Barriers and Facilitators to Breast Cancer Screening for Women With Severe Mental Illness

The Relationship Between Breast and Gynecological Cancers and a Diagnosis of Serious Mental Illness: A Scoping Review

Women who are living with a diagnosis of serious mental illness face an elevated risk of premature mortality from breast and gynecological cancers. To understand the risk factors associated with prevalence and premature death from breast or gynecological cancer in women diagnosed with an SMI, a scoping review was conducted, using the Arksey and O'Malley framework in accordance with the PRISMAScR guidelines. Four electronic databases were searched for research from 2012 to 2024. The 21 selected articles identified potential factors associated with our target: clinical status, coordination of care across health services, and social and family support. The findings suggest that the keys to improving outcomes are conducting proper screening among women diagnosed with SMI, coordinating mental health and oncological care, and capitalizing on available family support.

Transmural collaborative care model for the review of antipsychotics: a feasibility study of a complex intervention

General practitioners (GPs) are often unaware of antipsychotic (AP)-induced cardiovascular risk (CVR) and therefore patients using atypical APs are not systematically monitored. We evaluated the feasibility of a complex intervention designed to review the use of APs and advise on CVR-lowering strategies in a transmural collaboration. A mixed methods prospective cohort study in three general practices in the Netherlands was conducted in 2021. The intervention comprised three steps: a digital information meeting, a multidisciplinary meeting, and a shared decision-making visit to the GP. We assessed patient recruitment and retention rates, advice given and adopted, and CVR with QRISK3 score and mental state with MHI-5 at baseline and three months post-intervention. GPs invited 57 of 146 eligible patients (39%), of whom 28 (19%) participated. The intervention was completed by 23 (82%) and follow-up by 18 participants (64%). At the multidisciplinary meeting, 22 (78%) patients were advised to change AP use. Other advice concerned medication (other than APs), lifestyle, monitoring, and psychotherapy. At 3-months post-intervention, 41% (28/68) of this advice was adopted. Our findings suggest that this complex intervention is feasible for evaluating health improvement in patients using AP in a trial.

Barriers and facilitators for people with severe mental illness accessing cancer screening: A systematic review

OBJECTIVE

Evidence suggests that people with severe mental illness (PwSMI) are 2.1 times more likely to die from cancer before the age of 75, compared to people without Severe mental illness (SMI). Yet, cancer screening uptake is low among PwSMI. This mixed-methods systematic review aimed to identify the barriers and facilitators for PwSMI deciding to access and attend primary cancer screening of the cervix, breast and colon.

METHODS

Six electronic databases and two grey literature sources were searched, with 1017 records screened against inclusion criteria. Included papers were appraised and data synthesised using the constructs of Normalisation Process Theory.

RESULTS

Twenty papers met the inclusion criteria. Factors that impact upon uptake of PwSMI accessing cancer screening were found to include age, gender, race, and income. Common barriers to attending screening included poor communication from healthcare staff, stigmatising attitudes, and accessibility problems such as no access to transportation. While, facilitators included social support from friends, family, and healthcare providers.

CONCLUSIONS

Due to ease and privacy, colorectal screening was found to have fewer barriers when compared to cervical and breast screening. The review identified multiple barriers that can be addressed and targeted to support decision-making for cancer screening among PwSMI. The protocol was registered with PROSPERO (CRD42022331781).

Conceptualization of Breast Cancer and Attitudes toward Breast Cancer Screening: A Qualitative Study on Iranian and Australian Women

OBJECTIVE

Regular screening can lead to early diagnosis of breast cancer. Australia is one of the countries with a high rate of participation in breast cancer screening, while in Iran, most patients are diagnosed in advanced stages. This qualitative study used a thematic analysis method to examine the attitudes and beliefs of Iranian and Australian women toward breast cancer and breast cancer screening.

METHOD

In-depth interviews were conducted with eight Iranian and seven Australian women. Data were collected through semi-structured interviews and analyzed using thematic analysis with an inferential approach.

RESULTS

According to the results, four main themes were extracted for the perceptions of breast cancer, including "the meaning of breast cancer", "causes of breast cancer", "prevention of breast cancer" and "effects of significant people in life". Considering the perceptions of breast cancer screening, three themes were identified, including "beliefs about breast cancer screening," "sources of information about breast cancer screening," and "barriers to breast cancer screening."

CONCLUSION

Cultural and social factors influence women's perceptions of breast cancer and screening. Therefore, investigating the cultural meaning of breast cancer and breast cancer screening for women can be useful for screening and prevention purposes.

Experiences of Everyday Life among Individuals with Co-Existence of Serious Mental Illness and Cancer-A Qualitative Systematic Literature Review

Daily life with severe mental health (SMI) and cancer comorbidity entails multiple challenges. The study aims to explore everyday life experiences among individuals with SMI and cancer comorbidity from the perspectives of patients, significant others, and involved healthcare professionals. The study is registered in PROSPERO (CRD42021259604). A qualitative systematic review was conducted through searches in the databases MEDLINE, CINAHL, PsychInfo, and Web of Sciences (last search 14 February 2023). Inclusion criteria were empirical qualitative research studies investigating experiences of healthcare and everyday life among persons living with SMI and who were subsequently diagnosed with cancer from the perspective of the individuals themselves, their significant others, and healthcare professionals involved in their care. Exclusion criteria: Literature reviews, quantitative studies, intervention studies, quantitative parts of mix-methods studies, non-English languages, persons <18 years, dementia/learning disabilities, diagnosed with anxiety/depression as a consequence of cancer. Seven articles, published between January 2011 and February 2023, were included and analysed through a thematic analysis. The PRISMA 2020 checklist guided the study. The results were presented in four themes: 'Navigating between different worlds and logics', 'Decision-making capacity depending on the assessor', 'Cancer must give way to severe mental illness or vice versa', and 'Significant others as a safety net'. Research about the everyday lives of persons with SMI and cancer comorbidities from patients' and relatives' perspectives is lacking and thus called for.