1
|
Orom H, Stanar S, Allard NC, Hay JL, Waters EA, Kiviniemi MT, Lewicka M. Reasons people avoid colorectal cancer information: a mixed-methods study. Psychol Health 2025; 40:952-974. [PMID: 37950399 DOI: 10.1080/08870446.2023.2280177] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2023] [Revised: 10/25/2023] [Accepted: 11/01/2023] [Indexed: 11/12/2023]
Abstract
OBJECTIVE With screening, colorectal cancer can be detected when treatable, or even prevented. However, approximately one in five people tend to avoid colorectal cancer information, and avoidance is associated with being less likely to have been screened for the disease. Crucial to developing strategies to reduce information avoidance, we sought a comprehensive understanding of reasons people avoid colorectal cancer information. METHODS AND MEASURES In a mixed methods study, we surveyed 200 participants who varied with respect to avoidance and interviewed 15 people who tended to avoid colorectal cancer information (all aged 40-75) about reasons for avoiding. RESULTS In both survey and interviews, primary reasons for information avoidance were: (1) shielding from anxiety and other aversive emotion, (2) perceived information sufficiency and (3) feelings of information overload. Trait anxiety, fear of diagnosis, anticipating negative interactions with healthcare, and negative associations with screening procedures exacerbated avoidance. Participants justified information non-relevance by attributing risk to other people's characteristics such as family history, gastrointestinal symptoms, being male, or living an unhealthy lifestyle. CONCLUSION Novel findings include the triggering influence of trait anxiety and financial constraints on information avoidance. Also, information overload and incorrect understanding of risk factors may exacerbate perceptions of information sufficiency and avoidance.
Collapse
Affiliation(s)
- Heather Orom
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | - Sanja Stanar
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | - Natasha C Allard
- Department of Community Health and Health Behavior, University at Buffalo, Buffalo, New York, USA
| | - Jennifer L Hay
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan-Kettering Cancer Center, New York, New York, USA
| | - Erika A Waters
- School of Medicine, Department of Surgery, Division of Public Health Sciences, Washington University in St. Louis, St. Louis, Missouri, USA
| | - Marc T Kiviniemi
- Department of Health, Behavior and Society, University of Kentucky, Louisville, Kentucky, USA
| | - Malwina Lewicka
- Department of Psychiatry & Behavioral Sciences, Memorial Sloan Kettering Cancer Center, New York, New York, USA
| |
Collapse
|
2
|
Weller SC, Pappadis MR, Krishnan S, Stearnes MR, Sheffield KM, Tan A, Qi JZ, Goodwin JS. Understanding motivations of older women to continue or discontinue breast cancer screening. MEDRXIV : THE PREPRINT SERVER FOR HEALTH SCIENCES 2025:2025.01.30.25321380. [PMID: 39974035 PMCID: PMC11838665 DOI: 10.1101/2025.01.30.25321380] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 02/21/2025]
Abstract
Background Breast cancer screening guidelines indicate screening in women over 75 years of age is optional, depending upon patient health and preferences. Objectives To link experiences and perceptions of older women concerning screening to their intention to continue or discontinue screening. Design Qualitative comparative study, comparing continuers and discontinuers. Setting Community-residing adults. Participants A purposive sample (n=59) with equal representation of White, Black, and Hispanic women by age (70-74 years and 75 and older) and educational level (≤12 grade and >12 grade). Measurements In-depth qualitative interviews explored women's perceptions of mammograms, the benefits and risks of screening, and personal screening experiences. Interviews were coded and quality-checked by two or more coders. A qualitative comparative analysis (QCA) was used to identify combinations of personal characteristics and themes linked to the intention to continue (n=32) or discontinue (n=27) screening. Results Personal experience themes were strongly linked to the intention to continue or discontinue. Women who mentioned recent screening (within three years) and either a spontaneously mentioned cancer story concerning a friend or family member or a doctor's screening recommendation intended to continue screening (91% true positive rate, model sensitivity). Women who did not schedule screening and who did not mention a cancer story or a doctor's recommendation (or neither) intended to discontinue screening (81% true negative rate, model specificity). These themes transcended differences in race/ethnicity, age, and educational level. Conclusion Continuation of breast cancer screening in older women is motivated by their personal screening history combined with cancer experiences and/or a doctor's screening recommendation.
Collapse
Affiliation(s)
- Susan C. Weller
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB), Galveston, TX 77555
- Department of Family Medicine, School of Medicine; UTMB
- Sealy Center on Aging, UTMB
| | - Monique R. Pappadis
- Department of Population Health and Health Disparities, School of Public and Population Health, University of Texas Medical Branch (UTMB), Galveston, TX 77555
- Sealy Center on Aging, UTMB
- Department of Occupational Therapy, School of Health Professions, UTMB
| | - Shilpa Krishnan
- Department of Rehabilitation Medicine, Division of Physical Therapy, Emory University, School of Medicine; Atlanta, GA, USA
| | | | - Kristin M. Sheffield
- Sealy Center on Aging, UTMB
- Department of Surgery, School of Medicine, UTMB
- Global Medical Affairs, Eli Lilly and Company, Indianapolis, IN 46285
| | - Alai Tan
- College of Nursing, Ohio State University, Columbus, OH 43210
| | - Jeffrey Z. Qi
- Harvard College, Faculty of Arts and Sciences, Harvard University
| | - James S. Goodwin
- Sealy Center on Aging, UTMB
- Department of Internal Medicine, UTMB
| |
Collapse
|
3
|
Alrayshouni Z, Dayekh A, El‐Tassi A, Pakai A. Rationalizing the Influence of Co-Design on Distress, Clinical Decision-Making and Disease Self-Management of Cancer Patients-as-Partners: A Quasi-Experimental Study. Health Expect 2024; 27:e14113. [PMID: 38872504 PMCID: PMC11176735 DOI: 10.1111/hex.14113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2024] [Revised: 05/27/2024] [Accepted: 05/31/2024] [Indexed: 06/15/2024] Open
Abstract
INTRODUCTION Cancer is regarded as a major worldwide burden. Patient distress has been linked to disease progression. Studies show that engagement strategies affect clinical decision-making and patient outcomes. The optimal engagement method is a partnership that integrates the patient's expertise into the comprehensive co-design of the healthcare system. OBJECTIVES This is the first study to investigate cancer patient-as-partner experience and its impact on distress levels, decision-making and self-management. METHODS It is a quantitative and quasi-experimental study that adopted a partnership committee at a Lebanese hospital. A stratified random sampling approach was used, and data were collected by self-administered questionnaires. We utilized the standardized distress thermometer and PPEET. RESULTS We recruited 100 patient partners. Cancer patients-as-partners had optimal engagement experience in QI projects (mean = 4; SD = 0.4). The main partnership benefit was improved hospitalization experience (49%). Almost half of PP reported no challenges faced (49%). Recommendations for improvement were training (19%), team dynamics management (12%) and proper time allocation (7%). The distress level post-partnership was significantly reduced (t = 12.57, p < 0.0001). This study highlights the importance of partnership and its ability to influence shared decision-making preference [χ2(2) = 13.81, p = 0.025] and self-management practices [F(3, 11.87) = 7.294, p = 0.005]. CONCLUSION Research findings suggest that partners from disadvantaged groups can have optimal partnership experience. A partnership model of care can shape the healthcare system into a people-oriented culture. Further research is needed to explore diverse PP engagement methodologies and their effect on organizational development. PATIENT OR PUBLIC CONTRIBUTION Patients and family members were engaged in the co-design of the study methodology, especially the modification of a research instrument. Patient partners with lived experience were involved in the patient partnership committee as core members to improve healthcare system design and evaluation.
Collapse
Affiliation(s)
| | - Alaa Dayekh
- Doctoral School of Health Sciences, Faculty of Health SciencesUniversity of PécsPécsHungary
| | - Ahmad El‐Tassi
- Nursing Department, Faculty of Health SciencesBeirut Arab UniversityBeirutLebanon
| | - Annamária Pakai
- Doctoral School of Health Sciences, Faculty of Health SciencesUniversity of PécsPécsHungary
| |
Collapse
|
4
|
Fransen MP, Damman OC, Bas S, Uiters E, Timmermans DR. Decision-making in breast cancer screening: A qualitative exploration of the match between women's beliefs and screening information in the Netherlands. PATIENT EDUCATION AND COUNSELING 2024; 122:108155. [PMID: 38325207 DOI: 10.1016/j.pec.2024.108155] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/06/2023] [Revised: 01/12/2024] [Accepted: 01/14/2024] [Indexed: 02/09/2024]
Abstract
OBJECTIVE Decision-making about breast cancer screening requires balanced and understandable information that takes prior beliefs of screening invitees into account. METHODS In qualitative interviews with 22 Dutch women who were invited for screening for the first time (49-52 years of age, varying health literacy levels), we gained insight in their beliefs on breast cancer and breast cancer screening, and explored how the current screening information matched these beliefs. RESULTS Breast cancer was perceived as an unpredictable, severe, and uncontrollable disease. Women considered screening as self-evident and an important mean to gain some control over breast cancer. Information on benefits of screening was in line with women's prior beliefs and confirmed women's main reasons to participate. Information about false-positive outcomes, overtreatment, and false negative outcomes did not correspond to women's prior beliefs and this information was generally not considered relevant for decision-making. Preferences for additional information merely concerned practical information on the screening procedure. CONCLUSION Complex information on the harms of screening does not match women's beliefs and is not taken into account in their decision-making. PRACTICE IMPLICATIONS Information regarding breast cancer screening could be further aligned to prior beliefs by taking into account values, filling knowledge gaps and correct misconceptions.
Collapse
Affiliation(s)
- Mirjam P Fransen
- National Institute for Public Health and the Environment, Centre for Prevention, Lifestyle and Health, Bilthoven, the Netherlands; Amsterdam UMC, Location University of Amsterdam, Public and Occupational Health, Meibergdreef 9, 1105 AZ Amsterdam, the Netherlands; Amsterdam Public Health Research institute, Quality of Care, Amsterdam, the Netherlands.
| | - Olga C Damman
- Amsterdam Public Health Research institute, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Public and Occupational Health, Van der Boechorststraat 7 1081 Amsterdam, the Netherlands
| | - Sharell Bas
- National Institute for Public Health and the Environment, Centre for Prevention, Lifestyle and Health, Bilthoven, the Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment, Centre for Prevention, Lifestyle and Health, Bilthoven, the Netherlands
| | - Daniëlle Rm Timmermans
- Amsterdam Public Health Research institute, Quality of Care, Amsterdam, the Netherlands; Amsterdam UMC, Location Vrije Universiteit Amsterdam, Public and Occupational Health, Van der Boechorststraat 7 1081 Amsterdam, the Netherlands
| |
Collapse
|
5
|
Yebyo HG, van Wifferen F, Pluymen LPM, Leeflang MMG, Dekker E, Coupé VMH, Puhan MA, Greuter MJE, Stegeman I. Benefit-Harm Analysis for Informed Decision Making on Participating in Colorectal Cancer Screening: A Modeling Study. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2024; 27:397-404. [PMID: 38141815 DOI: 10.1016/j.jval.2023.12.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Revised: 12/04/2023] [Accepted: 12/06/2023] [Indexed: 12/25/2023]
Abstract
OBJECTIVES To facilitate informed decision making on participating in colorectal cancer (CRC) screening, we assessed the benefit-harm balance of CRC screening for a wide range of subgroups over different time horizons. METHODS The study combined incidence proportions of benefits and harms of (not) participating in CRC screening estimated by the Adenoma and Serrated pathway to CAncer microsimulation model, a preference eliciting survey, and benefit-harm balance modeling combining all outcomes to determine the net health benefit of CRC screening over 10, 20, and 30 years. Probability of net health benefit was estimated for 210 different subgroups based on age, sex, previous participation in CRC screening, and lifestyle. RESULTS CRC screening was net beneficial in 183 of 210 subgroups over 30 years (median probability [MP] of 0.79, interquartile range [IQR] of 0.69-0.85) across subgroups. Net health benefit was greater for men (MP 0.82; IQR 0.69-0.89) than women (MP 0.76; IQR 0.67-0.83) and for those without history of participation in previous screenings (MP 0.84; IQR 0.80-0.89) compared with those with (MP 0.69; IQR 0.59-0.75). Net health benefit decreased with increasing age, from MP of 0.84 (IQR 0.80-0.86) at age 55 to 0.61 (IQR 0.56-0.71) at age 75. Shorter time horizons led to lower benefit, with MP of 0.70 (IQR 0.62-0.80) over 20 years and 0.54 (IQR 0.48-0.67) over 10 years. CONCLUSIONS Our benefit-harm analysis provides information about net health benefit of screening participation, based on important characteristics and preferences of individuals, which could assist screening invitees in making informed decisions on screening participation.
Collapse
Affiliation(s)
- Henock G Yebyo
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Zürich, Switzerland; Ldwig Maximilian University (LMU), Institute for Medical Information Processing, Biometry, and Epidemiology (IBE), Public Health and Health Services Research, Munich, Germany
| | - Francine van Wifferen
- Amsterdam UMC location Vrije Universiteit, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands.
| | - Linda P M Pluymen
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Mariska M G Leeflang
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands
| | - Evelien Dekker
- Amsterdam UMC location University of Amsterdam, Gastroenterology and Hepatology, Amsterdam, The Netherlands
| | - Veerle M H Coupé
- Amsterdam UMC location Vrije Universiteit, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Milo A Puhan
- University of Zurich, Epidemiology, Biostatistics and Prevention Institute, Zürich, Zürich, Switzerland
| | - Marjolein J E Greuter
- Amsterdam UMC location Vrije Universiteit, Epidemiology and Data Science, De Boelelaan 1117, Amsterdam, The Netherlands; Amsterdam Public Health, Methodology, Amsterdam, The Netherlands
| | - Inge Stegeman
- Amsterdam Public Health, Methodology, Amsterdam, The Netherlands; Amsterdam UMC location University of Amsterdam, Epidemiology and Data Science, Amsterdam, The Netherlands; University Medical Centre Utrecht, Department of Otorhinolaryngology and Head & Neck Surgery, Utrecht, The Netherlands; University Medical Centre Utrecht, Brain Centre, Utrecht, The Netherlands
| |
Collapse
|
6
|
Kim S. Effect of Mortality alongside 5-Year Survival Rates and Incidence on the Public's Perceived Benefits of Cancer Screening and Screening Intention: A Web-Based Experimental Study. Med Decis Making 2024; 44:135-140. [PMID: 38156617 DOI: 10.1177/0272989x231218278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2024]
Abstract
BACKGROUND Mortality is critical information in evaluating the benefits of cancer screening. However, 5-y survival rates and incidence, without mortality, have been frequently communicated to the public. Based on the literature that people's perceptions and judgments can be altered by the way of presenting health statistics, the current study examined whether mortality alongside 5-y survival and incidence would influence laypeople's perceptions of the effectiveness of cancer screening and screening intention. METHODS In an online-based experimental survey conducted in South Korea in October 2022, 300 adults were randomly assigned to 1 of 2 groups (mortality: no v. yes) to be presented with 3 different cancers (A, B, and C). The perceived effectiveness of cancer screening and screening intention were measured using 7-point scales for each cancer. RESULTS Across all cancers, participants in the no-mortality group perceived cancer screening to be more effective and were more willing to undergo screening compared with those in the mortality group, although the results were not statistically significant on the intention. CONCLUSIONS In general, mortality had an effect of decreasing the perceived effectiveness of cancer screening and screening intention compared with no mortality, although the effect on the intention was not statistically significant. IMPLICATIONS When communicating the benefits of cancer screening to the public, mortality statistics may play a role in mitigating the potentially inflated perception of the benefits of cancer screening and screening intention. HIGHLIGHTS Five-year survival rates, either alone or with incidence rates, are frequently communicated to the public in the context of the benefits of cancer screening.However, 5-y survival rates can sometimes be inflated without a reduction in mortality.Including mortality statistics in communications decreased the perceived effectiveness of cancer screening and screening intentions.Mortality information needs to be communicated in the benefits of cancer screening.
