian primary care population designed to identify people at increased risk for breast, ovarian, colorectal, and prostate cancer; melanoma; ischemic heart disease; and type 2 diabetes. METHODS We prospectively validated the questionnaire in 6 general practices in Perth, Western Australia among 526 patients aged 20 to 50 years who responded to a single invitation from their general practice. They completed the 15-item questionnaire before a reference standard 3-generation pedigree was obtained by a genetic counselor blinded to the questionnaire responses. We calculated diagnostic performance statistics for the questionnaire using the pedigree as the reference standard. RESULTS A combination of 9 questions had the following diagnostic performance, expressed as value (95% CI), to identify increased risk of any of the 7 conditions: area under the receiver operating characteristic curve 84.6% (81.2%-88.1%), 95% sensitivity (92%-98%), and 54% specificity (48%-60%). The combination of questions to detect increased risk had sensitivity of 92% (84%-99%) and 96% (93%-99%) for the 5 and 6 conditions applicable only to men and women, respectively. The specificity was 63% (28%-52%) for men and 49% (42%-56%) for women. The positive predictive values were 67% (56%-78%) and 68% (63%-73%), and the false-positive rates were 9% (0.5%-17%) and 9% (3%-15%) for men and women, respectively. CONCLUSIONS This simple family history screening questionnaire shows good performance for identifying primary care patients at increased disease risk because of their family history. It could be used in primary care as part of a systematic approach to tailored disease prevention.
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Affiliation(s)
- Jon D Emery
- School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Crawley, Western Australia
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Abstract
This article discusses the clinical utility of genomic information for personalized preventive care of a healthy adult. Family health history is currently the most applicable genomic predictor for common, multifactorial diseases, and can also show patterns that suggest an inherited high susceptibility to a particular form of cancer or other disease. Both bloodline ancestry and shared environmental factors are important predictors for many disease states. DNA and family history analyses give information that is probabilistic, not deterministic. Therefore, family history can highlight behavioral, social, or cultural risk factors that can be modified to prevent diseases.
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Affiliation(s)
- Kathryn Teng
- Internal Medicine, Center for Personalized Healthcare (Cleveland Clinic), 9500 Euclid Avenue, NE5-203, Cleveland, OH 44195, USA.
| | - Louise S Acheson
- Departments of Family Medicine, Oncology, and Reproductive Biology, University Hospitals Case Medical Center, Case Western Reserve University, 11100 Euclid Avenue, Cleveland, OH 44106-5036, USA
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Schwarz P. [Are questions better than the glucose tolerance test?]. MMW Fortschr Med 2013; 155 Spec No 2:38. [PMID: 24734454 DOI: 10.1007/s15006-013-2389-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
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