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Neilson LJ, Sharp L, Patterson JM, von Wagner C, Hewitson P, McGregor LM, Rees CJ. The Newcastle ENDOPREM™: a validated patient reported experience measure for gastrointestinal endoscopy. BMJ Open Gastroenterol 2021; 8:bmjgast-2021-000653. [PMID: 34697041 PMCID: PMC8547355 DOI: 10.1136/bmjgast-2021-000653] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2021] [Accepted: 08/05/2021] [Indexed: 12/27/2022] Open
Abstract
Objectives Measuring patient experience of gastrointestinal (GI) procedures is a key component of evaluation of quality of care. Current measures of patient experience within GI endoscopy are largely clinician derived and measured; however, these do not fully represent the experiences of patients themselves. It is important to measure the entirety of experience and not just experience directly during the procedure. We aimed to develop a patient-reported experience measure (PREM) for GI procedures. Design Phase 1: semi-structured interviews were conducted in patients who had recently undergone GI endoscopy or CT colonography (CTC) (included as a comparator). Thematic analysis identified the aspects of experience important to patients. Phase 2: a question bank was developed from phase 1 findings, and iteratively refined through rounds of cognitive interviews with patients who had undergone GI procedures, resulting in a pilot PREM. Phase 3: patients who had attended for GI endoscopy or CTC were invited to complete the PREM. Psychometric properties were investigated. Phase 4 involved item reduction and refinement. Results Phase 1: interviews with 35 patients identified six overarching themes: anxiety, expectations, information & communication, embarrassment & dignity, choice & control and comfort. Phase 2: cognitive interviews refined questionnaire items and response options. Phase 3: the PREM was distributed to 1650 patients with 799 completing (48%). Psychometric properties were found to be robust. Phase 4: final questionnaire refined including 54 questions assessing patient experience across five temporal procedural stages. Conclusion This manuscript gives an overview of the development and validation of the Newcastle ENDOPREM™, which assesses all aspects of the GI procedure experience from the patient perspective. It may be used to measure patient experience in clinical care and, in research, to compare patients’ experiences of different endoscopic interventions.
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Affiliation(s)
- Laura J Neilson
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK .,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
| | - Linda Sharp
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
| | | | | | - Paul Hewitson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Colin J Rees
- Department of Gastroenterology, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK.,Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK.,Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, UK
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Robb KA, Gatting LP, von Wagner C, McGregor LM. Preference for Deliberation and Perceived Usefulness of Standard- and Narrative-Style Leaflet Designs: Implications for Equitable Cancer-Screening Communication. Ann Behav Med 2020; 54:193-201. [PMID: 31595299 DOI: 10.1093/abm/kaz039] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND In the UK, cancer-screening invitations are mailed with information styled in a standard, didactic way to allow for informed choice. Information processing theory suggests this "standard style" could be more appealing to people who prefer deliberative thinking. People less likely to engage in deliberative thinking may be disenfranchised by the design of current standard-style information. PURPOSE To examine the distribution of preference for deliberative thinking across demographic groups (Study 1) and explore associations between preference for deliberative thinking and perceived usefulness of standard- and narrative-style screening information (Study 2). METHODS In Study 1, adults aged 45-59 (n = 4,241) were mailed a questionnaire via primary care assessing preference for deliberative thinking and demographic characteristics. In Study 2, a separate cohort of adults aged 45-59 (n = 2,058) were mailed standard- and narrative-style leaflets and a questionnaire assessing demographic characteristics, preference for deliberative thinking, and perceived leaflet usefulness. Data were analyzed using multiple regression. RESULTS In Study 1 (n = 1,783) and Study 2 (n = 650), having lower socioeconomic status, being a women, and being of nonwhite ethnicity was associated with lower preference for deliberative thinking. In Study 2, the standard-style leaflet was perceived as less useful among participants with lower preference for deliberative thinking, while perceived usefulness of the narrative-style leaflet did not differ by preference for deliberative thinking. CONCLUSIONS Information leaflets using a standard style may disadvantage women and those experiencing greater socioeconomic deprivation. More work is required to identify design styles that have a greater appeal for people with low preference for deliberative thinking.
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Affiliation(s)
- Kathryn A Robb
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Lauren P Gatting
- Institute of Health and Wellbeing, University of Glasgow, Gartnavel Royal Hospital, Glasgow, UK
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, London, UK
| | - Lesley M McGregor
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, Stirling, UK
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Miller J, Currie S, McGregor LM, O'Carroll RE. 'It's like being conscripted, one volunteer is better than 10 pressed men': A qualitative study into the views of people who plan to opt-out of organ donation. Br J Health Psychol 2020; 25:257-274. [PMID: 31999878 PMCID: PMC7216962 DOI: 10.1111/bjhp.12406] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 12/22/2019] [Indexed: 11/27/2022]
Abstract
Objectives To overcome the shortage of organ donors, Scotland and England are introducing an opt-out organ donor registration system in 2020. This means individuals will be automatically considered to consent for donation unless they actively opt-out of the register. Research has found that emotional barriers play a key role in donor decisions under opt-in legislation, yet little is known about factors that influence donor decisions under opt-out consent. Our objectives were to investigate attitudes towards organ donation and opt-out consent from individuals who plan to opt-out, and to explore the reasons why they plan to opt-out. Design Qualitative interview study. Methods Semi-structured interviews were conducted with 15 individuals from Scotland (n = 14) and England (n = 1) who self-reported the intention to opt-out of the register following the legislative change to opt-out. The interviews were transcribed verbatim and analysed using thematic analysis. Results Three main themes were identified: (1) consent versus coercion, which describes the perception of freedom of choice under an opt-in system and fears of 'government interference' and threatened autonomy under opt-out, (2) self-protection, encompassing fears of medical mistrust, bodily integrity concerns, and apprehension regarding the recipient selection process, and lastly, (3) 'riddled with pitfalls', which includes the notion that opt-out consent may increase susceptibility of stigma and reproach when registering an opt-out decision. Conclusions This study reinforces existing opt-in literature surrounding medical mistrust and bodily integrity concerns. A threat to one's autonomous choice and heightened reactance arising from perceptions of unwarranted government control have emerged as novel barriers. Statement of contribution What is already known about this subject? Although around 90% of individuals in the United Kingdom support organ donation, just 40% are actively registered as donors. As part of measures to improve rates of organ transplantation, Scotland and England are moving to an opt-out organ donation consent system in 2020. Existing research has shown that feelings and emotions are important factors that influence donor relevant decisions under the current opt-in system, but little research has explored potential deterrents under the new plans for opt-out consent. Minimizing the number of people opting out of the donor register is key to ensure sustained rates of transplantation. What does this study add? This study explored why people plan to opt-out of the new system in Scotland and England. Medical mistrust and bodily integrity concerns remain as salient barriers under opt-out laws. Fears of unwarranted government control and a perceived threat to one's freedom of choice emerged as a novel barrier.
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Affiliation(s)
- Jordan Miller
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, UK
| | - Sinéad Currie
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, UK
| | - Lesley M McGregor
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, UK
| | - Ronan E O'Carroll
- Division of Psychology, Faculty of Natural Sciences, University of Stirling, UK
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Neilson LJ, Patterson J, von Wagner C, Hewitson P, McGregor LM, Sharp L, Rees CJ. Patient experience of gastrointestinal endoscopy: informing the development of the Newcastle ENDOPREM™. Frontline Gastroenterol 2020; 11:209-217. [PMID: 32419912 PMCID: PMC7223270 DOI: 10.1136/flgastro-2019-101321] [Citation(s) in RCA: 23] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/02/2019] [Revised: 11/12/2019] [Accepted: 12/13/2019] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Measuring patient experience is important for evaluating the quality of patient care, identifying aspects requiring improvement and optimising patient outcomes. Patient Reported Experience Measures (PREMs) should, ideally, be patient derived, however no such PREMs for gastrointestinal (GI) endoscopy exist. This study explored the experiences of patients undergoing GI endoscopy and CT colonography (CTC) in order to: identify aspects of care important to them; determine whether the same themes are relevant across investigative modalities; develop the framework for a GI endoscopy PREM. METHODS Patients aged ≥18 years who had undergone oesophagogastroduodenoscopy (OGD), colonoscopy or CTC for symptoms or surveillance (but not within the national bowel cancer screening programme) in one hospital were invited to participate in semi-structured interviews. Recruitment continued until data saturation. Inductive thematic analysis was undertaken. RESULTS 35 patients were interviewed (15 OGD, 10 colonoscopy, 10 CTC). Most patients described their experience chronologically, and five 'procedural stages' were evident: before attending for the test; preparing for the test; at the hospital, before the test; during the test; after the test. Six themes were identified: anxiety; expectations; choice & control; communication & information; comfort; embarrassment & dignity. These were present for all three procedures but not all procedure stages. Some themes were inter-related (eg, expectations & anxiety; communication & anxiety). CONCLUSION We identified six key themes encapsulating patient experience of GI procedures and these themes were evident for all procedures and across multiple procedure stages. These findings will be used to inform the development of the Newcastle ENDOPREM™.