Collapse
Affiliation(s)
- Soyun Kim
- Institute of Health Policy and Management, Seoul National University Medical Research Center, Seoul, Republic of Korea
| |
Collapse
|
7
|
Wolf AMD, Oeffinger KC, Shih TYC, Walter LC, Church TR, Fontham ETH, Elkin EB, Etzioni RD, Guerra CE, Perkins RB, Kondo KK, Kratzer TB, Manassaram-Baptiste D, Dahut WL, Smith RA. Screening for lung cancer: 2023 guideline update from the American Cancer Society. CA Cancer J Clin 2024; 74:50-81. [PMID: 37909877 DOI: 10.3322/caac.21811] [Citation(s) in RCA: 108] [Impact Index Per Article: 108.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 09/14/2023] [Indexed: 11/03/2023] Open
Abstract
Lung cancer is the leading cause of mortality and person-years of life lost from cancer among US men and women. Early detection has been shown to be associated with reduced lung cancer mortality. Our objective was to update the American Cancer Society (ACS) 2013 lung cancer screening (LCS) guideline for adults at high risk for lung cancer. The guideline is intended to provide guidance for screening to health care providers and their patients who are at high risk for lung cancer due to a history of smoking. The ACS Guideline Development Group (GDG) utilized a systematic review of the LCS literature commissioned for the US Preventive Services Task Force 2021 LCS recommendation update; a second systematic review of lung cancer risk associated with years since quitting smoking (YSQ); literature published since 2021; two Cancer Intervention and Surveillance Modeling Network-validated lung cancer models to assess the benefits and harms of screening; an epidemiologic and modeling analysis examining the effect of YSQ and aging on lung cancer risk; and an updated analysis of benefit-to-radiation-risk ratios from LCS and follow-up examinations. The GDG also examined disease burden data from the National Cancer Institute's Surveillance, Epidemiology, and End Results program. Formulation of recommendations was based on the quality of the evidence and judgment (incorporating values and preferences) about the balance of benefits and harms. The GDG judged that the overall evidence was moderate and sufficient to support a strong recommendation for screening individuals who meet the eligibility criteria. LCS in men and women aged 50-80 years is associated with a reduction in lung cancer deaths across a range of study designs, and inferential evidence supports LCS for men and women older than 80 years who are in good health. The ACS recommends annual LCS with low-dose computed tomography for asymptomatic individuals aged 50-80 years who currently smoke or formerly smoked and have a ≥20 pack-year smoking history (strong recommendation, moderate quality of evidence). Before the decision is made to initiate LCS, individuals should engage in a shared decision-making discussion with a qualified health professional. For individuals who formerly smoked, the number of YSQ is not an eligibility criterion to begin or to stop screening. Individuals who currently smoke should receive counseling to quit and be connected to cessation resources. Individuals with comorbid conditions that substantially limit life expectancy should not be screened. These recommendations should be considered by health care providers and adults at high risk for lung cancer in discussions about LCS. If fully implemented, these recommendations have a high likelihood of significantly reducing death and suffering from lung cancer in the United States.
Collapse
Affiliation(s)
- Andrew M D Wolf
- University of Virginia School of Medicine, Charlottesville, Virginia, USA
| | - Kevin C Oeffinger
- Department of Medicine, Duke University School of Medicine and Duke Cancer Institute Center for Onco-Primary Care, Durham, North Carolina, USA
| | - Tina Ya-Chen Shih
- David Geffen School of Medicine and Jonsson Comprehensive Cancer Center, University of California Los Angeles, Los Angeles, California, USA
| | - Louise C Walter
- Department of Medicine, University of California San Francisco and San Francisco Veterans Affairs Medical Center, San Francisco, California, USA
| | - Timothy R Church
- Masonic Cancer Center, University of Minnesota, Minneapolis, Minnesota, USA
| | - Elizabeth T H Fontham
- Health Sciences Center, School of Public Health, Louisiana State University, New Orleans, Louisiana, USA
| | - Elena B Elkin
- Department of Health Policy and Management, Columbia University Mailman School of Public Health, New York, New York, USA
| | - Ruth D Etzioni
- Fred Hutchinson Cancer Research Center, University of Washington, Seattle, Washington, USA
| | - Carmen E Guerra
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Rebecca B Perkins
- Obstetrics and Gynecology, Boston University Chobanian and Avedisian School of Medicine, Boston, Massachusetts, USA
| | - Karli K Kondo
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| | - Tyler B Kratzer
- Cancer Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia, USA
| | | | | | - Robert A Smith
- Early Cancer Detection Science, American Cancer Society, Atlanta, Georgia, USA
| |
Collapse
|
8
|
Sangster SL, Lawson KL. "We're Going to Book This for You": Threats to Informed Decision-Making in the Down Syndrome Determination Experience. JOURNAL OF OBSTETRICS AND GYNAECOLOGY CANADA 2024; 46:102237. [PMID: 37827331 DOI: 10.1016/j.jogc.2023.102237] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2023] [Revised: 09/15/2023] [Accepted: 09/19/2023] [Indexed: 10/14/2023]
Abstract
OBJECTIVES To identify and describe threats to informed decision-making at key junctures of the Down syndrome (DS) determination experience. METHODS We conducted 32 narrative interviews with 42 participants (10 couples and 22 individuals). Participants relayed their stories of receiving their child's or a prospective child's DS determination. Interviews were recorded, transcribed verbatim, and analyzed thematically. RESULTS We identified the following 5 threats to informed decision-making: routinization of screening, screening for reassurance's sake, equating an openness to screening with an openness to testing and termination, misunderstanding and miscommunicating about probability, and a lack of up-to-date, accurate, neutral information. CONCLUSIONS The results contribute to an existing body of literature on the DS determination experience with a uniquely Canadian lens. The threats outline how well-intended counselling can ultimately undermine reproductive autonomy and informed decision-making. With knowledge of how these seemingly harmless behaviours threaten informed decision-making and reproductive autonomy, care providers can modify their counselling to lessen their impact.
Collapse
Affiliation(s)
| | - Karen L Lawson
- Department of Psychology, University of Saskatchewan, Saskatoon, SK
| |
Collapse
|
9
|
Shams M, Abdallah S, Alsadoun L, Hamid YH, Gasim R, Hassan A. Oncological Horizons: The Synergy of Medical and Surgical Innovations in Cancer Treatment. Cureus 2023; 15:e49249. [PMID: 38143618 PMCID: PMC10743204 DOI: 10.7759/cureus.49249] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/21/2023] [Indexed: 12/26/2023] Open
Abstract
The landscape of cancer treatment has witnessed a remarkable transformation in recent years, marked by the convergence of medical and surgical innovations. Historically, cancer therapy faced challenges, including limited efficacy and severe side effects. This narrative review explores the historical progression of cancer treatments, shedding light on significant breakthroughs in both medical and surgical oncology. It comprehensively addresses the medical domain, covering chemotherapy, targeted therapies, immunotherapy, hormonal treatments, and radiological procedures. Simultaneously, it delves into the surgical realm, discussing the evolution of surgical techniques, minimally invasive procedures, and the role of surgery across various stages of cancer. The article emphasizes the fusion of medical and surgical approaches, highlighting neoadjuvant and adjuvant therapies and the significance of multidisciplinary tumor boards. It also addresses innovations, challenges, and the pivotal role of patient-centered care. Furthermore, it offers insights into the future directions and forecasts in the constantly evolving field of integrated oncological care. This review provides a comprehensive understanding of the dynamic and transformative nature of cancer treatment, reflecting the unwavering commitment of the medical and surgical communities in the ongoing fight against cancer.
Collapse
Affiliation(s)
| | | | - Lara Alsadoun
- Trauma and Orthopaedics, Chelsea and Westminster Hospital, London, GBR
| | - Yusra H Hamid
- Community Medicine, Faculty of Medicine, University of Khartoum, Khartoum, SDN
| | - Rayan Gasim
- Internal Medicine, University of Khartoum, Khartoum, SDN
| | | |
Collapse
|
10
|
Owens OL, Leonard M, Singh A. Efficacy of Alexa, Google Assistant, and Siri for Supporting Informed Prostate Cancer Screening Decisions for African-American Men. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2023; 38:1752-1759. [PMID: 37382796 DOI: 10.1007/s13187-023-02330-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 06/11/2023] [Indexed: 06/30/2023]
Abstract
Prostate cancer is the most prevalent non-skin cancer among all men, but African-Americans have morbidity and mortality at significantly higher rates than White men. To reduce this burden, authorities such as the American Cancer Society recommend that men make informed/shared screening decisions with a healthcare provider. Informed/shared screening decisions require that men have adequate prostate cancer knowledge. Virtual assistants are interactive communication technologies that have become popular for seeking health information, though information quality has been mixed. No prior research has investigated the quality of prostate cancer information disseminated by virtual assistants. The purpose of this study was to determine the response rates, accuracy, breadth, and credibility of three popular virtual assistants (Alexa, Google Assistant, and Siri) for supporting informed/shared prostate cancer screening decisions for African-American men. Each virtual assistant was evaluated on a tablet, cell phone, and smart speaker using 12 frequently asked screening questions. Responses were rated dichotomously (i.e., yes/no), and analyses were conducted using SPSS. Alexa on a phone or tablet and Google Assistant on a smart speaker had the best overall performance based on a combination of response, accuracy, and credibility scores. All other assistants scored below 75% in one or more areas. Additionally, all virtual assistants lacked the breadth to support an informed/shared prostate cancer screening decision. African-American men may be especially disadvantaged by using virtual assistants for prostate cancer information because of the lack of emphasis on their greater disease risk, higher mortality rates, and appropriate ages at which they should begin screening conversations.
Collapse
Affiliation(s)
- Otis L Owens
- College of Social Work, University of South Carolina, 1512 Pendleton Street, Columbia, SC, USA.
| | - Michael Leonard
- College of Social Work, University of South Carolina, 1512 Pendleton Street, Columbia, SC, USA
| | - Aman Singh
- Honors College, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
11
|
Lippey J, Keogh L, Campbell I, Mann GB, Forrest LE. Impact of a risk based breast screening decision aid on understanding, acceptance and decision making. NPJ Breast Cancer 2023; 9:65. [PMID: 37553371 PMCID: PMC10409718 DOI: 10.1038/s41523-023-00569-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Accepted: 07/21/2023] [Indexed: 08/10/2023] Open
Abstract
Internationally, population breast cancer screening is moving towards a risk-stratified approach and requires engagement and acceptance from current and future screening clients. A decision aid ( www.defineau.org ) was developed based on women's views, values, and knowledge regarding risk-stratified breast cancer screening. This study aims to evaluate the impact of the decision aid on women's knowledge, risk perception, acceptance of risk assessment and change of screening frequency, and decision-making. Here we report the results of a pre and post-survey in which women who are clients of BreastScreen Victoria were invited to complete an online questionnaire before and after viewing the decision aid. 3200 potential participants were invited, 242 responded with 127 participants completing both surveys. After reviewing the decision aid there was a significant change in knowledge, acceptance of risk-stratified breast cancer screening and of decreased frequency screening for lower risk. High levels of acceptance of risk stratification, genetic testing and broad support for tailored screening persisted pre and post review. The DEFINE decision aid has a positive impact on acceptance of lower frequency screening, a major barrier to the success of a risk-stratified program and may contribute to facilitating change to the population breast screening program in Australia.
Collapse
Affiliation(s)
- Jocelyn Lippey
- Sir Peter MacCallum Department of Oncology, Melbourne, Australia
- University of Melbourne, Department of Surgery, Melbourne, Australia
- St. Vincent's Hospital, Department of Surgery, Fitzroy, Australia
| | - Louise Keogh
- University of Melbourne, Melbourne School of Population and Global Health, Melbourne, Australia
| | - Ian Campbell
- Cancer Genetics Laboratory, Peter MacCallum Cancer Centre, Melbourne, Australia
| | - Gregory Bruce Mann
- Department of Surgery, The University of Melbourne, Melbourne, Australia
- Breast Service, The Royal Melbourne Hospital, Melbourne, Australia
| | - Laura Elenor Forrest
- Parkville Familial Cancer Centre, Peter MacCallum Cancer Centre, Melbourne, Australia.
| |
Collapse
|
12
|
Blake SN, Hugtenburg JG, van der Vlugt M, Dekker E, Fransen MP. Decision-making on colorectal cancer screening in Curaçao - interviews with the target population. BMC Public Health 2023; 23:1437. [PMID: 37501171 PMCID: PMC10373279 DOI: 10.1186/s12889-023-16335-x] [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: 02/03/2023] [Accepted: 07/18/2023] [Indexed: 07/29/2023] Open
Abstract
BACKGROUND During the first year of the population based colorectal cancer (CRC) screening program on Curaçao, about 20% of invitees participated. This study explored the target population's perceptions and awareness on CRC (screening), beliefs on the program provision, their preferences and information needs for informed decision-making. METHODS Semi-structured interviews with 23 individuals, who were not yet invited for CRC screening, were recorded, transcribed, coded and analyzed. RESULTS CRC (screening) was discussed in the context of personal health, where own responsibility and food were important. Cancer was perceived as an unpredictable disease that causes suffering and leads to death and was also associated with fear. Despite being aware of the program, most respondents were not familiar with the screening procedure. Provision of the screening program was regarded positively and as an opportunity to contribute to health improvement. This seemed related to the expressed trust in the Caribbean Prevention Center (program organizer). Respondents preferred to make independent decisions about CRC screening participation. A personal approach, visual aids and media were the preferred sources of information. CONCLUSION The results of our interviews suggest that it may be beneficial to provide information on CRC screening in Curaçao within the context of personal health. While including sensitivity to fears and respect for the autonomy of the target population. Finally, electronic media maybe useful in supporting informed decision-making.
Collapse
Affiliation(s)
- Shacara N Blake
- Caribbean Prevention Center (Fundashon Prevenshon), Willemstad, Curaçao.
