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Beal EW, McNamara M, Owen M, McAlearney AS, Tsung A. Interventions to Improve Surveillance for Hepatocellular Carcinoma in High-Risk Patients: A Scoping Review. J Gastrointest Cancer 2024; 55:1-14. [PMID: 37328730 DOI: 10.1007/s12029-023-00944-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/09/2023] [Indexed: 06/18/2023]
Abstract
PURPOSE Hepatocellular carcinoma (HCC) is most often a sequela of chronic liver disease or chronic hepatitis B infection. Among high-risk patients, surveillance for HCC every 6 months is recommended by international guidelines. However, rates of HCC surveillance are suboptimal (11-64%). Barriers at the patient, provider, and healthcare delivery system levels have been identified. METHODS We performed a systemic scoping review to identify and characterize interventions to improve HCC surveillance that has previously been evaluated. Searches using key terms in PubMed and Embase were performed to identify studies examining interventions designed to improve the surveillance rate for HCC in patients with cirrhosis or chronic liver disease that were published in English between January 1990 and September 2021. RESULTS Included studies (14) had the following study designs: (1) randomized clinical trials (3, 21.4%), (2) quasi-experimental (2, 14.3%), (3) prospective cohort (6, 42.8%), and (4) retrospective cohort (3, 21.4%). Interventions included mailed outreach invitations, nursing outreach, patient education with or without printed materials, provider education, patient navigation, chronic disease management programs, nursing-led protocols for image ordering, automated reminders to physicians and nurses, web-based clinical management tools, HCC surveillance databases, provider compliance reports, radiology-led surveillance programs, subsidized HCC surveillance, and the use of oral medications. It was found that HCC surveillance rates increased after intervention implementation in all studies. CONCLUSION Despite improvements in HCC surveillance rates with intervention, compliance remained suboptimal. Further analysis of which interventions yield the greatest increases in HCC surveillance, design of multi-pronged strategies, and improved implementation are needed.
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Affiliation(s)
- Eliza W Beal
- Departments of Surgery and Oncology, Barbara Ann Karmanos Cancer Institute, Wayne State University School of Medicine, 4100 John R, Mailcode: HW04HO, Detroit, MI, 48201, USA.
| | - Molly McNamara
- The Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Mackenzie Owen
- The Ohio State University College of Medicine, Columbus, OH, 43210, USA
| | - Ann Scheck McAlearney
- The Center for the Advancement of Team Science, Analytics, and Systems Thinking in Health Services and Implementation Science Research (CATALYST), The Ohio State University College of Medicine, Columbus, OH, 43210, USA
- Department of Family and Community Medicine, The Ohio State University Wexner Medical Center, Columbus, OH, 43210, USA
| | - Allan Tsung
- Department of Surgery, Division of Surgical Oncology, University of Virginia, Charlottsville, VA, 22908, USA
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Hurtaud A, Coomans C, Vuillemin B, Benamar A, Couraud M, Pham BN, Sanchez S, Barbe C. Impact of a dTcaP booster vaccine awareness campaign initiated by the French national health insurance for adults aged 25 years in 2021. BMC Health Serv Res 2023; 23:903. [PMID: 37612678 PMCID: PMC10463893 DOI: 10.1186/s12913-023-09805-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2023] [Accepted: 07/10/2023] [Indexed: 08/25/2023] Open
Abstract
BACKGROUND Vaccination schedules differ from country to country. In France, the diphtheria, tetanus, pertussis, poliomyelitis (dTcaP) booster vaccine coverage for adults aged 25 has been lower than those recommended. We evaluated the impact of an awareness campaign undertaken by the French national health insurance system in 2021. METHODS A randomized, controlled study with adults residing in the Ardennes region was conducted to evaluate the effect on vaccine coverage of the booster vaccine reminder campaign carried out via letter and/or email and/or SMS. The randomization unit was the municipal administrative area (canton). Ten cantons were grouped into the intervention group (INT) and nine were the control group (CON). Outcomes were the booster vaccine delivery and the consultation of a general practitioner (GP) within 12 months (since the French national health insurance running the campaign suggested patients to consult their GP). RESULTS A total of 1,975 adults were included (INT: 67.3% vs. CON: 32.7%). Of them, 331 received a booster vaccine (INT: 17.4% vs. CON: 15.5%; p = 0.29), and 1,442 consulted a GP (INT: 73.7% vs. CON: 76.8%; p = 0.14). Those who consulted a GP had more frequent vaccine delivery (INT: 19.1% vs. CON: 10.5%; p < 0.0001). CONCLUSIONS This study found that the awareness campaign run by the French national health insurance did not improve the uptake of the dTcaP booster and that there was a low rate of vaccinated adults aged 25 years. A GP consultation was associated with dTcaP booster vaccine delivery which may show that there is a need of involving GPs in vaccination follow-ups. Patients recognize GPs as providers of credible information and they may play a key role in individualized preventive healthcare actions. Systematic consultations with GPs for follow-up could be proposed to insured adults aged 25 years in the future.
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Affiliation(s)
- Aline Hurtaud
- Department of General Medicine, University of Reims Champagne-Ardenne UFR Medicine, 51 rue Cognacq Jay, Reims, 51100, France
| | - Capucine Coomans
- Department of General Medicine, University of Reims Champagne-Ardenne UFR Medicine, 51 rue Cognacq Jay, Reims, 51100, France
| | - Brigitte Vuillemin
- Department of General Medicine, University of Reims Champagne-Ardenne UFR Medicine, 51 rue Cognacq Jay, Reims, 51100, France
| | - Akima Benamar
- Caisse Primaire d'Assurance Maladie des Ardennes, 14 Avenue Georges Corneau, Charleville- Mézières, 08100, France
| | - Maxime Couraud
- Caisse Primaire d'Assurance Maladie des Ardennes, 14 Avenue Georges Corneau, Charleville- Mézières, 08100, France
| | - Bach-Nga Pham
- Research on Health University Department, University of Reims Champagne-Ardenne UFR Medicine, 51 rue Cognacq Jay, Reims, 51100, France
| | - Stéphane Sanchez
- Research on Health University Department, University of Reims Champagne-Ardenne UFR Medicine, 51 rue Cognacq Jay, Reims, 51100, France
| | - Coralie Barbe
- Research on Health University Department, University of Reims Champagne-Ardenne UFR Medicine, 51 rue Cognacq Jay, Reims, 51100, France.
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Nduka IJ, Ejie IL, Okafor CE, Eleje GU, Ekwunife OI. Interventions to increase mammography screening uptake among women living in low-income and middle-income countries: a systematic review. BMJ Open 2023; 13:e066928. [PMID: 36750281 PMCID: PMC9906257 DOI: 10.1136/bmjopen-2022-066928] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2023] Open
Abstract
OBJECTIVE To systematically identify interventions that increase the use of mammography screening in women living in low-income and middle-income countries (LMICs). DESIGN Systematic review. DATA SOURCES MEDLINE, Embase, Global Health, CINAHL, PsycINFO, Web of Science, Cochrane Central Register of Controlled Trials, Google Scholar and African regional databases. ELIGIBILITY CRITERIA Studies conducted in LMICs, published between 1 January 1990 and 30 June 2021, in the English language. Studies whose population included asymptomatic women eligible for mammography screening. Studies with a reported outcome of using mammography by either self-report or medical records. No restrictions were set on the study design. DATA EXTRACTION AND SYNTHESIS Screening, data extraction and risk-of-bias assessment were conducted by two independent reviewers. A narrative synthesis of the included studies was conducted. RESULTS Five studies met the inclusion criteria consisting of two randomised controlled trials, one quasi-experiment and two cross-sectional studies. All included studies employed client-oriented intervention strategies including one-on-one education, group education, mass and small media, reducing client out-of-pocket costs, reducing structural barriers, client reminders and engagement of community health workers (CHWs). Most studies used multicomponent interventions, resulting in increases in the rate of use of mammography than those that employed a single strategy. CONCLUSION Mass and small media, group education, reduction of economic and structural barriers, client reminders and engagement of CHWs can increase use of mammography among women in LMICs. Promoting the adoption of these interventions should be considered, especially the multicomponent interventions, which were significantly effective relative to a single strategy in increasing use of mammography. PROSPERO REGISTRATION NUMBER CRD42021269556.
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Affiliation(s)
- Ifeoma Jovita Nduka
- Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria
| | - Izuchukwu Loveth Ejie
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria
| | - Charles Ebuka Okafor
- Centre for Applied Health Economics, School of Medicine and Dentistry, Griffith University, Nathan, Queensland, Australia
- Menzies Health Institute, Southport, Queensland, Australia
| | - George Uchenna Eleje
- Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Nigeria
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Nigeria
| | - Obinna Ikechukwu Ekwunife
- Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Nigeria
- Takemi Program in International Health, Harvard University T H Chan School of Public Health, Boston, Massachusetts, USA
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Nduka IJ, Ejie IL, Okafor CE, Eleje GU, Ekwunife OI. Interventions to increase mammography screening uptake among women living in low-income and middle-income countries: a protocol for a systematic review. BMJ Open 2022; 12:e056901. [PMID: 35354628 PMCID: PMC8968630 DOI: 10.1136/bmjopen-2021-056901] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
INTRODUCTION Breast cancer is the most prevalent cancer and the second leading cause of cancer-related deaths among women in low and middle-income countries (LMICs), including sub-Saharan Africa. Mammography screening is the most effective screening method for the early detection of breast cancers in asymptomatic individuals and the only screening test that decreases the risk of breast cancer mortality. Despite the perceived benefits, it has a low utilisation rate in comparison with breast self-examination and clinical breast examination. Several interventions to increase the uptake of mammography have been assessed as well as systematic reviews on mammography uptake. Nonetheless, none of the published systematic reviews focused on women living in LMICs. The review aims to identify interventions that increase mammography screening uptake among women living in LMICs. METHODS AND ANALYSIS Relevant electronic databases will be systematically searched from 1 January 1990 to 30 June 2021 for published and grey literature, including citation and reference list tracking, on studies focusing on interventions to increase mammography screening uptake carried out in LMICs and written in the English language. The search will incorporate the key terms: mammography, interventions, low- and middle-income countries and their associated synonyms. Randomised controlled trials, observational studies and qualitative and mixed methods studies of interventions (carried out with and without comparison groups) reporting interventions to increase mammography screening uptake in LMICs will be identified, data extracted and assessed for methodological quality by two independent reviewers with disagreements to be resolved by consensus or by a third author. We will use narrative synthesis and/or meta-analysis depending on the characteristics of the data. ETHICS AND DISSEMINATION Ethical approval is not required as it is a protocol for a systematic review. Findings will be disseminated through peer-reviewed publications and conference presentations. PROSPERO REGISTRATION NUMBER CRD42021269556.
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Affiliation(s)
- Ifeoma Jovita Nduka
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Izuchukwu Loveth Ejie
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Charles Ebuka Okafor
- Centre for Applied Health Economics, Griffith University School of Medicine, Brisbane, Queensland, Australia
- Menzies Health Institute, Griffith University, Gold Coast, Queensland, Australia
| | - George Uchenna Eleje
- Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University Teaching Hospital, Nnewi, Anambra, Nigeria
- Effective Care Research Unit, Department of Obstetrics and Gynaecology, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
| | - Obinna Ikechukwu Ekwunife
- Department of Clinical Pharmacy and Pharmacy Management, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
- Research Group for Evidence-Based Health Care, Nnamdi Azikiwe University, Awka, Anambra, Nigeria
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Chan TKC, Tan LWL, van Dam RM, Seow WJ. Cancer Screening Knowledge and Behavior in a Multi-Ethnic Asian Population: The Singapore Community Health Study. Front Oncol 2021; 11:684917. [PMID: 34476210 PMCID: PMC8406849 DOI: 10.3389/fonc.2021.684917] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2021] [Accepted: 07/07/2021] [Indexed: 12/24/2022] Open
Abstract
Background Cancer has become the leading cause of mortality in Singapore and among other Asian populations worldwide. Despite the presence of National Cancer Screening programmes in Singapore, less than half of the population has had timely screening according to guidelines. The underlying factors of poor cancer screening rates and health outcomes among Asian ethnic groups remain poorly understood. We therefore examined cancer screening participation rates and screening behavior in a multi-ethnic Singapore population. Methods We collected data from 7,125 respondents of the 2015–2016 Singapore Community Health Study. Factors associated with cervical, breast, and colorectal cancer screening were evaluated using modified Poisson regression. Adjusted prevalence ratios were computed with 95% confidence intervals after adjusting for confounders. Results The mean age of the respondents was 57.7 ± 10.9 years; 58.9% were female and were predominately Chinese (73.0%), followed by Malay (14.2%), and Indian (10.9%). Less than half of the respondents in the recommended age groups had undergone cancer screening (cervical, 43%; breast, 35.1%; colorectal, 27.3%). Malay respondents were significantly less likely to screen as recommended for cervical (aPR = 0.75, CI = 0.65–0.86, p < 0.001), breast (aPR = 0.83, CI = 0.68–0.99, p = 0.045), and colorectal cancer (aPR = 0.55, CI = 0.44–0.68, p < 0.001), as compared to Chinese respondents. Respondents who had obtained lower secondary level education were 42% more likely to screen for cervical cancer (aPR = 1.42, CI = 1.23–1.64, p < 0.001), and 22% more likely to screen for breast cancer (aPR = 1.22, CI = 1.02–1.46, p = 0.032), compared to those with primary level education and below. Respondents with a household income ≥S$10,000/month were 71% more likely to screen for breast cancer (aPR = 1.71, CI = 1.37–2.13, p < 0.001), as compared with <$2,000/month. Conclusions Ethnicity and socio-economic status were significantly associated with lower uptake of cancer screening tests in Singapore. To improve the screening uptake among disadvantaged groups, a multi-faceted approach is needed that addresses the barriers to screening such as the adequacy of subsidy schemes and ethnic differences.
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Affiliation(s)
| | - Linda Wei Lin Tan
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore
| | - Rob M van Dam
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
| | - Wei Jie Seow
- Saw Swee Hock School of Public Health, National University of Singapore and National University Health System, Singapore, Singapore.,Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore and National University Health System, Singapore, Singapore
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Muñoz-Sanz JJ, Jiménez-Palomares M, Garrido-Ardila EM, Rodríguez-Mansilla J. Non-Participation in Breast Cancer Screening in Spain and Potential Application in the Present and Future: A Cross Sectional Study. Cancers (Basel) 2021; 13:cancers13174331. [PMID: 34503140 PMCID: PMC8430829 DOI: 10.3390/cancers13174331] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Revised: 08/24/2021] [Accepted: 08/25/2021] [Indexed: 11/24/2022] Open
Abstract
Simple Summary Breast cancer screening programmes have the aim of reducing breast cancer mortality. This article is an observational, descriptive, cross-sectional and retrospective study of 2507 women who were invited to participate in the Breast Cancer Prevention Programme in Extremadura (Spain) and did not attend their appointment. We analysed the different reasons why women do not participate in the Breast Cancer Early Detection Programme in Extremadura (Spain) and discuss the results offering possible tools to improve the screening programs. Women who did not participate in the breast cancer screening programme in Extremadura had low educational levels and were older women. Abstract Background: Currently, we are beginning to observe a stabilisation and even a decrease in breast cancer mortality in the world, which may be related, among other reasons, to breast cancer screening. Methods: The objective of this study was to analyse the different reasons why women do not participate in the Breast Cancer Early Detection Programme in Extremadura (Spain) and to discuss the results, offering possible tools to improve the screening programs. This is an observational, descriptive, cross-sectional and retrospective study. A questionnaire with 14 questions was carried out by telephone or mail. Results: A total of 3970 questionnaires were collected. However, only 2507 were valid. A total of 70.36% of young and educated women underwent mammographic controls. The type of women who did not attend the screening programme appointment corresponded to a woman of approximately 60 years of age, with no formal studies, married, with children, who does not work outside their home and who lived in the health area of Badajoz. Among the main reasons for not going to the appointment, 53.9% of the women surveyed indicated that they had check-ups with their gynaecologist, and this specialist referred them for a mammograph. These women were younger and have a higher level of education. Women with a lower educational level and older women did not have any mammography done and did not undergo screening. They indicated that they did not go to the appointment because they were afraid of having a mammography (44%) or because they did not receive the appointment in time (31.6%). A total of 26.9% of the women who did not attend the appointment for other reasons stated that they had problems in attending because they had a physical limitation (dependency). Conclusions: Women who did not participate in the breast cancer screening programme in Extremadura had low educational levels and were older women. Specifically, fear of having a mammogram was the main argument raised by these women. In addition, a small group stated that they did not consider mammography to be useful. At present and in the future, good quality screening programs must be carried out to contribute to the reduction in breast cancer mortality. Furthermore, enhancing the participation of women is essential to increase the attendance rate and, therefore, the success of the screening programmes.