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Affiliation(s)
- Laura J Neilson
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Joanne Patterson
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
- Speech and Language Therapy Department, Sunderland Royal Hospital, Sunderland, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Paul Hewitson
- Nuffield Department of Population Health, University of Oxford, Oxford, UK
| | | | - Linda Sharp
- Population Health Sciences Institute & Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
| | - Colin J Rees
- Department of Gastroenterology, South Tyneside District Hospital, South Tyneside and Sunderland NHS Foundation Trust, South Shields, UK
- Population Health Sciences Institute & Newcastle University Centre for Cancer, Newcastle University, Newcastle upon Tyne, Tyne and Wear, UK
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von Wagner C, Bonello B, Stoffel ST, Skrobanski H, Kerrison R, McGregor LM. Predictors of intention translation in flexible sigmoidoscopy screening for colorectal cancer. Health Psychol 2019; 38:1083-1095. [PMID: 31556658 DOI: 10.1037/hea0000793] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/11/2024]
Abstract
OBJECTIVE This prospective study aimed to identify predictors of intention and subsequent attendance of flexible sigmoidoscopy screening using constructs derived from the Health Belief Model (HBM). METHOD A total of 4,330 people aged 54 years and registered at 1 of 83 participating English general practices were sent a preinvitation questionnaire to assess sociodemographics, HBM variables including perceived benefits, barriers, seriousness, health motivation, and external cues to action as well a range of other constructs and personal characteristics known to relate to cancer screening. RESULTS Of the 1,578 respondents (36.4%), 1,555 (98.5%) answered the intention question: 52.9% stated definitely yes, 38.1% probably yes, 6.8% probably not, and 2.2% definitely not. Intentions were positively associated with a higher score on a scale of benefits (odds ratio [OR] = 4.62; 95% confidence intervals [CI; 3.24, 6.59]) and health motivation, that is, interest in other ways of preventing colorectal cancer (OR = 2.61; 95% CI [1.62, 4.22]), while a higher score on perceived barriers (OR = 0.19; 95% CI [0.12, 0.31]) and currently following recommended healthy lifestyle behaviors (OR = 0.31; 95% CI [0.16, 0.59]) were negatively associated. Attendance was verified for 922 intenders (65.2%) of whom 737 (79.9%) attended. Attendance was predicted by health motivation (OR = 1.75; 95% CI [1.07, 2.86]), perceived benefits (OR = 1.82; 95% CI [1.37, 2.43]), perceived barriers (OR = 0.47; 95% CI [0.32, 0.69]), individual-level deprivation (OR = 0.26; 95% CI [0.14, 0.50]), and having diabetes (OR = 0.48; 95% CI [0.25, 0.94]). CONCLUSION This study supported the usefulness of the HBM in predicting cancer screening and was further enhanced by adding non-HBM variables such as individual socioeconomic deprivation and comorbidities. (PsycINFO Database Record (c) 2019 APA, all rights reserved).
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von Wagner C, Hirst Y, Waller J, Ghanouni A, McGregor LM, Kerrison RS, Verstraete W, Vlaev I, Sieverding M, Stoffel ST. The impact of descriptive norms on motivation to participate in cancer screening - Evidence from online experiments. Patient Educ Couns 2019; 102:1621-1628. [PMID: 30975450 PMCID: PMC6686210 DOI: 10.1016/j.pec.2019.04.001] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/29/2018] [Revised: 03/29/2019] [Accepted: 04/01/2019] [Indexed: 06/09/2023]
Abstract
OBJECTIVE The current study tested in two online experiments whether manipulating normative beliefs about cancer screening uptake increases intention to attend colorectal screening among previously disinclined individuals. METHODS 2461 men and women from an Internet panel (Experiment 1 N = 1032; Experiment 2, N = 1423) who initially stated that they did not intend to take up screening were asked to guess how many men and women they believe to get screened for colorectal cancer. Across participants, we varied the presence/absence of feedback on the participant's estimate, as well as the stated proportion of men and women doing the screening test. RESULTS Across the two experiments, we found that receiving one of the experimental messages stating that uptake is higher than estimated significantly increased the proportion of disinclined men and women becoming intenders. While, we found a positive relationship between the communicated uptake and screening intentions, we did not find evidence that providing feedback on the estimate has an added benefit. CONCLUSION Screening intention can be effectively manipulated through a high uptake message. PRACTICE IMPLICATIONS Communication of high screening uptake is an easy and effective way to motivate disinclined individuals to engage in colorectal cancer screening.
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Affiliation(s)
- Christian von Wagner
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK.
| | - Yasemin Hirst
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Jo Waller
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Alex Ghanouni
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Lesley M McGregor
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Robert S Kerrison
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Wouter Verstraete
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
| | - Ivo Vlaev
- University of Warwick, Warwick Business School, Scarman Road, CV4 7AL, Coventry, UK
| | - Monika Sieverding
- University of Heidelberg, Institute of Psychology, Hauptstraße 47-51, 69117, Heidelberg, Germany
| | - Sandro T Stoffel
- University College London, ResearchDepartment of Behavioural Science and Health, 1-19 Torrington Place, WC1E 6BT, London, UK
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McGregor LM, Skrobanski H, Ritchie M, Berkman L, Miller H, Freeman M, Patel N, Morris S, Rees C, von Wagner C. Using specialist screening practitioners (SSPs) to increase uptake of bowel scope (flexible sigmoidoscopy) screening: results of a feasibility single-stage phase II randomised trial. BMJ Open 2019; 9:e023801. [PMID: 30772850 PMCID: PMC6398706 DOI: 10.1136/bmjopen-2018-023801] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To determine the feasibility of specialist screening practitioners (SSPs) offering patient navigation (PN) to facilitate uptake of bowel scope screening (BSS) among patients who do not confirm or attend their appointment. DESIGN A single-stage phase II trial. SETTING South Tyneside District Hospital, Tyne and Wear, England, UK. PARTICIPANTS Individuals invited for BSS at South Tyneside District Hospital during the 6-month recruitment period were invited to participate in the study. INTERVENTION Consenting individuals were randomly assigned to either the PN intervention or usual care group in a 4:1 ratio. The intervention involved BSS non-attenders receiving a phone call from an SSP to elicit their reasons for non-attendance and offer educational, practical and emotional support as required. If requested by the patient, another BSS appointment was then scheduled. PRIMARY OUTCOME MEASURE The number of non-attenders in the intervention group who were navigated and then rebooked and attended their new BSS appointment. SECONDARY OUTCOME MEASURES Barriers to BSS attendance, patient-reported outcomes including informed choice and satisfaction with BSS and the PN intervention, reasons for study non-participation, SSPs' evaluation of the PN process and a cost analysis. RESULTS Of those invited to take part (n=1050), 152 (14.5%) were randomised into the study: PN intervention=109; usual care=43. Most participants attended their BSS appointment (PN: 79.8%; control: 79.1%) leaving 22 eligible for PN: only two were successfully contacted. SSPs were confident in delivering PN, but were concerned that low BSS awareness and information overload may have deterred patients from taking part in the study. Difficulty contacting patients was reported as a burden to their workload. CONCLUSIONS PN, as implemented, was not a feasible intervention to increase BSS uptake in South Tyneside. Interventions to increase BSS awareness may be better suited to this population. TRIAL REGISTRATION NUMBER ISRCTN13314752; Results.
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Affiliation(s)
- Lesley M McGregor
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Hanna Skrobanski
- Research Department of Behavioural Science and Health, University College London, London, UK
- School of Health Sciences, Faculty of Health & Medical Sciences, University of Surrey, Guildford, UK
| | - Mary Ritchie
- South of Tyne Bowel Cancer Screening Centre, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, UK
| | | | - Hayley Miller
- South of Tyne Bowel Cancer Screening Centre, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, UK
- Trinity Medical Centre, South Shields, UK
| | - Madeleine Freeman
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Nishma Patel
- Department of Applied Health Research, University College London, London, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Colin Rees
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, Tyne and Wear, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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Stoffel ST, Hirst Y, Ghanouni A, McGregor LM, Kerrison R, Verstraete W, Gallagher A, Waller J, von Wagner C. Testing active choice for screening practitioner's gender in endoscopy among disinclined women: An online experiment. J Med Screen 2018; 26:98-103. [PMID: 30428750 PMCID: PMC6484820 DOI: 10.1177/0969141318806322] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objectives A large proportion of women have a preference for a same-gender endoscopy practitioner. We tested how information about practitioner gender affected intention to have bowel scope screening in a sample of women disinclined to have the test. Methods In an online experimental survey, women aged 35–54 living in England who did not intend to participate in bowel scope screening (N = 1060) were randomised to one of four experimental conditions: (1) control (practitioner’s gender is unknown), (2) opposite-gender (male practitioner by default), (3) same gender (female practitioner by default), and (4) active choice (the patient could choose the gender of the practitioner). Intention was measured following the interventions. Results Of 1010 (95.3%) women who completed the survey, most were White-British (83.6%), and working (63.3%). Compared with control, both active choice and same-gender conditions increased intention among disinclined women (9.3% vs. 16.0% and 17.9%; OR: 1.85; 95% CI: 1.07–3.20 and OR: 2.07; 95% CI: 1.23–3.50). There were no differences in intention between the opposite-gender and control conditions (9.8% vs. 9.3%; OR: 1.06; 95% CI: 0.60–1.90) or the active choice and same-gender conditions (16.0% vs. 17.9%: OR: 0.89; 95% CI: 0.55–1.46, using same gender as baseline). Conclusions Offering disinclined women a same-gender practitioner, either by choice or default, increased subsequent intention, while an opposite gender default did not negatively affect intention. Reducing uncertainty about gender of practitioner could positively affect uptake in women, and should be tested in a randomised controlled trial.