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
- Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), Amsterdam, the Netherlands.
| | - Jacqueline G Hugtenburg
- Caribbean Prevention Center (Fundashon Prevenshon), Willemstad, Curaçao
- Faculty of Social and Behavioral Sciences, University of Curaçao, Willemstad, Curaçao
- Department of Clinical Pharmacology, Amsterdam UMC location Vrije Universiteit Amsterdam, Amsterdam, the Netherlands
| | - Manon van der Vlugt
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), Amsterdam, the Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Gastroenterology, Endocrinology and Metabolism (AGEM), Amsterdam, the Netherlands
| | - Mirjam P Fransen
- Department of Public and Occupational Health, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
- National Institute for Public Health and the Environment, Centre for Nutrition Prevention and Health Services, Bilthoven, the Netherlands
| |
Collapse
|
13
|
Lacey HP, Lacey SC, Dayal P, Forest C, Blasi D. Context Matters: Emotional Sensitivity to Probabilities and the Bias for Action in Cancer Treatment Decisions. Med Decis Making 2023; 43:417-429. [PMID: 36951184 PMCID: PMC10595072 DOI: 10.1177/0272989x231161341] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/24/2023]
Abstract
BACKGROUND Past studies have shown a commission bias for cancer treatment, a tendency to choose active treatment even when watchful waiting is less risky. This bias suggests motivations for action beyond mortality statistics, but recent evidence suggests that individuals differ in their emotional sensitivity to probabilities (ESP), the tendency to calibrate emotional reactions to probability. The current study aims to examine the role of ESP in the commission bias, specifically whether those higher in ESP are more likely to choose watchful waiting when risk probabilities align with that choice. METHODS Participants (N = 1,055) read a scenario describing a hypothetical cancer diagnosis and chose between surgery and watchful waiting, with random assignment between versions where the mortality rate was either lower for surgery or for watchful waiting. We modeled choice using the Possibility Probability Questionnaire (PPQ), a measure of ESP, and several other individual differences in a logistic regression. RESULTS We observed a commission bias as in past studies with most participants choosing surgery both when surgery was optimal (71%) and when watchful waiting was optimal (58%). An ESP × Condition interaction indicated that the predictive role of ESP depended on condition. Those higher in ESP were more likely to choose surgery when probabilities favored surgery, β = 0.57, P < 0.001, but when probabilities favored watchful waiting, ESP had a near-zero relationship with choice, β = 0.05, P < 0.99. CONCLUSIONS The role of ESP in decision making is context specific. Higher levels of ESP predict choosing action when that action is warranted but do not predict a shift away from surgery when watchful waiting offers better chances of survival. ESP does not overcome the commission bias. HIGHLIGHTS Past studies have identified a "commission bias," a tendency to choose active treatment over watchful waiting, even when mortality rate is lower for waiting.Evaluation of risk probabilities is related to individual differences in emotional sensitivity to probabilities (ESP) and has been shown to predict reactions to and decisions about health risk situations.ESP appears to be selectively factored into decision making. ESP was a robust predictor of choosing surgery when probability information supported surgery but did not predict decisions when probability information supported watchful waiting.Those who are most emotionally attuned to probabilities are just as susceptible to the commission bias as those who are less attuned.
Collapse
Affiliation(s)
- Heather P Lacey
- Department of Psychology, Center for Health and Behavioral Sciences, Bryant University, Smithfield, RI, USA
| | - Steven C Lacey
- Carroll School of Management, Boston University, Chestnut Hill, MA, USA
| | - Prerna Dayal
- Department of Psychology, Center for Health and Behavioral Sciences, Bryant University, Smithfield, RI, USA
| | - Caroline Forest
- Department of Psychology, Center for Health and Behavioral Sciences, Bryant University, Smithfield, RI, USA
| | - Dana Blasi
- Department of Psychology, Center for Health and Behavioral Sciences, Bryant University, Smithfield, RI, USA
| |
Collapse
|
14
|
Almunawar MN, Anshari M, Rosdi NBDM, Kisa A, Younis M. Reconsidering Patient Value to Create Better Healthcare. JOURNAL OF HEALTH MANAGEMENT 2023. [DOI: 10.1177/09720634231153721] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/12/2023]
Abstract
Healthcare can be seen as a value shop, in which solutions to health problems are offered in exchange for valuable contributions. However, the full value exchange between the healthcare provider and the patient is not always apparent. The value shop concept runs the risk of considering only what the patient pays (i.e., money, either paid by the patient or reimbursed by the government) while ignoring another important value, data. Yet without this data, the patient’s problem cannot be solved. This article offers a new paradigm in which a health provider can deliver better value by integrating all dimensions of the provider’s and patient’s value.
Collapse
Affiliation(s)
| | - Muhammad Anshari
- UBD School of Business and Economics, Universiti Brunei Darussalam, Brunei
| | | | - Adnan Kisa
- School of Health Sciences, Kristiania University College, Oslo, Norway
| | - Mustafa Younis
- School of Public Health, Jackson State University, Jackson, MS, USA
| |
Collapse
|
15
|
Brinkmann M, Diedrich L, Hemmerling M, Krauth C, Robra BP, Stahmeyer JT, Dreier M. Heterogeneous Preferences for Colorectal Cancer Screening in Germany: Results of a Discrete Choice Experiment. VALUE IN HEALTH : THE JOURNAL OF THE INTERNATIONAL SOCIETY FOR PHARMACOECONOMICS AND OUTCOMES RESEARCH 2023; 26:104-114. [PMID: 36031478 DOI: 10.1016/j.jval.2022.07.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/12/2021] [Revised: 07/06/2022] [Accepted: 07/13/2022] [Indexed: 06/15/2023]
Abstract
OBJECTIVES Colorectal cancer (CRC) screening tests differ in benefits, harms, and processes, making individual informed decisions preference based. The objective was to analyze the preferences of insurees in Germany for characteristics of CRC screening modalities. METHODS A generic discrete choice experiment with 2-alternative choice sets and 6 attributes (CRC mortality, CRC incidence, complications, preparation, need for transportation, and follow-up; 3 levels each) depicting characteristics of fecal testing, sigmoidoscopy, and colonoscopy was generated. Participants completed 8 choice tasks. Internal validity was tested using a within-set dominated pair. Between June and October 2020, written questionnaires were sent to a stratified random sample (n = 5000) of 50-, 55-, and 60-year-old insurees of the AOK (Allgemeine Ortskrankenkasse) Lower Saxony, who had previously received an invitation to participate in the organized screening program including evidence-based information. Preferences were analyzed using conditional logit, mixed logit, and latent-class model. RESULTS From 1282 questionnaires received (26% [1282 of 4945]), 1142 were included in the analysis. Approximately 42% of the respondents chose the dominated alternative in the internal validity test. Three heterogeneous preference classes were identified. Most important attributes were preparation (class 1; n = 505, 44%), CRC mortality (class 2; n = 347, 30%), and CRC incidence (class 3; n = 290, 25%). Contrary to a priori expectations, a higher effort was preferred for bowel cleansing (class 1) and accompaniment home (classes 1 and 2). CONCLUSION Internal validity issues of choice data need further research and warrant attention in future discrete choice experiment surveys. The observed preference heterogeneity suggests different informational needs, although the underlying reasons remained unclear.
Collapse
Affiliation(s)
- Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
| | - Leonie Diedrich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | | | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Bernt-Peter Robra
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Jona T Stahmeyer
- Health Services Research Unit, AOK Niedersachsen, Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| |
Collapse
|
16
|
James LJ, Wong G, Tong A, Craig JC, Howard K, Howell M. Patient preferences for cancer screening in chronic kidney disease: a best-worst scaling survey. Nephrol Dial Transplant 2022; 37:2449-2456. [PMID: 34958393 DOI: 10.1093/ndt/gfab360] [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: 08/08/2021] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND Despite an increased cancer risk for patients with chronic kidney disease (CKD), uptake of cancer screening varies due to competing priorities and complex health-related issues. This study aimed to elicit the preferences and important attributes of cancer screening in patients with CKD. METHODS An on-line best-worst scaling survey was used to ascertain the relative importance of 22 screening attributes among CKD patients using an incomplete block design. Preference scores (0-1) were calculated by multinomial logistic regression. Preference heterogeneity was evaluated. RESULTS The survey was completed by 83 patients: 26 not requiring kidney replacement therapy, 20 receiving dialysis and 37 transplant recipients (mean age 59 years, 53% men, 75% prior to cancer screening). The five most important attributes were early detection {preference score 1.0 [95% confidence interval (CI) 0.90-1.10]}, decreased risk of cancer death [0.85 (0.75-0.94)], false negatives [0.71 (0.61-0.80)], reduction in immunosuppression if detected [0.68 (0.59-0.78)] and non-invasive interventions after positive results [0.68 (0.59-0.78)]. Preference heterogeneity reflected the stage of CKD. Immunosuppression reduction [mean difference 0.11 (95% CI 0.02-0.19)] and views of family/friends [0.10 (reference attribute)] were important for transplant recipients. Screening frequency [-0.18 (95% CI -0.26 to -0.10)] and overdiagnosis of harmless cancers [-0.14 (95% CI -0.22 to -0.10)] were important for dialysis patients. CONCLUSION Early detection, risk of cancer-related death, false negatives, immunosuppression reduction and non-invasive interventions following detection are important cancer screening considerations among CKD patients. Patient preferences are key to shared decision-making and individualized cancer screening.
Collapse
Affiliation(s)
- Laura J James
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Germaine Wong
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Westmead, NSW, Australia
| | - Allison Tong
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| | - Jonathan C Craig
- College of Medicine and Public Health, Flinders University, Adelaide, Australia
| | - Kirsten Howard
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia
| | - Martin Howell
- Sydney School of Public Health, Faculty of Medicine and Health, University of Sydney, Sydney, NSW, Australia.,Centre for Kidney Research, Children's Hospital at Westmead, Westmead, NSW, Australia
| |
Collapse
|
17
|
Hernández-Leal MJ, Pérez-Lacasta MJ, Cardona-Cardona A, Codern-Bové N, Vidal-Lancis C, Rue M, Forné C, Carles-Lavila M. Women's preference to apply shared decision-making in breast cancer screening: a discrete choice experiment. BMJ Open 2022; 12:e064488. [PMID: 36351714 PMCID: PMC9644356 DOI: 10.1136/bmjopen-2022-064488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
OBJECTIVE To analyse women's stated preferences for establishing the relative importance of each attribute of shared decision-making (SDM) and their willingness to pay (WTP) for more participatory care in breast cancer screening programmes (BCSP). DESIGN A discrete choice experiment was designed with 12 questions (choice tasks). It included three attributes: 'How the information is obtained', regarding benefits and harms; whether there is a 'Dialogue for scheduled mammography' between the healthcare professional and the woman; and, 'Who makes the decision', regarding participation in BCSP. Data were obtained using a survey that included 12 choice tasks, 1 question on WTP and 7 socioeconomic-related questions. The analysis was performed using conditional mixed-effect logit regression and stratification according to WTP. SETTING Data collection related to BCSP was conducted between June and November 2021 in Catalonia, Spain. PARTICIPANTS Sixty-five women aged between 50 and 60. MAIN OUTCOME MEASURES Women's perceived utility of each attribute, trade-off on these attributes and WTP for SDM in BCSP. RESULT The only significant attribute was 'Who makes the decision'. The decision made alone (coefficient=2.879; 95% CI=2.297 to 3.461) and the decision made together with a healthcare professional (2.375; 95% CI=1.573 to 3.177) were the options preferred by women. The former contributes 21% more utility than the latter. Moreover, 52.3% of the women stated a WTP of €10 or more for SDM. Women's preferences regarding attributes did not influence their WTP. CONCLUSIONS The participant women refused a current paternalistic model and preferred either SDM or informed decision-making in BCSP.
Collapse
Affiliation(s)
- María José Hernández-Leal
- Department of Economics, University Rovira i Virgili, Reus, Spain
- Research Centre on Economics and Sustainability (ECO-SOS), Reus, Spain
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
| | - María José Pérez-Lacasta
- Department of Economics, University Rovira i Virgili, Reus, Spain
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
| | - Angels Cardona-Cardona
- Area Q: Evaluation and Research in the Field of Social Sciences and Health, Barcelona, Spain
| | - Núria Codern-Bové
- School of Nursing and Occupational Therapy (EUIT), Autonomous University of Barcelona, Terrasa, Spain
| | - Carmen Vidal-Lancis
- Cancer Prevention and Control Program, Catalan Institute of Oncology-IDIBELL, L'Hospitalet de Llobregat, Spain
| | - Montserrat Rue
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
- Department of Basic Medical Sciences, University of Lleida-IRB, Lleida, Spain
| | - Carles Forné
- Department of Basic Medical Sciences, University of Lleida, Lleida, Spain
- HEOR freelance consultant, Heorfy Consulting, Reus, Spain
| | - Misericòrdia Carles-Lavila
- Department of Economics, University Rovira i Virgili, Reus, Spain
- Research Centre on Economics and Sustainability (ECO-SOS), Reus, Spain
- Research Group on Statistics, Economic Evaluation and Health (GRAEES), Reus, Spain
| |
Collapse
|
18
|
Lau J, Ng A, Wong GJ, Siew KY, Tan JKH, Pang Y, Tan KK. How effective are digital technology-based interventions at promoting colorectal cancer screening uptake in average-risk populations? A systematic review and meta-analysis of randomized controlled trials. Prev Med 2022; 164:107343. [PMID: 36368343 DOI: 10.1016/j.ypmed.2022.107343] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2022] [Revised: 10/31/2022] [Accepted: 11/05/2022] [Indexed: 11/11/2022]
Abstract
Despite the global prevalence of colorectal cancer (CRC) and efforts in screening advocacy, screening uptake remains relatively low. Considering the greater accessibility and popularity of telemedicine in behaviour change interventions, this meta-analysis seeks to examine the usefulness of digital interventions in promoting CRC screening uptake as compared to existing non-digital strategies. A systematic search on five databases identified articles published before September 2022. Randomized controlled trials comparing the effectiveness of digital interventions to usual care were included and assessed using the Cochrane's Risk of Bias tool. Effectiveness of interventions was measured by CRC screening completion rates, and pooled effect sizes were computed for both digital intervention subtypes identified - decision-making aids and tailored educational interventions. 14 studies (17,075 participants) assessed to have low or some risk of bias were included in this meta-analysis. A random-effects model revealed that digital interventions were more likely to promote CRC screening uptake (OR = 1.31, 95% CI: 1.11-1.56), and using a decision-making aid was almost 1.5 times more likely to result in screening completion (i.e., completed a colorectal investigation using stool-based or direct visualization test) (OR = 1.42, 95% CI: 1.24-1.63). Meanwhile, the tailored educational intervention subtype failed to achieve statistical significance in promoting screening uptake, bearing in mind the significant heterogeneity across studies (I2 = 88.6%). Digital decision-making aids significantly improved CRC screening uptake compared to tailored digital educational interventions and usual care. However, as all included studies were conducted in Western settings, its role in augmenting existing CRC screening promotion strategies especially among Asians should be further evaluated.