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Affiliation(s)
- Juan José Muñoz-Sanz
- Merida University Center (Badajoz), Department of Nursing, Extremadura University, 06800 Badajoz, Spain;
| | - María Jiménez-Palomares
- ADOLOR Research Group, Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, Extremadura University, 06006 Badajoz, Spain; (M.J.-P.); (J.R.-M.)
| | - Elisa María Garrido-Ardila
- ADOLOR Research Group, Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, Extremadura University, 06006 Badajoz, Spain; (M.J.-P.); (J.R.-M.)
- Correspondence: ; Tel.: +34-653369655
| | - Juan Rodríguez-Mansilla
- ADOLOR Research Group, Department of Medical-Surgical Therapy, Faculty of Medicine and Health Sciences, Extremadura University, 06006 Badajoz, Spain; (M.J.-P.); (J.R.-M.)
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Krist L, Bedir A, Fricke J, Kluttig A, Mikolajczyk R. The effect of home visits as an additional recruitment step on the composition of the final sample: a cross-sectional analysis in two study centers of the German National Cohort (NAKO). BMC Med Res Methodol 2021; 21:176. [PMID: 34425747 PMCID: PMC8383386 DOI: 10.1186/s12874-021-01357-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2020] [Accepted: 07/22/2021] [Indexed: 12/04/2022] Open
Abstract
Background Participation in epidemiologic studies has been declining over the last decades. In addition to postal invitations and phone calls, home visits can be conducted to increase participation. The aim of this study was therefore to evaluate the effects of home visits in terms of response increase and composition of the additionally recruited and final sample. Methods In the framework of the German National Cohort (NAKO) recruitment process, two of 18 study centers, Halle (Saale) and Berlin-Center, performed home visits as additional recruitment step after postal invitation and reminders. Response increase was calculated and differences between participants recruited via home visits and standard recruitment were examined. Proportions are presented as percentages with 95%-confidence intervals. Results In the general population in Halle, 21.3-22.8% participated after postal invitation and two reminders in the five assessed recruitment waves. The increase of the overall response was 2.8 percentage points (95%confidence interval: 1.9-4.0) for home visits compared to 2.4 percentage points (95%CI: 1.7-3.3) for alternatively sent third postal reminder. Participants recruited via home visits had similar characteristics to those recruited via standard recruitment. Among persons of Turkish descent in Berlin-Center site of the NAKO, home visits conducted by native speakers increased the participation of women, persons living together with their partner, were born in Turkey, had lower German language skills, lower-income, lower education, were more often smokers and reported more often diabetes and depression to a degree which changed overall estimates for this subsample. Conclusions As an additional recruitment measure in the general population, home visits increased response only marginally, and the through home visits recruited participants did not differ from those already recruited. Among persons with migration background, home visits by a native speaker increased participation of persons not reached by the standard recruitment, but the effects of using a native speaker approach could not be separated from the effect of home visits. Supplementary Information The online version contains supplementary material available at 10.1186/s12874-021-01357-z.
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Affiliation(s)
- Lilian Krist
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany.
| | - Ahmed Bedir
- Department of Radiation Oncology, Health Services Research Group, University Hospital Halle (Saale), Halle (Saale), Germany
| | - Julia Fricke
- Institute of Social Medicine, Epidemiology and Health Economics, Charité-Universitätsmedizin, Berlin, Germany
| | - Alexander Kluttig
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
| | - Rafael Mikolajczyk
- Institute of Medical Epidemiology, Biometry, and Informatics, Martin Luther University Halle-Wittenberg, Halle (Saale), Germany
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Mandrik O, Tolma E, Zielonke N, Meheus F, Ordóñez-Reyes C, Severens JL, Murillo R. Systematic reviews as a "lens of evidence": Determinants of participation in breast cancer screening. J Med Screen 2021; 28:70-79. [PMID: 32517538 PMCID: PMC8167916 DOI: 10.1177/0969141320930743] [Citation(s) in RCA: 5] [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: 01/14/2020] [Revised: 04/25/2020] [Accepted: 05/11/2020] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To assess the determinants of the participation rate in breast cancer screening programs by conducting a systematic review of reviews. METHODS We conducted a systematic search in PubMed via Medline, Scopus, Embase, and Cochrane identifying the literature up to April 2019. Out of 2258 revealed unique abstracts, we included 31 reviews, from which 25 were considered as systematic. We applied the Walsh & McPhee Systems Model of Clinical Preventive Care to systematize the determinants of screening participation. RESULTS The reviews, mainly in high-income settings, reported a wide range for breast cancer screening participation rate: 16-90%. The determinants of breast cancer screening participation were simple low-cost interventions such as invitation letters, basic information on screening, multiple reminders, fixed appointments, prompts from healthcare professionals, and healthcare organizational factors (e.g. close proximity to screening facility). More complex interventions (such as face-to-face counselling or home visits), mass media or improved access to transport should not be encouraged by policy makers unless other information appears. The repeated participation in mammography screening was consistently high, above 62%. Previous positive experience with screening influenced the repeated participation in screening programs. The reviews were inconsistent in the use of terminology related to breast cancer screening participation, which may have contributed to the heterogeneity in the reported outcomes. CONCLUSIONS This study shows that consistent findings of systematic reviews bring more certainty into the conclusions on the effects of simple invitation techniques, fixed appointments and prompts, as well as healthcare organizational factors on promoting participation rate in screening mammography.
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Affiliation(s)
- O Mandrik
- School of Health and Related Research, Health Economic and Decision Science (HEDS), The University of Sheffield, Sheffield, UK
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - E Tolma
- Faculty of Public Health, Kuwait University, Jabriya, Kuwait
| | - N Zielonke
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - F Meheus
- Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
| | - C Ordóñez-Reyes
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
| | - JL Severens
- Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- Institute for Medical Technology Assessment (iMTA), Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - R Murillo
- Section of Early Detection and Prevention, International Agency for Research on Cancer, Lyon, France
- Centro Javeriano de Oncología, Hospital Universitario San Ignacio, Bogotá, Colombia
- Faculty of Medicine, Pontificia Universidad Javeriana, Bogotá, Colombia
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O'Flaherty M, Lloyd-Williams F, Capewell S, Boland A, Maden M, Collins B, Bandosz P, Hyseni L, Kypridemos C. Modelling tool to support decision-making in the NHS Health Check programme: workshops, systematic review and co-production with users. Health Technol Assess 2021; 25:1-234. [PMID: 34076574 DOI: 10.3310/hta25350] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Local authorities in England commission the NHS Health Check programme to invite everyone aged 40-74 years without pre-existing conditions for risk assessment and eventual intervention, if needed. However, the programme's effectiveness, cost-effectiveness and equity impact remain uncertain. AIM To develop a validated open-access flexible web-based model that enables local commissioners to quantify the cost-effectiveness and potential for equitable population health gain of the NHS Health Check programme. OBJECTIVES The objectives were as follows: (1) co-produce with stakeholders the desirable features of the user-friendly model; (2) update the evidence base to support model and scenario development; (3) further develop our computational model to allow for developments and changes to the NHS Health Check programme and the diseases it addresses; (4) assess the effectiveness, cost-effectiveness and equity of alternative strategies for implementation to illustrate the use of the tool; and (5) propose a sustainability and implementation plan to deploy our user-friendly computational model at the local level. DESIGN Co-production workshops surveying the best-performing local authorities and a systematic literature review of strategies to increase uptake of screening programmes informed model use and development. We then co-produced the workHORSE (working Health Outcomes Research Simulation Environment) model to estimate the health, economic and equity impact of different NHS Health Check programme implementations, using illustrative-use cases. SETTING Local authorities in England. PARTICIPANTS Stakeholders from local authorities, Public Health England, the NHS, the British Heart Foundation, academia and other organisations participated in the workshops. For the local authorities survey, we invited 16 of the best-performing local authorities in England. INTERVENTIONS The user interface allows users to vary key parameters that represent programme activities (i.e. invitation, uptake, prescriptions and referrals). Scenarios can be compared with each other. MAIN OUTCOME MEASURES Disease cases and case-years prevented or postponed, incremental cost-effectiveness ratios, net monetary benefit and change in slope index of inequality. RESULTS The survey of best-performing local authorities revealed a diversity of effective approaches to maximise the coverage and uptake of NHS Health Check programme, with no distinct 'best buy'. The umbrella literature review identified a range of effective single interventions. However, these generally need to be combined to maximally improve uptake and health gains. A validated dynamic, stochastic microsimulation model, built on robust epidemiology, enabled service options analysis. Analyses of three contrasting illustrative cases estimated the health, economic and equity impact of optimising the Health Checks, and the added value of obtaining detailed local data. Optimising the programme in Liverpool can become cost-effective and equitable, but simply changing the invitation method will require other programme changes to improve its performance. Detailed data inputs can benefit local analysis. LIMITATIONS Although the approach is extremely flexible, it is complex and requires substantial amounts of data, alongside expertise to both maintain and run. CONCLUSIONS Our project showed that the workHORSE model could be used to estimate the health, economic and equity impact comprehensively at local authority level. It has the potential for further development as a commissioning tool and to stimulate broader discussions on the role of these tools in real-world decision-making. FUTURE WORK Future work should focus on improving user interactions with the model, modelling simulation standards, and adapting workHORSE for evaluation, design and implementation support. STUDY REGISTRATION This study is registered as PROSPERO CRD42019132087. FUNDING This project was funded by the National Institute for Health Research (NIHR) Health Technology Assessment programme and will be published in full in Health Technology Assessment; Vol. 25, No. 35. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Martin O'Flaherty
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | | | - Simon Capewell
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Angela Boland
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Michelle Maden
- Liverpool Reviews and Implementation Group, University of Liverpool, Liverpool, UK
| | - Brendan Collins
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Piotr Bandosz
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Lirije Hyseni
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
| | - Chris Kypridemos
- Department of Public Health and Policy, University of Liverpool, Liverpool, UK
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Vernon SW, Del Junco DJ, Coan SP, Murphy CC, Walters ST, Friedman RH, Bastian LA, Fisher DA, Lairson DR, Myers RE. A stepped randomized trial to promote colorectal cancer screening in a nationwide sample of U.S. Veterans. Contemp Clin Trials 2021; 105:106392. [PMID: 33823295 DOI: 10.1016/j.cct.2021.106392] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2020] [Revised: 03/24/2021] [Accepted: 03/29/2021] [Indexed: 12/19/2022]
Abstract
BACKGROUND Colorectal cancer (CRC) screening (CRCS) facilitates early detection and lowers CRC mortality. OBJECTIVES To increase CRCS in a randomized trial of stepped interventions. Step 1 compared three modes of delivery of theory-informed minimal cue interventions. Step 2 was designed to more intensively engage those not completing CRCS after Step 1. METHODS Recruitment packets (60,332) were mailed to a random sample of individuals with a record of U.S. military service during the Vietnam-era. Respondents not up-to-date with CRCS were randomized to one of four Step 1 groups: automated telephone, telephone, letter, or survey-only control. Those not completing screening after Step 1 were randomized to one of three Step 2 groups: automated motivational interviewing (MI) call, counselor-delivered MI call, or Step 2 control. Intention-to-treat (ITT) analyses assessed CRCS on follow-up surveys mailed after each step. RESULTS After Step 1 (n = 1784), CRCS was higher in the letter, telephone, and automated telephone groups (by 1%, 5%, 7%) than in survey-only controls (43%), although differences were not statistically significant. After Step 2 (n = 516), there were nonsignificant increases in CRCS in the two intervention groups compared with the controls. CRCS following any combination of stepped interventions overall was 7% higher (P = 0.024) than in survey-only controls (55.6%). CONCLUSIONS In a nationwide study of Veterans, CRCS after each of two stepped interventions of varying modes of delivery did not differ significantly from that in controls. However, combined overall, the sequence of stepped interventions significantly increased CRCS.
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Affiliation(s)
- Sally W Vernon
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, United States.
| | - Deborah J Del Junco
- Department of Surgery, Center for Translational Injury Research, The University of Texas McGovern Medical School, Houston, TX, United States
| | - Sharon P Coan
- Department of Health Promotion and Behavioral Sciences, UTHealth School of Public Health, Houston, TX, United States
| | - Caitlin C Murphy
- Department of Population & Data Sciences, University of Texas Southwestern Medical Center, Dallas, TX, United States
| | - Scott T Walters
- Health Behavior and Health Systems, University of North Texas Health Science Center, Ft. Worth, TX, United States
| | - Robert H Friedman
- Medical Information Systems Unit, Boston University School of Medicine and Boston Medical Center, Boston, MA, United States
| | - Lori A Bastian
- General Internal Medicine, VA Connecticut, West Haven, CT 06516 and Department of Medicine, Yale University School of Medicine, New Haven, CT 06510, United States
| | | | - David R Lairson
- Department of Management Policy and Community Health, UTHealth School of Public Health, Houston, TX, United States
| | - Ronald E Myers
- Division of Population Science, Department of Medical Oncology, Sidney Kimmel Cancer Center, Thomas Jefferson University, Philadelphia, PA, United States
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11
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Gong E, Chukwuma A, Ghazaryan E, de Walque D. Invitations and incentives: a qualitative study of behavioral nudges for primary care screenings in Armenia. BMC Health Serv Res 2020; 20:1110. [PMID: 33261604 PMCID: PMC7709231 DOI: 10.1186/s12913-020-05967-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2020] [Accepted: 11/25/2020] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Non-communicable diseases account for a growing proportion of deaths in Armenia, which require early detection to achieve disease control and prevent complications. To increase rates of screening, demand-side interventions of personalized invitations, descriptive social norms, labeled cash transfers, and conditional cash transfers were tested in a field experiment. Our complementary qualitative study explores factors leading to the decision to attend screening and following through with that decision, and experiences with different intervention components. METHODS Informed by the Health Belief Model as our conceptual framework, we collected eighty in-depth interviews with service users and twenty service providers and analyzed them using open coding and thematic analysis. RESULTS An individual's decision to screen depends on 1) the perceived need for screening based on how they value their own health and perceive hypertension and diabetes as a harmful but manageable condition, and 2) the perceived utility of a facility-based screening, and whether screening will provide useful information on disease status or care management and is socially acceptable. Following through with the decision to screen depends on their knowledge of and ability to attend screenings, as well as any external motivators such as an invitation or financial incentive. CONCLUSIONS Personalized invitations from physicians can prompt individuals to reconsider their need for screening and can, along with financial incentives, motivate individuals to follow through with the decision to screen. The effect of descriptive social norms in invitations should be further studied. Efforts to increase preventive screenings as an entry point into primary care in Armenia may benefit from implementation of tailored messages and financial incentives. TRIAL REGISTRATION The protocol was approved on January 11, 2019 by the Institutional Review Board of the Center of Medical Genetics and Primary Health Care in Armenia (02570094). https://www.socialscienceregistry.org/trials/3776 .
