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Lynch BM, Youlden D, Fritschi L, Newman B, Pakenham KI, Leggett B, Owen N, Aitken JF. Self-reported information on the diagnosis of colorectal cancer was reliable but not necessarily valid. J Clin Epidemiol 2007; 61:498-504. [PMID: 18394544 DOI: 10.1016/j.jclinepi.2007.05.018] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2006] [Revised: 04/23/2007] [Accepted: 05/03/2007] [Indexed: 12/22/2022]
Abstract
OBJECTIVE Self-report is commonly used in epidemiologic studies; however, few data exist on the reliability and validity of this method for eliciting information related to the diagnosis of colorectal cancer. We examined the test-retest reliability and validity of colorectal cancer patients reporting on the process of their diagnosis. STUDY DESIGN AND SETTING One hundred and sixteen participants completed two telephone interviews, 1 month apart, and 95 general practitioners (GPs) completed a written questionnaire, to elicit information relating to key elements of the process of diagnosis of colorectal cancer. RESULTS Acute symptoms such as rectal bleeding had higher reliability and validity than more general symptoms. Colonoscopy was the most accurately recalled diagnostic test. Recall of diagnosis date, and date of colonoscopy, had high test-retest reliability. There were considerable differences between dates of diagnostic tests given by participants and GPs, but there was no evidence of a bias in a particular direction. Accuracy of recall did not diminish as time from diagnosis increased. CONCLUSION This study confirms that self-reported symptoms, tests, and dates in the colorectal cancer diagnostic pathway are generally reliable; however, the validity of reported symptoms and tests can be moderate to poor.
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Affiliation(s)
- Brigid M Lynch
- Viertel Centre for Research in Cancer Control, The Cancer Council Queensland, PO Box 201, Spring Hill 4006, Brisbane, Australia.
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Laurence COM, Burgess T, Beilby J, Symon B, Wilkinson D. Electronic medical records may be inadequate for improving population health status through general practice: cervical smears as a case study. Aust N Z J Public Health 2007; 28:317-20. [PMID: 15704693 DOI: 10.1111/j.1467-842x.2004.tb00436.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVE [corrected] To determine whether routine electronic records are an accurate source of population health data in general practice through reviewing cervical smears rates in four South Australian practices. METHODS The cervical screening rate in a purposive sample of four general practices (three rural and one urban) was obtained using an audit of medical records and a telephone follow-up. RESULTS The cervical screening rate using only immediately available electronic medical records indicated an overall low rate for the participating practices (44.9%). However, telephone follow-up and adjustments to the denominator indicated the real rate to be 85.7%. The offer of appointments during the telephone follow-up further improved this rate for eligible women (93.8%). CONCLUSIONS AND IMPLICATIONS Electronic medical records may be inadequate in preventive screening in general practice, without ensuring their accuracy. Updating records by telephone or personal follow-up produces a much more accurate denominator.
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Aklimunnessa K, Mori M, Khan MMH, Sakauchi F, Kubo T, Fujino Y, Suzuki S, Tokudome S, Tamakoshi A, Motohashi Y, Tsuji I, Nakamura Y, Iso H, Mikami H, Inaba Y, Hoshiyama Y, Suzuki H, Shimizu H, Toyoshima H, Wakai K, Ito Y, Hashimoto S, Kikuchi S, Koizumi A, Kawamura T, Watanabe Y, Miki T, Date C, Sakata K, Nose T, Hayakawa N, Yoshimura T, Shibata A, Okamoto N, Shino H, Ohno Y, Kitagawa T, Kuroki T, Tajima K. Effectiveness of cervical cancer screening over cervical cancer mortality among Japanese women. Jpn J Clin Oncol 2006; 36:511-8. [PMID: 16844732 DOI: 10.1093/jjco/hyl060] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
BACKGROUND Various studies have revealed that cervical cancer (CC) screening significantly reduces both CC incidence and mortality in developed countries. Although Japan introduced a nationwide government funded annual CC screening for the women aged 30+ in 1982, the effectiveness of CC screening on CC mortality has not yet been evaluated by any prospective cohort study. Therefore, the present study evaluated the association of CC mortality with self-reported CC screening and some other factors by a nationwide cohort study. METHODS Baseline survey of the Japan Collaborative Cohort Study for the enrollment of subjects was completed during 1988-90 and followed until 2003. This study only analyzed 63,541 women, aged 30-79 years, who were free from any cancer history at enrollment. RESULTS During the follow-up period, 38 CC deaths were identified. The mean age at mortality was 67.0 years, with a mortality rate of 4.2 per 100,000 person-years. Participation rate in CC screening was 46.9%. Age-adjusted Cox model indicated significantly lower CC mortality [hazard ratio (HR) = 0.30, 95% confidence interval (CI) = 0.12-0.74] due to CC screening. Protectiveness remained almost the same (HR = 0.30, 95% CI = 0.12-0.76) when adjusted for age, body mass index and number of deliveries. The results also revealed that CC screening could reduce at least 50% of CC deaths even after excluding the effect of possible self-selection bias. CONCLUSIONS CC screening in Japan may reduce CC mortality significantly for women aged 30-79 years. However, further studies with more CC deaths and increased statistical power are needed to validate the findings.