Collapse
Affiliation(s)
- Jerrald Lau
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Alyssa Ng
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Gretel Jianlin Wong
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Kernix Yuqing Siew
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Jarrod K H Tan
- Department of Surgery, National University Hospital, Singapore
| | - Yan Pang
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore
| | - Ker-Kan Tan
- Yong Loo Lin School of Medicine, National University of Singapore, Singapore; Saw Swee Hock School of Public Health, National University of Singapore, Singapore; Department of Surgery, National University Hospital, Singapore.
| |
Collapse
|
19
|
Brinkmann M, Fricke LM, Diedrich L, Robra BP, Krauth C, Dreier M. Attributes in stated preference elicitation studies on colorectal cancer screening and their relative importance for decision-making among screenees: a systematic review. HEALTH ECONOMICS REVIEW 2022; 12:49. [PMID: 36136248 PMCID: PMC9494881 DOI: 10.1186/s13561-022-00394-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/29/2022] [Accepted: 09/07/2022] [Indexed: 06/16/2023]
Abstract
INTRODUCTION The SIGMO study (Sigmoidoscopy as an evidence-based colorectal cancer screening test - a possible option?) examines screening eligible populations' preferences for colorectal cancer (CRC) screening in Germany using a discrete choice experiment (DCE). Attribute identification and selection are essential for the construction of choice tasks and should be evidence-based. As a part of the SIGMO study this systematic review provides an overview of attributes included in studies eliciting stated preferences for CRC screening tests and their relative importance for decision-making. METHODS Systematic search (November 2021) for English-language studies published since January 2000 in PubMed, Embase, Web of Science, Biomedical Reference Collection: Corporate Edition, LIVIVO and PsycINFO. DCEs and conjoint analysis ranking or rating tasks on screening eligible populations' preferences for stool testing, sigmoidoscopy, and/or colonoscopy were included. Attributes were extracted and their relative importance was calculated and ranked. Risk of bias (RoB) of included studies was assessed using a modified GRADE (Grading of Recommendations Assessment, Development and Evaluation) approach. Study selection and RoB rating were carried out independently by two reviewers. Data were extracted by one reviewer and checked by another one. RESULTS A total of 23 publications on 22 studies were included. Overall RoB was rated as serious/critical for 21 studies and as moderate for 2 studies. Main reasons for high RoB were non-random sampling, low response rates, lack of non-responder analyses, and, to a lesser extent, weaknesses in the measurement instrument and data analysis. Extracted attributes (n = 120) referred to procedure-related characteristics (n = 42; 35%), structural characteristics of health care (n = 24; 20%), test characteristics (n = 23; 19%), harms (n = 16; 13%), benefits (n = 13; 11%), and level of evidence (n = 2; 2%). Most important attributes were reduction in CRC mortality (and incidence) (n = 7), test sensitivity (n = 7), out-of-pocket costs (n = 4), procedure (n = 3), and frequency (n = 2). CONCLUSIONS Health preference studies on CRC were found to have a high RoB. The composition of choice tasks revealed a lack of attributes on patient-important outcomes (like incidence reduction), while attributes not considered relevant for individual screening decisions (like sensitivity) were frequently used. Future studies eliciting stated preferences in cancer screening should apply the principles of informed decision-making in attribute identification and selection.
Collapse
Affiliation(s)
- Melanie Brinkmann
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany.
| | - Lara Marleen Fricke
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Leonie Diedrich
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Bernt-Peter Robra
- Institute of Social Medicine and Health Systems Research, Otto-von-Guericke University Magdeburg, Magdeburg, Germany
| | - Christian Krauth
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| | - Maren Dreier
- Institute for Epidemiology, Social Medicine and Health Systems Research, Hannover Medical School, Hannover, Germany
| |
Collapse
|
20
|
Knowledge, Attitude, and Perception of Cancer Patients towards COVID-19 in Pakistan: A Cross-Sectional Study. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19137926. [PMID: 35805584 PMCID: PMC9265320 DOI: 10.3390/ijerph19137926] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/30/2022] [Revised: 06/20/2022] [Accepted: 06/23/2022] [Indexed: 12/12/2022]
Abstract
Background: Cancer patients, being immunocompromised, are at higher risk of coronavirus disease (COVID-19). The current study determines cancer patients’ knowledge, attitude, perception, and impact of the COVID-19 pandemic. Method: A cross-sectional online survey was conducted in Pakistan from 1 April 2020 to 1 May 2020. The study respondents were cancer patients with ages equal to or greater than 18 years. Following a request for participation, the URL for the survey was distributed on numerous channels. Other social media platforms, including WeChat, WhatsApp, Facebook, Twitter, Instagram, Messenger, and LinkedIn, were used to increase cancer patient interaction. The questionnaire comprised five different sections such as: (1) sociodemographic information, (2) knowledge, (3) attitude, (4) perception, and (5) impact of COVID-19 on cancer patients. Descriptive medical statistics such as frequency, percentage, mean, and standard deviation were used to illustrate the demographic characteristics of the study participants. To compare mean knowledge scores with selected demographic variables, independent sample t-tests and one-way analysis of variance (ANOVA) were used, which are also practical methods in epidemiological, public health and medical research. The cut-off point for statistical significance was set at a p-value of 0.05. Results: More than 300 cancer patients were invited, of which 208 agreed to take part. The response rate was 69.33% (208/300). Gender, marital status, and employment status had a significant association with knowledge scores. Of the total recruited participants, 96% (n = 200) (p < 0.01) knew about COVID-19, and 90% were aware of general symptoms of COVID-19 disease, such as route of transmission and preventive measurements. In total, 94.5% (n = 197) (p < 0.01) were willing to accept isolation if they were infected with COVID-19, and 98% (n = 204) (p < 0.01) had reduced their use of public transportation. More than 90% (n = 188) (p < 0.01) of cancer patients were found to be practicing preventative measures such as using a face mask, keeping social distance, and avoiding handshaking and hugging. Around 94.4% (n = 196) (p < 0.01) of cancer patients had been impacted by, stopped or had changed cancer treatment during this pandemic, resulting in COVID-related anxiety and depression. Conclusion: The included cancer patients exhibited a good level of COVID-19 knowledge, awareness, positive attitude, and perception. Large-scale studies and efforts are needed to raise COVID-19 awareness among less educated and high-risk populations. The present survey indicates that mass-level effective health education initiatives are required for developing countries to improve and reduce the gap between KAP and COVID-19.
Collapse
|
21
|
Lee HJ, Qian CL, Landay SL, O'Callaghan D, Kaslow-Zieve E, Azoba CC, Fuh CX, Temel B, Ufere N, Petrillo LA, Fong ZV, Greer JA, El-Jawahri A, Temel JS, Traeger L, Nipp RD. Communicating the Information Needed for Treatment Decision Making Among Patients With Pancreatic Cancer Receiving Preoperative Therapy. JCO Oncol Pract 2022; 18:e313-e324. [PMID: 34618600 DOI: 10.1200/op.21.00388] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2021] [Revised: 07/06/2021] [Accepted: 09/13/2021] [Indexed: 12/23/2022] Open
Abstract
PURPOSE Preoperative therapy for pancreatic cancer represents a new treatment option with the potential to improve outcomes for patients, yet with complex risks. By not discussing the potential risks and benefits of new treatment options, clinicians may hinder patients from making informed decisions. METHODS From 2017 to 2019, we conducted a mixed-methods study. First, we elicited clinicians' (n = 13 medical, radiation, and surgery clinicians), patients' (n = 18), and caregivers' (n = 14) perceptions of information needed for decision making regarding preoperative therapy and generated a list of key elements. Next, we audio-recorded patients' (n = 20) initial multidisciplinary oncology visits and used qualitative content analyses to describe how clinicians discussed this information and surveyed patients to ask if they heard each key element. RESULTS We identified 13 key elements of information patients need when making decisions regarding preoperative therapy, including treatment complications, alternatives, logistics, and potential outcomes. Patients reported hearing infrequently about complications (eg, hospitalizations [n = 3 of 20]) and alternatives (n = 8 of 20) but frequently recalled logistics and potential outcomes (eg, likelihood of surgery [n = 19 of 20]). Clinicians infrequently discussed complications (eg, hospitalizations [n = 7 of 20]), but frequently discussed alternatives, logistics, and potential outcomes (eg, likelihood of surgery [n = 20 of 20]). No overarching differences in clinician discussion content emerged to explain why patients did or did not hear about each key element. CONCLUSION We identified key elements of information patients with pancreatic cancer need when considering preoperative therapy. Patients infrequently heard about treatment complications and alternatives, while frequently hearing about logistics and potential outcomes, underscoring areas for improvement in educating patients about new treatment options in oncology.
Collapse
Affiliation(s)
- Howard J Lee
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Carolyn L Qian
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Sophia L Landay
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Deirdre O'Callaghan
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Emilia Kaslow-Zieve
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Chinenye C Azoba
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Charn-Xin Fuh
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Brandon Temel
- Department of Medicine, Massachusetts General Hospital, Boston, MA
- Harvard Medical School, Boston, MA
| | - Nneka Ufere
- Harvard Medical School, Boston, MA
- Division of Gastroenterology, Massachusetts General Hospital, Boston, MA
| | - Laura A Petrillo
- Harvard Medical School, Boston, MA
- Division of Palliative Care, Massachusetts General Hospital, Boston, MA
| | - Zhi Ven Fong
- Harvard Medical School, Boston, MA
- Department of Surgery, Massachusetts General Hospital, Boston, MA
| | - Joseph A Greer
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Areej El-Jawahri
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| | - Jennifer S Temel
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| | - Lara Traeger
- Harvard Medical School, Boston, MA
- Department of Psychiatry, Massachusetts General Hospital, Boston, MA
| | - Ryan D Nipp
- Harvard Medical School, Boston, MA
- Division of Hematology and Oncology, Massachusetts General Hospital, Boston, MA
| |
Collapse
|
22
|
Col NF, Haugen V. Shared Decision-Making and Short-Course Radiotherapy for Operable Rectal Adenocarcinoma: A Patient's Right to Choose. J Wound Ostomy Continence Nurs 2022; 49:180-183. [PMID: 35255072 DOI: 10.1097/won.0000000000000852] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
BACKGROUND As new treatment options for colorectal cancer (CRC) emerge, physicians and WOC nurses must be prepared to assist patients to choose care that meets their needs and preferences. A patient with T2N0M0 rectal adenocarcinoma was offered the US current standard of practice; he was not offered alternative treatment options. This case study emphasizes the need to ensure patients are offered all reasonable options for treatment. Shared decision-making is a process that helps patients actively participate in their heath choices rather than exclusively relying on the judgment of a health care provider. CASE Mr J was a 70-year-old man with operable CRC who sought care at a health care facility in his community. He was offered a single option, based on standard of care for this tumor stage: long-course neoadjuvant chemoradiotherapy followed by surgery and additional chemotherapy. After seeking a second opinion at a cancer care center in another state, Mr J chose to undergo a viable alternative treatment option (short-course radiotherapy, followed by surgery, with chemotherapy contingent on his nodal status post-surgery). No nodal involvement was found post- surgery (T2N0M0) enabling him to avoid postoperative chemotherapy. CONCLUSIONS This case illustrates the need for all health care providers and carers to regularly engage in shared decision-making when choosing among treatment options. In this case, short-course radiotherapy offered Mr J a shorter duration of treatment and avoided the risk for adverse side effects associated with chemotherapy, resulting in improved health-related quality of life. Initial omission to disclose all treatment options to Mr J may have reflected the preferences of the surgeon, institutional financial pressures, or discomfort with shared decision-making, but it failed to provide him with full range of options, given his diagnosis and tumor stage. All members of the patient's care team, including the WOC nurse, play a pivotal role in ensuring transparency in medical care, including advocating for shared decision-making where patients are made aware of all viable treatments, followed by supporting the patient as they reach a decision.
Collapse
Affiliation(s)
- Nananda F Col
- Nananda Col, MD, MPP, MPH, FACP, Shared Decision Making Resources, Georgetown, Maine, and University of New England, Biddeford, Maine
- Vicki Haugen, BSN, RN, MPH, CWOCN, CHANS , Home Care and Hospice, Boothbay, Maine
| | - Vicki Haugen
- Nananda Col, MD, MPP, MPH, FACP, Shared Decision Making Resources, Georgetown, Maine, and University of New England, Biddeford, Maine
- Vicki Haugen, BSN, RN, MPH, CWOCN, CHANS , Home Care and Hospice, Boothbay, Maine
| |
Collapse
|
23
|
Bertels L, Knottnerus B, Bastiaans L, Danquah A, van H, Dekker E, van K. Decision-making in screening positive participants who follow up with colonoscopy in the Dutch colorectal cancer screening programme: A mixed-method study. Psychooncology 2022; 31:245-252. [PMID: 34535928 PMCID: PMC9291115 DOI: 10.1002/pon.5814] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/12/2021] [Revised: 06/15/2021] [Accepted: 08/11/2021] [Indexed: 12/18/2022]
Abstract
OBJECTIVE To explore worry and decision-making processes used by faecal immunochemical test (FIT)-positive participants in the Dutch national screening programme for colorectal cancer. METHODS A mixed-methods study consisting of 22 semi-structured interviews in FIT-positive participants who underwent the recommended colonoscopy within 4-6 months after the FIT result, followed by a widespread questionnaire in a larger target population (N = 1495). RESULTS In the interviews, we recognised two different decision-making processes. The first is an affective heuristic decision process where the decision to participate is made instantly and is paired with high-risk perception, worry and (severe) emotional turmoil. The second is a more time-consuming analytical decision process in which participants describe discussing options with others. In the questionnaire, high levels of cancer worry (CWS > 9) were reported by 34% of respondents. Decisional difficulties were reported by 15% of respondents, and 34% of respondents reported discussing the positive FIT result with their GP. Individuals with high levels of cancer worry contacted their GP less often than those with low levels. CONCLUSIONS The Dutch two-step screening programme may result in high levels of cancer worry in a non-cancer population. More research is needed to monitor worry and its role in decision-making in cancer screening, as well as ways to facilitate decision-making for participants.
Collapse
Affiliation(s)
- Lucinda Bertels
- Department of General PracticeCancer Center Amsterdam and Amsterdam Public HealthAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Socio‐Medical SciencesErasmus School of Health Policy and ManagementRotterdamThe Netherlands
| | - Bart Knottnerus
- Department of General PracticeCancer Center Amsterdam and Amsterdam Public HealthAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
- Netherlands Institute for Health Services Research (Nivel)UtrechtThe Netherlands
| | - Lottie Bastiaans
- Department of General Practice, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Augustina Danquah
- Department of General Practice, Amsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Henk van
- Department of General PracticeCancer Center Amsterdam and Amsterdam Public HealthAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and HepatologyCancer Center AmsterdamAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| | - Kristel van
- Department of General PracticeCancer Center Amsterdam and Amsterdam Public HealthAmsterdam UMCUniversity of AmsterdamAmsterdamThe Netherlands
| |
Collapse
|
24
|
Colorectal Cancer Screening: Have We Addressed Concerns and Needs of the Target Population? GASTROINTESTINAL DISORDERS 2021. [DOI: 10.3390/gidisord3040018] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
Despite the recognized benefits of colorectal cancer (CRC) screening, uptake is still suboptimal in many countries. In addressing this issue, one important element that has not received sufficient attention is population preference. Our review provides a comprehensive summary of the up-to-date evidence relative to this topic. Four OVID databases were searched: Ovid MEDLINE® ALL, Biological Abstracts, CAB Abstracts, and Global Health. Among the 742 articles generated, 154 full texts were selected for a more thorough evaluation based on predefined inclusion criteria. Finally, 83 studies were included in our review. The general population preferred either colonoscopy as the most accurate test, or fecal occult blood test (FOBT) as the least invasive for CRC screening. The emerging blood test (SEPT9) and capsule colonoscopy (nanopill), with the potential to overcome the pitfalls of the available techniques, were also favored. Gender, age, race, screening experience, education and beliefs, the perceived risk of CRC, insurance, and health status influence one’s test preference. To improve uptake, CRC screening programs should consider offering test alternatives and tailoring the content and delivery of screening information to the public’s preferences. Other logistical measures in terms of the types of bowel preparation, gender of endoscopist, stool collection device, and reward for participants can also be useful.
