A choice experiment to identify the most important elements of a successful cancer screening program according to those who research and manage such programs

Barriers of organized cervical cancer screening in Albania and Montenegro

BACKGROUND

Organized cervical screening is vital for preventing cervical cancer. However, many existing screening programs fail to achieve their full potential, as demonstrated by core performance indicators. There are barriers that hinder the implementation and reduce effectiveness of the programs. This article explores barriers of cervical cancer screening in two Southeastern European countries, Albania and Montenegro, aiming to inform targeted strategies to improve healthcare equity and outcomes for women.

METHODS

The barrier assessment followed the EU-TOPIA framework, designed to identify barriers to effective breast-, cervical-, or colon cancer screening. This approach relies on an iterative process performed by country representatives responsible for screening and researchers with expertise in screening program planning and evaluation. It includes three steps: comprehensive description of screening activities; identification of key barriers via a previously published tool; and comprehensive assessment of the identified key barriers.

RESULTS

The barrier assessment revealed shared challenges in cervical cancer screening in Albania and Montenegro. Both countries face difficulties in their invitation systems, limited outreach activities, and low participation rates. Fully integrated data systems at national level are absent, hindering program monitoring and data sharing. Financial constraints and resource limitations negatively affect program sustainability and quality, reducing public awareness and accessibility. Additionally, neither country has comprehensive up-to-date long-term strategies to support prevention and early detection efforts.

CONCLUSIONS

Our study underscores the importance of addressing organizational barriers in cervical cancer screening to improve program effectiveness and accessibility. Aligning screening practices with EU and WHO standards is crucial for Albania and Montenegro as prospective EU members. Lessons from international best practices, such as integrating IT systems, employing multi-channel outreach strategies, and adopting legally supported long-term policies, offer actionable pathways for improvement. Policymakers should prioritize sustainable funding, centralized systems, and innovative approaches to overcome structural challenges.

Roadmap to improve the organized cancer screening programs - The case of colorectal cancer screening in Montenegro

BACKGROUND

Implementation of organized cancer screening programs comes with many challenges and barriers, which may inhibit the achievement of the screening activities' desired benefits. In this paper we outline a plan for improving the colorectal cancer (CRC) screening system in Montenegro.

METHODS

We formulated a roadmap, which was generally defined as a country-specific strategic plan to improve cancer screening programs. The roadmap development was an iterative, step-by-step process. First, we described the current screening program, then identified and described key barriers, and finally proposed actions to overcome them. Multiple sources of information (e.g., documents, expert opinions) were collected and processed by local and international stakeholders.

RESULTS

The CRC screening program was implemented between 2013-2019 by gradually increasing the invitation of the target population. Key barriers of the implementation were defined: 1) Lack of colonoscopy capacity in the northern part of the country; 2) Inadequate information technology systems; 3) Inadequate public promotion of screening. The defined actions were related to overcoming lack of available resources (e.g., financial, human and technological), to improve the policy environment and the knowledge, and to facilitate information sharing.

CONCLUSION

The collaboration between local stakeholders of CRC screening and researchers experienced in planning and evaluating screening programs resulted in the first comprehensive description of CRC screening in Montenegro, detailed understanding of key barriers that emerged during implementation and a carefully designed list of actions. The implementation of these actions and the evaluation of whether barriers were solved will be captured in the upcoming period by maintaining this collaboration.

Methodology to derive preference for health screening programmes using discrete choice experiments: a scoping review

BACKGROUND

While involving users in healthcare decision-making has become increasingly common and important, there is a lack of knowledge about how to best design community-based health screening programs. Reviews of methods that incorporate discrete choice experiments (DCEs) are scarce, particularly for non-cancer illnesses like cardiovascular disease, diabetes and liver disease. We provide an overview of currently available applications and methods available by using DCEs in health screening programs, for chronic conditions.

METHODS

A scoping review was undertaken, where four electronic databases were searched for key terms to identify eligible DCE studies related to community health screening. We included studies that met a pre-determined criteria, including being published between 2011 and 2021, in English and reported findings on human participants. Data were systematically extracted, tabulated, and summarised in a narrative review.

RESULTS

A total of 27 studies that used a DCE to elicit preferences for cancer (n = 26) and cardiovascular disease screening (n = 1) programmes were included in the final analysis. All studies were assessed for quality, against a list of 13 criteria, with the median score being 9/13 (range 5-12). Across the 27 studies, the majority (80%) had the same overall scores. Two-thirds of included studies reported a sample size calculation, approximately half (13/27) administered the survey completely online and over 75% used the general public as the participating population.

CONCLUSION

Our review has led to highlighting several areas of current practice that can be improved, particularly greater use of sample size calculations, increased use of qualitative methods, better explanation of the chosen experimental design including how choice sets are generated, and methods for analysis.

Quality assured implementation of the Slovenian breast cancer screening programme

SETTING

The organised, population-based breast cancer screening programme in Slovenia began providing biennial mammography screening for women aged 50-69 in 2008. The programme has taken a comprehensive approach to quality assurance as recommended by the European guidelines for quality assurance in breast cancer screening and diagnosis (4th edition), including centralized assessment, training and supervision, and proactive monitoring of performance indicators. This report describes the progress of implementation and rollout from 2003 through 2019.

METHODS

The screening protocol and key quality assurance procedures initiated during the planning from 2003 and rollout from 2008 of the screening programme, including training of the professional staff, are described. The organisational structure, gradual geographical rollout, and coverage by invitation and examination are presented.

RESULTS

The nationwide programme was up and running in all screening regions by the end of 2017, at which time the nationwide coverage by invitation and examination had reached 70% and 50%, respectively. Nationwide rollout of the population-based programme was complete by the end of 2019. By this time, coverage by invitation and examination had reached 98% and 76%, respectively. The participation rates consistently exceeded 70% from 2014 to 2019.

CONCLUSIONS

The successful implementation of the screening programme can be attributed to an independent central management, external guidance, and strict adherence to quality assurance procedures, all of which contributed to increasing governmental and popular support. The benefits of quality assurance have influenced all aspects of breast care and have provided a successful model for multidisciplinary management of other diseases.