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Dunlop KLA, Keogh LA, Smith AL, Aranda S, Aitken J, Watts CG, Smit AK, Janda M, Mann GJ, Cust AE, Rankin NM. Acceptability and appropriateness of a risk-tailored organised melanoma screening program: Qualitative interviews with key informants. PLoS One 2023; 18:e0287591. [PMID: 38091281 PMCID: PMC10718433 DOI: 10.1371/journal.pone.0287591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2022] [Accepted: 06/08/2023] [Indexed: 12/18/2023] Open
Abstract
INTRODUCTION In Australia, opportunistic screening (occurring as skin checks) for the early detection of melanoma is common, and overdiagnosis is a recognised concern. Risk-tailored cancer screening is an approach to cancer control that aims to provide personalised screening tailored to individual risk. This study aimed to explore the views of key informants in Australia on the acceptability and appropriateness of risk-tailored organised screening for melanoma, and to identify barriers, facilitators and strategies to inform potential future implementation. Acceptability and appropriateness are crucial, as successful implementation will require a change of practice for clinicians and consumers. METHODS This was a qualitative study using semi-structured interviews. Key informants were purposively selected to ensure expertise in melanoma early detection and screening, prioritising senior or executive perspectives. Consumers were expert representatives. Data were analysed deductively using the Tailored Implementation for Chronic Diseases (TICD) checklist. RESULTS Thirty-six participants were interviewed (10 policy makers; 9 consumers; 10 health professionals; 7 researchers). Key informants perceived risk-tailored screening for melanoma to be acceptable and appropriate in principle. Barriers to implementation included lack of trial data, reluctance for low-risk groups to not screen, variable skill level in general practice, differing views on who to conduct screening tests, confusing public health messaging, and competing health costs. Key facilitators included the perceived opportunity to improve health equity and the potential cost-effectiveness of a risk-tailored screening approach. A range of implementation strategies were identified including strengthening the evidence for cost-effectiveness, engaging stakeholders, developing pathways for people at low risk, evaluating different risk assessment criteria and screening delivery models and targeted public messaging. CONCLUSION Key informants were supportive in principle of risk-tailored melanoma screening, highlighting important next steps. Considerations around risk assessment, policy and modelling the costs of current verses future approaches will help inform possible future implementation of risk-tailored population screening for melanoma.
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Affiliation(s)
- Kate L. A. Dunlop
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Louise A. Keogh
- Centre for Health Equity, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
| | - Andrea L. Smith
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
| | - Sanchia Aranda
- School of Health Sciences, University of Melbourne, Melbourne, Australia
| | - Joanne Aitken
- Viertel Cancer Research Centre, Cancer Council Queensland, Brisbane, Queensland, Australia
| | - Caroline G. Watts
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Surveillance, Evaluation & Research Program, Kirby Institute, UNSW Sydney, Sydney, New South Wales, Australia
| | - Amelia K. Smit
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Monika Janda
- Centre for Health Services Research, The University of Queensland, St Lucia, Queensland, Australia
| | - Graham J. Mann
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
- John Curtin School of Medical Research, Australian National University, Acton, Australian Capital Territory, Australia
- Centre for Cancer Research, Westmead Institute for Medical Research, The University of Sydney, Westmead, Sydney, New South Wales, Australia
| | - Anne E. Cust
- The Daffodil Centre, The University of Sydney, A Joint Venture with Cancer Council NSW, Sydney, NSW, Australia
- Melanoma Institute Australia, The University of Sydney, Sydney, NSW, Australia
| | - Nicole M. Rankin
- Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Melbourne, Victoria, Australia
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Dunlop K, Rankin NM, Smit AK, Salgado Z, Newson AJ, Keogh L, Cust AE. Acceptability of risk-stratified population screening across cancer types: Qualitative interviews with the Australian public. Health Expect 2021; 24:1326-1336. [PMID: 33974726 PMCID: PMC8369084 DOI: 10.1111/hex.13267] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Revised: 03/12/2021] [Accepted: 04/10/2021] [Indexed: 01/05/2023] Open
Abstract
BACKGROUND There is mounting evidence of the benefit of risk-stratified (risk-tailored) cancer population screening, when compared to standard approaches. However, shifting towards this approach involves changes to practice that may give rise to implementation challenges. OBJECTIVES To explore the public's potential acceptance of risk-stratified screening across different cancer types, including reducing screening frequency if at low risk and the use of personal risk information, to inform implementation strategies. METHOD Semi-structured interviews were conducted with 40 public participants; half had received personal genomic risk information and half had not. Participants were prompted to consider different cancers. Data were analysed thematically as one dataset. RESULTS Themes included the following: (a) a sense of security; (b) tailored screening is common sense; (c) risk and the need to take action; (d) not every cancer is the same; and (e) trust and belief in health messages. Both groups expressed similar views. Participants were broadly supportive of risk-stratified screening across different cancer types, with strong support for increased screening frequency for high-risk groups. They were less supportive of reduced screening frequency or no screening for low-risk groups. Findings suggest the public will be amenable to reducing screening when the test is invasive and uncomfortable; be less opposed to forgo screening if offered the opportunity to screen at some stage; and view visible cancers such as melanoma differently. CONCLUSIONS Approaching distinct cancer types differently, tailoring messages for different audiences and understanding reasons for participating in screening may assist with designing future implementation strategies for risk-stratified cancer screening.