Collapse
|
25
|
Young B, Robb KA. Understanding patient factors to increase uptake of cancer screening: a review. Future Oncol 2021; 17:3757-3775. [PMID: 34378403 DOI: 10.2217/fon-2020-1078] [Citation(s) in RCA: 32] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023] Open
Abstract
Early detection of cancer through organized screening is a central component of population-level strategies to reduce cancer mortality. For screening programs to be effective, it is important that those invited to screening participate. However, uptake rates are suboptimal in many populations and vary between screening programs, indicating a complex combination of patient factors that require elucidation to develop evidence-based strategies to increase participation. In this review, the authors summarize individual-level (sociodemographic and psychosocial) factors associated with cancer screening uptake and evidence for the effectiveness of behavioral interventions to increase uptake. The authors reflect on current trends and future directions for behavioral cancer screening research to overcome challenges and address unmet needs in reducing cancer mortality.
Collapse
Affiliation(s)
- Ben Young
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
| | - Kathryn A Robb
- Institute of Health & Wellbeing, University of Glasgow, Glasgow, G12 0XH, UK
| |
Collapse
|
26
|
Lee M, Kang BA, You M. Knowledge, attitudes, and practices (KAP) toward COVID-19: a cross-sectional study in South Korea. BMC Public Health 2021; 21:295. [PMID: 33546644 PMCID: PMC7863060 DOI: 10.1186/s12889-021-10285-y] [Citation(s) in RCA: 141] [Impact Index Per Article: 35.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Accepted: 01/20/2021] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND The public must routinely practice precautionary behaviors to control the spread of COVID-19, as no vaccines and antiviral treatments are currently available. This paper examines the public's knowledge, attitudes, and practices (KAP) related to COVID-19 and their relationships and identified the pandemic's vulnerable populations to provide recommendations for behavioral interventions and policies. METHODS Data collection took place over 3 days (June 26-29) via an online survey 5 months after the Korea Centers for Disease Control and Prevention (KCDC) confirmed the first COVID case in South Korea; 970 subjects were included in the statistical data analysis. RESULTS Knowledge directly affected both attitudes (e.g., perceived risk and efficacy belief) and practices (e.g., personal hygiene practices and social distancing). Among the influencing factors of COVID-19 preventive behaviors, efficacy belief was the most influential and significant practice factor. It mediated the relationship between knowledge and all three preventive behaviors (wearing facial masks, practicing hand hygiene, and avoiding crowded places). The level of knowledge varied by sociodemographic characteristics. Females (β = 0.06, p < 0.05) and individuals with higher levels of education (β = 0.06, p < 0.05) demonstrated higher levels of knowledge. CONCLUSION To increase precautionary behaviors among the public, health officials and policymakers must promote knowledge and efficacy belief. Future interventions and policies should also be developed in a 'person-centered' approach, targeting vulnerable subgroups, embracing them, and closing the gap of KAP toward COVID-19.
Collapse
Affiliation(s)
- Minjung Lee
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.,Office of Dental Education, School of Dentistry, Seoul National University, Seoul, South Korea
| | - Bee-Ah Kang
- Department of Communication, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea
| | - Myoungsoon You
- Department of Public Health Sciences, Graduate School of Public Health, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea. .,Institute of Health and Environment, Seoul National University, 1 Gwanak-ro, Gwanak-gu, Seoul, 08826, South Korea.
| |
Collapse
|
27
|
Darlington AE, Morgan JE, Wagland R, Sodergren SC, Culliford D, Gamble A, Phillips B. COVID-19 and children with cancer: Parents' experiences, anxieties and support needs. Pediatr Blood Cancer 2021; 68:e28790. [PMID: 33219739 PMCID: PMC7744834 DOI: 10.1002/pbc.28790] [Citation(s) in RCA: 64] [Impact Index Per Article: 16.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2020] [Revised: 09/21/2020] [Accepted: 10/12/2020] [Indexed: 12/26/2022]
Abstract
BACKGROUND Children with cancer were designated as clinically extremely vulnerable if they were to contract SARS-CoV-2 due to immune suppression in the early phase of the COVID-19 pandemic. Our aim was to explore experiences, information and support needs, and decision making of parents with a child with cancer in response to this phase in the United Kingdom. METHODS Parents of a child with cancer completed a survey at a time when the UK moved into a period of 'lockdown'. An online survey was developed by the research team to capture parents' experiences, information and support needs, and decision making, using closed statements and open text boxes. Descriptive quantitative analyses and qualitative thematic content analysis were undertaken. FINDINGS One hundred seventy-one parents/caregivers completed the survey. Eighty-five percent were worried about the virus and they were vigilant about the virus (92%) or cancer symptoms (93.4%). For two-thirds (69.6%), hospital was no longer considered a safe place. Eight overarching themes were identified related to the virus: (a) risk of infection; (b) information, guidance and advice; (c) health care provision; (d) fears and anxieties; or related to lockdown/isolation: (e) psychological and social impact; (f) keeping safe under lockdown; (g) provisions and dependence; and (h) employment and income. CONCLUSIONS This is the first study, to the best of our knowledge, to report experiences of parents of a child with cancer during the SARS-CoV-2/COVID-19 pandemic. The majority of parents were worried about SARS-CoV-2 and transmitting the virus to their child. Hospital was no longer perceived to be a safe place, and parents were worried about suboptimal cancer care. Parents described fear and anxiety and the psychological, social and economic impact of isolation.
Collapse
Affiliation(s)
| | - Jessica E. Morgan
- Centre for Reviews and DisseminationUniversity of YorkYorkUK,Department of Paediatric OncologyLeeds Teaching Hospitals NHS TrustLeedsUK
| | - Richard Wagland
- School of Health SciencesUniversity of SouthamptonSouthamptonUK
| | | | - David Culliford
- NIHR Applied Research Collaboration WessexUniversity of SouthamptonSouthamptonUK
| | | | - Bob Phillips
- Centre for Reviews and DisseminationUniversity of YorkYorkUK,Department of Paediatric OncologyLeeds Teaching Hospitals NHS TrustLeedsUK
| |
Collapse
|
28
|
McFarlane SJ, Morgan SE, Occa A, Peng W. An Evaluation of Clinical Trial Multimedia to Support Hispanic Cancer Patients' Informational and Decision-Making Needs. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:110-117. [PMID: 31444640 DOI: 10.1007/s13187-019-01606-2] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/10/2023]
Abstract
The inclusion of diverse populations in clinical trial research is a social justice imperative. Creating the communicative tools that can support cancer patients across varied cultural backgrounds in processing complex clinical trial information, to achieve informed consent, has been a challenge. This study sought to evaluate specific clinical trial multimedia-a website, four animations, and a decision aid-to meet the decision-making and informational needs of Hispanic patients. The multimedia content was positively evaluated by Hispanic cancer patients. However, the discussions also yielded important steps for culturally adapting these tools to account for particular informational needs and cultural values that would be important to incorporate into these, and future, clinical trial multimedia interventions that target Hispanic populations.
Collapse
Affiliation(s)
| | - Susan E Morgan
- School of Communication, University of Miami, Coral Gables, FL, USA
| | - Aurora Occa
- Department of Communication, University of Kentucky, Lexington, KY, USA
| | - Wei Peng
- School of Communication, University of Miami, Coral Gables, FL, USA
| |
Collapse
|
29
|
Randomized Controlled Trial of Personalized Colorectal Cancer Risk Assessment vs Education to Promote Screening Uptake. Am J Gastroenterol 2021; 116:391-400. [PMID: 33009045 DOI: 10.14309/ajg.0000000000000963] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2020] [Accepted: 08/27/2020] [Indexed: 12/11/2022]
Abstract
INTRODUCTION Risk stratification has been proposed as a strategy to improve participation in colorectal cancer (CRC) screening, but evidence is lacking. We performed a randomized controlled trial of risk stratification using the National Cancer Institute's Colorectal Cancer Risk Assessment Tool (CCRAT) on screening intent and completion. METHODS A total of 230 primary care patients eligible for first-time CRC screening were randomized to risk assessment via CCRAT or education control. Follow-up of screening intent and completion was performed by record review and phone at 6 and 12 months. We analyzed change in intent after intervention, time to screening, overall screening completion rates, and screening completion by CCRAT risk score tertile. RESULTS Of the patients, 61.7% of patients were aged <60 years, 58.7% female, and 94.3% with college or higher education. Time to screening did not differ between arms (hazard ratio 0.78 [95% confidence interval (CI) 0.52-1.18], P = 0.24). At 12 months, screening completion was 38.6% with CCRAT vs 44.0% with education (odds ratio [OR] 0.80 [95% CI 0.47-1.37], P = 0.41). Changes in screening intent did not differ between the risk assessment and education arms (precontemplation to contemplation: OR 1.52 [95% CI 0.81-2.86], P = 0.19; contemplation to precontemplation: OR 1.93 [95% CI 0.45-8.34], P = 0.38). There were higher screening completion rates at 12 months in the top CCRAT risk tertile (52.6%) vs the bottom (32.4%) and middle (31.6%) tertiles (P = 0.10). DISCUSSION CCRAT risk assessment did not increase screening participation or intent. Risk stratification might motivate persons classified as higher CRC risk to complete screening, but unintentionally discourage screening among persons not identified as higher risk.
Collapse
|
30
|
Bertels L, Lucassen P, van Asselt K, Dekker E, van Weert H, Knottnerus B. Motives for non-adherence to colonoscopy advice after a positive colorectal cancer screening test result: a qualitative study. Scand J Prim Health Care 2020; 38:487-498. [PMID: 33185121 PMCID: PMC7781896 DOI: 10.1080/02813432.2020.1844391] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/18/2022] Open
Abstract
SETTING Participants with a positive faecal immunochemical test (FIT) in screening programs for colorectal cancer (CRC) have a high risk for colorectal cancer and advanced adenomas. They are therefore recommended follow-up by colonoscopy. However, more than ten percent of positively screened persons do not adhere to this advice. OBJECTIVE To investigate FIT-positive individuals' motives for non-adherence to colonoscopy advice in the Dutch CRC screening program. SUBJECTS Non-adherent FIT-positive participants of the Dutch CRC screening program. DESIGN We conducted semi structured in-depth interviews with 17 persons who did not undergo colonoscopy within 6 months after a positive FIT. Interviews were undertaken face-to-face and data were analysed thematically with open coding and constant comparison. RESULTS All participants had multifactorial motives for non-adherence. A preference for more personalised care was described with the following themes: aversion against the design of the screening program, expectations of personalised care, emotions associated with experiences of impersonal care and a desire for counselling where options other than colonoscopy could be discussed. Furthermore, intrinsic motives were: having a perception of low risk for CRC (described by all participants), aversion and fear of colonoscopy, distrust, reluctant attitude to the treatment of cancer and cancer fatalism. Extrinsic motives were: having other health issues or priorities, practical barriers, advice from a general practitioner (GP) and financial reasons. CONCLUSION Personalised screening counselling might have helped to improve the interviewees' experiences with the screening program as well as their knowledge on CRC and CRC screening. Future studies should explore whether personalised screening counselling also has potential to increase adherence rates. Key points Participants with a positive FIT in two-step colorectal cancer (CRC) screening programs are at high risk for colorectal cancer and advanced adenomas. Non-adherence after an unfavourable screening result happens in all CRC programs worldwide with the consequence that many of the participants do not undergo colonoscopy for the definitive assessment of the presence of colorectal cancer. Little qualitative research has been done to study the reasons why individuals participate in the first step of the screening but not in the second step. We found a preference for more personalised care, which was not reported in previous literature on this subject. Furthermore, intrinsic factors, such as a low risk perception and distrust, and extrinsic factors, such as the presence of other health issues and GP advice, may also play a role in non-adherence. A person-centred approach in the form of a screening counselling session may be beneficial for this group of CRC screening participants.
Collapse
Affiliation(s)
- Lucinda Bertels
- Department of General Practice, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Department of Socio-Medical Sciences, Erasmus School of Health Policy & Management, Erasmus University Rotterdam, Rotterdam, The Netherlands
- CONTACT Lucinda Bertels , .Department of General Practice, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; Erasmus School of Health Policy & Management, Rotterdam
| | - Peter Lucassen
- Department of Primary and Community Care, Radboud University Medical Centre, Radboud Institute for Health Sciences, Nijmegen, The Netherlands
| | - Kristel van Asselt
- Department of General Practice, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Evelien Dekker
- Department of Gastroenterology and Hepatology, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Henk van Weert
- Department of General Practice, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
| | - Bart Knottnerus
- Department of General Practice, Cancer Center Amsterdam, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Amsterdam, The Netherlands
- Netherlands Institute for Health Services Research (Nivel), Utrecht, The Netherlands
| |
Collapse
|
31
|
Highet M, Jessiman-Perreault G, Hilton E, Law G, Allen-Scott L. Understanding the decision to immunize: insights into the information needs and priorities of people who have utilized an online human papillomavirus (HPV) vaccine decision aid tool. Canadian Journal of Public Health 2020; 112:191-198. [PMID: 33078333 PMCID: PMC7571294 DOI: 10.17269/s41997-020-00425-z] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Accepted: 09/21/2020] [Indexed: 11/19/2022]
Abstract
Setting People in Alberta are more likely to seek information about cancer prevention online than they are to have this conversation with their primary care provider. As people turn to the internet to support health decision-making, it is critical that we improve the supportiveness of the virtual health setting for cancer prevention. Intervention In 2014, the Alberta Cancer Prevention Legacy Fund launched an online HPV Decision Aid Tool to support evidence-informed decision-making in response to suboptimal uptake of the HPV (human papillomavirus) vaccine. Google Analytics data from approximately 2000 recent interactions with this tool have yielded insights into the concerns that impact people’s decision-making about the vaccine. Outcomes Most users of this tool are adults interested in the vaccine for themselves (69%), rather than parents considering immunizing their children (31%). No differences were found in the information-seeking behaviour of parents of girls compared with parents of boys, suggesting that mental models among those who are considering the HPV vaccine may have shifted in recent years. Concerns differed by respondent; cost was the most important concern among adults (62.0%), while parents were most concerned about vaccine safety (61.5%). Only 23% of users asked “what is HPV”, suggesting that many people in Alberta now have basic knowledge about the virus. Implications Results provide a real-time “pulse” on knowledge and attitudes towards HPV immunization, which informs our approach to tailoring messaging with the aim of increasing vaccine uptake in Alberta. Outcomes will provide evidence needed to inform new interventions aimed at increasing HPV immunization rates.