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Affiliation(s)
- Estelle Gong
- Mount Sinai Health System, New York, NY 10019 USA
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12
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Raynault MF, Féthière C, Côté D. Social inequalities in breast cancer screening: evaluating written communications with immigrant Haitian women in Montreal. Int J Equity Health 2020; 19:209. [PMID: 33228706 PMCID: PMC7685600 DOI: 10.1186/s12939-020-01322-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2019] [Accepted: 11/10/2020] [Indexed: 01/09/2023] Open
Abstract
Background The province of Quebec (Canada) has implemented a breast cancer screening program to diagnose this cancer at an early stage. The strategy is to refer women 50 to 69 years old for a mammogram every two years by sending an invitation letter that acts as a prescription. Ninety per cent (90%) of deaths due to breast cancer occur in women aged 50 and over. Numerous studies have shown social inequalities in health for most diseases. With breast cancer, a significant paradox arises: its incidence is lower among disadvantaged women and yet, more of them die from this disease. The health care system might play a role in this inequality. The scientific literature documents the potential for creating such inequalities when prevention does not consider equity among social groups. Immigrant women are often disadvantaged. They die of breast cancer more than non-immigrants. Studies attribute this to late-stage diagnosis due to poor adherence to mammography screening programs. Purpose of the study The main objective of our research is to assess how Haitian immigrant women in Montreal are reached by the Quebec Breast Cancer Screening Program, and specifically how they perceive the mammogram referral letter sent by the program. Methods The study uses a two-step qualitative method: i) In-depth interviews with influential community workers to identify the most relevant issues; ii) Focus groups with disadvantaged women from Montreal’s Haitian community. Results A mammogram referral letter from the Breast Cancer Screening Program may be a barrier to compliance with mammography by underprivileged Haitian women in Montreal. This might be attributable to a low level of literacy, poor knowledge of the disease, and lack of financial resources. Conclusion Barriers may be underestimated in underprivileged immigrant and non-immigrant communities. A preventive strategy must be adapted to different sub-groups and must also take into account lower literacy levels. To increase mammography uptake, it is crucial that the benefits of prevention be clearly identified and described in understandable terms. Finally, economic access to follow-up measures should be considered.
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Affiliation(s)
- Marie-France Raynault
- Lea-Roback Research Centre on Social Inequalities in Health, CHUM-Centre hospitalier de l'Université de Montréal, 1301, Sherbrooke East, Montreal, Quebec, H2L 1M3, Canada. .,School of Public Health, University of Montreal, 7101, av. du Parc, Montreal, Quebec, H3N 1X9, Canada.
| | - Christelle Féthière
- School of Public Health, University of Montreal, 7101, av. du Parc, Montreal, Quebec, H3N 1X9, Canada
| | - Dominique Côté
- Lea-Roback Research Centre on Social Inequalities in Health, CHUM-Centre hospitalier de l'Université de Montréal, 1301, Sherbrooke East, Montreal, Quebec, H2L 1M3, Canada
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Barba D, León-Sosa A, Lugo P, Suquillo D, Torres F, Surre F, Trojman L, Caicedo A. Breast cancer, screening and diagnostic tools: All you need to know. Crit Rev Oncol Hematol 2020; 157:103174. [PMID: 33249359 DOI: 10.1016/j.critrevonc.2020.103174] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2020] [Revised: 09/18/2020] [Accepted: 11/05/2020] [Indexed: 02/06/2023] Open
Abstract
Breast cancer is one of the most frequent malignancies among women worldwide. Methods for screening and diagnosis allow health care professionals to provide personalized treatments that improve the outcome and survival. Scientists and physicians are working side-by-side to develop evidence-based guidelines and equipment to detect cancer earlier. However, the lack of comprehensive interdisciplinary information and understanding between biomedical, medical, and technology professionals makes innovation of new screening and diagnosis tools difficult. This critical review gathers, for the first time, information concerning normal breast and cancer biology, established and emerging methods for screening and diagnosis, staging and grading, molecular and genetic biomarkers. Our purpose is to address key interdisciplinary information about these methods for physicians and scientists. Only the multidisciplinary interaction and communication between scientists, health care professionals, technical experts and patients will lead to the development of better detection tools and methods for an improved screening and early diagnosis.
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Affiliation(s)
- Diego Barba
- Escuela de Medicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Mito-Act Research Consortium, Quito, Ecuador
| | - Ariana León-Sosa
- Escuela de Medicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Mito-Act Research Consortium, Quito, Ecuador
| | - Paulina Lugo
- Hospital de los Valles HDLV, Quito, Ecuador; Fundación Ayuda Familiar y Comunitaria AFAC, Quito, Ecuador
| | - Daniela Suquillo
- Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Mito-Act Research Consortium, Quito, Ecuador; Ingeniería en Procesos Biotecnológicos, Colegio de Ciencias Biológicas y Ambientales COCIBA, Universidad San Francisco de Quito USFQ, Quito, Ecuador
| | - Fernando Torres
- Escuela de Medicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Hospital de los Valles HDLV, Quito, Ecuador
| | - Frederic Surre
- University of Glasgow, James Watt School of Engineering, Glasgow, G12 8QQ, United Kingdom
| | - Lionel Trojman
- LISITE, Isep, 75006, Paris, France; Universidad San Francisco de Quito USFQ, Colegio de Ciencias e Ingenierías Politécnico - USFQ, Instituto de Micro y Nanoelectrónica, IMNE, USFQ, Quito, Ecuador
| | - Andrés Caicedo
- Escuela de Medicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Instituto de Investigaciones en Biomedicina, Universidad San Francisco de Quito USFQ, Quito, Ecuador; Mito-Act Research Consortium, Quito, Ecuador; Sistemas Médicos SIME, Universidad San Francisco de Quito USFQ, Quito, Ecuador.
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Pati MK, Swaroop N, Kar A, Aggarwal P, Jayanna K, Van Damme W. A narrative review of gaps in the provision of integrated care for noncommunicable diseases in India. Public Health Rev 2020; 41:8. [PMID: 32435518 PMCID: PMC7222468 DOI: 10.1186/s40985-020-00128-3] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/16/2019] [Accepted: 04/27/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Low- and middle-income countries (LMICs) account for a higher burden of noncommunicable diseases (NCD) and home to a higher number of premature deaths (before age 70) from NCDs. NCDs have become an integral part of the global development agenda; hence, the scope of action on NCDs extends beyond just the health-related sustainable development goal (SDG 3). However, the organization and integration of NCD-related health services have faced several gaps in the LMIC regions such as India. Although the national NCD programme of India has been in operation for a decade, challenges remain in the integration of NCD services at primary care. In this paper, we have analysed existing gaps in the organization and integration of NCD services at primary care and suggested plausible solutions that exist. METHOD The identification of gaps is based out of a review of peer-reviewed articles, reports on national and global guidelines/protocols. The gaps are organized and narrated at four levels such as community, facility, health system, health policy and research, as per the WHO Innovative Care for Chronic Conditions framework (WHO ICCC). RESULT The review found that challenges in the identification of eligible beneficiaries, shortage and poor capacity of frontline health workers, poor functioning of community groups and poor community knowledge on NCD risk factors were key gaps at the community level. Challenges at facility level such as poor facility infrastructure, lack of provider knowledge on standards of NCD care and below par quality of care led to poor management of NCDs. At the health system level, we found, organization of care, programme management and monitoring systems were not geared up to address NCDs. Multi-sectoral collaboration and coordination were proposed at the policy level to tackle NCDs; however, gaps remained in implementation of such policies. Limited research on the effect of health promotion, prevention and, in particular, non-medical interventions on NCDs was found as a key gap at the research level. CONCLUSION This paper reinforces the need for an integrated comprehensive model of NCD care especially at primary health care level to address the growing burden of these diseases. This overarching review is quite relevant and useful in organizing NCD care in Indian and similar LMIC settings.
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Affiliation(s)
- Manoj Kumar Pati
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
| | - N. Swaroop
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
| | - Arin Kar
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
| | | | - Krishnamurthy Jayanna
- Karnataka Health Promotion Trust, IT Park, 5th floor, 1-4, Rajajinagar Industrial Area behind KSSIDC Admin Office, Rajajinagar, Bangalore, Karnataka 560044 India
- Centre for Global Public Health, University of Manitoba, Winnipeg, Canada
| | - Wim Van Damme
- Health Policy Department, Institute of Tropical Medicine, Antwerp, Belgium
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15
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Riordan F, Racine E, Smith SM, Murphy A, Browne J, Kearney PM, Bradley C, James M, Murphy M, McHugh SM. Feasibility of an implementation intervention to increase attendance at diabetic retinopathy screening: protocol for a cluster randomised pilot trial. Pilot Feasibility Stud 2020; 6:64. [PMID: 32426158 PMCID: PMC7216495 DOI: 10.1186/s40814-020-00608-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/27/2019] [Accepted: 04/23/2020] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Diabetic retinopathy screening (DRS) leads to the earlier detection of retinopathy and treatment that can prevent or delay the development of diabetes-related blindness. However, uptake continues to be sub-optimal in many countries, including Ireland. Routine management of type 2 diabetes largely takes place in primary care. As such, there may be an opportunity in primary care to introduce interventions to improve DRS uptake. However, few studies test the feasibility of interventions to enhance DRS uptake in this context. Our aim is to investigate the feasibility of an implementation intervention (IDEAs (Improving Diabetes Eye screening Attendance)) delivered in general practice to improve the uptake of the national DRS programme, RetinaScreen. METHODS The IDEAs study is a cluster randomised pilot trial with an embedded process evaluation and economic evaluation. Following stratification by practice size, eight general practices (clusters) will be randomly allocated to intervention (n = 4) or wait-list control groups (n = 4). The intervention will be delivered for 6 months, after which, it will be administered to wait-list control practices. The intervention is multi-faceted and comprises provider-level components (training, audit and feedback, health care professional prompt, reimbursement) and patient-level components (GP-endorsed reminder with information leaflet delivered opportunistically face-to-face, and systematically by phone and letter). Patient inclusion criteria are type 1 or type 2 diabetes and DRS programme non-attendance. A multi-method approach will be used to determine screening uptake, evaluate the trial and study procedures and examine the acceptability and feasibility of the intervention from staff and patient perspectives. Quantitative and qualitative data will be collected on intervention uptake and delivery, research processes and outcomes. Data will be collected at the practice, health professional and patient level. A partial economic evaluation will be conducted to estimate the cost of delivering the implementation intervention in general practice. Formal continuation criteria will be used to determine whether IDEAs should progress to a definitive trial. DISCUSSION Findings will determine whether IDEAsis feasible and acceptable and will be used to refine the intervention and study procedures. A definitive trial will determine whether IDEAs is a cost-effective intervention to improve DRS uptake and reduce diabetes-related blindness. TRIAL REGISTRATION ClinicalTrials.gov NCT03901898. Registered 3rd April 2019.
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Affiliation(s)
- Fiona Riordan
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Emmy Racine
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Susan M. Smith
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Aileen Murphy
- Department of Economics, Cork University Business School, University College Cork, Cork, Ireland
| | - John Browne
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Patricia M. Kearney
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
| | - Colin Bradley
- Department of General Practice, University College Cork, Cork, Ireland
| | - Mark James
- Medical Education Unit, University College Cork, Cork, Ireland
| | - Mark Murphy
- Department of General Practice, Royal College of Surgeons of Ireland, Dublin, Ireland
| | - Sheena M. McHugh
- School of Public Health, University College Cork, Western Gateway Building, Western Rd, Cork, Ireland
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Beauchamp A, Mohebbi M, Cooper A, Pridmore V, Livingston P, Scanlon M, Davis M, O’Hara J, Osborne R. The impact of translated reminder letters and phone calls on mammography screening booking rates: Two randomised controlled trials. PLoS One 2020; 15:e0226610. [PMID: 31923178 PMCID: PMC6953872 DOI: 10.1371/journal.pone.0226610] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2019] [Accepted: 11/26/2019] [Indexed: 12/20/2022] Open
Abstract
INTRODUCTION Participation in mammographic screening for breast cancer in Australia is approximately 54% among the general population, but screening among women from some culturally and linguistically diverse (CALD) backgrounds is lower. BreastScreen Victoria apply strategies to increase screening including reminder letters and phone calls; however, these are usually provided in English. Using intervention strategies generated from the Ophelia (OPtimise HEalth LIteracy and Access) community co-design process, translated mammography reminder letters and in-language phone calls were tested within two randomised control trials (RCTs). METHODS AND ANALYSIS Women aged 50-75 years who were due for their 2-yearly screening mammography (for RCT#1) or were under-screened, i.e. ≥27 months since last screen (for RCT#2) were randomised into intervention or control groups. RCT#1 compared sending women routine reminder letters (English only) with translated (Arabic or Italian) letters. RCT#2 compared reminder telephone calls to women in their preferred language (Arabic or Italian) to no telephone call. The primary outcome for each trial was screening booking rates within 14-days. Primary outcomes were tested using Pearson's chi-square test. Rates within language group (incidence ratio: IR) were compared using the Cochran-Mantel-Haenszel test. RESULTS For RCT#1 (letters) 1,032 women were randomised into the intervention arm or to usual care. Uptake of screening bookings was similar between both groups, with no differences observed by language group. For RCT#2 (phone calls), 195 women were randomised to the intervention group or to usual care. Overall, 64.2% of women in the intervention arm and 6% in the control arm booked a screening appointment within 14 days (p<0.0001). The IR (95%CI) of booking was 10.1 (3.9, 26.3) times higher among Italian women, and 11.6 (2.9, 46.5) times higher among Arabic women in the intervention compared to usual care groups. DISCUSSION AND CONCLUSION A service improvement initiative derived from community members and breast screen providers was found to be highly effective. This evidence informed the service provider, BreastScreen Victoria, who have implemented these improvements into routine practice to improve screening among CALD groups and reduce health inequalities.
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Affiliation(s)
- Alison Beauchamp
- Department of Medicine–Western Health, University of Melbourne, Melbourne, Australia
- Australian Institute for Musculoskeletal Science (AIMSS), Melbourne, Australia
- Faculty of Health, Deakin University, Geelong, Australia
- Monash Rural Health, Warragul, Australia
| | | | | | | | | | | | | | | | - Richard Osborne
- Faculty of Health, Deakin University, Geelong, Australia
- Centre for Global Health and Equity, Faculty of Health, Arts and Design, Swinburne University of Technology, Hawthorn, Australia
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Communication Channels Used by Women to Contact a Population-Based Breast Cancer Screening Program in Catalonia, Spain. J Med Syst 2019; 43:244. [PMID: 31236712 DOI: 10.1007/s10916-019-1382-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/20/2017] [Accepted: 06/10/2019] [Indexed: 10/26/2022]
Abstract
Communication is a corner stone of population-based breast cancer screening programs that need to invite all the women from their target population and provide them with balanced information on screening to guaranty informed participation. Invited women also need to be able to contact screening programs to get further information on screening procedures and/or cancel and reschedule appointments. This study describes the communication channels used by women invited for breast cancer screening to contact the program. The study population consisted of 141,684 women, aged 50-69 years, who were invited during 2015-2016 for screening by the Catalan Breast Cancer Screening Program (Spain). Multiple logistic regression models were performed to assess the association between age, screening history, socioeconomic status and reasons for contacting the program and the outcome variables (contact with the program; contact through information and communication technology (ICT) channels). Among the 141,684 women invited for BC screening, 22.5% contacted the screening office mainly to reschedule (42.2%) and cancel (29.2%) appointments. While the communication channel mostly used was the telephone, 24.8% of the women used ICT. ICT was more frequently used by women who had never been screened. Women who wanted to change their appointment were 65% (OR 1.65, 95%CI 1.54-1.76) more likely to use ICT than women who wanted to cancel it. This study showed the need to reinforce communication between women and breast cancer screening programs and the importance of offering communication channels suiting all women's needs to facilitate appointments' rescheduling and cancelling and therefore improve screening programs' efficiency.
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Gianino MM, Lenzi J, Bonaudo M, Fantini MP, Siliquini R, Ricciardi W, Damiani G. Organized screening programmes for breast and cervical cancer in 17 EU countries: trajectories of attendance rates. BMC Public Health 2018; 18:1236. [PMID: 30400786 PMCID: PMC6220470 DOI: 10.1186/s12889-018-6155-5] [Citation(s) in RCA: 26] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/25/2018] [Accepted: 10/26/2018] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The aim was to analyse participation trajectories in organised breast and cervical cancer screening programmes and the association between socioeconomic variables and participation. METHODS A pooled, cross-sectional, time series analysis was used to evaluate secondary data from 17 European countries in 2004-2014. RESULTS The results show that the mammographic screening trend decreases after an initial increase (coefficient for the linear term = 0.40; p = 0.210; 95% CI = - 0.25, 1.06; coefficient for the quadratic term = - 0.07; p = 0.027; 95% CI = - 0.14, - 0.01), while the cervical screening trend is essentially stable (coefficient for the linear term = 0.39, p = 0.312, 95% CI = - 0.42, 1.20; coefficient for the quadratic term = 0.02, p = 0.689, 95% CI = - 0.07, 0.10). There is a significant difference among the country-specific slopes for breast and cervical cancer screening (SD = 16.7, p < 0.001; SD = 14.4, p < 0.001, respectively). No association is found between participation rate and educational level, income, type of employment, unemployment and preventive expenditure. However, participation in cervical cancer screening is significantly associated with a higher proportion of younger women (≤ 49 years) and a higher Gini index (that is, higher income inequality). CONCLUSIONS In conclusion three messages: organized cancer screening programmes may reduce the socioeconomic inequalities in younger people's use of preventive services over time; socioeconomic variables are not related to participation rates; these rates do not reach a level of stability in several countries. Therefore, without effective recruitment strategies and tailored organizations, screening participation may not achieve additional gains.