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Affiliation(s)
- Sandro T Stoffel
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Yasemin Hirst
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Alex Ghanouni
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Lesley M McGregor
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Robert Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Wouter Verstraete
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Ailish Gallagher
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Jo Waller
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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Kerrison RS, McGregor LM, Counsell N, Marshall S, Prentice A, Isitt J, Rees CJ, von Wagner C. Use of Two Self-referral Reminders and a Theory-Based Leaflet to Increase the Uptake of Flexible Sigmoidoscopy in the English Bowel Scope Screening Program: Results From a Randomized Controlled Trial in London. Ann Behav Med 2018; 52:941-951. [PMID: 30346495 PMCID: PMC6196365 DOI: 10.1093/abm/kax068] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
Background We previously initiated a randomized controlled trial to test the effectiveness of two self-referral reminders and a theory-based leaflet (sent 12 and 24 months after the initial invitation) to increase participation within the English Bowel Scope Screening program. Purpose This study reports the results following the second reminder. Methods Men and women included in the initial sample (n = 1,383) were re-assessed for eligibility 24 months after their invitation (12 months after the first reminder) and excluded if they had attended screening, moved away, or died. Eligible adults received the same treatment they were allocated 12 months previous, that is, no reminder ("control"), or a self-referral reminder with either the standard information booklet ("Reminder and Standard Information Booklet") or theory-based leaflet designed using the Behavior Change Wheel ("Reminder and Theory-Based Leaflet"). The primary outcome was the proportion screened within each group 12 weeks after the second reminder. Results In total, 1,218 (88.1%) individuals were eligible. Additional uptake following the second reminder was 0.4% (2/460), 4.8% (19/399), and 7.9% (29/366) in the control, Reminder and Standard Information Booklet, and Reminder and Theory-Based Leaflet groups, respectively. When combined with the first reminder, the overall uptake for each group was 0.7% (3/461), 14.5% (67/461), and 21.5% (99/461). Overall uptake was significantly higher in the Reminder and Standard Information Booklet and Reminder and Theory-Based Leaflet groups than in the control (odds ratio [OR] = 26.1, 95% confidence interval [CI] = 8.1-84.0, p < .001 and OR = 46.9, 95% CI = 14.7-149.9, p < .001, respectively), and significantly higher in the Reminder and Theory-Based Leaflet group than in the Reminder and Standard Information Booklet group (OR = 1.8, 95% CI = 1.3-2.6, p < .001). Conclusion A second reminder increased uptake among former nonparticipants. The added value of the theory-based leaflet highlights a potential benefit to reviewing the current information booklet. Trials Registry Number ISRCTN44293755.
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Affiliation(s)
- Robert S Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Lesley M McGregor
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, UK
| | - Sarah Marshall
- St Mark’s Bowel Cancer Screening Centre, St Mark’s Hospital, Middlesex, UK
| | - Andrew Prentice
- St Mark’s Bowel Cancer Screening Centre, St Mark’s Hospital, Middlesex, UK
| | - John Isitt
- Partners in Creation, Top Studio, London, UK
| | - Colin J Rees
- South Tyneside NHS Foundation Trust, South Tyneside School of Medicine, Pharmacy and Health, Durham University, Durham, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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von Wagner C, Bonello B, Stoffel S, Skrobanski H, Freeman M, Kerrison RS, McGregor LM. Barriers to bowel scope (flexible sigmoidoscopy) screening: a comparison of non-responders, active decliners and non-attenders. BMC Public Health 2018; 18:1161. [PMID: 30290783 PMCID: PMC6173878 DOI: 10.1186/s12889-018-6071-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/01/2018] [Accepted: 09/25/2018] [Indexed: 02/07/2023] Open
Abstract
BACKGROUND Participation in bowel scope screening (BSS) is low (43%), limiting its potential to reduce colorectal cancer (CRC) incidence and mortality. This study aimed to quantify the prevalence of barriers to BSS and examine the extent to which these barriers differed according to non-participant profiles: non-responders to the BSS invitation, active decliners of the invitation, and non-attenders of confirmed appointments. METHODS Individuals invited for BSS between March 2013 and December 2015, across 28 General Practices in England, were sent a questionnaire. Questions measured initial interest in BSS, engagement with the information booklet, BSS participation, and, where applicable, reasons for BSS non-attendance. Chi-square tests of independence were performed to examine the relationship between barriers, non-participant groups and socio-demographic variables. RESULTS 1478 (45.8%) questionnaires were returned for analysis: 1230 (83.2%) attended screening, 114 (7.7%) were non-responders to the BSS invitation, 100 (6.8%) were active decliners, and 34 (2.3%) were non-attenders. Non-responders were less likely to have read the whole information booklet than active decliners (x2 (2, N = 157) = 7.00, p = 0.008) and non-attenders (x2 (2, N = 101) = 8.07, p = 0.005). Non-responders also had lower initial interest in having BSS than either active decliners (x2 (2, N = 213) = 6.07, p = 0.014) or non-attenders (x2 (2, N = 146) = 32.93, p < 0.001). Overall, anticipated pain (33%) and embarrassment (30%) were the most commonly cited barriers to BSS participation. For non-attenders, however, practical, appointment-related reasons were most common (27%). CONCLUSIONS Interventions to improve BSS uptake should be more nuanced and use targeted strategies to address the specific needs of each group.
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Affiliation(s)
- Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Bernardette Bonello
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
- MRC/CSO Social and Public Health Sciences Unit, University of Glasgow, Glasgow, G2 3QB UK
| | - Sandro Stoffel
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Hanna Skrobanski
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
- School of Health Sciences, University of Surrey, Guildford, GU2 7XH UK
| | - Madeleine Freeman
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Robert S Kerrison
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
| | - Lesley M McGregor
- Research Department of Behavioural Science and Health, University College London, Gower Street, London, WC1E 6BT UK
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McGregor LM, Kerrison RS, Green T, Macleod U, Hughes M, Gibbins M, Morris S, Rees C, von Wagner C. Using primary care-based paper and telephone interventions to increase uptake of bowel scope screening in Yorkshire: a protocol of a randomised controlled trial. BMJ Open 2018; 8:e024616. [PMID: 30056395 PMCID: PMC6067356 DOI: 10.1136/bmjopen-2018-024616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/12/2018] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Evidence suggests bowel scope screening (BSS) can significantly reduce an individual's risk of developing colorectal cancer (CRC). BSS for 55 year olds was therefore introduced to the English Bowel Cancer Screening Programme (BCSP) in 2013. However, the benefits are only gained from test completion and uptake is low (43%). Primary care involvement has consistently shown benefits to cancer screening uptake and so this study aims to build on this knowledge and evaluate general practitioner (GP) practice led interventions designed to increase BSS attendance. METHODS AND ANALYSIS A three-arm randomised controlled trial will be conducted to evaluate three interventions: one intervention for prospective BSS invitees (primer letter with locally tailored leaflet sent by an individual's GP practice) and two interventions for those who do not attend their BSS appointment (a self-referral letter sent by an individual's GP practice and a patient navigation call made on behalf of an individual's GP practice). The trial will be set in Yorkshire. Individuals soon to receive their invitation to attend BSS at one of the Hull and East Yorkshire Bowel Cancer Screening centre sites, will be randomly assigned to one of three groups: control (usual care; no input from GP practice), Intervention group A (primer letter/leaflet and a self-referral letter), Intervention group B (primer letter/leaflet and a patient navigation call). Attendance data will be obtained from the BCSP database (via National Health Service (NHS) Digital) 3 months after the last intervention. Regression analysis will compare uptake, and additional clinical outcomes, across the three groups. The analysis will be multivariate and adjust for several covariates including gender and area-level deprivation. ETHICS AND DISSEMINATION NHS ethical approval has been obtained from London-Harrow Research Ethics Committee. The results will be submitted for publication in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER ISRCTN16252122; Pre-results.
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Affiliation(s)
- Lesley M McGregor
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Robert S Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Trish Green
- Hull York Medical School, University of Hull, Hull, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
| | - Mark Hughes
- Hull and East Yorkshire Bowel Cancer Screening Centre, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | | | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Colin Rees
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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McGregor LM, Tookey S, Raine R, von Wagner C, Black G. Persuasion, Adaptation, and Double Identity: Qualitative Study on the Psychological Impact of a Screen-Detected Colorectal Cancer Diagnosis. Gastroenterol Res Pract 2018; 2018:1275329. [PMID: 29977285 PMCID: PMC6011067 DOI: 10.1155/2018/1275329] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/19/2018] [Accepted: 04/30/2018] [Indexed: 11/29/2022] Open
Abstract
The NHS Bowel Cancer Screening Programme (BCSP) is aimed at reducing colorectal cancer (CRC) mortality through early detection within a healthy population. This study explores how 5 people (three females) experience and make sense of their screen-detected diagnosis and the psychological implications of this diagnostic pathway. A biographical narrative interview method was used, and transcripts were analysed using a thematic analysis with a phenomenological lens. Themes specifically relating to posttreatment experience and reflections are reported here: Do it: being living proof, Resisting the threat of recurrence, Rationalising bodily change, and Continuing life-"carrying on normally." Participants described their gratefulness to the BCSP, motivating a strong desire to persuade others to be screened. Furthermore, participants professed a duality of experience categorised by the normalisation of life after diagnosis and treatment and an identification of strength post cancer, as well as a difficulty adjusting to the new changes in life and a contrasting identity of frailty. Understanding both the long- and short-term impacts of a CRC diagnosis through screening is instrumental to the optimisation of support for patients. The results perhaps highlight a particular target for psychological distress reduction, which could reduce the direct and indirect cost of cancer to the patient.