Collapse
Affiliation(s)
- Megan Highet
- Alberta Cancer Prevention Legacy Fund, Alberta Health Services, Holy Cross Centre, 2210 2 Street S.W., Calgary, Alberta, T2S 3C3, Canada.
| | - Geneviève Jessiman-Perreault
- Alberta Cancer Prevention Legacy Fund, Alberta Health Services, Holy Cross Centre, 2210 2 Street S.W., Calgary, Alberta, T2S 3C3, Canada
| | | | - Greg Law
- Alberta Cancer Prevention Legacy Fund, Alberta Health Services, Holy Cross Centre, 2210 2 Street S.W., Calgary, Alberta, T2S 3C3, Canada
| | - Lisa Allen-Scott
- Alberta Cancer Prevention Legacy Fund, Alberta Health Services, Holy Cross Centre, 2210 2 Street S.W., Calgary, Alberta, T2S 3C3, Canada.,Department of Oncology, Cumming School of Medicine, University of Calgary, Calgary, Canada.,Department of Community Health Sciences, Cumming School of Medicine, University of Calgary, Calgary, Canada
| |
Collapse
|
32
|
Alishahi Tabriz A, Neslund-Dudas C, Turner K, Rivera MP, Reuland DS, Elston Lafata J. How Health-Care Organizations Implement Shared Decision-making When It Is Required for Reimbursement: The Case of Lung Cancer Screening. Chest 2020; 159:413-425. [PMID: 32798520 DOI: 10.1016/j.chest.2020.07.078] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2019] [Revised: 07/15/2020] [Accepted: 07/29/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND The Centers for Medicare and Medicaid Services stipulate shared decision-making (SDM) counseling as a prerequisite to lung cancer screening (LCS) reimbursement, despite well-known challenges implementing SDM in practice. RESEARCH QUESTION How have health-care organizations implemented SDM for LCS? STUDY DESIGN AND METHODS For this qualitative study, we used data from in-depth, semistructured interviews with key informants directly involved in implementing SDM for LCS, managing SDM for LCS, or both. We identified respondents using a snowball sampling technique and used template analysis to identify and analyze responses thematically. RESULTS We interviewed 30 informants representing 23 health-care organizations located in 12 states and 4 Census regions. Respondents described two types of SDM for LCS programs: centralized models (n = 7), in which front-end practitioners (eg, primary care providers) referred patients to an LCS clinic where trained staff (eg, advanced practice nurses) delivered SDM at the time of screening, or decentralized models (n = 10), in which front-end practitioners delivered SDM before referring patients for screening. Some organizations used both models simultaneously (n = 6). Respondents discussed tradeoffs between SDM quality and access. They perceived centralized models as enhancing SDM quality, but limiting patient access to care, and vice versa. Respondents reported ongoing challenges with limited resources and budgetary constraints, ambiguity regarding what constitutes SDM, and an absence of benchmarks for evaluating SDM for LCS quality. INTERPRETATION Those responsible for developing and managing SDM for LCS programs voiced concerns regarding both patient access and SDM quality, regardless of organizational context, or the SDM for LCS model implemented. The challenge facing these organizations, and those wanting to help patients and clinicians balance the tradeoffs inherent with LCS, is how to move beyond a check-box documentation requirement to a process that enables LCS to be offered to all high-risk patients, but used only by those who are informed and for whom screening represents a value-concordant service.
Collapse
Affiliation(s)
| | | | - Kea Turner
- University of South Florida College of Medicine, Tampa, FL; Moffitt Cancer Center, Tampa, FL
| | - M Patricia Rivera
- School of Medicine, University of North Carolina, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Daniel S Reuland
- School of Medicine, University of North Carolina, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC
| | - Jennifer Elston Lafata
- Eshelman School of Pharmacy, Chapel Hill, NC; UNC Lineberger Comprehensive Cancer Center, Chapel Hill, NC; Henry Ford Health System, Detroit, MI.
| |
Collapse
|
33
|
Poller DN, Schmitt F. Should uncertainty concerning the risk of malignancy be included in diagnostic (nongynecologic) cytopathology reports? Cancer Cytopathol 2020; 129:16-21. [PMID: 32649050 DOI: 10.1002/cncy.22322] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/25/2020] [Accepted: 06/01/2020] [Indexed: 12/11/2022]
Abstract
In diagnostic cytology, the known site-specific false positive rates at various anatomical sites for the risk malignancy (ROM) when a confirmed malignant diagnosis is made are comparatively well documented. ROM figures for diagnostic cytology specimens may vary according to the anatomical site of the specimen, the exact nature of the specimen received, the staining method(s) used, and the use of additional laboratory techniques including molecular profiling; furthermore, they often differ to some extent from institution to institution, between differing cytologists within the same institution, and over time. A brief literature review for a selected group of routine diagnostic cytology specimens shows a published ROM for a confirmed malignant diagnosis as follows: bile duct brushings, ~99% (range, 97%-100%); breast fine needle aspiration, 98.5% (range, 92%-100%); serous effusion fluid, 98.9% (range, 90%-100% although lower for squamous cell carcinoma, mesothelioma, and lymphoma), pulmonary endobronchial ultrasound cytology, ~99% (range, 86.6%-100%); thyroid FNA, 98% (range, 97%-99% if NIFTP tumors are excluded), salivary gland FNA, ~90%; (range 57%-100%) and lateral neck cyst FNA, ~99% (range, 95.5%-100%). Because most diagnostic cytology specimens have a small but accepted false-positive rate, this information is vitally important for the clinical management of patients and for shared patient decision making. In our view, the known false-positive rate for a given diagnostic cytology specimen could be included within the cytology report to assist in explaining the limitations of the diagnostic cytology interpretation and help facilitate the clinical decision-making process.
Collapse
Affiliation(s)
- David N Poller
- Department of Pathology, Queen Alexandra Hospital, Portsmouth, United Kingdom
| | - Fernando Schmitt
- Institute of Molecular Pathology and Immunology of University of Porto, Porto, Portugal.,Medical Faculty of Porto University, Porto, Portugal
| |
Collapse
|
34
|
Harry ML, Saman DM, Truitt AR, Allen CI, Walton KM, O'Connor PJ, Ekstrom HL, Sperl-Hillen JM, Bianco JA, Elliott TE. Pre-implementation adaptation of primary care cancer prevention clinical decision support in a predominantly rural healthcare system. BMC Med Inform Decis Mak 2020; 20:117. [PMID: 32576202 PMCID: PMC7310565 DOI: 10.1186/s12911-020-01136-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2019] [Accepted: 05/24/2020] [Indexed: 01/12/2023] Open
Abstract
Background Cancer is a leading cause of death in the United States. Primary care providers (PCPs) juggle patient cancer prevention and screening along with managing acute and chronic health problems. However, clinical decision support (CDS) may assist PCPs in addressing patients’ cancer prevention and screening needs during short clinic visits. In this paper, we describe pre-implementation study design and cancer screening and prevention CDS changes made to maximize utilization and better fit a healthcare system’s goals and culture. We employed the Consolidated Framework for Implementation Research (CFIR), useful for evaluating the implementation of CDS interventions in primary care settings, in understanding barriers and facilitators that led to those changes. Methods In a three-arm, pragmatic, 36 clinic cluster-randomized control trial, we integrated cancer screening and prevention CDS and shared decision-making tools (SDMT) into an existing electronic medical record-linked cardiovascular risk management CDS system. The integrated CDS is currently being tested within a predominately rural upper Midwestern healthcare system. Prior to CDS implementation, we catalogued pre-implementation changes made from 2016 to 2018 based on: pre-implementation site engagement; key informant interviews with healthcare system rooming staff, providers, and leadership; and pilot testing. We identified influential barriers, facilitators, and changes made in response through qualitative content analysis of meeting minutes and supportive documents. We then coded pre-implementation changes made and associated barriers and facilitators using the CFIR. Results Based on our findings from system-wide pre-implementation engagement, pilot testing, and key informant interviews, we made changes to accommodate the needs of the healthcare system based on barriers and facilitators that fell within the Intervention Characteristics, Inner Setting, and Outer Setting CFIR domains. Changes included replacing the expansion of medical assistant roles in one intervention arm with targeted SDMT, as well as altering cancer prevention CDS and study design elements. Conclusions Pre-implementation changes to CDS may help meet healthcare systems’ evolving needs and optimize the intervention by being responsive to real-world implementation barriers and facilitators. Frameworks like the CFIR are useful tools for identifying areas where pre-implementation barriers and facilitators may result in design changes, both to research studies and CDS systems. Trial registration NCT02986230.
Collapse
Affiliation(s)
- Melissa L Harry
- Essentia Health, Essentia Institute of Rural Health, 6AV-2, 502 East Second Street, Duluth, MN, 55805, USA
| | - Daniel M Saman
- Essentia Health, Essentia Institute of Rural Health, 6AV-2, 502 East Second Street, Duluth, MN, 55805, USA.
| | - Anjali R Truitt
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA
| | - Clayton I Allen
- Essentia Health, Essentia Institute of Rural Health, 6AV-2, 502 East Second Street, Duluth, MN, 55805, USA
| | - Kayla M Walton
- Essentia Health, Essentia Institute of Rural Health, 6AV-2, 502 East Second Street, Duluth, MN, 55805, USA
| | - Patrick J O'Connor
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA
| | - Heidi L Ekstrom
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA
| | - JoAnn M Sperl-Hillen
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA
| | - Joseph A Bianco
- Essentia Health - Ely Clinic, 300 W Conan Street, Ely, MN, 55731, USA
| | - Thomas E Elliott
- HealthPartners Institute, 3311 E. Old Shakopee Road, Bloomington, MN, 55425, USA
| |
Collapse
|
35
|
Douma LN, Uiters E, Verweij MF, Timmermans DRM. Autonomous and informed decision-making: The case of colorectal cancer screening. PLoS One 2020; 15:e0233308. [PMID: 32469889 PMCID: PMC7259584 DOI: 10.1371/journal.pone.0233308] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Accepted: 05/01/2020] [Indexed: 12/26/2022] Open
Abstract
INTRODUCTION It is increasingly considered important that people make an autonomous and informed decision concerning colorectal cancer (CRC) screening. However, the realisation of autonomy within the concept of informed decision-making might be interpreted too narrowly. Additionally, relatively little is known about what the eligible population believes to be a 'good' screening decision. Therefore, we aimed to explore how the concepts of autonomous and informed decision-making relate to how the eligible CRC screening population makes their decision and when they believe to have made a 'good' screening decision. METHODS We conducted 27 semi-structured interviews with the eligible CRC screening population (eighteen CRC screening participants and nine non-participants). The general topics discussed concerned how people made their CRC screening decision, how they experienced making this decision and when they considered they had made a 'good' decision. RESULTS Most interviewees viewed a 'good' CRC screening decision as one based on both reasoning and feeling/intuition, and that is made freely. However, many CRC screening non-participants experienced a certain social pressure to participate. All CRC screening non-participants viewed making an informed decision as essential. This appeared to be the case to a lesser extent for CRC screening participants. For most, experiences and values were involved in their decision-making. CONCLUSION Our sample of the eligible CRC screening population viewed aspects related to the concepts of autonomous and informed decision-making as important for making a 'good' CRC screening decision. However, in particular the existence of a social norm may be affecting a true autonomous decision-making process. Additionally, the present concept of informed decision-making with its strong emphasis on making a fully informed and well-considered decision does not appear to be entirely reflective of the process in practice. More efforts could be made to attune to the diverse values and factors that are involved in deciding about CRC screening participation.
Collapse
Affiliation(s)
- Linda N. Douma
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| | - Marcel F. Verweij
- Department of Social Sciences, Wageningen University, Wageningen, The Netherlands
| | - Danielle R. M. Timmermans
- Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam Public Health research institute, Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Bilthoven, The Netherlands
| |
Collapse
|
36
|
Benoit A, Grynberg M, Morello R, Sermondade N, Grandazzi G, Moutel G. Does a web-based decision aid improve informed choice for fertility preservation in women with breast cancer (DECISIF)? Study protocol for a randomised controlled trial. BMJ Open 2020; 10:e031739. [PMID: 32047010 PMCID: PMC7044978 DOI: 10.1136/bmjopen-2019-031739] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/16/2019] [Revised: 12/04/2019] [Accepted: 12/05/2019] [Indexed: 01/29/2023] Open
Abstract
INTRODUCTION Chemotherapy may cause infertility in young survivors of breast cancer. Various fertility preservation techniques increase the likelihood of survivors becoming genetic mothers. Disclosure of cancer diagnosis may impact decision making about fertility preservation. This protocol will develop and test the effectiveness of a web-based decision aid for helping women with breast cancer to make well-informed choices about fertility preservation. METHODS AND ANALYSIS This study will be conducted in three phases using mixed methods. In phase I, the aim is to develop a web-based patient decision aid (PDA) in French with a steering committee and using a focus group of five women already treated for breast cancer. In phase II, the face validity of the decision aid will be assessed using questionnaires. In phase III, the PDA will be assessed by a two-arm randomised controlled trial. This will involve a quantitative evaluation of the PDA in clinical practice comparing the quality of the decision-making process between usual care and the PDA. The primary outcome will be informed choice and its components. The secondary outcomes will be decisional conflict and anxiety. Data will be collected during and after an oncofertility consultation. Phase III is underway. Since September 2018, 52 participants have been enrolled in the study and have completed the survey. We expect to have results by February 2020 for a total of 186 patients. ETHICS AND DISSEMINATION This study protocol was approved by the Ouest V Research Ethics Board. Results will be spread through peer-reviewed publications, and reported at suitable meetings. TRIAL REGISTRATION NUMBER The ClinicalTrials.gov registry .(NCT03591848).
Collapse
Affiliation(s)
- Alexandra Benoit
- UNICAEN, Inserm U1086, ANTICIPE, Normandie Université, Caen, France
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine-Béclère, Clamart, France
| | - Michael Grynberg
- Department of Reproductive Medicine and Fertility Preservation, Hôpital Antoine-Béclère, Clamart, France
- U1133, Université Paris Diderot, Paris, France
| | - Rémy Morello
- UNICAEN, Inserm U1086, ANTICIPE, Normandie Universite, Caen, France
- Biostatistics and Clinical Research Unit, CHU Caen, Caen, France
| | - Nathalie Sermondade
- Department of Cytogenetic and Reproductive Biology, Hôpital Jean Verdier, Bondy, France
| | - Guillaume Grandazzi
- UNICAEN, Inserm U1086, ANTICIPE, Normandie Universite, Caen, France
- Espace Régional de Réflexion éthique, CHU Caen, Caen, France
| | - Grégoire Moutel
- UNICAEN, Inserm U1086, ANTICIPE, Normandie Universite, Caen, France
- Espace Régional de Réflexion éthique, CHU Caen, Caen, France
| |
Collapse
|
37
|
Douma LN, Uiters E, Timmermans DRM. Decision-making styles in the context of colorectal cancer screening. BMC Psychol 2020; 8:11. [PMID: 32014059 PMCID: PMC6998095 DOI: 10.1186/s40359-020-0381-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2019] [Accepted: 01/26/2020] [Indexed: 12/12/2022] Open
Abstract
BACKGROUND Our study examined the use of decision-making styles, as identified by Scott and Bruce (1995) (i.e. differentiating between a rational, intuitive, dependent, avoidant and spontaneous decision-making style), within the context of colorectal cancer (CRC) screening participation. In the field of cancer screening, informed decision-making is considered important, which follows the Rational Decision model. Subsequently, gaining more insight into decision-making styles being used in real life, could improve support to people when making their screening decision. In addition, we examined whether the decision-making style that people used was associated with their experienced decisional conflict. METHODS An online survey was carried out among a sample of first-time CRC screening invitees (1282 respondents, response rate 49%). We assessed people's decision-making styles, CRC screening participation, education level, self-reported health literacy, and decisional conflict, and examined the possible associations between them. RESULTS In our study, people who had to decide about CRC screening scored high on using both a rational and intuitive decision-making style. Respondents scoring higher on using a spontaneous or dependent decision-making style were more likely to have participated in CRC screening, while respondents scoring higher on using an avoidant decision-making style were more likely not to have participated in CRC screening. However, differences were small. Generally, people in our study experienced low decisional conflict. CONCLUSION Our eligible CRC screening population scored high on using both a rational and intuitive decision-making style. To optimise support to people, public education materials could be appealing more to the intuitive processes at hand. That being said, the current education materials aimed at informed/rational decision-making do not necessarily seem to create a problem, as people generally experienced low decisional conflict. Possible concerns regarding the use of a spontaneous, dependent or avoidant decision-making style could be that these styles might be contributing to less informed decisions. However, it is relevant to consider that the found differences are small and that any possible concern applies to a relatively small group of people.