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Affiliation(s)
- Khandoker Aklimunnessa
- Department of Public Health, Sapporo Medical University School of Medicine, Sapporo 060-8556, Japan
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Corkrey R, Parkinson L, Bates L. Pressing the key pad: trial of a novel approach to health promotion advice. Prev Med 2005; 41:657-66. [PMID: 15917066 DOI: 10.1016/j.ypmed.2004.12.008] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2004] [Revised: 11/29/2004] [Accepted: 12/29/2004] [Indexed: 11/23/2022]
Abstract
BACKGROUND A relatively simple procedure, the Pap test, is effective in detecting early changes in the cervix; however, many at-risk women, even in developed countries, do not have regular Pap tests. METHODS A randomized controlled trial of an interactive voice response (IVR) cervical screening brief advice involving 17,008 households is described. The IVR system automatically made calls to households and explained the nature of the call; selected one eligible woman aged 18-69 years; determined her screening status; delivered a message appropriate to her screening status; offered additional messages to counter common barriers; offered additional information on cervical screening and cancer; offered additional contact numbers; and offered to arrange for someone to call back. Cervical screening rate data were obtained from the Australian Health Insurance Commission (HIC) for 6 months before and following the intervention. RESULTS The cervical screening rate was found to have increased by 0.43% in intervention compared to the control postcodes, and the increase was greater for older women at 1.34%. CONCLUSIONS The overall conclusion was that IVR technology was a feasible means to contact women to deliver brief interventions aimed at increasing cervical screening rates and could economically target at-risk groups. The potential for linking IVR to centralized Pap test Registers to issue Pap test reminders should be explored.
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Affiliation(s)
- Ross Corkrey
- Lighthouse Field Station, School of Biological Sciences, University of Aberdeen, Cromarty, Rossshire, Scotland IV11 8YJ, UK.
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Vernon SW, Meissner H, Klabunde C, Rimer BK, Ahnen DJ, Bastani R, Mandelson MT, Nadel MR, Sheinfeld-Gorin S, Zapka J. Measures for Ascertaining Use of Colorectal Cancer Screening in Behavioral, Health Services, and Epidemiologic Research. Cancer Epidemiol Biomarkers Prev 2004. [DOI: 10.1158/1055-9965.898.13.6] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Affiliation(s)
- Sally W. Vernon
- 1School of Public Health and Center for Health Promotion and Prevention Research, University of Texas at Houston, Houston, Texas
| | - Helen Meissner
- 2Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Carrie Klabunde
- 2Division of Cancer Control and Population Sciences, National Cancer Institute, Bethesda, Maryland
| | - Barbara K. Rimer
- 3Department of Health Behavior and Health Education, University of North Carolina, Chapel Hill, North Carolina
| | - Dennis J. Ahnen
- 4School of Medicine, University of Colorado and Denver Veterans Affairs Medical Center, Denver, Colorado
| | - Roshan Bastani
- 5School of Public Health and Jonsson Comprehensive Cancer Center, University of California at Los Angeles, Los Angeles, California
| | | | - Marion R. Nadel
- 7Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | - Jane Zapka
- 9Medical School, University of Massachusetts, Worcester, Massachusetts; and
- 10Medical University of South Carolina, Charleston, South Carolina
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Vernon SW, Briss PA, Tiro JA, Warnecke RB. Some methodologic lessons learned from cancer screening research. Cancer 2004; 101:1131-45. [PMID: 15316907 DOI: 10.1002/cncr.20513] [Citation(s) in RCA: 69] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Credible and useful methodologic evaluations are essential for increasing the uptake of effective cancer screening tests. In the current article, the authors discuss selected issues that are related to conducting behavior change interventions in cancer screening research and that may assist researchers in better designing future evaluations to increase the credibility and usefulness of such interventions. Selection and measurement of the primary outcome variable (i.e., cancer screening behavior) are discussed in detail. The report also addresses other aspects of study design and execution, including alternatives to the randomized controlled trial, indicators of study quality, and external validity. The authors conclude that the uptake of screening should be the main outcome when evaluating cancer screening strategies; that researchers should agree on definitions and measures of cancer screening behaviors and assess the reliability and validity of these definitions and measures in different populations and settings; and that the development of methods for increasing the external validity of randomized designs and reducing bias in nonrandomized studies is needed.