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Affiliation(s)
- Lesley M. McGregor
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Sara Tookey
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London WC1E 6BT, UK
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, London WC1E 6BT, UK
| | - Georgia Black
- Department of Applied Health Research, University College London, London WC1E 6BT, UK
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McGregor LM, Bonello B, Kerrison RS, Skrobanski H, Stoffel S, von Wagner C. Barriers to bowel scope (flexible sigmoidoscopy) screening: A comparison of non-responders, active decliners and non-attenders. Eur J Surg Oncol 2017. [DOI: 10.1016/j.ejso.2017.10.177] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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14
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Smith SG, Wardle J, Atkin W, Raine R, McGregor LM, Vart G, Morris S, Duffy SW, Moss S, Hackshaw A, Halloran S, Kralj-Hans I, Howe R, Snowball J, Handley G, Logan RF, Rainbow S, Smith S, Thomas M, Counsell N, von Wagner C. Reducing the socioeconomic gradient in uptake of the NHS bowel cancer screening Programme using a simplified supplementary information leaflet: a cluster-randomised trial. BMC Cancer 2017; 17:543. [PMID: 28806955 PMCID: PMC5556676 DOI: 10.1186/s12885-017-3512-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2016] [Accepted: 07/28/2017] [Indexed: 12/25/2022] Open
Abstract
BACKGROUND Uptake of colorectal cancer screening is low in the English NHS Bowel Cancer Screening Programme (BCSP). Participation in screening is strongly associated with socioeconomic status. The aim of this study was to determine whether a supplementary leaflet providing the 'gist' of guaiac-based Faecal Occult Blood test (gFOBt) screening for colorectal cancer could reduce the socioeconomic status (SES) gradient in uptake in the English NHS BCSP. METHODS The trial was integrated within routine BCSP operations in November 2012. Using a cluster randomised controlled design all adults aged 59-74 years who were being routinely invited to complete the gFOBt were randomised based on day of invitation. The Index of Multiple Deprivation was used to create SES quintiles. The control group received the standard information booklet ('SI'). The intervention group received the SI booklet and the Gist leaflet ('SI + Gist') which had been designed to help people with lower literacy engage with the invitation. Blinding of hubs was not possible and invited subjects were not made aware of a comparator condition. The primary outcome was the gradient in uptake across IMD quintiles. RESULTS In November 2012, 163,525 individuals were allocated to either the 'SI' intervention (n = 79,104) or the 'SI + Gist' group (n = 84,421). Overall uptake was similar between the intervention and control groups (SI: 57.3% and SI + Gist: 57.6%; OR = 1.02, 95% CI: 0.92-1.13, p = 0.77). Uptake was 42.0% (SI) vs. 43.0% (SI + Gist) in the most deprived quintile and 65.6% vs. 65.8% in the least deprived quintile (interaction p = 0.48). The SES gradient in uptake was similar between the study groups within age, gender, hub and screening round sub-groups. CONCLUSIONS Providing supplementary simplified information in addition to the standard information booklet did not reduce the SES gradient in uptake in the NHS BCSP. The effectiveness of the Gist leaflet when used alone should be explored in future research. TRIAL REGISTRATION ISRCTN74121020 , registered: 17/20/2012.
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Affiliation(s)
- Samuel G. Smith
- Leeds Institute of Health Sciences, University of Leeds, Leeds, LS2 9LB UK
| | - Jane Wardle
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
| | - Wendy Atkin
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, W2 1NY UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, WC1E 7HB UK
| | - Lesley M. McGregor
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
| | - Gemma Vart
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
- Research & Enterprise Royal Holloway University of London, London, England
| | - Steve Morris
- Department of Applied Health Research, University College London, London, WC1E 7HB UK
| | - Stephen W. Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, EC1M 6BQ UK
| | - Susan Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, EC1M 6BQ UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, WC1E 7HB UK
| | - Stephen Halloran
- Bowel Cancer Screening Southern Programme Hub, Guildford, GU2 7XX UK
| | - Ines Kralj-Hans
- Academic Neuroscience Centre, King’s College London, London, SE5 8AF UK
| | - Rosemary Howe
- Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, W2 1NY UK
| | - Julia Snowball
- Bowel Cancer Screening Southern Programme Hub, Guildford, GU2 7XX UK
| | - Graham Handley
- North East Bowel Cancer Screening Hub, Gateshead, NE9 6SX UK
| | - Richard F. Logan
- Eastern Hub of the Bowel Cancer Screening Programme, Nottingham, NG7 2UH UK
| | - Sandra Rainbow
- Bowel Cancer Screening Programme London Programme Hub, London, HA1 3UJ UK
| | - Steve Smith
- Midlands & North West Bowel Cancer Screening Programme Hub, Rugby, CV22 5PX UK
| | - Mary Thomas
- Department of Applied Health Research, University College London, London, WC1E 7HB UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, University College London, London, WC1E 7HB UK
| | - Christian von Wagner
- Department of Behavioural Science and Health, University College London, London, WC1E 7HB UK
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15
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Kerrison RS, McGregor LM, Marshall S, Isitt J, Counsell N, Rees CJ, von Wagner C. Improving uptake of flexible sigmoidoscopy screening: a randomized trial of nonparticipant reminders in the English Screening Programme. Endoscopy 2017; 49:35-43. [PMID: 27997965 PMCID: PMC6193284 DOI: 10.1055/s-0042-118452] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2016] [Accepted: 08/29/2016] [Indexed: 12/14/2022]
Abstract
Background and study aims Uptake of flexible sigmoidoscopy screening in the English Bowel Scope Screening (BSS) Programme is low. The aim of this study was to test the impact of a nonparticipant reminder and theory-based leaflet to promote uptake among former nonresponders (previously did not confirm their appointment) and nonattenders (previously confirmed their appointment but did not attend). Patients and methods Eligible adults were men and women in London who had not attended a BSS appointment within 12 months of their invitation. Individuals were randomized (1:1:1) to receive no reminder (control), a 12-month reminder plus standard information booklet (TMR-SIB), or a 12-month reminder plus bespoke theory-based leaflet (TMR-TBL) designed to address barriers to screening. The primary outcome of the study was the proportion of individuals screened within each group 12 weeks after the delivery of the reminder. Results A total of 1383 men and women were randomized and analyzed as allocated (n = 461 per trial arm). Uptake was 0.2 % (n = 1), 10.4 % (n = 48), and 15.2 % (n = 70) in the control, TMR-SIB, and TMR-TBL groups, respectively. Individuals in the TMR-SIB and TMR-TBL groups were significantly more likely to attend screening than individuals in the control group (adjusted odds ratio [OR] 53.7, 95 % confidence interval [CI] 7.4 - 391.4, P < 0.001 and OR 89.0, 95 %CIs 12.3 - 645.4, P < 0.01, respectively). Individuals in the TMR-TBL group were also significantly more likely to attend screening than individuals in the TMR-SIB group (OR 1.7, 95 %CIs 1.1 - 2.5, P = 0.01). Across all groups, former nonattenders were more likely to participate in screening than former nonresponders (uptake was 14.2 % and 8.0 %, respectively; OR 2.5, 95 %CIs 1.4 - 4.4, P < 0.01). The adenoma detection rate among screened adults was 7.6 %, which is comparable to the rate in initial attenders. Conclusions Reminders targeting former nonparticipants can improve uptake and are effective for both former nonresponders and nonattenders. Theory-based information designed to target barriers to screening added significantly to this strategy.