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Affiliation(s)
- Maria Michela Gianino
- Department of Public Health Sciences and Pediatrics, Università di Torino, Via Santena 5 bis, 10126 Turin, Italy
| | - Jacopo Lenzi
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - Università di Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy
| | - Marco Bonaudo
- Department of Public Health Sciences and Pediatrics, Università di Torino, Via Santena 5 bis, 10126 Turin, Italy
| | - Maria Pia Fantini
- Department of Biomedical and Neuromotor Sciences, Alma Mater Studiorum - Università di Bologna, Via Ugo Foscolo 7, 40123 Bologna, Italy
| | - Roberta Siliquini
- Department of Public Health Sciences and Pediatrics, Università di Torino, Via Santena 5 bis, 10126 Turin, Italy
| | - Walter Ricciardi
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCSS, Largo Agostino Gemelli 8, 00168 Roma, Italy
- Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Roma, Italy
| | - Gianfranco Damiani
- Fondazione Policlinico Universitario ‘Agostino Gemelli’ IRCSS, Largo Agostino Gemelli 8, 00168 Roma, Italy
- Istituto di Sanità Pubblica, Università Cattolica del Sacro Cuore, Largo Francesco Vito 1, 00168 Roma, Italy
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Allgood KL, Hunt B, Kanoon JM, Simon MA. Evaluation of Mammogram Parties as an Effective Community Navigation Method. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2018; 33:1061-1068. [PMID: 28290092 PMCID: PMC5840031 DOI: 10.1007/s13187-017-1206-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/19/2023]
Abstract
Women of color do not have the same level of access to mammography services as their White counterparts, and this inequity may be one of the contributing factors to the documented racial disparity in breast cancer mortality in the US. The present study sought to assess the effectiveness of the mammogram party, a promising, but under-studied approach to increasing mammography uptake, particularly among under-served populations. The program targeted mammogram-eligible women in community settings on the west and southwest sides of Chicago, gathering basic demographic information, mammography history, and interest in assistance obtaining a mammogram. Women were navigated either through traditional one-on-one navigation or to a mammogram party. Seven outcome metrics were calculated for each type of navigation. We compared navigation outcomes for those who attended to those who did not attend a mammogram party using two-tailed t tests and chi-square tests. We found that the mammography completion rate for mammogram parties was comparable to that for standard one-on-one navigation (65.8 vs. 63.7%), which is more labor-intensive as evidenced by the number of contacts needed to successfully navigate a woman to mammography (10.9 vs. 15.0). Mammogram parties offer a unique opportunity for fellowship and support for clients who are particularly fearful of mammograms or identifying breast cancer. Programmatically, mammogram parties are an efficient way to complete several mammograms in 1 day. Having the option to both navigate women to mammogram parties or one-on-one navigation allows for more flexibility for scheduling and may ensure a completed a mammogram.
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Affiliation(s)
- Kristi L Allgood
- Sinai Health System, Sinai Urban Health Institute, 1500 S. Fairfield Avenue, K435, Chicago, IL, 60608, USA.
| | - Bijou Hunt
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
| | - Jacqueline M Kanoon
- Sinai Health System, Sinai Urban Health Institute, 1500 S. Fairfield Avenue, K435, Chicago, IL, 60608, USA
- Sinai Health System, Sinai Urban Health Institute, Chicago, IL, USA
- Office of Community Engaged Research and Implementation Science (OCERIS), University of Illinois Cancer Center, Chicago, IL, USA
- University of Illinois at Chicago, Chicago, IL, USA
| | - Melissa A Simon
- Department of Obstetrics and Gynecology, Robert H. Lurie Comprehensive Cancer Center, Chicago, IL, USA
- Department of Preventive Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
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20
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Valuing Healthcare Improvement: Implicit Norms, Explicit Normativity, and Human Agency. HEALTH CARE ANALYSIS 2018; 26:189-205. [PMID: 29058204 DOI: 10.1007/s10728-017-0350-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
I argue that greater attention to human agency and normativity in both researching and practicing service improvement may be one strategy for enhancing improvement science, illustrating with examples from cancer screening. Improvement science tends to deliberately avoid explicit normativity, for paradigmatically coherent reasons. But there are good reasons to consider including explicit normativity in thinking about improvement. Values and moral judgements are central to social life, so an adequate account of social life must include these elements. And improvement itself is unavoidably normative: it assumes that things could and should be better than they are. I seek to show that normativity will always be implicated in the creation of evidence, the design of programs, the practice of healthcare, and in citizens' judgements about that care, and to make a case that engaging with this normativity is worthwhile.
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21
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Slater JS, Parks MJ, Nelson CL, Hughes KD. The Efficacy of Direct Mail, Patient Navigation, and Incentives for Increasing Mammography and Colonoscopy in the Medicaid Population: A Randomized Controlled Trial. Cancer Epidemiol Biomarkers Prev 2018; 27:1047-1056. [PMID: 29891726 DOI: 10.1158/1055-9965.epi-18-0038] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2018] [Revised: 03/24/2018] [Accepted: 06/05/2018] [Indexed: 12/20/2022] Open
Abstract
Background: Despite lower cancer screening rates and survival rates in the Medicaid population compared with those with private insurance, there is a dearth of population-based, evidence-based interventions targeting Medicaid clients to address this problem.Methods: This study reports results of a population-based randomized controlled trial (RCT) among all individuals enrolled in Minnesota's Medicaid program who were overdue for breast cancer (n = 22,113) and/or colorectal cancer (n = 94,294) screening. Individuals were randomized to intervention or control groups. The intervention group received persuasive and innovative direct mail materials coupled with a $20 incentive for using their Medicaid benefit to get screened. Direct mail materials provided a phone number to a call center staffed by patient navigators who addressed barriers and scheduled appointments via three-way calls. The control group received the intervention 15 months later. Primary outcomes were completion of mammography or colonoscopy within 12 weeks of the intervention. Billing claims served as evidence of screening.Results: Multivariate logistic regression showed significant differences for both breast cancer (P < 0.001) and colorectal cancer (P < 0.01). The odds of receiving a mammogram for the treatment group were significantly higher than the control group [OR = 1.30; 95% confidence interval (95% CI) = 1.16-1.46], and the treatment group was more likely to receive a colonoscopy than the control group (OR = 1.12; 95% CI = 1.04-1.21).Conclusions: This population-based intervention increased breast cancer and colorectal cancer screening in a Medicaid population overdue for screening.Impact: These findings may have broad application for reaching individuals who generally remain outside the health care system despite having public health insurance. Cancer Epidemiol Biomarkers Prev; 27(9); 1047-56. ©2018 AACR.
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Affiliation(s)
- Jonathan S Slater
- Minnesota Department of Health, Cancer Control Section, St. Paul, Minnesota.
| | - Michael J Parks
- Minnesota Department of Health, Cancer Control Section, St. Paul, Minnesota
| | - Christina L Nelson
- Minnesota Department of Health, Cancer Control Section, St. Paul, Minnesota
| | - Kelly D Hughes
- Minnesota Department of Health, Cancer Control Section, St. Paul, Minnesota
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22
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Buist DSM, Gao H, Anderson ML, Onega T, Brandzel S, Rabelhofer MA, Bradford SC, Aiello Bowles EJ. Breast cancer screening outreach effectiveness: Mammogram-specific reminders vs. comprehensive preventive services birthday letters. Prev Med 2017; 102:49-58. [PMID: 28655547 PMCID: PMC5638650 DOI: 10.1016/j.ypmed.2017.06.028] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2017] [Revised: 06/19/2017] [Accepted: 06/22/2017] [Indexed: 12/28/2022]
Abstract
We compared the effectiveness of two outreach strategies on timely mammography adherence: a mammogram-specific reminder letter (sent just before a woman was due) to a birthday letter (addresses multiple preventive services and not timed around due dates). We evaluated screening mammography adherence following 79,848 mammogram-specific and 151,626 birthday letters mailed between 2002 and 2012 to women aged 40-74years enrolled in Kaiser Permanente Washington. Screening mammogram adherence was specifically tied to due date and was evaluated separately by age group and up-to-date or overdue status at the time of mailing. We used generalized estimating equations to account for correlation between repeated observations, to model the odds of screening mammography adherence by letter type. Among women up-to-date, adherence following birthday letters was 22-76% lower compared to the mammogram-specific reminders, with the greatest decreases in adherence in women aged 70-74. Birthday letters were more effective at activating screening uptake among some subgroups of overdue women aged 50-69 and most overdue women aged 70-74, but universally low adherence rates were observed in overdue women. Increasing number of recommended services for women aged 50-74 who were up-to-date resulted in 12-17% lower mammography adherence, but had no effect in women aged 40-49 or in overdue women. Birthday letters are less effective than mammogram-specific reminder letters at prompting women to undergo timely breast cancer screening, particularly among women up-to-date with screening. Birthday letters may be effective at increasing overall preventive care; however, supplemental outreach may be needed around the due date to increase timely preventive services receipt.
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Affiliation(s)
- Diana S M Buist
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Hongyuan Gao
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Melissa L Anderson
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Tracy Onega
- Geisel School of Medicine, Dartmouth, 1 Rope Ferry Rd, Hanover, NH 03755, USA.
| | - Susan Brandzel
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA; Health Stories Project Insights, 601 Union Street, Suite 4820, Seattle, WA 98101, USA.
| | - Melissa A Rabelhofer
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
| | - Susan Carol Bradford
- Kaiser Permanente Washington, Clinical Prevention and Improvement, 310 15th Ave E, Seattle, WA 98112, USA.
| | - Erin J Aiello Bowles
- Kaiser Permanente Washington Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA 98101, USA.
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23
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Kendall CE, Walmsley S, Lau C, Jembere N, Burchell AN, Loutfy M, Raboud J, Rosenes R, Rourke SB, Antoniou T. A cross-sectional population-based study of breast cancer screening among women with HIV in Ontario, Canada. CMAJ Open 2017; 5:E673-E681. [PMID: 28855308 PMCID: PMC5621963 DOI: 10.9778/cmajo.20170038] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND As women with HIV live longer, the need for age-appropriate breast cancer screening will increase. We compared rates of screening mammography among women with and without HIV. METHODS We used administrative health databases to identify all women in Ontario, Canada, who were eligible for screening mammography (aged 50 to 74 yr and no history of breast cancer) as of Apr. 1, 2011. We used multivariable log-binomial regression to compare the 2-year period prevalence of screening mammography in 2011 to 2013 among women with and without HIV and to examine the correlates of screening among women with HIV. RESULTS We identified 1 447 015 screen-eligible women, among whom 623 (0.04%) were women with HIV. Women with HIV were less likely to undergo screening than women without HIV (50.1% v. 63.4%, p < 0.001). Following multivariable adjustment, HIV-positive status was associated with significantly lower odds of undergoing mammography (adjusted prevalence ratio [PR] 0.83, 95% confidence interval [CI] 0.77-0.89). Compared with women with HIV receiving regular care from both a family physician and an HIV specialist, women with HIV receiving neither kind of care (adjusted PR 0.64, 95% CI 0.50-0.83) or predominantly specialist care (adjusted PR 0.77; 95% CI 0.60 to 0.97) were less likely to undergo screening mammography. INTERPRETATION Women with HIV are less likely to undergo breast cancer screening mammography than women without HIV. Addressing this disparity requires optimizing care delivery to ensure adequate provision of comprehensive primary care to people with HIV.
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Affiliation(s)
- Claire E Kendall
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Sharon Walmsley
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Cindy Lau
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Nathaniel Jembere
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Ann N Burchell
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Mona Loutfy
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Janet Raboud
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Ron Rosenes
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Sean B Rourke
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
| | - Tony Antoniou
- Affiliations: C.T. Lamont Primary Health Care Research Centre (Kendall), Bruyère Research Institute, Ottawa, Ont.; Toronto General Hospital Research Institute (Walmsley, Raboud), University Health Network; Institute for Clinical Evaluative Sciences and the University of Toronto (Lau, Jembere); Department of Family and Community Medicine and Centre for Urban Health Solutions (Burchell), Li Ka Shing Knowledge Institute, St. Michael's Hospital, and the Department of Family and Community Medicine (Burchell), University of Toronto; Women's College Research Institute (Loutfy), Women's College Hospital; Community health advocate and consultant (Rosenes); Ontario HIV Treatment Network (Rourke); Department of Family Medicine (Antoniou), St. Michael's Hospital, Toronto, Ont
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24
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Secginli S, Nahcivan NO, Gunes G, Fernandez R. Interventions Promoting Breast Cancer Screening Among Turkish Women With Global Implications: A Systematic Review. Worldviews Evid Based Nurs 2017; 14:316-323. [PMID: 28605115 DOI: 10.1111/wvn.12245] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/21/2016] [Indexed: 11/28/2022]
Abstract
BACKGROUND Breast cancer is a major health concern and remains the most common malignancy in women worldwide and in Turkey. Mammography, clinical breast examination (CBE), and breast self-examination (BSE) are recommended methods to detect early breast cancer in women. Many strategies have been developed to increase the rates of mammography, CBE, and BSE among Turkish women. Despite the benefits of breast cancer screening, these modalities are still underutilized by the majority of Turkish women. AIM To systematically review the scientific evidence on the effectiveness of various strategies aimed at improving screening behaviors for breast cancer in Turkish women. METHODS A systematic review of the literature published between 2000 and 2015 was conducted, searching 10 databases of Ovid MEDLINE, PubMed, Cochrane CENTRAL Register of Controlled Trials, CINAHL, PsycINFO, Web of Knowledge, Scopus, Google Scholar, ULAKBIM Turkish Medical Database, and Council of Higher Education Thesis Center. RESULTS Twenty-three studies were included in the final review. The majority of the studies investigated the effects of multiple strategies to improve BSE. Group education comprised educational sessions, printed and audiovisual materials, which significantly improved BSE, CBE, and mammography screening rates at 3 months, 6 months, and 12 months after the intervention. One-to-one education demonstrated no significant difference in BSE rates at 6-month and 12-month follow-up. However, one-to-one education demonstrated significant differences in CBE and mammography rates at the 3-month follow-up. LINKING EVIDENCE TO ACTION The use of group education comprising a multicomponent intervention demonstrated an increase in breast-screening behaviors among Turkish women. Further research investigating the duration of educational interventions is needed in order to suggest a "dose response."
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Affiliation(s)
- Selda Secginli
- Associate Professor, Public Health Nursing Department, Florence Nightingale Nursing Faculty, Istanbul University, Sisli, Istanbul, Turkey
| | - Nursen O Nahcivan
- Professor, Public Health Nursing Department, Florence Nightingale Nursing Faculty, Istanbul University, Sisli, Istanbul, Turkey
| | - Gussun Gunes
- Assistant Professor, Library and Documentation Department, Marmara University, Goztepe Campus, Kadikoy, Istanbul, Turkey
| | - Ritin Fernandez
- Professor, School of Nursing and Midwifery, Faculty of Science, Medicine and Health, University of Wollongong, Wollongong.,Centre for Research in Nursing and Health, St. George Hospital, Kogarah, NSW, Australia
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25
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Persell SD, Brown T, Lee JY, Henley E, Long T, Sanchez T, Knight R. Mailed outreach and facilitated test ordering to promote cholesterol screening in community health centers: A randomized trial. J Eval Clin Pract 2017; 23:620-624. [PMID: 28028918 DOI: 10.1111/jep.12687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2016] [Revised: 11/09/2016] [Accepted: 11/10/2016] [Indexed: 11/30/2022]
Abstract
RATIONALE, AIMS, AND OBJECTIVES Lipid screening is central to cardiovascular risk assessment. We sought to determine whether a simple mailed outreach message and facilitated test ordering increase cholesterol screening among federally qualified community health center patients with no recent cholesterol screening test performed. METHODS Using a patient-randomized controlled trial, we examined the effects of delivering a simple mailed outreach intervention promoting cholesterol testing and facilitated test ordering (without requiring an office visit). Participants were adult patients 50 to 75 years old, with no diagnosed cardiovascular disease or diabetes, and no cholesterol test within 5 years who had received care from community health centers in Illinois and Arizona. The intervention took place in 2014 and was powered to detect a 10% increase in screening due to the intervention. RESULTS Participants' (n = 480) mean age was 57.5 years, 51.0% were male, and 43.8% were smokers. There was no significant difference between groups in the primary study outcome-completion of total cholesterol and high-density lipoprotein cholesterol tests or complete lipid panel within 3 months; 32 participants (13.3%) in intervention group versus 26 (10.8%) in control group met the primary outcome, with absolute difference of 2.5 percentage points (95% confidence interval -6.6 to 11.6). CONCLUSIONS This outreach intervention promoting cholesterol screening was ineffective. Interventions that attempt to minimize barriers to cholesterol screening on multiple fronts and that are more compelling to patients are needed.