Collapse
Affiliation(s)
- Linda N. Douma
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Postbus 1, 3720 BA Bilthoven, The Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM), Postbus 1, 3720 BA Bilthoven, The Netherlands
| | - Danielle R. M. Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, 1081 BT Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), Postbus 1, 3720 BA Bilthoven, The Netherlands
| |
Collapse
|
38
|
Woudstra AJ, Smets EMA, Verdam MGE, Fransen MP. The Role of Health Literacy in Explaining the Relation between Educational Level and Decision Making about Colorectal Cancer Screening. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234644. [PMID: 31766603 PMCID: PMC6926788 DOI: 10.3390/ijerph16234644] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/01/2019] [Revised: 10/08/2019] [Accepted: 11/15/2019] [Indexed: 02/07/2023]
Abstract
Little is known about why educational inequalities exist in informed decision making in colorectal cancer (CRC) screening. Insight into the role and impact of health literacy is essential for intervention development. This study investigates associations between health literacy and informed decision making in CRC screening and explores to what extent health literacy mediates the association between education and informed decision making in CRC screening. In total, 696 individuals eligible for CRC screening (55–75 years of age) were recruited from online panels and filled in an online questionnaire at T0 (n = 696), T1 (n = 407) and T2 (n = 327). A hypothetical mediation model was tested using structural equation modelling. Outcomes included CRC knowledge, CRC screening knowledge, attitude, injunctive norm, descriptive norm, risk perception, self-efficacy, decisional conflict and decisional certainty. Health literacy domains included Comprehension, Application, Numeracy and Communication. Comprehension, Application and Numeracy, were found to mediate the association between education and knowledge about CRC and CRC screening, injunctive norm, descriptive norm, decisional conflict and decisional certainty. In light of these findings, targeting multiple health literacy domains in decision-support interventions is essential for facilitating informed decision making in CRC screening.
Collapse
Affiliation(s)
- Anke J. Woudstra
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
- Correspondence:
| | - Ellen M. A. Smets
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (E.M.A.S.); (M.G.E.V.)
| | - Mathilde G. E. Verdam
- Department of Medical Psychology, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands; (E.M.A.S.); (M.G.E.V.)
- Department of Methodology and Statistics, Institute of Psychology, Leiden University, Wassenaarseweg 52, 2333 AK Leiden, The Netherlands
| | - Mirjam P. Fransen
- Department of Public Health, Amsterdam Public Health Research Institute, Amsterdam UMC, University of Amsterdam, Meibergdreef 9, 1105 AZ Amsterdam, The Netherlands;
| |
Collapse
|
39
|
Tripp L, Abelson J. Supporting women at average risk to make informed decisions about mammography when there is no "right" answer: a qualitative citizen deliberation study. CMAJ Open 2019; 7:E730-E737. [PMID: 31836630 PMCID: PMC6910141 DOI: 10.9778/cmajo.20190102] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND Women are encouraged to make informed choices about mammography screening that align with their values and preferences, yet information materials developed by screening programs rarely provide complete, balanced information about screening. Through a series of deliberations with Ontario citizens, we elicited perspectives on materials developed by screening programs to support informed decision-making. METHODS We held 4 deliberative engagement events with citizens to discuss the current evidence about mammography and informed decision-making for the general population (i.e., women not at high risk) in the context of organized screening programs. Participants reviewed and provided feedback on the educational materials currently produced by screening programs in 8 provinces (British Columbia, Alberta, Saskatchewan, Manitoba, Ontario, Quebec, Nova Scotia and Newfoundland and Labrador) and 2 territories (Yukon Territory and Northwest Territory) and identified the key features that should guide the design of these materials to optimally support informed decision-making. RESULTS In general, participants viewed the educational materials as insufficient to support informed decision-making. They identified the following key features of optimal educational materials: they should be accessible, complete and accurate, and provide information on both benefits and risks of screening in a comprehensive, easy-to-understand manner. Information materials should evoke the trust of the reader, and they should be consistent across Canada. INTERPRETATION Canadian women have insufficient access to reliable information sources and complete evidence about mammography screening, and, without this information, they are unable to make fully informed decisions. Canadian breast screening programs must take steps to improve the information shared with women to support informed decision-making that aligns with women's values and preferences.
Collapse
Affiliation(s)
- Laura Tripp
- Department of Health Research Methods, Evidence, and Impact (Tripp, Abelson) and Centre for Health Economics and Policy Analysis (Abelson), McMaster University, Hamilton, Ont
| | - Julia Abelson
- Department of Health Research Methods, Evidence, and Impact (Tripp, Abelson) and Centre for Health Economics and Policy Analysis (Abelson), McMaster University, Hamilton, Ont.
| |
Collapse
|
40
|
de Vries H, Pajor EM, Curfs KCJ, Eggers SM, Oenema A. How to foster informed decision making about food supplements: results from an international Delphi study. HEALTH EDUCATION RESEARCH 2019; 34:435-446. [PMID: 31157369 PMCID: PMC6646950 DOI: 10.1093/her/cyz017] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Accepted: 05/24/2019] [Indexed: 06/09/2023]
Abstract
Food supplement use can have beneficial and detrimental effects, making informed decisions about supplement use important. How these decisions are made and which communication strategies can stimulate informed decision making is unclear. This study identified the important characteristics of (i) informed decision making about food supplement use and (ii) important factors indicating how to communicate about food supplements to foster informed decision making. An online three-round Delphi study was conducted. International experts within the field of (risk) communication about food supplements or related fields were recruited via email. The participants' age ranged from 25 to 69 years, and sample sizes for the three rounds were 38, 89 and 51, respectively. Experts indicated that for making an informed decision about food supplement use one needs to have knowledge of their positive and negative effects, the ability to compare these effects, knowing alternatives besides supplements, feeling informed, and feeling able (self-efficacious) to make the decision and making the decision voluntarily. Important communication strategies mentioned were: provision of information about positive and negative effects and the nature of these effects including scientific evidence, ensuring information is easily accessible, well ordered, tailored and provided by a trustworthy, credible and independent source.
Collapse
Affiliation(s)
- Hein de Vries
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Em�lia M Pajor
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Kenny C J Curfs
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Sander M Eggers
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| | - Anke Oenema
- Department of Health Promotion, Care and Public Health Research Institute (CAPHRI), Maastricht University, PO Box 616, 6200 MD Maastricht, The Netherlands
| |
Collapse
|
41
|
James L, Wong G, Craig JC, Howard K, Howell M, Tong A. Nephrologists' perspectives on cancer screening in patients with chronic kidney disease: An interview study. Nephrology (Carlton) 2019; 24:414-421. [PMID: 29633488 DOI: 10.1111/nep.13269] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 03/30/2018] [Indexed: 12/11/2022]
Abstract
AIM Patients with chronic kidney disease (CKD) have an increased risk of cancer compared with the general population. Despite this, there is considerable variability in cancer screening practices among nephrologists that may reflect uncertainties about the benefits and harms of screening, the additional costs, and competing priorities among the complex issues that patients are confronted with. We aimed to describe nephrologists' perspectives and approaches to cancer screening in CKD. METHODS Semi-structured interviews were conducted with 29 nephrologists from 15 units across Australia and New Zealand. Interviews were transcribed and thematically analyzed. RESULTS Five themes were identified: empowering patients to make informed decisions (respecting patient preferences, communicating evidence-based recommendations, creating awareness of consequences, preparing for transplantation); justifiable risk taking (avoiding undue consequences in vulnerable populations, balancing the costs and benefits, warranted by long term immunosuppression, assurance of reasonable survival gains); ambiguity of evidence in supporting decisions (absence of standardized recommendations, limited transferability of population-based data); depending on a shared multidisciplinary approach (collaboration with primary health care, access to coordinated skin cancer clinics); and prioritizing current or imminent complications. CONCLUSION Nephrologists approach decisions about cancer screening in patients with CKD based on patient preferences, assessment of risk, justifiable survival gains, and current health priorities. Evidence-based guidelines, communication frameworks and specialist clinics may support informed and shared decision making about cancer screening in CKD.
Collapse
Affiliation(s)
- Laura James
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Germaine Wong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia.,Centre for Transplant and Renal Research, Westmead Hospital, Sydney, New South Wales, Australia
| | - Jonathan C Craig
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Kirsten Howard
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia
| | - Martin Howell
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| | - Allison Tong
- Sydney School of Public Health, University of Sydney, Sydney, New South Wales, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, New South Wales, Australia
| |
Collapse
|
42
|
Ruparel M, Quaife SL, Ghimire B, Dickson JL, Bhowmik A, Navani N, Baldwin DR, Duffy S, Waller J, Janes SM. Impact of a Lung Cancer Screening Information Film on Informed Decision-making: A Randomized Trial. Ann Am Thorac Soc 2019; 16:744-751. [PMID: 31082267 PMCID: PMC6543473 DOI: 10.1513/annalsats.201811-841oc] [Citation(s) in RCA: 31] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2018] [Accepted: 04/01/2019] [Indexed: 11/20/2022] Open
Abstract
Rationale: Lung cancer screening has the potential to save lives, but it also carries a risk of potential harms. Explaining the benefits and harms of screening in a way that is balanced and comprehensible to individuals with various levels of education is essential. Although a shared decision-making approach is mandated by the Centers for Medicare & Medicaid Services, there have been no randomized studies to evaluate the impact of different forms of lung screening information. Objectives: To evaluate the impact of a novel information film on informed decision-making in individuals considering participating in lung cancer screening. Methods: A subset of participants from LSUT (Lung Screen Uptake Trial) were randomly allocated either to view the information film and receive a written information booklet or to receive the booklet alone. The primary outcome was the objective knowledge score after intervention. Secondary outcomes included subjective knowledge, decisional conflict, final screening participation, and acceptability of the materials. Univariate and multivariate analyses were performed to determine differences in pre- and postintervention knowledge scores in both groups and between groups for the primary and secondary outcomes. Results: In the final analysis of 229 participants, both groups showed significantly improved subjective and objective knowledge scores after intervention. This improvement was greatest in the film + booklet group, where mean objective knowledge improved by 2.16 points (standard deviation [SD] 1.8) compared with 1.84 points (SD 1.9) in the booklet-alone group (β coefficient 0.62; confidence interval, 0.17-1.08; P = 0.007 in the multivariable analysis). Mean subjective knowledge increased by 0.92 points (SD 1.0) in the film + booklet group and 0.55 points (SD 1.1) in the booklet-alone group (β coefficient 0.32; CI, 0.05-0.58; P = 0.02 in the multivariable analysis). Decisional certainty was higher in the film + booklet (mean 8.5/9 points [SD 1.3], group than in the booklet-alone group (mean 8.2/9 points [SD 1.5]). Both information materials were well accepted, and there were no differences in final screening participation rates between groups. Conclusions: The information film improved knowledge and reduced decisional conflict without affecting lung-screening uptake. Clinical trial registered with clinicaltrials.gov (NCT02558101).
Collapse
Affiliation(s)
- Mamta Ruparel
- Lungs for Living Research Centre, UCL Respiratory, and
| | - Samantha L. Quaife
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Bhagabati Ghimire
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | | | - Angshu Bhowmik
- Department of Thoracic Medicine, Homerton University Hospital, London, United Kingdom
| | - Neal Navani
- Lungs for Living Research Centre, UCL Respiratory, and
- Department of Thoracic Medicine, University College London Hospital, London, United Kingdom; and
| | - David R. Baldwin
- Respiratory Medicine Unit, David Evans Research Centre, Nottingham University Hospitals, Nottingham, United Kingdom
| | - Stephen Duffy
- Wolfson Institute of Preventive Medicine, Barts and The London School of Medicine and Dentistry, Queen Mary University, London, United Kingdom
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, United Kingdom
| | - Sam M. Janes
- Lungs for Living Research Centre, UCL Respiratory, and
| |
Collapse
|
43
|
Tonge JE, Atack M, Crosbie PA, Barber PV, Booton R, Colligan D. "To know or not to know…?" Push and pull in ever smokers lung screening uptake decision-making intentions. Health Expect 2019; 22:162-172. [PMID: 30289583 PMCID: PMC6433322 DOI: 10.1111/hex.12838] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Revised: 08/22/2018] [Accepted: 08/24/2018] [Indexed: 11/29/2022] Open
Abstract
BACKGROUND In the United States, lung cancer screening aims to detect cancer early in nonsymptomatic current and former smokers. A lung screening pilot service in an area of high lung cancer incidence in the United Kingdom has been designed based on United States trial evidence. However, our understanding of acceptability and reasons for lung screening uptake or decline in a United Kingdom nontrial context are currently limited. OBJECTIVE To explore with ever smokers the acceptability of targeted lung screening and uptake decision-making intentions. DESIGN Qualitative study using semistructured focus groups and inductive thematic analysis to explore acceptability and uptake decision-making intentions with people of similar characteristics to lung screening eligible individuals. SETTING AND PARTICIPANTS Thirty-three participants (22 ex-smokers; 11 smokers) men and women, smokers and ex-smokers, aged 50-80 were recruited purposively from community and health settings in Manchester, England. RESULTS Lung screening was widely acceptable to participants. It was seen as offering reassurance about lung health or opportunity for early detection and treatment. Participant's desire to know about their lung health via screening was impacted by perceived benefits; emotions such as worry about a diagnosis and screening tests; practicalities such as accessibility; and smoking-related issues including perceptions of individual risk and smoking stigma. DISCUSSION Decision making was multifaceted with indications that current smokers faced higher participation barriers than ex-smokers. Reducing participation barriers through careful service design and provision of decision support information will be important in lung screening programmes to support informed consent and equitable uptake.
Collapse
Affiliation(s)
- Janet E. Tonge
- Macmillan Cancer Improvement PartnershipParkway Business CentreManchester Health and Care CommissioningManchesterUK
- Present address:
Leeds Institute of Health SciencesUniversity of LeedsUK
| | - Melanie Atack
- Macmillan Cancer Improvement PartnershipParkway Business CentreManchester Health and Care CommissioningManchesterUK
- Present address:
The Christie NHS Foundation TrustManchesterUK
| | - Phil A. Crosbie
- North West Lung Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Phil V. Barber
- North West Lung Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Richard Booton
- North West Lung Centre, Wythenshawe HospitalManchester University NHS Foundation TrustManchesterUK
| | - Denis Colligan
- Macmillan Cancer Improvement PartnershipParkway Business CentreManchester Health and Care CommissioningManchesterUK
| |
Collapse
|
44
|
Douma LN, Uiters E, Timmermans DRM. Do people with a different goal-orientation or specific focus make different decisions about colorectal cancer-screening participation? PLoS One 2019; 14:e0213003. [PMID: 30817788 PMCID: PMC6394955 DOI: 10.1371/journal.pone.0213003] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2018] [Accepted: 02/13/2019] [Indexed: 11/19/2022] Open
Abstract
Objective Previous studies have shown that having promotion-oriented goals (e.g. wanting to become healthy) or prevention-oriented goals (e.g. wanting to avoid getting ill) can affect people’s health-related decisions and behaviour by emphasising aspects and information that seem relevant in light of what they want to achieve. However, this issue has not yet been researched regarding colorectal cancer (CRC) screening. With our study, we aimed to examine the relationship between people’s goal-orientation or focus on advantages or disadvantages and their CRC screening participation, as this could provide insights for supporting people in making this complex decision. Methods An online survey was carried out among a sample of first-time CRC screening invitees (1282 respondents, response rate 49%). We assessed people’s goal-orientation (i.e. promotion-orientation and prevention-orientation), focus on the advantages or disadvantages of CRC screening, screening participation and main considerations (e.g. cancer is a serious illness) concerning their screening decision. Results Generally, CRC screening participants scored higher on both promotion-orientation and prevention-orientation than non-participants. Both CRC screening participation and non-participation were not associated with a dominant goal-orientation. CRC screening participants did show a dominant focus on the advantages of CRC screening. Mediation analysis showed support for our premise that the relationship between people’s goal-orientation or focus on advantages or disadvantages and their screening participation could be (partially) mediated by people’s main considerations concerning CRC screening. Conclusion CRC screening participants and non-participants differed in their goal-orientation and focus on advantages or disadvantages. CRC screening participation appears to be associated with a focus on the advantages of CRC screening, which could impede the making of an informed decision. CRC screening non-participation appears not to be associated with any clear goal-orientation or focus, or we have not yet managed to capture this, which could be either beneficial or problematic for making an informed decision.