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Affiliation(s)
- Robert S. Kerrison
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Lesley M. McGregor
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
| | - Sarah Marshall
- St Mark’s Bowel Cancer Screening Centre, St Mark’s Hospital, Harrow, United Kingdom
| | - John Isitt
- Resonant Behaviour Change and Social Marketing, London, United Kingdom
| | - Nicholas Counsell
- Cancer Research UK and University College London Cancer Trials Centre, University College London, London, United Kingdom
| | - Colin J. Rees
- South Tyneside NHS Foundation Trust, South Tyneside School of Medicine, Pharmacy and Health, Durham University, Durham, United Kingdom
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, United Kingdom
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16
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Raine R, Moss SM, von Wagner C, Atkin W, Hans IK, Howe R, Solmi F, Morris S, Counsell N, Hackshaw A, Halloran S, Handley G, Logan RF, Rainbow S, Smith S, Snowball J, Seaman H, Thomas M, Smith SG, McGregor LM, Vart G, Wardle J, Duffy SW. A national cluster-randomised controlled trial to examine the effect of enhanced reminders on the socioeconomic gradient in uptake in bowel cancer screening. Br J Cancer 2016; 115:1479-1486. [PMID: 27875518 PMCID: PMC5155361 DOI: 10.1038/bjc.2016.365] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Revised: 09/20/2016] [Accepted: 10/13/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND The NHS Bowel Cancer Screening Programme in England offers biennial guaiac faecal occult blood testing (gFOBt). There is a socioeconomic gradient in participation and socioeconomically disadvantaged groups have worse colorectal cancer survival than more advantaged groups. We compared the effectiveness and cost of an enhanced reminder letter with the usual reminder letter on overall uptake of gFOBt and the socioeconomic gradient in uptake. METHODS We enhanced the usual reminder by including a heading 'A reminder to you' and a short paragraph restating the offer of screening in simple language. We undertook a cluster-randomised trial of all 168 480 individuals who were due to receive a reminder over 20 days in 2013. Randomisation was based on the day of invitation. Blinding of individuals was not possible, but the possibility of bias was minimal owing to the lack of direct contact with participants. The enhanced reminder was sent to 78 067 individuals and 90 413 received the usual reminder. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation. Data were analysed by logistic regression with conservative variance estimates to take account of cluster randomisation. RESULTS There was a small but statistically significant (P=0.001) increase in participation with the enhanced reminder (25.8% vs 25.1%). There was significant (P=0.005) heterogeneity of the effect by socioeconomic status with an 11% increase in the odds of participation in the most deprived quintile (from 13.3 to 14.1%) and no increase in the least deprived. We estimated that implementing the enhanced reminder nationally could result in up to 80 more people with high or intermediate risk colorectal adenomas and up to 30 more cancers detected each year if it were implemented nationally. The intervention incurred a small one-off cost of £78 000 to modify the reminder letter. CONCLUSIONS The enhanced reminder increases overall uptake and reduces the socioeconomic gradient in bowel cancer screening participation at little additional cost.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Sue M Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M6BQ, UK
| | - Christian von Wagner
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Wendy Atkin
- Cancer Screening and Prevention Group, Faculty of Medicine, Department of Surgery & Cancer, Imperial College London, London, SW7 2AZ UK
| | - Ines Kralj Hans
- Department of Biostatistics, King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Rosemary Howe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Francesca Solmi
- UCL Division of Psychiatry, 6th Floor, Wing B, Maple House, 149 Tottenham Court Road, London W1T 7NF, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, 90 Tottenham Court Road, London, W1T 4TJ, UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, 90 Tottenham Court Road, London, W1T 4TJ, UK
| | - Stephen Halloran
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7XH, UK
| | - Graham Handley
- North East Bowel Cancer Screening Programme Hub, Biochemistry Department, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Richard F Logan
- Eastern Bowel Cancer Screening Programme Hub, Nottingham University Hospitals, Nottingham NG7 2UH, UK
| | - Sandra Rainbow
- London Bowel Cancer Screening Programme Hub, The Northwest London Hospitals NHS Trust, Northwick Park & St Mark's Hospitals, Watford Road, Harrow, Middlesex HA1 3UJ, UK
| | - Steve Smith
- Midlands and North West Bowel Cancer Screening Programme Hub, Hospital of St Cross, Barby Road, Rugby CV22 5PX, UK
| | - Julia Snowball
- Southern Bowel Cancer Screening Programme Hub, Surrey Research Park, 20 Priestly Road, Guildford Road, Surrey GU2 7YS, UK
| | - Helen Seaman
- Southern Bowel Cancer Screening Programme Hub, Surrey Research Park, 20 Priestly Road, Guildford Road, Surrey GU2 7YS, UK
| | - Mary Thomas
- NIHR CLAHRC North Thames, Department of Applied Health Research, University College London, London, WC1E 7HB, UK
| | - Samuel G Smith
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Lesley M McGregor
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 7HB, UK
| | - Gemma Vart
- Research Office, University of Roehampton, London SW15 5PU UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, London, WC1E 7HB, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
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Vrinten C, McGregor LM, Heinrich M, von Wagner C, Waller J, Wardle J, Black GB. What do people fear about cancer? A systematic review and meta-synthesis of cancer fears in the general population. Psychooncology 2016; 26:1070-1079. [PMID: 27643482 PMCID: PMC5573953 DOI: 10.1002/pon.4287] [Citation(s) in RCA: 95] [Impact Index Per Article: 11.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2016] [Revised: 08/15/2016] [Accepted: 09/15/2016] [Indexed: 12/13/2022]
Abstract
Background Cancer has long inspired fear, but the effect of fear is not well understood; it seems both to facilitate and to deter early diagnosis behaviours. To elucidate fear's behavioural effects, we systematically reviewed and synthesised qualitative literature to explore what people fear about cancer. Methods We searched Medline, Embase, PsycInfo, Web of Science, AnthroSource, and Anthrobase for studies on cancer fear in breast, cervical, and colorectal cancer screening and analysed 102 studies from 26 countries using thematic synthesis. Results Fears of cancer emanated from a core view of cancer as a vicious, unpredictable, and indestructible enemy, evoking fears about its proximity, the (lack of) strategies to keep it at bay, the personal and social implications of succumbing, and fear of dying from cancer. Conclusions This view of cancer as ‘an enemy’ reprises the media's ‘war on cancer’ theme and may affect the acceptance of cancer early detection and prevention messages, since cancer's characteristics influenced whether ‘fight’ or ‘flight’ was considered appropriate.
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Affiliation(s)
| | | | | | | | - Jo Waller
- Department of Epidemiology and Public Health, UCL, London, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, UCL, London, UK
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18
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Smith SG, McGregor LM, Raine R, Wardle J, von Wagner C, Robb KA. Inequalities in cancer screening participation: examining differences in perceived benefits and barriers. Psychooncology 2016; 25:1168-1174. [PMID: 27309861 PMCID: PMC5082500 DOI: 10.1002/pon.4195] [Citation(s) in RCA: 38] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/18/2015] [Revised: 06/09/2016] [Accepted: 06/10/2016] [Indexed: 01/22/2023]
Abstract
OBJECTIVE Inequalities exist in colorectal cancer (CRC) screening uptake, with people from lower socioeconomic status backgrounds less likely to participate. Identifying the facilitators and barriers to screening uptake is important to addressing screening disparities. We pooled data from 2 trials to examine educational differences in psychological constructs related to guaiac fecal occult blood testing. METHODS Patients (n = 8576) registered at 7 general practices in England, within 15 years of the eligible age range for screening (45-59.5 years), were invited to complete a questionnaire. Measures included perceived barriers (emotional and practical) and benefits of screening, screening intentions, and participant characteristics including education. RESULTS After data pooling, 2181 responses were included. People with high school education or no formal education reported higher emotional and practical barriers and were less likely to definitely intend to participate in screening, compared with university graduates in analyses controlling for study arm and participant characteristics. The belief that one would worry more about CRC after screening and concerns about tempting fate were strongly negatively associated with education. In a model including education and participant characteristics, respondents with low emotional barriers, low practical barriers, and high perceived benefits were more likely to definitely intend to take part in screening. CONCLUSIONS In this analysis of adults approaching the CRC screening age, there was a consistent effect of education on perceived barriers toward guaiac fecal occult blood testing, which could affect screening decision making. Interventions should target specific barriers to reduce educational disparities in screening uptake and avoid exacerbating inequalities in CRC mortality.
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Affiliation(s)
- S G Smith
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK.
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - L M McGregor
- Department of Epidemiology and Public Health, University College London, London, UK
| | - R Raine
- Department of Applied Health Research, University College London, London, UK
| | - J Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - C von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK
| | - K A Robb
- Department of Epidemiology and Public Health, University College London, London, UK
- Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK
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McGregor LM, Skrobanski H, Miller H, Ritchie M, Berkman L, Morris S, Rees C, von Wagner C. Using Specialist Screening Practitioners (SSPs) to increase uptake of the Bowel Scope (Flexible Sigmoidoscopy) Screening Programme: a study protocol for a feasibility single-stage phase II trial. Pilot Feasibility Stud 2016; 2:54. [PMID: 27965871 PMCID: PMC5153869 DOI: 10.1186/s40814-016-0093-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2016] [Accepted: 08/12/2016] [Indexed: 01/22/2023] Open
Abstract
Background The NHS Bowel Scope Screening (BSS) programme offers men and women aged 55 years a once-only flexible sigmoidoscopy (FS), a test that can help reduce colorectal cancer (CRC) incidence and mortality. However, the benefits of BSS are contingent on uptake. This National Institute for Health Research-funded single-stage phase II trial will test the feasibility of using patient navigation (PN), an intervention that offers support to patients to overcome barriers to healthcare, to increase BSS uptake within a socially deprived area of England. Methods/design All individuals invited for BSS at South Tyneside NHS Foundation Trust during the 6-month recruitment period will be invited to take part in the study. Consenting participants will be randomised to receive PN or usual care in a 2:1 ratio. PN involves non-attenders receiving a phone call from a Specialist Screening Practitioner (SSP) who will elicit reasons for non-attendance and offer educational, practical, and emotional support as needed. If requested by the patient, another appointment for BSS will then be arranged. We anticipate 30 % of participants will be non-attenders. Using A’Hern single-stage design, with 20 % significance level and 80 % power, at least 35 participants who receive PN need to subsequently attend for PN to be considered worthy of further investigation in a definitive trial. The primary outcome measure will be the number of participants in the PN group who re-book and attend their BSS appointment. A qualitative analysis of the PN transcripts, and interviews with the SSPs, will also be conducted, alongside a quantitative analysis of completed patient-reported experience questionnaires. An economic analysis will calculate the costs of delivering PN. Discussion This feasibility study will be instrumental in deciding whether to conduct the first definitive trial of PN in BSS in England. If PN is subsequently shown to be cost-effective at increasing uptake of BSS, NHS policies could be modified to implement PN as a standard service. The results will be disseminated in peer-reviewed journals and at scientific conferences. Trial registration International Standard Randomised Controlled Trial Number, ISRCTN13314752 Electronic supplementary material The online version of this article (doi:10.1186/s40814-016-0093-8) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lesley M McGregor
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT UK
| | - Hanna Skrobanski
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT UK
| | - Hayley Miller
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Avenue, Sheriff Hill, Gateshead, Tyne and Wear NE9 6SX UK
| | - Mary Ritchie
- Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Queen Elizabeth Avenue, Sheriff Hill, Gateshead, Tyne and Wear NE9 6SX UK
| | | | - Stephen Morris
- Department of Applied Health Research, University College London, London, WC1E 6BT UK
| | - Colin Rees
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, Harton Lane, South Shields, Tyne and Wear NE34 0PL UK
| | - Christian von Wagner
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, WC1E 6BT UK
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McGregor LM, Bonello B, Kerrison RS, Nickerson C, Baio G, Berkman L, Rees CJ, Atkin W, Wardle J, von Wagner C. Uptake of Bowel Scope (Flexible Sigmoidoscopy) Screening in the English National Programme: the first 14 months. J Med Screen 2016; 23:77-82. [PMID: 26387824 DOI: 10.1177/0969141315604659] [Citation(s) in RCA: 45] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2015] [Accepted: 07/24/2015] [Indexed: 12/13/2022]
Abstract
OBJECTIVE To examine uptake in the first six pilot centres of the English Bowel Scope Screening (BSS) programme, which began in early 2013 and invites adults aged 55 for a one off Flexible Sigmoidoscopy. METHODS Between March 2013 and May 2014 the six pilot centres sent 21,187 invitations. Using multivariate logistic regression analysis, we examined variation in uptake by gender, socioeconomic deprivation (using the Index of Multiple Deprivation), area-based ethnic diversity (proportion of non-white residents), screening centre, and appointment time (routine: daytime vs out-of-hours: evening/weekend). RESULTS Uptake was 43.1%. Men were more likely to attend than women (45% vs 42%; OR 1.136, 95% CI 1.076, 1.199, p < 0.001). Combining data across centres, there was a socioeconomic gradient in uptake, ranging from 33% in the most deprived to 53% in the least deprived quintile. Areas with the highest level of ethnic diversity also had lower uptake (39%) than other areas (41-47%) (all p < 0.02), but there was no gradient. Individuals offered a routine appointment were less likely to attend than those offered an out-of-hours appointment (42% vs. 44%; OR 0.931, 95% CI 0.882, 0.983, p = 0.01). Multivariate analyses confirmed independent effects of deprivation, gender, and centre, but not of ethnic diversity or appointment time. CONCLUSION Early indications of uptake are encouraging. Future efforts should focus on increasing public awareness of the programme and reducing socioeconomic inequalities.