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Affiliation(s)
- Sally W Vernon
- Center for Health Promotion and Prevention Research, The University of Texas-Houston School of Public Health, Houston, Texas 77030, USA.
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Tucker JL. The theory and methodology of provider profiling. INTERNATIONAL JOURNAL OF HEALTH CARE QUALITY ASSURANCE INCORPORATING LEADERSHIP IN HEALTH SERVICES 2001; 13:316-21. [PMID: 11484650 DOI: 10.1108/09526860010378771] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Physician profiling is the comparison of physician practice patterns to determine the existence and effects of significant differences in outcomes. To optimize care quality, these comparisons can be used to influence provider behavior through awareness when outcomes are poor or do not warrant provider expenditures. To maximize the value of such a technique, the underlying bases for comparison and the uses of derived data must be understood. Several factors must be considered or controlled for when determining comparable providers. Additionally, the worth or significance of findings must also be understood. This paper seeks to provide information in these two areas for the benefit of those responsible for managing care at all levels.
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Affiliation(s)
- J L Tucker
- US Army-Baylor University Graduate Program, San Antonio, Texas, USA
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Taylor RJ, Mamoon HA, Morrell SL, Wain GV. Cervical screening by socio-economic status in Australia. Aust N Z J Public Health 2001; 25:256-60. [PMID: 11494996 DOI: 10.1111/j.1467-842x.2001.tb00573.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVES To examine differentials and time trends in self-reported Pap test rates by socio-economic status (SES) from the 1989/90 and 1995 Australian National Health Surveys (NHS). METHODS The unit record data for females were extracted from the two NHSs and combined. The outcome variable of interest was 'having a Pap test in the past three years'. The principal study factor was SES measured as individual characteristics and SES of area of residence. Migrant status, rurality, year of survey and age were controlled for in logistic regression models. RESULTS Self-reported rates of having a Pap test in the past three years were higher in women from higher compared with lower SES groups. Compared with women with a bachelor or higher degree, the odds of reporting having a Pap test in the past three years in women with no post-school qualification was 0.86 (p<0.0005). Women with a gross annual income of less than $20,000 had significantly lower odds (OR=0.79) compared with women earning $40,000 or more. Blue collar (OR=0.84) and not employed (OR=0.73) women also had significantly lower odds compared to the referent white collar group. CONCLUSION This study reveals differentials in Pap screening behaviour by individual measures of SES in Australia. Area-based SES measures under-estimated the SES differentials in Pap test rates compared with individual measures. Derived population attributable fractions reveal that about a quarter of self-reported under-screening is accounted for by low SES when measured individually, compared to 8% when SES is measured ecologically.
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Affiliation(s)
- R J Taylor
- NSW Cervical Screening Program, Westmead Hospital, New South Wales, Australia
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Hancock L, Sanson-Fisher R, Perkins J, Corkrey R, Burton R, Reid S. Effect of a community action intervention on cervical cancer screening rates in rural Australian towns: the CART project. Prev Med 2001; 32:109-17. [PMID: 11162336 DOI: 10.1006/pmed.2000.0776] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND The effect of community action on cervical cancer screening rates was explored in 20 rural Australian towns. METHODS Town quarterly Pap test counts, from the Australian Health Insurance Commission, were converted to town rates using Census populations. Pap test rates for 12 quarters before and after mobilization were examined. RESULTS Wilcoxon-Mann-Whitney tests demonstrated significantly higher per capita Pap test rates pre- to postmobilization for intervention towns compared to matched control towns for women whose last Pap test was more than 2 years ago (P=0.008). Maximum efficiency robust tests examining the equality of mean differences (intervention-control) of per capita rates between pre- and post-mobilization periods also found significant differences for Pap tests where last procedure was between 1 and 2 years ago (R = 13.9, P = 0.039) and near significance for Pap tests where last procedure was less than one year ago (R = 10.6, P = 0.087). CONCLUSIONS It appeared that underscreened women were more likely and overscreened women were less likely to have a Pap test in response to the intervention. The results indicate that a community action program can positively impact cervical cancer screening rates.
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Affiliation(s)
- L Hancock
- Hunter Centre for Health Advancement, Wallsend 2287 NSW, Newcastle, Australia.
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