Collapse
Affiliation(s)
- Linda N. Douma
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, BT Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), BA Bilthoven, The Netherlands
- * E-mail:
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM), BA Bilthoven, The Netherlands
| | - Danielle R. M. Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health Research Institute, VU University Medical Center, Van der Boechorststraat 7, BT Amsterdam, The Netherlands
- National Institute for Public Health and the Environment (RIVM), BA Bilthoven, The Netherlands
| |
Collapse
|
45
|
Owens OL, Felder T, Tavakoli AS, Revels AA, Friedman DB, Hughes-Halbert C, Hébert JR. Evaluation of a Computer-Based Decision Aid for Promoting Informed Prostate Cancer Screening Decisions Among African American Men: iDecide. Am J Health Promot 2019; 33:267-278. [PMID: 29996666 DOI: 10.1177/0890117118786866] [Citation(s) in RCA: 28] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
PURPOSE To evaluate the effects of iDecide on prostate cancer knowledge, informed decision-making self-efficacy, technology use self-efficacy, and intention to engage in informed decision-making among African American men. DESIGN One-group, pretest/posttest. SETTING Community settings in South Carolina. PARTICIPANTS African American men, ages 40 years +, without a prior prostate cancer diagnosis (n = 354). INTERVENTION iDecide, an embodied conversational agent-led, computer-based prostate cancer screening decision aid. MEASURES Prostate cancer knowledge, informed decision-making self-efficacy, technology use self-efficacy, and intention to engage in informed decision-making. ANALYSIS Descriptive statistics, paired t tests, general linear modeling, Spearman correlations. RESULTS On average, participants experienced significant improvements in their prostate cancer knowledge ( P ≤ .001), informed decision-making self-efficacy ( P ≤ .001), and technology use self-efficacy ( P ≤ .001), postintervention. Additionally, 67% of participants reported an intention to engage in informed decision-making. CONCLUSION Given the significant improvements across all measures, this research demonstrates that embodied conversational agent-led decision aids can be used to enhance the capacity for making informed prostate cancer screening decisions among African American men and increase their technology use self-efficacy. One critical limitation of this study is that most men had received prostate cancer screening prior to engaging in our intervention, so the implications of this intervention may be different for men who do not have a history of screening. Additionally, actual engagement in informed decision-making postintervention was not assessed.
Collapse
Affiliation(s)
- Otis L Owens
- 1 College of Social Work, University of South Carolina, Columbia, SC, USA.,2 Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
| | - Tisha Felder
- 2 Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA.,3 College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Abbas S Tavakoli
- 3 College of Nursing, University of South Carolina, Columbia, SC, USA
| | - Asa A Revels
- 4 Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Daniela B Friedman
- 4 Department of Health Promotion, Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Chanita Hughes-Halbert
- 5 Department of Psychiatry and Behavioral Sciences, Hollings Cancer Center Medical University of South Carolina, Columbia, SC, USA
| | - James R Hébert
- 2 Statewide Cancer Prevention and Control Program, University of South Carolina, Columbia, SC, USA
| |
Collapse
|
46
|
Owens OL, Beer JM, Reyes LI, Thomas TL. Systematic Review of Commercially Available Mobile Phone Applications for Prostate Cancer Education. Am J Mens Health 2019; 13:1557988318816912. [PMID: 30526243 PMCID: PMC6775560 DOI: 10.1177/1557988318816912] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/20/2018] [Revised: 11/01/2018] [Accepted: 11/12/2018] [Indexed: 12/22/2022] Open
Abstract
Prostate cancer is the most commonly diagnosed non-skin cancer among all men and the second most common cause of death. To ameliorate the burden of prostate cancer, there is a critical need to identify strategies for providing men with information about prostate cancer screening and the importance of informed decision making. With mobile phones becoming more ubiquitous, many individuals are adopting their phones as sources for health information. The objective of this systematic review is to identify and evaluate commercially available apps for promoting informed prostate cancer screening decisions. Two keywords "prostate cancer screening" and "prostate cancer" were entered into the search engines of Google and iOS app stores in May 2017. Evaluations were conducted on apps' (a) quality, (b) grade-level readability, (c) cultural sensitivity, and (d) usability heuristics. None of the 14 apps meeting the inclusion criteria contained the full breadth of information covered in the 2016 American Cancer Society's Prostate Cancer Prevention and Early Detection Guidelines, but over half were inclusive of topics consistent with these guidelines. Most apps' readability was higher than an eighth-grade reading level. Most apps were also not framed and had a neutral tone. Only four apps met most criteria for being culturally sensitive to African Americans. Usability among apps was variable, but some contained major usability concerns. Recommendations for improving educational apps for prostate cancer screening include: disseminating evidence-based information; using culturally sensitive language; knowing the implications of the one and framing of content; making apps interactive; and following common usability principles.
Collapse
Affiliation(s)
- Otis L. Owens
- College of Social Work, University of South Carolina, Columbia, SC, USA
| | - Jenay M. Beer
- College of Public Health, University of Georgia, Athens, GA, USA
| | - Ligia I. Reyes
- Department of Health Promotion Education and Behavior, Arnold School of Public Health, University of South Carolina, Columbia, SC, USA
| | - Tracey L. Thomas
- Health Sciences Department, Health and Behavioral Studies College, James Madison University, Harrisonburg, VA, USA
| |
Collapse
|
47
|
Arias F, Bursian AC, Sappenfield JW, Price CE. Delirium History and Preoperative Mild Neurocognitive Disorder: An Opportunity for Multidisciplinary Patient-Centered Care. AMERICAN JOURNAL OF CASE REPORTS 2018; 19:1324-1328. [PMID: 30397190 PMCID: PMC6232917 DOI: 10.12659/ajcr.911437] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Patient: Male, 75 Final Diagnosis: Mild neurocognitive disorder Symptoms: Apathy • irritability • reduced concentration worsening visual disturbances Medication: — Clinical Procedure: Preoperative workup Specialty: Anesthesiology
Collapse
Affiliation(s)
- Franchesca Arias
- Pain Research and Intervention Center of Excellence, University of Florida, Gainesville, FL, USA.,Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.,Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, FL, USA
| | - Alberto C Bursian
- Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, FL, USA.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Joshua W Sappenfield
- Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, FL, USA.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| | - Catherine E Price
- Department of Clinical and Health Psychology, University of Florida, Gainesville, FL, USA.,Perioperative Cognitive Anesthesia Network, University of Florida, Gainesville, FL, USA.,Department of Anesthesiology, University of Florida College of Medicine, Gainesville, FL, USA
| |
Collapse
|
48
|
Douma LN, Uiters E, Timmermans DRM. Why are the public so positive about colorectal cancer screening? BMC Public Health 2018; 18:1212. [PMID: 30376841 PMCID: PMC6208033 DOI: 10.1186/s12889-018-6106-1] [Citation(s) in RCA: 11] [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: 05/01/2018] [Accepted: 10/10/2018] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Colorectal cancer (CRC) screening is widely recommended. Earlier research showed that the general public are positive about CRC screening, as too the eligible CRC screening population. Among the eligible CRC screening population this positive perception has been shown to be associated with their perceptions of cancer, preventive health screening and their own health. It is unclear whether these concepts are also associated with the positive perception of the general public. Knowing this can provide insight into the context in which public perception concerning CRC screening is established. The aim of our study was to examine which main perceptions are associated with the public perception concerning CRC screening. METHODS An online survey was carried out in a Dutch population sample (adults 18+) among 1679 respondents (response rate was 56%). We assessed the public's perceptions concerning cancer, preventive health screening, own health, and the government, and examined their possible association with public opinion concerning CRC screening. RESULTS The public's positive attitude towards CRC screening is associated with the public's positive attitude towards preventive health screening in general, their perceived seriousness of cancer, their belief of health being important, and their trust in the government regarding national screening programmes. CONCLUSION Trust in the government and perceptions regarding the seriousness of cancer, preventive health screening and the importance of one's health seem to be important factors influencing how the public view CRC screening. The public are likely to process information about CRC screening in such a way that it confirms their existing beliefs of cancer being serious and preventive screening being positive. This makes it likely that they will notice information about the possible benefits of CRC screening more than information about its possible downsides, which would also contribute to the positive perception of CRC screening.
Collapse
Affiliation(s)
- Linda N. Douma
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT The Netherlands
- National Institute for Public Health and the Environment (RIVM), Postbus 1, Bilthoven, 3720 BA The Netherlands
| | - Ellen Uiters
- National Institute for Public Health and the Environment (RIVM), Postbus 1, Bilthoven, 3720 BA The Netherlands
| | - Danielle R. M. Timmermans
- Department of Public and Occupational Health, Amsterdam Public Health research institute, VU University Medical Center, Van der Boechorststraat 7, Amsterdam, 1081 BT The Netherlands
- National Institute for Public Health and the Environment (RIVM), Postbus 1, Bilthoven, 3720 BA The Netherlands
| |
Collapse
|
49
|
Gyulai A, Nagy A, Pataki V, Tonté D, Ádány R, Vokó Z. General practitioners can increase participation in cervical cancer screening - a model program in Hungary. BMC FAMILY PRACTICE 2018; 19:67. [PMID: 29778099 PMCID: PMC5960501 DOI: 10.1186/s12875-018-0755-0] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/20/2017] [Accepted: 05/01/2018] [Indexed: 11/10/2022]
Abstract
BACKGROUND Cervical cancer is a preventable disease. Unfortunately, its mortality is high in Hungary: 9.2 deaths /100000 women/year in 2015. The Hungarian organized, nationwide cervical screening program was launched in 2003, but it could improve the coverage rate of cervical cancer screening only by a few percentage points. The vast majority of women still uses opportunistic screening and the organized screening program had little impact on participation by women who never or rarely consult their gynecologists. We assessed whether involving general practitioners in the cervical cancer screening process would increase participation. METHODS The study consisted of two parts: 1. A questionnaire-based health survey was conducted using a representative sample of women aged 25 to 65 years from 11 Hungarian counties, in which we studied where women obtained information about cervical cancer screening. 2. Additionally, a model program and its evaluation were implemented in the practices of general practitioners in one of the 11 counties (Zala county). In this program, general practitioners were informed of their patients' participation in the cervical cancer screening program, and they motivated those who refused the invitation. RESULTS Questionnaire-based health survey: A total of 74% (95% confidence interval (CI): 70-77%) of the target population had a screening examination within the previous 3 years. The majority (58, 95% CI: 54-62%) of the target population did not ask for information about cervical cancer screening at all. Only 21% (95% CI: 17-26%) consulted their general practitioners about cancer screening. Evaluation of the model program: the general practitioners effectively motivated 24 out of 88 women (27, 95% CI: 18-38%) who initially refused to participate in the screening program. CONCLUSION The majority of Hungarian women are not informed about cervical cancer screening beyond the invitation letter. General practitioners could play a more important role in mobilizing the population to utilize preventive services. The involvement of general practitioners in the organization of the cervical cancer screening program could increase the participation of those women who generally refuse the services.
Collapse
Affiliation(s)
- Anikó Gyulai
- Department of Public Health, Faculty of Health, University of Debrecen, Sóstói u. 2-4, Nyíregyháza, H-4400 Hungary
| | - Attila Nagy
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai út 26, Debrecen, H-4028 Hungary
| | - Vera Pataki
- GlaxoSmithKline Hungary Ltd., Csörsz u. 43, Budapest, H-1124 Hungary
| | - Dóra Tonté
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai út 26, Debrecen, H-4028 Hungary
| | - Róza Ádány
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai út 26, Debrecen, H-4028 Hungary
| | - Zoltán Vokó
- Department of Preventive Medicine, Faculty of Public Health, University of Debrecen, Kassai út 26, Debrecen, H-4028 Hungary
- Department of Health Policy & Health Economics, Institute of Economics, Faculty of Social Sciences, Eötvös Loránd University, Pázmány Péter sétány 1/a, Budapest, H-1117 Hungary
| |
Collapse
|
50
|
Kim H, Filson C, Joski P, von Esenwein S, Lipscomb J. Association Between Online Information-Seeking and Adherence to Guidelines for Breast and Prostate Cancer Screening. Prev Chronic Dis 2018; 15:E45. [PMID: 29679480 PMCID: PMC5912925 DOI: 10.5888/pcd15.170147] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022] Open
Abstract
Introduction From 2012 through 2014, the US Preventive Services Task Force (USPSTF) recommended biennial mammography for women aged 50 to 75 and recommended against the prostate specific antigen (PSA) test for men of any age, emphasizing informed decision making for patients. Because of time constraints and other patient health priorities, health care providers often do not discuss benefits and risks associated with cancer screening. We analyzed the association between seeking information online about breast and prostate cancer and undergoing mammography and PSA screening. Methods We assessed guideline concordance in mammogram and PSA screening, according to USPSTF guidelines for those at average risk for disease. We used data on 4,537 survey respondents from the National Cancer Institute’s Health Information National Trends Survey (HINTS) for 2012 through 2014 to assess online information-seeking, defined as whether people searched for cancer-related information online in the past 12 months. We used HINTS data to construct multivariable logistic regression models to isolate the effect of exposure to online information on the incidence of cancer screening. Results After controlling for available covariates, we found no significant association between online information-seeking and guideline-concordant screening for breast or prostate cancer. Significant covariate values suggest that factors related to access to care were significantly associated with conformance to mammography guidelines for women recommended for screening and that physician discussion was significantly associated with nonconformance to guidelines for prostate-specific antigen screening (ie, having a PSA test in spite of the recommendation not to have it). Decomposition of differences between those who sought online information and those who did not indicated that uncontrolled confounders probably had little effect on findings. Conclusion We found little evidence that online information-seeking significantly affected screening for breast or prostate cancer in accordance with USPSTF guidelines among people at average risk.
Collapse
Affiliation(s)
- Hankyul Kim
- Rollins School of Public Health,1518 Clifton Rd, NE, Atlanta, GA 30322.
| | - Christopher Filson
- Emory University School of Medicine, Atlanta, Georgia.,Winship Cancer Institute of Emory University, Atlanta, Georgia
| | - Peter Joski
- Rollins School of Public Health, Emory University, Atlanta, Georgia
| | | | - Joseph Lipscomb
- Rollins School of Public Health, Emory University, Atlanta, Georgia.,Winship Cancer Institute of Emory University, Atlanta, Georgia
| |
Collapse
|