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Affiliation(s)
- Lesley M McGregor
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
| | - Bernardette Bonello
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
| | - Robert S Kerrison
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
| | | | - Gianluca Baio
- Department of Statistical Science, University College London
| | | | - Colin J Rees
- South Tyneside NHS Foundation Trust, South Tyneside School of Medicine, Health and Pharmacy, University of Durham, County Durham
| | - Wendy Atkin
- Deparment of Surgery and Cancer, Imperial College London, St Mary's Campus, London
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London
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Kerrison RS, McGregor LM, Marshall S, Isitt J, Counsell N, Wardle J, von Wagner C. Use of a 12 months' self-referral reminder to facilitate uptake of bowel scope (flexible sigmoidoscopy) screening in previous non-responders: a London-based feasibility study. Br J Cancer 2016; 114:751-8. [PMID: 26977856 PMCID: PMC4984863 DOI: 10.1038/bjc.2016.43] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2015] [Revised: 12/07/2015] [Accepted: 02/01/2016] [Indexed: 12/31/2022] Open
Abstract
BACKGROUND In March 2013, NHS England extended its national Bowel Cancer Screening Programme to include 'one-off' Flexible Sigmoidoscopy screening (NHS Bowel Scope Screening, BSS) for men and women aged 55. With less than one in two people currently taking up the screening test offer, there is a strong public health mandate to develop system-friendly interventions to increase uptake while the programme is rolling out. This study aimed to assess the feasibility of sending a reminder to previous BSS non-responders, 12 months after the initial invitation, with consideration for its potential impact on uptake. METHOD This study was conducted in the ethnically diverse London Boroughs of Brent and Harrow, where uptake is below the national average. Between September and November 2014, 160 previous non-responders were randomly selected to receive a reminder of the opportunity to self-refer 12 months after their initial invitation. The reminder included instructions on how to book an appointment, and provided options for the time and day of the appointment and the gender of the endoscopist performing the test. To address barriers to screening, the reminder was sent with a brief locally tailored information leaflet designed specifically for this study. Participants not responding within 4 weeks were sent a follow-up reminder, after which there was no further intervention. Self-referral rates were measured 8 weeks after the delivery of the follow-up reminder and accepted as final. RESULTS Of the 155 participants who received the 12 months' reminder (returned to sender, n=5), 30 (19.4%) self-referred for an appointment, of which 24 (15.5%) attended and were successfully screened. Attendance rates differed by gender, with significantly more women attending an appointment than men (20.7% vs 8.8%, respectively; OR=2.73, 95% CI=1.02-7.35, P=0.05), but not by area (Brent vs Harrow) or area-level deprivation. Of the 30 people who self-referred for an appointment, 27 (90%) indicated a preference for a same-sex practitioner, whereas three (10%) gave no preference. Preference for a same-sex practitioner was higher among women than men (χ(2)=7.78, P<0.05), with only 67% of men (six of nine) requesting a same-sex practitioner, compared with 100% of women (n=21). CONCLUSIONS Sending previous non-responders a 12 months' reminder letter with a brief information leaflet is a feasible and efficacious intervention, which merits further investigation in a randomised controlled trial.
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Affiliation(s)
- Robert S Kerrison
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Lesley M McGregor
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Sarah Marshall
- St. Mark's Bowel Cancer Screening Centre, St. Mark's Hospital, Watford Road, Harrow, Middlesex HA1 3UJ, UK
| | - John Isitt
- Resonant Behaviour Change and Social Marketing, Canterbury Court, 1-3 Brixton Road, London, SW9 6DE, UK
| | - Nicholas Counsell
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Jane Wardle
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
| | - Christian von Wagner
- Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, 1-19 Torrington Place, London WC1E 7HB, UK
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McGregor LM, von Wagner C, Atkin W, Kralj-Hans I, Halloran SP, Handley G, Logan RF, Rainbow S, Smith S, Snowball J, Thomas MC, Smith SG, Vart G, Howe R, Counsell N, Hackshaw A, Morris S, Duffy SW, Raine R, Wardle J. Reducing the Social Gradient in Uptake of the NHS Colorectal Cancer Screening Programme Using a Narrative-Based Information Leaflet: A Cluster-Randomised Trial. Gastroenterol Res Pract 2016; 2016:3670150. [PMID: 27069473 PMCID: PMC4812359 DOI: 10.1155/2016/3670150] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2015] [Revised: 11/24/2015] [Accepted: 12/09/2015] [Indexed: 12/17/2022] Open
Abstract
Objective. To test the effectiveness of adding a narrative leaflet to the current information material delivered by the NHS English colorectal cancer (CRC) screening programme on reducing socioeconomic inequalities in uptake. Participants. 150,417 adults (59-74 years) routinely invited to complete the guaiac Faecal Occult Blood test (gFOBt) in March 2013. Design. A cluster randomised controlled trial (ISRCTN74121020) to compare uptake between two arms. The control arm received the standard NHS CRC screening information material (SI) and the intervention arm received the standard information plus a supplementary narrative leaflet, which had previously been shown to increase screening intentions (SI + N). Between group comparisons were made for uptake overall and across socioeconomic status (SES). Results. Uptake was 57.7% and did not differ significantly between the two trial arms (SI: 58.5%; SI + N: 56.7%; odds ratio = 0.93; 95% confidence interval: 0.81-1.06; p = 0.27). There was no interaction between group and SES quintile (p = 0.44). Conclusions. Adding a narrative leaflet to existing information materials does not reduce the SES gradient in uptake. Despite the benefits of using a pragmatic trial design, the need to add to, rather than replace, existing information may have limited the true value of an evidence-based intervention on behaviour.