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Affiliation(s)
- Stephen D Persell
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA.,Center for Primary Care Innovation, Institute for Public Health and Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Tiffany Brown
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Ji Young Lee
- Division of General Internal Medicine and Geriatrics, Department of Medicine, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA
| | - Eric Henley
- North Country Healthcare, Flagstaff, AZ, USA
| | - Timothy Long
- Near North Health Service Corporation, Chicago, IL, USA.,Alliance of Chicago Community Health Services, Chicago, IL, USA
| | - Thomas Sanchez
- Near North Health Service Corporation, Chicago, IL, USA.,Heartland Health Outreach, Chicago, IL, USA
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Raine R, Atkin W, von Wagner C, Duffy S, Kralj-Hans I, Hackshaw A, Counsell N, Moss S, McGregor L, Palmer C, Smith SG, Thomas M, Howe R, Vart G, Band R, Halloran SP, Snowball J, Stubbs N, Handley G, Logan R, Rainbow S, Obichere A, Smith S, Morris S, Solmi F, Wardle J. Testing innovative strategies to reduce the social gradient in the uptake of bowel cancer screening: a programme of four qualitatively enhanced randomised controlled trials. PROGRAMME GRANTS FOR APPLIED RESEARCH 2017. [DOI: 10.3310/pgfar05080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BackgroundBowel cancer screening reduces cancer-specific mortality. There is a socioeconomic gradient in the uptake of the English NHS Bowel Cancer Screening Programme (BCSP), which may lead to inequalities in cancer outcomes.ObjectiveTo reduce socioeconomic inequalities in uptake of the NHS BCSP’s guaiac faecal occult blood test (gFOBt) without compromising uptake in any socioeconomic group.DesignWorkstream 1 explored psychosocial determinants of non-uptake of gFOBt in focus groups and interviews. Workstream 2 developed and tested four theoretically based interventions: (1) ‘gist’ information, (2) a ‘narrative’ leaflet, (3) ‘general practice endorsement’ (GPE) and (4) an ‘enhanced reminder’ (ER). Workstream 3 comprised four national cluster randomised controlled trials (RCTs) of the cost-effectiveness of each intervention.MethodsInterventions were co-designed with user panels, user tested using interviews and focus groups, and piloted with postal questionnaires. RCTs compared ‘usual care’ (existing NHS BCSP invitations) with usual care plus each intervention. The four trials tested: (1) ‘gist’ leaflet (n = 163,525), (2) ‘narrative’ leaflet (n = 150,417), (3) GPE on the invitation letter (n = 265,434) and (4) ER (n = 168,480). Randomisation was based on day of mailing of the screening invitation. The Index of Multiple Deprivation (IMD) score associated with each individual’s home address was used as the marker of socioeconomic circumstances (SECs). Change in the socioeconomic gradient in uptake (interaction between treatment group and IMD quintile) was the primary outcome. Screening uptake was defined as the return of a gFOBt kit within 18 weeks of the invitation that led to a ‘definitive’ test result of either ‘normal’ (i.e. no further investigation required) or ‘abnormal’ (i.e. requiring referral for further testing). Difference in overall uptake was the secondary outcome.ResultsThe gist and narrative trials showed no effect on the SECs gradient or overall uptake (57.6% and 56.7%, respectively, compared with 57.3% and 58.5%, respectively, for usual care; allp-values > 0.05). GPE showed no effect on the gradient (p = 0.5) but increased overall uptake [58.2% vs. 57.5% in usual care, odds ratio (OR) = 1.07, 95% confidence interval (CI) 1.04 to 1.10;p < 0.0001]. ER showed a significant interaction with SECs (p = 0.005), with a stronger effect in the most deprived IMD quintile (14.1% vs. 13.3% in usual care, OR = 1.11, 95% CI 1.04 to 1.20;p = 0.003) than the least deprived (34.7% vs. 34.9% in usual care OR = 1.00, 95% CI 0.94 to 1.06;p = 0.98), and higher overall uptake (25.8% vs. 25.1% in usual care, OR = 1.07, 95% CI 1.03 to 1.11;p = 0.001). All interventions were inexpensive to provide.LimitationsIn line with NHS policy, the gist and narrative leaflets supplemented rather than replaced existing NHS BCSP information. This may have undermined their effect.ConclusionsEnhanced reminder reduced the gradient and modestly increased overall uptake, whereas GPE increased overall uptake but did not reduce the gradient. Therefore, given their effectiveness and very low cost, the findings suggest that implementation of both by the NHS BCSP would be beneficial. The gist and narrative results highlight the challenge of achieving equitable delivery of the screening offer when all communication is written; the format is universal and informed decision-making mandates extensive medical information.Future workSocioculturally tailored research to promote communication about screening with family and friends should be developed and evaluated.Trial registrationCurrent Controlled Trials ISRCTN74121020.FundingThis project was funded by the National Institute for Health Research (NIHR) Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 5, No. 8. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
| | - Wendy Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Stephen Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Ines Kralj-Hans
- Department of Biostatistics, King’s Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
| | - Allan Hackshaw
- University College London Cancer Trials Centre, London, UK
| | | | - Sue Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Lesley McGregor
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Cecily Palmer
- Department of Applied Health Research, University College London, London, UK
| | - Samuel G Smith
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Mary Thomas
- Department of Applied Health Research, University College London, London, UK
| | - Rosemary Howe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Gemma Vart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Roger Band
- Patient and Public Involvement Representative, Evesham, UK
| | - Stephen P Halloran
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, UK
| | - Julia Snowball
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Neil Stubbs
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, UK
| | - Graham Handley
- NHS Bowel Cancer Screening Programme North East Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, UK
| | - Richard Logan
- NHS Bowel Cancer Screening Programme Eastern Hub, Nottingham University Hospitals, Nottingham, UK
| | - Sandra Rainbow
- NHS Bowel Cancer Screening Programme London Hub, Northwick Park and St Marks Hospitals NHS Trust, Harrow, UK
| | - Austin Obichere
- North Central London Bowel Cancer Screening Centre, University College London Hospitals NHS Foundation Trust, London, UK
| | - Stephen Smith
- NHS Bowel Cancer Screening Programme Midlands and North West Hub, University Hospitals Coventry and Warwickshire NHS Trust, Hospital of St Cross, Rugby, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Francesca Solmi
- Department of Applied Health Research, University College London, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
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Cheong AT, Liew SM, Khoo EM, Mohd Zaidi NF, Chinna K. Are interventions to increase the uptake of screening for cardiovascular disease risk factors effective? A systematic review and meta-analysis. BMC FAMILY PRACTICE 2017; 18:4. [PMID: 28095788 PMCID: PMC5240221 DOI: 10.1186/s12875-016-0579-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/09/2016] [Accepted: 12/26/2016] [Indexed: 11/29/2022]
Abstract
Background Cardiovascular disease (CVD) is the leading cause of death globally. However, many individuals are unaware of their CVD risk factors. The objective of this systematic review is to determine the effectiveness of existing intervention strategies to increase uptake of CVD risk factors screening. Methods A systematic search was conducted through Pubmed, CINAHL, EMBASE and Cochrane Central Register of Controlled Trials. Additional articles were located through cross-checking of the references list and bibliography citations of the included studies and previous review papers. We included intervention studies with controlled or baseline comparison groups that were conducted in primary care practices or the community, targeted at adult populations (randomized controlled trials, non-randomized trials with controlled groups and pre- and post-intervention studies). The interventions were targeted either at individuals, communities, health care professionals or the health-care system. The main outcome of interest was the relative risk (RR) of screening uptake rates due to the intervention. Results We included 21 studies in the meta-analysis. The risk of bias for randomization was low to medium in the randomized controlled trials, except for one, and high in the non-randomized trials. Two analyses were performed; optimistic (using the highest effect sizes) and pessimistic (using the lowest effect sizes). Overall, interventions were shown to increase the uptake of screening for CVD risk factors (RR 1.443; 95% CI 1.264 to 1.648 for pessimistic analysis and RR 1.680; 95% CI 1.420 to 1.988 for optimistic analysis). Effective interventions that increased screening participation included: use of physician reminders (RR ranged between 1.392; 95% CI 1.192 to 1.625, and 1.471; 95% CI 1.304 to 1.660), use of dedicated personnel (RR ranged between 1.510; 95% CI 1.014 to 2.247, and 2.536; 95% CI 1.297 to 4.960) and provision of financial incentives for screening (RR 1.462; 95% CI 1.068 to 2.000). Meta-regression analysis showed that the effect of CVD risk factors screening uptake was not associated with study design, types of population nor types of interventions. Conclusions Interventions using physician reminders, using dedicated personnel to deliver screening, and provision of financial incentives were found to be effective in increasing CVD risk factors screening uptake. Electronic supplementary material The online version of this article (doi:10.1186/s12875-016-0579-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- A T Cheong
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.,Department of Family Medicine, Faculty of Medicine and Health Sciences, Universiti Putra Malaysia, 43400, Serdang, Selangor, Malaysia
| | - S M Liew
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia.
| | - E M Khoo
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - N F Mohd Zaidi
- Department of Primary Care Medicine, University of Malaya Primary Care Research Group (UMPCRG), Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
| | - K Chinna
- Department of Social and Preventive Medicine, Faculty of Medicine, University of Malaya, 50603, Kuala Lumpur, Malaysia
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Brandzel SD, Bowles EJA, Wieneke A, Bradford SC, Kimbel K, Gao H, Buist DS. Cancer Screening Reminders: Addressing the Spectrum of Patient Preferences. Perm J 2017; 21:17-051. [PMID: 29035189 PMCID: PMC5638633 DOI: 10.7812/tpp/17-051] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
CONTEXT Health care systems continue to seek evidence about how to optimize the efficiency and effectiveness of cancer screening reminders. Annual reminders to receive preventive services can be an efficient strategy. OBJECTIVE To understand patient motivators and barriers to cancer screening and preferences about reminder strategies. DESIGN We conducted 11 focus groups among adults recommended for cancer screening within Kaiser Permanente Washington. We held separate focus groups with women aged 21 to 49 years, women 50 to 75 years, and men 50 to 75 years. We used an inductive, validated coding scheme for analysis. MAIN OUTCOME MEASURES Motivators and barriers to obtaining recommended cancer screening and general cancer screening reminder content and modality preferences. RESULTS Half of our participants were women aged 50 to 75 years, and 25% were men aged 50 to 75 years. Differences by age, sex, insurance status, financial status, and health beliefs all drove the participants' preferences for whether they seek these recommended services and how and when they wish to be reminded about recommended cancer screening. Most participants preferred personalized reminders, and many favored receiving reminders less than 3 months before the recommended procedure date rather than a consolidated annual reminder. Younger participants more commonly requested electronic reminders, such as texts and e-mails. CONCLUSION Optimizing cancer screening reminders within a health care system involves a multifaceted approach that enables members to request which form of reminder they prefer (eg, electronic, paper, telephone) and the timing with which they want to be reminded, while staying affordable and manageable to the health care system.
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Affiliation(s)
- Susan D Brandzel
- Insights Director at Health Stories Project Insights in Seattle, WA.
| | - Erin J Aiello Bowles
- Research Associate for Kaiser Permanente Washington Health Research Institute in Seattle.
| | - Arika Wieneke
- Student in the School of Medicine at Western Michigan University in Kalamazoo.
| | | | - Kilian Kimbel
- Research Specialist for Kaiser Permanente Washington Health Research Institute in Seattle.
| | - Hongyuan Gao
- Programmer at Kaiser Permanente Washington Health Research Institute in Seattle.
| | - Diana Sm Buist
- Scientific Investigator for Kaiser Permanente Washington Health Research Institute in Seattle.
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Brandzel S, Chang E, Tuzzio L, Campbell C, Coronado N, Bowles EJA, Bradford SC, Buist DSM. Latina and Black/African American Women's Perspectives on Cancer Screening and Cancer Screening Reminders. J Racial Ethn Health Disparities 2016; 4:10.1007/s40615-016-0304-2. [PMID: 27864808 PMCID: PMC5436953 DOI: 10.1007/s40615-016-0304-2] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2016] [Revised: 10/06/2016] [Accepted: 10/13/2016] [Indexed: 11/24/2022]
Abstract
INTRODUCTION Racial and ethnic disparities continue to exist in cancer screening rates, especially among US Latina and Black/African American populations. We conducted six focus groups among 41 women from these communities in order to better understand their preferences about cancer screening reminders and the motivators and deterrents they face in obtaining recommended breast, cervical, and colon cancer screening. METHODS Using self-reported patient race/ethnicity from electronic medical records of a large, integrated health care system in Seattle, we recruited women ages 30-60 to participate in one of five 2-hour focus groups. Using verbatim transcripts from these discussions, we conducted a qualitative analysis to identify common themes. RESULTS The focus group participants were primarily strong endorsers and utilizers of recommended breast, cervical, and colon cancer screening services. Insurance and belief in preventive care were the most common motivators that they cited in obtaining cancer screening. However, they still reported multiple barriers to getting recommended cancer screening for themselves and community members, including lack of time, conflicting information about screening intervals, distrust in the health care system, and a lack of understanding of the benefits of preventive care. CONCLUSIONS Efforts to improve understanding about the benefits of cancer screening, clarify cancer screening guideline recommendations, increase cultural competency among health care professionals, and expand the times and locations where cancer screening is available are all options that may improve cancer screening rates among Latinas and Black/African American women.
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Affiliation(s)
- Susan Brandzel
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | - Eva Chang
- RTI International, 307 Waverley Oaks Rd #101, Waltham, MA, 02452, USA
| | - Leah Tuzzio
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | | | - Nora Coronado
- University of Washington, 1959 NE Pacific St., Seattle, WA, 98195, USA
| | - Erin J Aiello Bowles
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA
| | - Susan Carol Bradford
- Group Health Cooperative, Department of Clinical Improvement and Prevention, 201 16th Ave E, Seattle, WA, 98112, USA
| | - Diana S M Buist
- Group Health Research Institute, 1730 Minor Ave, Suite 1600, Seattle, WA, 98101, USA.
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Carey M, Sanson-Fisher R, Oldmeadow C, Mansfield E, Walsh J. Improving self-management of cancer risk factors, underscreening for cancer and depression among general practice patients: study protocol of a randomised controlled trial. BMJ Open 2016; 6:e014782. [PMID: 27864255 PMCID: PMC5128774 DOI: 10.1136/bmjopen-2016-014782] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
INTRODUCTION General practitioners have a key role in reducing cancer risk factors, screening for cancer and managing depression. Given the time-limited nature of consultations, a new and more time-efficient approach is needed which addresses multiple health needs simultaneously, and encourages patient self-management to address health risks. The aim of this cluster randomised controlled trial is to test the effectiveness of a patient feedback intervention in improving patient self-management of health needs related to smoking, risky alcohol consumption and underscreening for cancers at 1 month follow-up. METHODS AND ANALYSIS Adult general practice patients will be invited to participate in a baseline survey to assess cancer risk factors, screening needs and depression. A total of 360 participants identified by the baseline survey as having at least one health need (a self-reported cancer risk factor, underscreening for cancer, or an elevated depression score) will be randomised to an intervention or control group. Participants in the intervention group will receive tailored printed feedback summarising their identified health needs and recommended self-management actions to address these. All participants will be invited to complete a telephone interview 1 month following recruitment to assess self-management actions taken in relation to health needs identified in the baseline survey. Control group participants will receive tailored printed feedback on their identified health needs after their follow-up interview. A logistic regression model, with group allocation as the main predictor, will be used to assess the impact of the intervention on self-management actions. ETHICAL CONSIDERATIONS AND DISSEMINATION Participants identified as being at risk of depression will be advised to speak with their doctor. Results will be disseminated via publication in peer-reviewed journals. The study has been approved by the University of Newcastle Human Research Ethics Committee. TRIAL REGISTRATION NUMBER ACTRN12616001443482.