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Affiliation(s)
- Kate Dunlop
- Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNSWAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNSWAustralia
| | - Nicole M. Rankin
- Sydney School of Public Health, The Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
| | - Amelia K. Smit
- Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNSWAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNSWAustralia
| | - Zofia Salgado
- Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNSWAustralia
| | - Ainsley J. Newson
- Sydney Health Ethics, Sydney School of Public Health, The Faculty of Medicine and HealthThe University of SydneySydneyNSWAustralia
| | - Louise Keogh
- Melbourne School of Population and Global HealthThe University of MelbourneMelbourneVICAustralia
| | - Anne E. Cust
- Daffodil CentreThe University of Sydney, a joint venture with Cancer Council NSWSydneyNSWAustralia
- Melanoma Institute AustraliaThe University of SydneySydneyNSWAustralia
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Smit AK, Sharman AR, Espinoza D, Wallingford C, Young MA, Dunlop K, Tiller J, Newson AJ, Meiser B, Cust AE, Yanes T. Knowledge, views and expectations for cancer polygenic risk testing in clinical practice: A cross-sectional survey of health professionals. Clin Genet 2021; 100:430-439. [PMID: 34216141 DOI: 10.1111/cge.14025] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2021] [Revised: 06/21/2021] [Accepted: 07/01/2021] [Indexed: 11/27/2022]
Abstract
Polygenic risk scores (PRS) are becoming increasingly available in clinical practice to evaluate cancer risk. However, little is known about health professionals' knowledge, attitudes, and expectations of PRS. An online questionnaire was distributed by relevant health professional organisations predominately in Australia, Canada and the US to evaluate health professionals' knowledge, views and expectations of PRS. Eligible participants were health professionals who provide cancer risk assessments. Results from the questionnaire were analysed descriptively and content analysis was undertaken of free-text responses. In total, 105 health professionals completed the questionnaire (genetic counsellors 84%; oncologists 6%; clinical geneticists 4%; other 7%). Although responses differed between countries, most participants (61%) had discussed PRS with patients, 20% had ordered a test and 14% had returned test results to a patient. Confidence and knowledge around interpreting PRS were low. Although 69% reported that polygenic testing will certainly or likely influence patient care in the future, most felt unprepared for this. If scaled up to the population, 49% expect that general practitioners would have a primary role in the provision of PRS, supported by genetic health professionals. These findings will inform the development of resources to support health professionals offering polygenic testing, currently and in the future.
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Affiliation(s)
- Amelia K Smit
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Ashleigh R Sharman
- School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, Australia
| | - David Espinoza
- NHMRC Clinical Trials Centre, The University of Sydney, Australia
| | - Courtney Wallingford
- Dermatology Research Centre, The University of Queensland Diamantina Institute, University of Queensland, Brisbane, Australia
| | - Mary-Anne Young
- Kinghorn Centre for Clinical Genomics, Garvan Institute of Medical Research, Sydney, Australia
| | - Kate Dunlop
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia
| | - Jane Tiller
- Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, Melbourne, Australia
| | - Ainsley J Newson
- Faculty of Medicine and Health, Sydney School of Public Health, Sydney Health Ethics, The University of Sydney, Sydney, Australia
| | - Bettina Meiser
- Psychosocial Research Group, Prince of Wales Clinical School, University of NSW, Sydney, Australia
| | - Anne E Cust
- The Daffodil Centre, The University of Sydney, Cancer Council NSW, Sydney, Australia.,Melanoma Institute Australia, The University of Sydney, Sydney, Australia
| | - Tatiane Yanes
- Dermatology Research Centre, The University of Queensland Diamantina Institute, University of Queensland, Brisbane, Australia
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