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Affiliation(s)
- Lesley M. McGregor
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Wendy Atkin
- Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK
| | - Ines Kralj-Hans
- Department of Biostatistics, King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Stephen P. Halloran
- NHS Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, Guildford, Surrey GU2 7YS, UK
- Faculty of Health and Medical Sciences, University of Surrey, Guildford, Surrey GU2 7TE, UK
| | - Graham Handley
- NHS Bowel Cancer Screening North East Programme Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Richard F. Logan
- NHS Bowel Cancer Screening Eastern Programme Hub, Nottingham University Hospitals, Nottingham NG7 2UH, UK
| | - Sandra Rainbow
- NHS Bowel Cancer Screening London Programme Hub, Northwick Park and St Mark's Hospitals, Harrow, Middlesex HA1 3UJ, UK
| | - Steve Smith
- NHS Bowel Cancer Screening Midlands and North West Programme Hub, Hospital of St Cross, Barby Road, Rugby CV22 5PX, UK
| | - Julia Snowball
- NHS Bowel Cancer Screening Southern Programme Hub, Surrey Research Park, Guildford, Surrey GU2 7YS, UK
| | - Mary C. Thomas
- Department of Applied Health Research, University College London, London WC1E 7HB, UK
| | - Samuel G. Smith
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - Gemma Vart
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
| | - Rosemary Howe
- Department of Surgery & Cancer, Imperial College London, London SW7 2AZ, UK
| | - Nicholas Counsell
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, London W1T 4TJ, UK
| | - Allan Hackshaw
- Cancer Research UK & UCL Cancer Trials Centre, Cancer Institute, University College London, London W1T 4TJ, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London WC1E 7HB, UK
| | - Stephen W. Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London WC1E 7HB, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London WC1E 7HB, UK
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Wardle J, von Wagner C, Kralj-Hans I, Halloran SP, Smith SG, McGregor LM, Vart G, Howe R, Snowball J, Handley G, Logan RF, Rainbow S, Smith S, Thomas MC, Counsell N, Morris S, Duffy SW, Hackshaw A, Moss S, Atkin W, Raine R. Effects of evidence-based strategies to reduce the socioeconomic gradient of uptake in the English NHS Bowel Cancer Screening Programme (ASCEND): four cluster-randomised controlled trials. Lancet 2016; 387:751-9. [PMID: 26680217 PMCID: PMC4761689 DOI: 10.1016/s0140-6736(15)01154-x] [Citation(s) in RCA: 96] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Uptake in the national colorectal cancer screening programme in England varies by socioeconomic status. We assessed four interventions aimed at reducing this gradient, with the intention of improving the health benefits of screening. METHODS All people eligible for screening (men and women aged 60-74 years) across England were included in four cluster-randomised trials. Randomisation was based on day of invitation. Each trial compared the standard information with the standard information plus the following supplementary interventions: trial 1 (November, 2012), a supplementary leaflet summarising the gist of the key information; trial 2 (March, 2012), a supplementary narrative leaflet describing people's stories; trial 3 (June, 2013), general practice endorsement of the programme on the invitation letter; and trial 4 (July-August, 2013) an enhanced reminder letter with a banner that reiterated the screening offer. Socioeconomic status was defined by the Index of Multiple Deprivation score for each home address. The primary outcome was the socioeconomic status gradient in uptake across deprivation quintiles. This study is registered, number ISRCTN74121020. FINDINGS As all four trials were embedded in the screening programme, loss to follow-up was minimal (less than 0·5%). Trials 1 (n=163,525) and 2 (n=150,417) showed no effects on the socioeconomic gradient of uptake or overall uptake. Trial 3 (n=265 434) showed no effect on the socioeconomic gradient but was associated with increased overall uptake (adjusted odds ratio [OR] 1·07, 95% CI 1·04-1·10, p<0·0001). In trial 4 (n=168 480) a significant interaction was seen with socioeconomic status gradient (p=0·005), with a stronger effect in the most deprived quintile (adjusted OR 1·11, 95% CI 1·04-1·20, p=0·003) than in the least deprived (1·00, 0·94-1·06, p=0·98). Overall uptake was also increased (1·07, 1·03-1·11, p=0·001). INTERPRETATION Of four evidence-based interventions, the enhanced reminder letter reduced the socioeconomic gradient in screening uptake, but further reducing inequalities in screening uptake through written materials alone will be challenging. FUNDING National Institute for Health Research.
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Affiliation(s)
- Jane Wardle
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London, UK.
| | - Ines Kralj-Hans
- Department of Biostatistics, King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - Stephen P Halloran
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK; Royal Surrey County Hospital NHS Foundation Trust, Guildford, and University of Surrey, Guildford, UK
| | - Samuel G Smith
- Department of Epidemiology and Public Health, University College London, London, UK; Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Lesley M McGregor
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Gemma Vart
- Department of Epidemiology and Public Health, University College London, London, UK
| | - Rosemary Howe
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Julia Snowball
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford, Surrey, UK
| | - Graham Handley
- NHS Bowel Cancer Screening Programme North East Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead, UK
| | - Richard F Logan
- NHS Bowel Cancer Screening Programme Eastern Hub, Nottingham University Hospitals, Nottingham, UK
| | - Sandra Rainbow
- NHS Bowel Cancer Screening Hub, London Hub, Northwick Park and St Mark's Hospital, Harrow, Middlesex, UK
| | - Steve Smith
- NHS Bowel Cancer Screening Programme Midlands and North West Hub, University Hospitals Coventry and Warwickshire NHS Trust, Hospital of St Cross, Rugby, UK
| | - Mary C Thomas
- Department of Applied Health Research, University College London, London, UK
| | - Nicholas Counsell
- Cancer Research Centre UK and University College London Cancer Trials Centre, University College London, London, UK
| | - Steve Morris
- Department of Applied Health Research, University College London, London, UK
| | - Stephen W Duffy
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Allan Hackshaw
- Cancer Research Centre UK and University College London Cancer Trials Centre, University College London, London, UK
| | - Sue Moss
- Wolfson Institute of Preventive Medicine, Queen Mary University of London, London, UK
| | - Wendy Atkin
- Department of Surgery and Cancer, Imperial College London, London, UK
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK
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Raine R, Duffy SW, Wardle J, Solmi F, Morris S, Howe R, Kralj-Hans I, Snowball J, Counsell N, Moss S, Hackshaw A, von Wagner C, Vart G, McGregor LM, Smith SG, Halloran S, Handley G, Logan RF, Rainbow S, Smith S, Thomas MC, Atkin W. Impact of general practice endorsement on the social gradient in uptake in bowel cancer screening. Br J Cancer 2016; 114:321-6. [PMID: 26742011 PMCID: PMC4742577 DOI: 10.1038/bjc.2015.413] [Citation(s) in RCA: 29] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2015] [Revised: 10/20/2015] [Accepted: 10/24/2015] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND There is a socioeconomic gradient in the uptake of screening in the English NHS Bowel Cancer Screening Programme (BCSP), potentially leading to inequalities in outcomes. We tested whether endorsement of bowel cancer screening by an individual's general practice (GP endorsement; GPE) reduced this gradient. METHODS A cluster-randomised controlled trial. Over 20 days, individuals eligible for screening in England from 6480 participating general practices were randomly allocated to receive a GP-endorsed or the standard invitation letter. The primary outcome was the proportion of people adequately screened and its variation by quintile of Index of Multiple Deprivation. RESULTS We enrolled 265,434 individuals. Uptake was 58.2% in the intervention arm and 57.5% in the control arm. After adjusting for age, sex, hub and screening episode, GPE increased the overall odds of uptake (OR=1.07, 95% CI 1.04-1.10), but did not affect its socioeconomic gradient. We estimated that implementing GPE could result in up to 165 more people with high or intermediate risk colorectal adenomas and 61 cancers detected, and a small one-off cost to modify the standard invitation (£78,000). CONCLUSIONS Although GPE did not improve its socioeconomic gradient, it offers a low-cost approach to enhancing overall screening uptake within the NHS BCSP.
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Affiliation(s)
- Rosalind Raine
- Department of Applied Health Research, University College London, London WC1E 6BT, UK
| | - Stephen W Duffy
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - Jane Wardle
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Francesca Solmi
- Department of Applied Health Research, University College London, London WC1E 6BT, UK
| | - Stephen Morris
- Department of Applied Health Research, University College London, London WC1E 6BT, UK
| | - Rosemary Howe
- Department of Surgery and Cancer, Imperial College London, London W2 1PG, UK
| | - Ines Kralj-Hans
- Department of Biostatistics, King's Clinical Trials Unit, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
| | - Julia Snowball
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford GU2 7YS, UK
| | - Nicholas Counsell
- Cancer Research UK and University College London Cancer Trials Centre, London WC1E 6BT, UK
| | - Sue Moss
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
| | - Allan Hackshaw
- Cancer Research UK and University College London Cancer Trials Centre, London WC1E 6BT, UK
| | - Christian von Wagner
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Gemma Vart
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Lesley M McGregor
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Samuel G Smith
- Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, London EC1M 6BQ, UK
- Department of Epidemiology and Public Health, University College London, London WC1E 6BT, UK
| | - Stephen Halloran
- NHS Bowel Cancer Screening Programme Southern Hub, Royal Surrey County Hospital NHS Foundation Trust, Guildford GU2 7YS, UK
- Department of Biochemistry and Physiology, University of Surrey, Guildford GU2 7XH, UK
| | - Graham Handley
- NHS Bowel Cancer Screening Programme North East Hub, Gateshead Health NHS Foundation Trust, Queen Elizabeth Hospital, Gateshead NE9 6SX, UK
| | - Richard F Logan
- NHS Bowel Cancer Screening Programme Eastern Hub, Nottingham University Hospitals, Nottingham NG7 2UH, UK
| | - Sandra Rainbow
- NHS Bowel Cancer Screening Programme London Hub, Northwick Park and St Mark's Hospitals NHS Trust, Middlesex HA1 3UJ, UK
| | - Steve Smith
- NHS Bowel Cancer Screening Programme Midlands and North West Hub, University Hospitals Coventry and Warwickshire NHS Trust, Hospital of St Cross, Rugby CV22 5PX, UK
| | - Mary C Thomas
- Department of Applied Health Research, University College London, London WC1E 6BT, UK
| | - Wendy Atkin
- Department of Surgery and Cancer, Imperial College London, London W2 1PG, UK
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Palmer CK, Thomas MC, McGregor LM, von Wagner C, Raine R. Understanding low colorectal cancer screening uptake in South Asian faith communities in England--a qualitative study. BMC Public Health 2015; 15:998. [PMID: 26423750 PMCID: PMC4589976 DOI: 10.1186/s12889-015-2334-9] [Citation(s) in RCA: 26] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2015] [Accepted: 09/23/2015] [Indexed: 01/22/2023] Open
Abstract
Background Colorectal cancer screening uptake within the South Asian population in England is approximately half that of the general population (33 % vs 61 %), and varies by Muslim (31.9 %), Sikh (34.6 %) and Hindu (43.7 %) faith background. This study sought to explore reasons for low uptake of CRC screening in South Asian communities and for the variability of low uptake between three faith communities; and to identify strategies by which uptake might be improved. Methods We interviewed 16 ‘key informants’ representing communities from the three largest South Asian faith backgrounds (Islam, Hinduism and Sikhism) in London, England. Results Reasons for low colorectal cancer screening uptake were overwhelmingly shared across South Asian faith groups. These were: limitations posed by written English; limitations posed by any written language; reliance on younger family members; low awareness of colorectal cancer and screening; and difficulties associated with faeces. Non-written information delivered verbally and interactively within faith or community settings was preferred across faith communities. Conclusions Efforts to increase accessibility to colorectal cancer screening in South Asian communities should use local language broadcasts on ethnic media and face-to-face approaches within community and faith settings to increase awareness of colorectal cancer and screening, and address challenges posed by written materials.