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Affiliation(s)
- Mariko Carey
- Faculty of Health and Medicine, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Rob Sanson-Fisher
- Faculty of Health and Medicine, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Christopher Oldmeadow
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Elise Mansfield
- Faculty of Health and Medicine, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
| | - Justin Walsh
- Faculty of Health and Medicine, Priority Research Centre for Health Behaviour, University of Newcastle, Callaghan, New South Wales, Australia
- Hunter Medical Research Institute, Kookaburra Circuit, New Lambton Heights, New South Wales, Australia
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Duffy SW, Myles JP, Maroni R, Mohammad A. Rapid review of evaluation of interventions to improve participation in cancer screening services. J Med Screen 2016; 24:127-145. [PMID: 27754937 PMCID: PMC5542134 DOI: 10.1177/0969141316664757] [Citation(s) in RCA: 86] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
Objective Screening participation is spread differently across populations, according to factors such as ethnicity or socioeconomic status. We here review the current evidence on effects of interventions to improve cancer screening participation, focussing in particular on effects in underserved populations. Methods We selected studies to review based on their characteristics: focussing on population screening programmes, showing a quantitative estimate of the effect of the intervention, and published since 1990. To determine eligibility for our purposes, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search and expanded this until the search yielded eligible papers on title review which were less than 1% of the total. We classified the eligible studies by intervention type and by the cancer for which they screened, while looking to identify effects in any inequality dimension. Results The 68 papers included in our review reported on 71 intervention studies. Of the interventions, 58 had significant positive effects on increasing participation, with increase rates of the order of 2%–20% (in absolute terms). Conclusions Across different countries and health systems, a number of interventions were found more consistently to improve participation in cancer screening, including in underserved populations: pre-screening reminders, general practitioner endorsement, more personalized reminders for non-participants, and more acceptable screening tests in bowel and cervical screening.
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Affiliation(s)
- Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Jonathan P Myles
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Roberta Maroni
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
| | - Abeera Mohammad
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University of London, London, UK
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Schapira MM, Sprague BL, Klabunde CN, Tosteson ANA, Bitton A, Chen JS, Beaber EF, Onega T, MacLean CD, Harris K, Howe K, Pearson L, Feldman S, Brawarsky P, Haas JS. Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice. J Gen Intern Med 2016; 31:1148-55. [PMID: 27251058 PMCID: PMC5023599 DOI: 10.1007/s11606-016-3726-y] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/07/2015] [Revised: 03/25/2016] [Accepted: 04/22/2016] [Indexed: 01/17/2023]
Abstract
BACKGROUND Despite substantial resources devoted to cancer screening nationally, the availability of clinical practice-based systems to support screening guidelines is not known. OBJECTIVE To characterize the prevalence and correlates of practice-based systems to support breast and cervical cancer screening, with a focus on the patient-centered medical home (PCMH). DESIGN Web and mail survey of primary care providers conducted in 2014. The survey assessed provider (gender, training) and facility (size, specialty training, physician report of National Committee for Quality Assurance (NCQA) PCMH recognition, and practice affiliation) characteristics. A hierarchical multivariate analysis clustered by clinical practice was conducted to evaluate characteristics associated with the adoption of practice-based systems and technology to support guideline-adherent screening. PARTICIPANTS Primary care physicians in family medicine, general internal medicine, and obstetrics and gynecology, and nurse practitioners or physician assistants from four clinical care networks affiliated with PROSPR (Population-based Research Optimizing Screening through Personalized Regimens) consortium research centers. MAIN MEASURES The prevalence of routine breast cancer risk assessment, electronic health record (EHR) decision support, comparative performance reports, and panel reports of patients due for routine screening and follow-up. KEY RESULTS There were 385 participants (57.6 % of eligible). Forty-seven percent (47.0 %) of providers reported NCQA recognition as a PCMH. Less than half reported EHR decision support for breast (48.8 %) or cervical cancer (46.2 %) screening. A minority received comparative performance reports for breast (26.2 %) or cervical (19.7 %) cancer screening, automated reports of patients overdue for breast (18.7 %) or cervical (16.4 %) cancer screening, or follow-up of abnormal breast (18.1 %) or cervical (17.6 %) cancer screening tests. In multivariate analysis, reported NCQA recognition as a PCMH was associated with greater use of comparative performance reports of guideline-adherent breast (OR 3.23, 95 % CI 1.58-6.61) or cervical (OR 2.56, 95 % CI 1.32-4.96) cancer screening and automated reports of patients overdue for breast (OR 2.19, 95 % CI 1.15-41.7) or cervical (OR. 2.56, 95 % CI 1.26-5.26) cancer screening. CONCLUSIONS Providers lack systems to support breast and cervical cancer screening. Practice transformation toward a PCMH may support the adoption of systems to achieve guideline-adherent cancer screening in primary care settings.
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Affiliation(s)
- Marilyn M Schapira
- University of Pennsylvania and the Philadelphia VA Medical Center, 1110 Blockley Hall, 423 Guardian Drive, Philadelphia, PA, 19104, USA.
| | | | - Carrie N Klabunde
- Office of Disease Prevention, Office of the Director, National Institutes of Health, Bethesda, MD, USA
| | - Anna N A Tosteson
- Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Asaf Bitton
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | - Jane S Chen
- Brigham and Women's Hospital, Boston, MA, USA
| | | | - Tracy Onega
- Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA
| | | | | | | | - Loretta Pearson
- Geisel School of Medicine at Dartmouth and Norris Cotton Cancer Center, Lebanon, NH, USA
| | - Sarah Feldman
- Harvard Medical School, Boston, MA, USA.,Brigham and Women's Hospital, Boston, MA, USA
| | | | - Jennifer S Haas
- Division of General Internal Medicine and Primary Care, Brigham and Woman's Hospital, Boston, MA, USA
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Barley EA, Borschmann RD, Walters P, Tylee A. Interventions to encourage uptake of cancer screening for people with severe mental illness. Cochrane Database Syst Rev 2016; 9:CD009641. [PMID: 27668891 PMCID: PMC6457619 DOI: 10.1002/14651858.cd009641.pub3] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
BACKGROUND Adults with severe mental illness (i.e. schizophrenia or other related psychotic disorders and bipolar disorder) can be at greater risk of cancer than those without severe mental illness (SMI). Early detection of cancer through screening is effective in improving patient outcomes including death. However, people with SMI are less likely than others to take up available cancer screening. OBJECTIVES To determine the effectiveness of interventions targeted at adults with SMI, or their carers or health professionals, and aimed at increasing the uptake of cancer screening tests for which the adults with SMI are eligible. SEARCH METHODS We searched the Cochrane Schizophrenia Group's Trials Register (October 25, 2012; December 19, 2014; April 07, 2015; July 04, 2016). SELECTION CRITERIA All randomised controlled trials (RCTs) of interventions, targeted towards adults with SMI or their carers or health professionals, to encourage uptake of cancer screening tests for which the adults with SMI were eligible. DATA COLLECTION AND ANALYSIS Two review authors independently screened titles and abstracts and assessed these against the inclusion criteria. MAIN RESULTS We did not find any trials that met the inclusion criteria. AUTHORS' CONCLUSIONS A comprehensive search showed that currently there is no RCT evidence for any method of encouraging cancer screening uptake in people with SMI. No specific approach can therefore be recommended. High-quality, large-scale RCTs are needed urgently to help address the disparity between people with SMI and others in cancer screening uptake.
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Affiliation(s)
- Elizabeth A Barley
- University of West LondonCollege of Nursing, Midwifery and HealthcareParagon HouseBoston Manor RoadBrentfordMiddlesexUKTW8 9GA
| | - Rohan D Borschmann
- Royal Children's HospitalCentre for Adolescent Health, Murdoch Childrens Research InstituteFlemington RoadParkvilleMelbourneVictoriaAustralia3052
| | - Paul Walters
- Dorset HealthCare University NHS Foundation Trust and Bournemouth UniversityDepartment of Mental HealthC/o Weymouth & Portland CMHTRadipole LaneWeymouthUKDT4 0QE
| | - Andre Tylee
- King's College LondonHealth Service and Population Research Department, Institute of PsychiatryDe Crespigny ParkLondonUKSE5 8AF
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Eichholzer M, Richard A, Rohrmann S, Schmid SM, Leo C, Huang DJ, Güth U. Breast cancer screening attendance in two Swiss regions dominated by opportunistic or organized screening. BMC Health Serv Res 2016; 16:519. [PMID: 27663642 PMCID: PMC5035496 DOI: 10.1186/s12913-016-1760-4] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2015] [Accepted: 09/15/2016] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND In Switzerland, the French-speaking region has an organized breast cancer (BC) screening program; in the German-speaking region, only opportunistic screening until recently had been offered. We evaluated factors associated with attendance to breast cancer screening in these two regions. METHODS We analyzed the data of 50-69 year-old women (n = 2769) from the Swiss Health Survey 2012. Factors of interest included education level, place of residence, nationality, marital status, smoking history, alcohol consumption, physical activity, diet, self-perceived health, history of chronic diseases and mental distress, visits to medical doctors and cervical and colorectal cancer screening. Outcome measures were dichotomized into ≤2 years since most recent mammography versus >2 years or never. RESULTS In the German- and French-speaking regions, mammography attendance within the last two years was 34.9 % and 77.8 %, respectively. In the French region, moderate alcohol consumption (adjusted OR 2.01, 95 % CI 1.28-3.15) increased screening attendance. Compared to those with no visit to a physician during the recent year, women in both regions with such visits attended statistically significantly more often BC screening (1-5 times vs. no visit: German (adjusted OR 3.96, 95 % CI 2.58-6.09); French: OR 7.25, 95 % CI 4.04-13.01). Non-attendance to cervical screening had a negative effect in both the German (adjusted OR 0.44, 95 % CI 0.25-0.79) and the French region (adjusted OR 0.57, 95 % CI 0.35-0.91). The same was true for colorectal cancer screening (German (adjusted OR 0.66, 95 % CI 0.52-0.84); French: OR 0.52, 95 % CI 0.33-0.83). No other factor was associated with BC screening and none of the tests of interaction comparing the two regions revealed statistically significant results. CONCLUSION The effect of socio-demographic characteristics, lifestyle, health factors and screening behavior other than mammography on non-attendance to BC screening did not differ between the two regions with mainly opportunistic and organized screening, respectively, and did not explain the large differences in attendance between regions. Other potential explanations such as public promotion of attendance for BC screening, physicians' recommendations regarding mammography participation or women's beliefs should be further investigated.
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Affiliation(s)
- Monika Eichholzer
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland.
| | - Aline Richard
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Sabine Rohrmann
- Division of Chronic Disease Epidemiology, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Hirschengraben 84, CH-8001, Zurich, Switzerland
| | - Seraina M Schmid
- Department of Gynecology & Obstetrics, Spital Grabs, Spitalstrasse 44, CH-9472, Grabs, Switzerland.,Breast Center St. Gallen, Rorschacher Strasse 150, CH-9006, St.Gallen, Switzerland
| | - Cornelia Leo
- Department of Gynecology and Obstetrics, Kantonsspital Baden AG, Interdisciplinary Breast Centre, CH-5404, Baden, Switzerland
| | - Dorothy J Huang
- Department of Gynecology and Obstetrics, University Hospital Basel (UHB), Spitalstrasse 21, CH-4031, Basel, Switzerland
| | - Uwe Güth
- Breast Center Zurich, Seefeldstrasse 214, CH-8008, Zurich, Switzerland
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Clifton A, Burgess C, Clement S, Ohlsen R, Ramluggun P, Sturt J, Walters P, Barley EA. Influences on uptake of cancer screening in mental health service users: a qualitative study. BMC Health Serv Res 2016; 16:257. [PMID: 27405348 PMCID: PMC4942968 DOI: 10.1186/s12913-016-1505-4] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/26/2015] [Accepted: 07/05/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Cancers are a leading cause of death worldwide. People with mental illness are 30 % more likely to die from cancer than the general population. One reason for this may be low uptake of nationally offered cancer screening tests by people with mental illness. We aimed to identify barriers and facilitators for breast, cervical and bowel cancer screening uptake by people with mental illness in order to inform interventions to promote equal access. METHODS The interview study was conducted in both urban and rural settings. The study was informed by the Theoretical Domains Framework, using framework analysis and triangulation across participant groups. Participants included 45 mental health service users (service users) eligible for cancer screening, 29 mental health professionals and 11 professionals involved in cancer screening. RESULTS Themes emerging from the data that affected uptake included knowledge of screening programmes by both service users and healthcare providers; knowledge of, and attitudes towards, mental illness; health service-delivery factors; service users' beliefs and concerns about cancer screening, and practical issues. These are relevant to different stages of the screening process. Service users do not receive invitations to screening or cancer testing kits if they are admitted to hospital. They are not routinely invited for screening if they are not registered with a general practitioner (GP). Lack of integrated care means that mental health staff do not know if someone is overdue for a test and cancer screening is often not considered during health promotion. Barriers including information processing problems, the extent to which the screening process aggravates symptoms, poor staff client relationships and travel difficulties vary between individuals. Screening professionals are motivated to help, but may lack time or training to manage mental health needs. Reactive measures are available, but service users must request help which they may find difficult. CONCLUSIONS There are specific barriers to cancer screening uptake for mental health service users that prevent equality of care. Interventions that can be personalised are needed at individual, policy and service-delivery levels. Primary and secondary care staff and policy-makers should work together to develop an integrated approach to cancer screening in this population.
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Affiliation(s)
- Abigail Clifton
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA, UK
| | - Caroline Burgess
- Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, Addison House, Guy's Campus, London Bridge, London, SE1 1UL, UK
| | - Sarah Clement
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, Denmark Hill, London, SE5 8AF, UK
| | - Ruth Ohlsen
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA, UK
| | - Pras Ramluggun
- Faculty of Health and Life Sciences, Oxford Brookes University, Jackstraws Lane, Marston, Oxford, Oxon, OX3 0FL, UK
| | - Jackie Sturt
- Florence Nightingale Faculty of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA, UK
| | - Paul Walters
- Bournemouth University and Dorset HealthCare University NHS Foundation Trust, Sentinel House, Nuffield Road, Poole, BH17 0RB, UK
| | - Elizabeth A Barley
- College of Nursing, Midwifery and Healthcare, University of West London, Paragon House, Boston Manor Road, Brentford, Middlesex, TW8 9GA, UK.
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Alfonzo E, Andersson Ellström A, Nemes S, Strander B. Effect of Fee on Cervical Cancer Screening Attendance--ScreenFee, a Swedish Population-Based Randomised Trial. PLoS One 2016; 11:e0150888. [PMID: 26986848 PMCID: PMC4795635 DOI: 10.1371/journal.pone.0150888] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/03/2015] [Accepted: 02/19/2016] [Indexed: 11/18/2022] Open
Abstract
BACKGROUND Attendance in the cervical cancer screening programme is one of the most important factors to lower the risk of contracting the disease. Attendance rates are often low in areas with low socioeconomic status. Charging a fee for screening might possibly decrease attendance in this population. Screening programme coverage is low in low socio-economic status areas in Gothenburg, Sweden, but has increased slightly after multiple interventions in recent years. For many years, women in the region have paid a fee for screening. We studied the effect of abolishing this fee in a trial emanating from the regular cervical cancer screening programme. METHOD Individually randomised controlled trial. All 3 124 women in three low-resource areas in Gothenburg, due for screening during the study period, were randomised to receive an offer of a free test or the standard invitation stating the regular fee of 100 SEK (≈11 €). The study was conducted during the first six months of 2013. Attendance was defined as a registered Pap smear within 90 days from the date the invitation was sent out. RESULTS Attendance did not differ significantly between women who were charged and those offered free screening (RR 0.93; CI 0.85-1.02). No differences were found within the districts or as an effect of age, attendance after the most recent previous invitation or previous experience of smear taking. CONCLUSION Abolishment of a modest screening fee in socially disadvantaged urban districts with low coverage, after previous multiple systematic interventions, does not increase attendance in the short term. Other interventions might be more important for increasing attendance in low socio-economic status areas. TRIAL REGISTRATION ClinicalTrials.gov NCT02378324.
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Affiliation(s)
- Emilia Alfonzo
- The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
- * E-mail:
| | | | - Szilard Nemes
- The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
| | - Björn Strander
- The Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden
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Lång K, Nergården M, Andersson I, Rosso A, Zackrisson S. False positives in breast cancer screening with one-view breast tomosynthesis: An analysis of findings leading to recall, work-up and biopsy rates in the Malmö Breast Tomosynthesis Screening Trial. Eur Radiol 2016; 26:3899-3907. [PMID: 26943342 PMCID: PMC5052302 DOI: 10.1007/s00330-016-4265-y] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/29/2015] [Revised: 01/23/2016] [Accepted: 02/01/2016] [Indexed: 11/29/2022]
Abstract
Objectives To analyse false positives (FPs) in breast cancer screening with tomosynthesis (BT) vs. mammography (DM). Methods The Malmö Breast Tomosynthesis Screening Trial (MBTST) is a prospective population-based study comparing one-view BT to DM in screening. This study is based on the first half of the MBTST population (n = 7,500). Differences in FP recall rate, findings leading to recall, work-up and biopsy rate between cases recalled on BT alone, DM alone and BT+DM were analysed. Results The FP recall rate was 1.7 % for BT alone (n = 131), 0.9 % for DM alone (n = 69) and 1.1 % for BT + DM (n = 81). The FP recall rate for BT alone was halved after the initial phase of the trial, stabilising at 1.5 %. BT doubled the recall of stellate distortions compared to DM (n = 64 vs. n = 33). There were fewer fibroadenomas and cysts, and the biopsy rate was slightly lower for FP recalled on BT alone compared to DM alone (15.3 % vs. 27.6 %: p = 0.037 and 33.8 % vs. 36.2 %; p = 0.641, respectively). Conclusions FPs increased with BT screening mainly due to the recall of stellate distortions. The FP recall rate was still well within the European guidelines and showed evidence of a learning curve. Characterisation of rounded lesions was improved with BT. Key Points • Tomosynthesis screening gave a higher false-positive recall rate than mammography • There was a decline in the false-positive recall rate for tomosynthesis • The recall due to stellate distortions simulating malignancy was doubled with tomosynthesis • Tomosynthesis found more radial and postoperative scar tissue than mammography • Tomosynthesis is better at characterising rounded lesions
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Affiliation(s)
- Kristina Lång
- Department of Medical Radiology, Translational Medicine Malmö, Lund University, Inga Marie Nilssons gata 49, SE-20502, Malmö, Sweden.
| | - Matilda Nergården
- Department of Medical Radiology, Translational Medicine Malmö, Lund University, Inga Marie Nilssons gata 49, SE-20502, Malmö, Sweden
| | - Ingvar Andersson
- Department of Medical Radiology, Translational Medicine Malmö, Lund University, Inga Marie Nilssons gata 49, SE-20502, Malmö, Sweden
| | - Aldana Rosso
- Epidemiology and Register Centre South, Skåne University Hospital, Klinikgatan 22, SE-221 85, Lund, Sweden
| | - Sophia Zackrisson
- Department of Medical Radiology, Translational Medicine Malmö, Lund University, Inga Marie Nilssons gata 49, SE-20502, Malmö, Sweden
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Allgood PC, Maxwell AJ, Hudson S, Offman J, Hutchison G, Beattie C, Tuano-Donnelly R, Threlfall A, Summersgill T, Bellis L, Robinson C, Heaton S, Patnick J, Duffy SW. A randomised trial of the effect of postal reminders on attendance for breast screening. Br J Cancer 2016; 114:171-6. [PMID: 26784123 PMCID: PMC5154292 DOI: 10.1038/bjc.2015.451] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2015] [Revised: 11/30/2015] [Accepted: 12/01/2015] [Indexed: 12/03/2022] Open
Abstract
BACKGROUND Some women make an informed choice not to attend breast screening, whereas others may have forgotten about the appointment. We report on a randomised trial that investigates whether a reminder letter affects attendance. METHODS Women scheduled for a breast screening appointment were randomised to either receive a reminder letter a few days before their breast screening appointment in addition to the standard invitation letter (intervention) or not (control). The primary outcome was attendance within 30 days of the first offered appointment. Secondary outcomes were attendance within 90 and 180 days. RESULTS In all, 11,383 (49.9%) women were randomised to the intervention and 11,445 (50.1%) to the control. In the intervention arm, 7759 (68.2%) attended within 30 days of the first offered appointment compared with 7349 (64.2%) in the control arm. This difference was significant (P<0.001). The odds ratio (OR) (95% confidence interval) for the primary end point was 1.19 (1.13-1.26). This was not significantly affected by age, socioeconomic status or type of screen (prevalent or incident). Secondary endpoint analyses supported these results. Results did differ, however, between the different centres studied. CONCLUSIONS This study found that postal reminders increase breast screening uptake, and could be practicable to implement in the NHS Breast Screening Programme.
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Affiliation(s)
- Prue C Allgood
- Centre for Cancer Prevention, Wolfson Institute for Cancer Prevention, Charterhouse Square, London EC1M 6BQ, UK
| | - Anthony J Maxwell
- Nightingale Centre and Genesis Prevention Centre, University Hospital of South Manchester, Southmoor Road, Wythenshawe, Manchester, M23 9QZ, UK
| | - Sue Hudson
- Peel and Shriek Consulting, 182 Highbury Hill, London, N5 1AU, UK
| | - Judith Offman
- Centre for Cancer Prevention, Wolfson Institute for Cancer Prevention, Charterhouse Square, London EC1M 6BQ, UK
| | - Gillian Hutchison
- Bolton Hospital NHS Foundation Trust, Minerva Road, Farnworth, Greater Manchester, BL4 0JR, UK
| | - Cathryn Beattie
- Royal Liverpool University Hospital, Prescot Street, Liverpool, Merseyside, L7 8XP, UK
| | - Raquel Tuano-Donnelly
- Wrightington, Wigan and Leigh NHS Foundation Trust, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK
| | | | - Tina Summersgill
- Wrightington, Wigan and Leigh NHS Foundation Trust, Appley Bridge, Wigan, Lancashire, WN6 9EP, UK
| | - Lesley Bellis
- Royal Liverpool University Hospital, Prescot Street, Liverpool, Merseyside, L7 8XP, UK
| | - Collette Robinson
- Bolton Hospital NHS Foundation Trust, Minerva Road, Farnworth, Greater Manchester, BL4 0JR, UK
| | - Samantha Heaton
- Bolton Hospital NHS Foundation Trust, Minerva Road, Farnworth, Greater Manchester, BL4 0JR, UK
| | - Julietta Patnick
- Visiting Professor in Cancer Screening, University of Oxford, Cancer Epidemiology Unit, Richard Doll Building, Roosevelt Drive, Oxford, OX3 7LF, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute for Cancer Prevention, Charterhouse Square, London EC1M 6BQ, UK
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Parker LM, Rychetnik L, Carter SM. The role of communication in breast cancer screening: a qualitative study with Australian experts. BMC Cancer 2015; 15:741. [PMID: 26480942 PMCID: PMC4617891 DOI: 10.1186/s12885-015-1749-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 10/09/2015] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND One well-accepted strategy for optimising outcomes in mammographic breast cancer screening is to improve communication with women about screening. It is not always clear, however, what it is that communication should be expected to achieve, and why or how this is so. We investigated Australian experts' opinions on breast screening communication. Our research questions were: 1 What are the views of Australian experts about communicating with consumers on breast screening? 2 How do experts reason about this topic? METHODS We used a qualitative methodology, interviewing 33 breast screening experts across Australia with recognisable influence in the Australian mammographic breast cancer screening setting. We used purposive and theoretical sampling to identify experts from different professional roles (including clinicians, program managers, policy makers, advocates and researchers) with a range of opinions about communication in breast screening. RESULTS Experts discussed the topic of communication with consumers by focusing on two main questions: how strongly to guide consumers' breast cancer screening choices, and what to communicate about overdiagnosis. Each expert adopted one of three approaches to consumer communication depending on their views about these topics. We labelled these approaches: Be screened; Be screened and here's why; Screening is available please consider whether it's right for you. There was a similar level of support for all three approaches. Experts' reasoning was grounded in how they conceived of and prioritised their underlying values including: delivering benefits, avoiding harms, delivering more benefits than harms, respecting autonomy and transparency. CONCLUSIONS There is disagreement between experts regarding communication with breast screening consumers. Our study provides some insights into this persisting lack of consensus, highlighting the different meanings that experts give to values, and different ways that values are prioritised. We suggest that explicit discussion about ethical values might help to focus thinking, clarify concepts and promote consensus in policy around communication with consumers. More specifically, we suggest that decision-makers who are considering policy on screening communication should begin with identifying and agreeing on the specific values to be prioritised and use this to guide them in establishing what the communication aims will be and which communication strategy will achieve those aims.
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Affiliation(s)
- Lisa M Parker
- Centre for Values, Ethics and the Law in Medicine (VELiM), Sydney School of Public Health, The University of Sydney, Medical Foundation Building, K 25 (92-94 Parramatta Road), Sydney, NSW, 2006, Australia.
| | - Lucie Rychetnik
- School of Medicine Sydney, The University of Notre Dame (Australia), 160 Oxford St, Darlinghurst, NSW, 2010, Australia.
| | - Stacy M Carter
- Centre for Values, Ethics and the Law in Medicine (VELiM), Sydney School of Public Health, The University of Sydney, Medical Foundation Building, K 25 (92-94 Parramatta Road), Sydney, NSW, 2006, Australia.
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Groenenberg I, Crone MR, van Dijk S, Ben Meftah J, Middelkoop BJC, Assendelft WJJ, Stiggelbout AM. Response and participation of underserved populations after a three-step invitation strategy for a cardiometabolic health check. BMC Public Health 2015; 15:854. [PMID: 26335782 PMCID: PMC4558779 DOI: 10.1186/s12889-015-2139-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2015] [Accepted: 08/11/2015] [Indexed: 11/30/2022] Open
Abstract
Background Ethnic minority and native Dutch groups with a low socioeconomic status (SES) are underrepresented in cardiometabolic health checks, despite being at higher risk. We investigated response and participation rates using three consecutive inexpensive-to-costly culturally adapted invitation steps for a health risk assessment (HRA) and further testing of high-risk individuals during prevention consultations (PC). Methods A total of 1690 non-Western immigrants and native Dutch with a low SES (35–70 years) from six GP practices were eligible for participation. We used a ‘funnelled’ invitation design comprising three increasingly cost-intensive steps: (1) all patients received a postal invitation; (2) postal non-responders were approached by telephone; (3) final non-responders were approached face-to-face by their GP. The effect of ethnicity, ethnic mix of GP practice, and patient characteristics (gender, age, SES) on response and participation were assessed by means of logistic regression analyses. Results Overall response was 70 % (n = 1152), of whom 62 % (n = 712) participated in the HRA. This was primarily accomplished through the postal and telephone invitations. Participants from GP practices in the most deprived neighbourhoods had the lowest response and HRA participation rates. Of the HRA participants, 29 % (n = 207) were considered high-risk, of whom 59 % (n = 123) participated in the PC. PC participation was lowest among native Dutch with a low SES. Conclusions Underserved populations can be reached by a low-cost culturally adapted postal approach with a reminder and follow-up telephone calls. The added value of the more expensive face-to-face invitation was negligible. PC participation rates were acceptable. Efforts should be particularly targeted at practices in the most deprived areas. Electronic supplementary material The online version of this article (doi:10.1186/s12889-015-2139-x) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Iris Groenenberg
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands.
| | - Mathilde R Crone
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands.
| | - Sandra van Dijk
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands.
| | - Jamila Ben Meftah
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands.
| | - Barend J C Middelkoop
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands.
| | - Willem J J Assendelft
- Department of Public Health and Primary Care, Leiden University Medical Center, Hippocratespad 21, PO Box 9600, V0-P, 2300, RC, Leiden, The Netherlands. .,Department of Primary and Community Care, Radboud University Medical Center, Nijmegen, The Netherlands.
| | - Anne M Stiggelbout
- Department of Medical Decision Making, Leiden University Medical Center, 2300, RC, Leiden, The Netherlands.
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Kashaf MS, McGill E. Does Shared Decision Making in Cancer Treatment Improve Quality of Life? A Systematic Literature Review. Med Decis Making 2015; 35:1037-48. [DOI: 10.1177/0272989x15598529] [Citation(s) in RCA: 66] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2015] [Accepted: 06/22/2015] [Indexed: 11/15/2022]
Abstract
Background. The growing consensus espousing the use of shared decision making (SDM) in cancer treatment has coincided with the rise of health care evaluation paradigms that emphasize quality of life (QOL) as a central outcome measure. This review systematically examines the association between treatment SDM and QOL outcomes in cancer. Methods. A range of bibliographic databases and gray literature sources was searched. The search retrieved 16,726 records, which were screened by title, abstract, and full text to identify relevant studies. The review included 17 studies with a range of study designs and populations. Data were extracted on study methods, participants, setting, study or intervention description, outcomes, main findings, secondary findings, and limitations. Quality appraisal was used, in conjunction with a narrative approach, to synthesize the evidence. Results. The review found weak, but suggestive, evidence for a positive association between perceived patient involvement in decision making, a central dimension of SDM, and QOL outcomes in cancer. The review did not find evidence for an inverse association between SDM and QOL. The poor methodological quality and heterogeneity of the extant literature constrained the derived conclusions. In addition, the literature commonly treated various subscales of QOL instruments as separate outcomes, increasing the probability of spurious findings. Conclusions. There is weak evidence that aspects of shared decision-making approaches are positively associated with QOL outcomes and very little evidence of a negative association. The extant literature largely assessed patient involvement, only capturing one aspect of the shared decision-making construct, and is of poor quality, necessitating robust studies examining the association.
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Affiliation(s)
- Michael Saheb Kashaf
- Johns Hopkins University School of Medicine, Baltimore, MD (MSK)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK (EM)
| | - Elizabeth McGill
- Johns Hopkins University School of Medicine, Baltimore, MD (MSK)
- Department of Health Services Research and Policy, London School of Hygiene & Tropical Medicine, London, UK (EM)
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Loy EY, Molinar D, Chow KY, Fock C. National Breast Cancer Screening Programme, Singapore: evaluation of participation and performance indicators. J Med Screen 2015; 22:194-200. [PMID: 26081449 DOI: 10.1177/0969141315589644] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2013] [Accepted: 04/20/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVE To evaluate participation rates and performance indicators in the National Breast Cancer Screening Programme, BreastScreen Singapore (BSS). METHODS Data on women aged 40-69 screened in the period 2002-2009 was obtained from BSS and from the Singapore Cancer Registry. Participation rates and performance indicators (including screen detection rates, small tumour detection rates, recall rates, accuracy and interval cancer rates) were examined. RESULTS BSS participation rate has remained above 10% since 2005. Based on health surveys, national mammography rates have increased from 29.7% before BSS to 39.6% in 2010 after BSS. Performance indicators, with the exception of recall rates, specificity, and interval cancer rate (for first screen), generally improved from 2002-2006 to 2007-2009 and are comparable with organized breast screening programmes in other developed countries. CONCLUSION BSS breast cancer screening coverage and rescreen rates in Singapore could be improved. Mechanisms to monitor recall rates are in place, and training opportunities are provided to aid the professional development of radiologists.
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Ginsburg OM, Fischer HD, Shah BR, Lipscombe L, Fu L, Anderson GM, Rochon PA. A population-based study of ethnicity and breast cancer stage at diagnosis in Ontario. ACTA ACUST UNITED AC 2015; 22:97-104. [PMID: 25908908 DOI: 10.3747/co.22.2359] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
BACKGROUND Breast cancer stage at diagnosis is an important predictor of survival. Our goal was to compare breast cancer stage at diagnosis (by American Joint Committee on Cancer criteria) in Chinese and South Asian women with stage at diagnosis in the remaining general population in Ontario. METHODS We used the Ontario population-based cancer registry to identify all women diagnosed with breast cancer during 2005-2010, and we applied a validated surname algorithm to identify South Asian and Chinese women. We used logistic regression to compare, for Chinese or South Asian women and for the remaining general population, the frequency of diagnoses at stage ii compared with stage i and stages ii-iv compared with stage i. RESULTS The registry search identified 1304 Chinese women, 705 South Asian women, and 39,287 women in the remaining general population. The Chinese and South Asian populations were younger than the remaining population (mean: 54, 57, and 61 years respectively). Adjusted for age, South Asian women were more often diagnosed with breast cancer at stage ii than at stage i [odds ratio (or): 1.28; 95% confidence interval (ci): 1.08 to 1.51] or at stages ii-iv than at stage i (or: 1.27; 95% ci: 1.08 to 1.48); Chinese women were less likely to be diagnosed at stage ii than at stage i (or: 0.82; 95% ci: 0.72 to 0.92) or at stages ii-iv than at stage i (or: 0.73; 95% ci: 0.65 to 0.82). CONCLUSIONS Breast cancers were diagnosed at a later stage in South Asian women and at an earlier stage in Chinese women than in the remaining population. A more detailed analysis of ethnocultural factors influencing breast screening uptake, retention, and care-seeking behavior might be needed to help inform and evaluate tailored health promotion activities.
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Affiliation(s)
- O M Ginsburg
- Women's College Research Institute, Women's College Hospital, Toronto, ON. ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON. ; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON
| | - H D Fischer
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - B R Shah
- Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON. ; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON. ; Institute for Clinical Evaluative Sciences, Toronto, ON
| | - L Lipscombe
- Women's College Research Institute, Women's College Hospital, Toronto, ON. ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON. ; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON. ; Institute for Clinical Evaluative Sciences, Toronto, ON
| | - L Fu
- Institute for Clinical Evaluative Sciences, Toronto, ON
| | - G M Anderson
- Women's College Research Institute, Women's College Hospital, Toronto, ON. ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON. ; Institute for Clinical Evaluative Sciences, Toronto, ON
| | - P A Rochon
- Women's College Research Institute, Women's College Hospital, Toronto, ON. ; Institute of Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, ON. ; Department of Medicine, Faculty of Medicine, University of Toronto, Toronto, ON. ; Institute for Clinical Evaluative Sciences, Toronto, ON
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Missinne S, Bracke P. A cross-national comparative study on the influence of individual life course factors on mammography screening. Health Policy 2015; 119:709-19. [PMID: 25921692 DOI: 10.1016/j.healthpol.2015.04.002] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Revised: 03/05/2015] [Accepted: 04/07/2015] [Indexed: 11/16/2022]
Abstract
OBJECTIVES Drawing on insights from the life course perspective, the aim of this paper is to gain a better understanding of persistent socioeconomic inequalities related to the uptake of mammography screening in 13 European countries. We examine whether these inequalities originate in childhood and relate them to the history and progression of each country's screening programs. METHODS Retrospective data from the third wave of the Survey of Health, Ageing and Retirement (SHARELIFE) is analyzed by means of event-history analyses to examine the role of childhood preventive health behavior on mammography screening initiation. The results are framed within the context of policy developments concerning mammography screening in each of the separate European countries. RESULTS Childhood preventive health care behavior predicts mammography screening in 9 of the 13 countries after conventional measurements of socioeconomic position in childhood and adulthood are accounted for. Net effects of education and income are still found for respectively 6 and 7 countries, but in about half of these countries national screening programs are able to reduce the social gradient. Very strong cohort and period effects are found for every country. CONCLUSIONS In a substantial number of the European countries, socioeconomic inequalities in preventive health behavior originate in childhood, which point to the deeply rooted nature of these inequalities. A long-term perspective is essential to further unravel how health policies can reduce or eliminate these persistent inequalities.
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Affiliation(s)
- Sarah Missinne
- HeDeRa (Health and Demographic Research), Department of Sociology, Ghent University, Belgium; Research Foundation (FWO), Flanders, Belgium.
| | - Piet Bracke
- HeDeRa (Health and Demographic Research), Department of Sociology, Ghent University, Belgium.
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Offman J, Myles J, Ariyanayagam S, Colorado Z, Sharp M, Cruice M, North BV, Shiel S, Baker T, Jefferies R, Binysh K, Duffy SW. A telephone reminder intervention to improve breast screening information and access. Public Health 2014; 128:1017-22. [PMID: 25443131 DOI: 10.1016/j.puhe.2014.09.007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2014] [Revised: 08/21/2014] [Accepted: 09/08/2014] [Indexed: 11/23/2022]
Abstract
OBJECTIVES In the UK, women aged 50-70 are offered breast cancer screening every three years. Screening participation rates in London have been particularly low. Low rates have been associated with low socio-economic status, and some ethnic groups have been observed to be underserved by cancer screening. This paper reports on a telephone reminder intervention in London Newham, an area of high deprivation and ethnic diversity. STUDY DESIGN Observational study of planned intervention. METHODS Women invited for breast screening were telephoned to confirm receipt of the invitation letter, remind invitees of their upcoming appointment, and to provide further information. Aggregate data at general practice level on invitation to and attendance at breast screening and on numbers reached by telephone were analysed by logistic regression. RESULTS For the 29 participating GP practices (10,928 invitees) overall uptake in 2010 was higher compared to the previous screening round in 2007 (67% vs. 51%; p < 0.001). On average 59% of invitees were reached by the reminder calls. A 10% increase in women reached resulted in an 8% increase in the odds of women attending their screening appointment (95% CI: 5%-11%), after adjusting for 2007 attendance rates. Practices with a higher proportion of South Asian women were associated with a larger uptake adjusted for 2007 uptake and population reached by the telephone intervention, (4% increase in odds of attendance per 10% increase in South Asian population, CI 1%-7%, p = 0.003) while practices with a higher proportion of black women were associated with a smaller uptake similarly adjusted. (11% decrease in odds of attendance per 10% increase in black population, CI 9%-16%, p < 0.001). CONCLUSIONS A language- and culture-sensitive programme of reminder calls substantially improved breast cancer screening uptake.
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Affiliation(s)
- J Offman
- Centre for Cancer Prevention, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
| | - J Myles
- Centre for Cancer Prevention, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK.
| | - S Ariyanayagam
- NHS England Southside, 105 Victoria Street, London SW1E 6QT, UK
| | - Z Colorado
- Community Links, 105 Barking Road, Canning Town, London E16 4HQ, UK
| | - M Sharp
- Centre for Primary Care & Public Health, Blizard Institute, Yvonne Carter Building, 58 Turner Street, London E1 2AB, UK
| | - M Cruice
- NHS Commissioning Board London, 4th Floor, Drummond Street Wing, Stephenson House, 75 Hampstead Road, London NW1 2PL, UK
| | - B V North
- Centre for Cancer Prevention, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
| | - S Shiel
- Central and East London Breast Screening Service, 3rd Floor, West Wing, St Bartholomew's Hospital, London EC1A 7BE, UK
| | - T Baker
- Contracting and Quality Directorate, North and East London Commissioning Support Unit, Clifton House, 75-77 Worship Street, London EC2A 2DU, UK
| | - R Jefferies
- North and East London Commissioning Support Unit, Clifton House, 75-77 Worship Street, London EC2A 2DU, UK
| | - K Binysh
- Quality Assurance Reference Centre, Barts and the London NHS Trust, 1st Floor, 51/53 Bartholomew Close, West Smithfield, London EC1A 7BE, UK
| | - S W Duffy
- Centre for Cancer Prevention, Queen Mary, University of London, Wolfson Institute of Preventive Medicine, Charterhouse Square, London EC1M 6BQ, UK
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Vidal C, Garcia M, Benito L, Milà N, Binefa G, Moreno V. Use of text-message reminders to improve participation in a population-based breast cancer screening program. J Med Syst 2014; 38:118. [PMID: 25073694 DOI: 10.1007/s10916-014-0118-x] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2014] [Accepted: 07/16/2014] [Indexed: 11/28/2022]
Abstract
To analyze the effect of a cell text message reminder service on participation in a mammogram screening program in Catalonia, Spain. A quasi-experimental design was used with women aged 50 to 69 years who had been scheduled mammogram appointments in June or July 2011. Women were personally invited by letter to attend to the breast cancer screening program (n = 12,786). Prior to the invitation, 3,719 (29.1 %) of them had provided their cell telephone number to the National Health Service. These women received a text message reminder 3 days before their scheduled appointment. Logistic regression models were used to analyze whether the text message reminder was associated with participation in screening. Cost-effectiveness of adding a text message reminder to the invitation letter was also analyzed. The overall rate of participation in breast cancer screening was 68.4 %. The participation rate was significantly higher in the text messaging group, with an age-adjusted OR of 1.56 (95 %CI: 1.43-1.70). A detailed analysis showed that the increase in participation related to the text message reminder was higher among women without previous screening who lived in areas where access to postal mail was limited (OR=2.85; 95 %CI: 2.31-3.53) compared to those who lived in areas of easier postal mail access (OR=1.66; 95 %CI: 1.36-2.02). The invitation letter+text message reminder was a cost-effective strategy. Text message reminders are an efficient cost-effective approach to improve participation in difficult-to-reach populations, such as rural areas and newly developed suburbs.
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Affiliation(s)
- C Vidal
- Cancer Prevention and Control Program, Catalan Institute of Oncology, IDIBELL, Av. Gran Via 199-203, 08908, L'Hospitalet de Llobregat, Barcelona, Spain
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Arcas MM, Buron A, Ramis O, Esturi M, Hernández C, Macià F. [Can a mobile phone short message increase participation in breast cancer screening programmes?]. ACTA ACUST UNITED AC 2014; 29:188-96. [PMID: 25002239 DOI: 10.1016/j.cali.2014.02.003] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2013] [Revised: 01/27/2014] [Accepted: 02/07/2014] [Indexed: 11/25/2022]
Abstract
OBJECTIVE To evaluate the impact of a mobile phone short message on women's uptake in a breast cancer screening programme. METHODS A total of 703 women from a Basic Health Area of Barcelona, and with a mobile phone number registered, were invited to participate in a breast cancer screening programme between 25 January 2011 and 22 March 2011. The control group (n=470) followed the usual appointment track, and the intervention group (n=233) received, after the first letter of invitation, a mobile phone short message reminder. The differences between the two groups were analysed, comparing the uptake rates according to age, educational level, and participation in previous round, as well as the number of re-invitation calls to non-attenders according to uptake, age and level of education;and the percentages of exclusions of both groups. RESULTS The intervention group had a greater uptake than the control group (78.1% vs. 72.3%), with a significant trend observed in the 55-59 years age group (P=.036) and the low secondary educational level (P=.014).The intervention group mean of re-invitation calls of non-attenders lower than the control group (.41 vs. .65, P<.05), a pattern observed in all the categories of the independent variables, and among younger age groups, lower and middle educational levels, and previously participating women (.09 vs. .19, P=.012). CONCLUSIONS The inclusion of a mobile phone short message in a breast cancer screening programme may increase uptake rates and lead to a management improvement.
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Affiliation(s)
- M M Arcas
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Unidad Docente de Medicina Preventiva y Salud Pública PSMAR-UPF-ASPB, Barcelona, España
| | - A Buron
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Red de investigación en servicios sanitarios en enfermedades crónicas (REDISSEC), España.
| | - O Ramis
- Alhorasolutions S.L., Barcelona, España
| | - M Esturi
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - C Hernández
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - F Macià
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Institut Hospital del Mar d'Investigacions Mèdiques (IMIM), Barcelona, España; Red de investigación en servicios sanitarios en enfermedades crónicas (REDISSEC), España
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Abstract
Primary care providers have important roles across the cancer continuum, from encouraging screening and accurate diagnosis to providing care during and after treatment for both the cancer and any comorbid conditions. Evidence shows that higher cancer screening participation rates are associated with greater involvement of primary care. Primary care providers are pivotal in reducing diagnostic delay, particularly in health systems that have long waiting times for outpatient diagnostic services. However, so-called fast-track systems designed to speed up hospital referrals are weakened by significant variation in their use by general practitioners (GPs), and affect the associated conversion and detection rates. Several randomized controlled trials have shown primary care-led follow-up care to be equivalent to hospital-led care in terms of patient wellbeing, recurrence rates and survival, and might be less costly. For primary care-led follow-up to be successful, appropriate guidelines must be incorporated, clear communication must be provided and specialist care must be accessible if required. Finally, models of long-term cancer follow-up are needed that provide holistic care and incorporate management of co-morbid conditions. We discuss all these aspects of primary care, focusing on the most common cancers managed at the GP office-breast, colorectal, prostate, lung and cervical cancers.
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49
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Wang B, He M, Wang L, Engelgau MM, Zhao W, Wang L. Breast cancer screening among adult women in China, 2010. Prev Chronic Dis 2013; 10:E183. [PMID: 24199736 PMCID: PMC3820523 DOI: 10.5888/pcd10.130136] [Citation(s) in RCA: 36] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Introduction Breast cancer is the most frequently diagnosed type of cancer among women in China. However, China does not have a national screening program or national screening guidelines. Little information on participation in breast cancer screening among Chinese women is available. Methods We used data from the 2010 China Chronic Disease and Risk Factor Surveillance System that included 53,513 women aged 18 years or older. Women were asked about breast cancer screening participation (any type of screening method), and we examined screening participation rates. We adjusted estimates and performed multivariable logistic regression to adjust for potential confounders. Results Overall, 21.7% (95% confidence interval [CI], 19.2%–24.2%) of respondents reported previous breast cancer screening. The participation rates were highest among women aged 30 to 39 years (30.7%; 95% CI, 26.9%–34.4%) and lowest among women 70 years or older (6.3%; 95% CI, 5.1%–7.6%). Compared with women living in the western region, women in the eastern region were 1.5 times more likely to be screened (adjusted odds ratio [OR], 1.5; 95% CI, 1.2–2.0). Compared with women without insurance, women with urban insurance were more likely to be screened (prevalence ratio = 2.6; 95% CI, 2.3–3.0) and be screened within the last 2 years (OR = 1.3; 95% CI, 1.0–1.7; P = .04). Conclusion Breast cancer screening participation rates among Chinese women were low and varied greatly by age, region, and insurance status. Comprehensive and prioritized strategies are needed to improve breast cancer screening participation among older women, those without medical insurance, and those living in the west.
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Affiliation(s)
- Baohua Wang
- Chinese Center for Disease Control and Prevention, Beijing, China
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50
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Kempe KL, Larson RS, Shetterley S, Wilkinson A. Breast cancer screening in an insured population: whom are we missing? Perm J 2013; 17:38-44. [PMID: 23596367 DOI: 10.7812/tpp/12-068] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
INTRODUCTION Kaiser Permanente Colorado is an integrated health care system that uses automatic reminder programs and reduces barriers to access preventive services, including financial barriers. Breast cancer screening rates have not improved during the last five years, and rates differ between subgroups: for example, black and Latina women have lower rates of mammography screening than other racial groups. METHODS We retrospectively evaluated data from 47,946 women age 52 to 69 years who had continuous membership for 24 months but had not undergone mammography. Poisson regression models estimated relative risk for the impact of self-identified race/ethnicity, socioeconomic characteristics, health status, and use of health care services on screening completion. RESULTS The distribution of race/ethnicity among unscreened women was 55.5% white, 7.0% Latina, and 3.7% black, but race/ethnicity data were missing for 29%. Of these, no record of race/ethnicity was available for 86.7%, and for 5.1%, the data request was recorded but the women declined to identify their race/ethnicity. Nonwhite ethnicity increased risk of screening failure if black, Latina, "other" (eg, American Indian), or missing race/ethnicity. Population-attributable risks were low for minorities compared with the group for whom race/ethnicity data was missing. A greater number of office visits in any setting was associated with greater likelihood of undergoing mammography. Women with missing race/ethnicity data had fewer visits and were less likely to have an identified primary care physician. CONCLUSIONS Greater improvement in mammography screening rates could be achieved in our population by increasing screening among women with missing race/ethnicity data, rather than by targeting those who are known to be of racial/ethnic minorities. Efforts to address screening disparities have been refocused on inreach and outreach to our "missing women."
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Affiliation(s)
- Karin L Kempe
- Department of Population Care and Prevention Services at Kaiser Permanente Colorado in Denver, USA.
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