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Affiliation(s)
- Cecily K Palmer
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, UK.
| | - Mary C Thomas
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, UK.
| | - Lesley M McGregor
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, UK.
| | - Christian von Wagner
- Department of Epidemiology and Public Health, Cancer Research UK Health Behaviour Research Centre, University College London, 1-19 Torrington Place, London, UK.
| | - Rosalind Raine
- Department of Applied Health Research, University College London, 1-19 Torrington Place, London, UK.
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McGregor LM, von Wagner C, Vart G, Yuen WC, Raine R, Wardle J, Robb KA. The impact of supplementary narrative-based information on colorectal cancer screening beliefs and intention. BMC Cancer 2015; 15:162. [PMID: 25884168 PMCID: PMC4397889 DOI: 10.1186/s12885-015-1167-3] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2014] [Accepted: 03/05/2015] [Indexed: 02/08/2023] Open
Abstract
Background The potential benefits of colorectal cancer screening are limited by low uptake. This study tested whether providing narrative accounts of the colorectal cancer (CRC) screening experience positively affected beliefs about CRC screening and intention to be screened. Methods 4125 adults aged 45-59.5 years, from three general practices in England, were randomised to be sent the standard information on CRC screening or the standard information plus a narrative-based leaflet describing CRC screening experiences. Both groups were asked to complete and return a questionnaire on beliefs about CRC screening after reading the study materials. Between-group differences on responses were assessed with t-tests. A mediation analysis then addressed the mediating role of CRC screening beliefs on the group and intention relationship. Results Relative to the standard information group (n = 590), the standard information plus narrative leaflet group (n = 631) showed higher perceived vulnerability to CRC, higher perceived test response efficacy, a stronger belief that the screening test would provide peace of mind and less disgust with the test procedure. There were no between group differences on perceived self-efficacy or the understanding that the screening test should be done in the absence of symptoms. Respondents who received the additional narrative leaflet reported significantly higher CRC screening intentions than respondents who received the standard information only. Controlling for the CRC screening beliefs reduced the effect of group on intention to non-significance. Conclusions An additional narrative leaflet had a positive impact on beliefs about CRC screening which led to stronger screening intentions. Electronic supplementary material The online version of this article (doi:10.1186/s12885-015-1167-3) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Lesley M McGregor
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Christian von Wagner
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Gemma Vart
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Wing Chee Yuen
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Rosalind Raine
- Department of Applied Health Research, University College London, London, UK.
| | - Jane Wardle
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, University College London, London, UK.
| | - Kathryn A Robb
- Medical Research Council/Chief Scientist's Office, Social and Public Health Sciences Unit, Institute of Health and Wellbeing, University of Glasgow, Glasgow, UK.
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McGregor LM, Dickson A, Flowers P, Hayes PC, O'Carroll RE. Reclaiming their lives: the decision-making process in living liver donation--an interpretative phenomenological case study analysis of one couple. Psychol Health 2014; 29:1373-87. [PMID: 24991986 PMCID: PMC4192859 DOI: 10.1080/08870446.2014.940950] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVES Adult-to-adult living liver donation (LLD) is a controversial procedure due to the risk to the healthy donor. The decision to proceed with LLD is an important, yet under-researched area. This study aims to explore the decision-making process of the donor and recipient independently, and within the donor-recipient dyad. DESIGN A longitudinal, qualitative analysis of the LLD decision from the perspective of a LLD donor-recipient dyad. METHODS In-depth interviews were conducted with the donor and recipient separately on three occasions: pre LLD, six weeks post and six months post LLD. Transcripts were subject to interpretative phenomenological analysis. RESULTS During the pre-LLD interviews, a series of intra- and interpersonal negotiations were reported as both the donor and recipient grappled to make a decision about LLD. Following the decision, the focus then centred on the consequences of the decision and making sense of unanticipated outcomes. By six months post LLD, both were able to reflect on adapting to the changes their decision had ultimately caused. CONCLUSIONS This case study offers a unique insight into the risk assessment and decision-making demands of LLD and the results can help support future LLD candidates.
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Marlow LAV, McGregor LM, Nazroo JY, Wardle J. Facilitators and barriers to help-seeking for breast and cervical cancer symptoms: a qualitative study with an ethnically diverse sample in London. Psychooncology 2013; 23:749-57. [PMID: 24352798 PMCID: PMC4282580 DOI: 10.1002/pon.3464] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2013] [Revised: 11/22/2013] [Accepted: 11/22/2013] [Indexed: 01/07/2023]
Abstract
Objective Earlier diagnosis of cancer has become a policy priority. There is evidence that minority ethnic groups are more likely to delay help-seeking for cancer symptoms, but few studies have explored reasons for delay in these groups. The present study explored facilitators and barriers to help-seeking for breast and cervical cancer in an ethnically diverse sample of women. Methods Semi-structured interviews were carried out with 54 healthy women from a range of ethnic backgrounds; Indian, Pakistani, Bangladeshi, Caribbean, African, Black British, Black other, White British and White other. Framework analysis was used to identify themes. Results Appraising a symptom as possibly due to cancer was an important facilitator of help-seeking, although for some the prospect of a cancer diagnosis was a deterrent. Women believed that earlier diagnosis improved the chance of survival, and this facilitated prompt help-seeking. A sympathetic GP facilitated help-seeking, and an unsympathetic GP was a deterrent. Some ethnic minority women described the use of alternative medicine and prayer as a first-line strategy that might delay help-seeking. Language barriers, racism and a tendency to ‘soldier on’ were also mentioned by these women. Conclusions Models of delay in presentation for early cancer symptoms are likely to transfer across different ethnic groups. Encouraging open discussion about cancer among minority communities could help raise awareness about the importance of early detection and promote help-seeking as a priority response to a possible cancer symptom. © 2013 The Authors. Psycho-Oncology published by John Wiley & Sons, Ltd.
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Affiliation(s)
- Laura A V Marlow
- Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL, Gower Street, London, UK
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Abstract
Objective: This experimental study investigates the impact of message frame and risk perceptions upon willingness to consider living organ donation. Design: A 2 (gain vs. loss) by 2 (liver vs. kidney) by 2 (involved vs. not involved) between-group study was conducted. Method: Eighty-seven participants completed a questionnaire after reading a vignette designed to invite participants to consider living kidney or liver donation. Results: Within a gain frame scenario, willingness to donate was significantly higher when the risk of donating was lower. Conclusion: The results have important implications for the generalizability of framing theories and the promotion of living organ donation.
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McGregor LM, Swanson V, Hayes PC, Forsythe JR, O’Carroll RE. Considering adult living donor liver transplantation: A qualitative study of patients and their potential donors. Psychol Health 2010; 25:751-66. [DOI: 10.1080/08870440902822921] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Abstract
BACKGROUND/AIMS We have previously shown that prior to liver transplantation, patients exhibit impairment in memory and psychomotor speed. Despite significant improvement following transplantation, recovery remained incomplete at 1 year post-transplant. This study aimed to investigate the effects of liver transplantation on a wider range of cognitive abilities, and to assess the impact of any impairment upon day-to-day functioning, particularly driving ability. METHODS This study was a between-group design involving three groups of participants: liver transplant candidates, liver transplant recipients and healthy controls. All participants completed measures of affective status, functional capacity, quality of life, neuropsychological status and driving ability. RESULTS For the majority of measures, healthy controls performed best, followed by liver transplant recipients and then liver transplant candidates, respectively. This pattern was most pronounced with respect to functional limitations, language and attention. No significant difference between the three groups was observed for simulated driving ability. CONCLUSIONS The results suggest that while significant recovery occurs in many areas of psychosocial functioning following liver transplantation, this recovery may be incomplete, that is, many patients do not recover to their full pre-illness status. The measure we employed to assess driving ability was not a sensitive or discriminating measure in this study.
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McGregor LM, Hayes PC, O'Carroll RE. Living liver donation: Attitudes of the general public and general practitioners in Scotland. Psychol Health 2008; 23:603-16. [DOI: 10.1080/08870440701864512] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
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Abstract
This study assessed adherence to medication after liver transplantation and consisted of 2 components: a retrospective audit involving the examination of the Scottish national database, and a preliminary study assessing psychological factors implicated in poor adherence. In order to first establish an idea of the extent of poor adherence within the Scottish liver transplant population, a retrospective audit was carried out on all patients (N = 435) who received transplants before November 2003. Adherence was assessed by attendance at follow-up clinic appointments, blood immunosuppressant levels, and episodes of cellular rejection. It was found that attendance and immunosuppressant levels were often suboptimal and that nonadherence may have contributed to retransplantation and death. Cellular (acute) rejection after 6 months was associated with higher mortality. Explanations as to why liver transplant patients may not take their medication as recommended were then explored in detailed psychological assessments of 33 liver transplant recipients. The results indicated that low self-reported patient adherence was related to greater concerns regarding the potential adverse effects of medication, and a stronger belief that medicines in general are harmful. In addition, the greater the effect the transplantation had on patients' lives and the more it affected them emotionally, the less adherent the patients were likely to be. The results highlight potential areas that, if confirmed in a larger study, might be targeted in a psychological intervention to improve patient adherence and thereby transplantation outcomes.
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Affiliation(s)
- Ronan E O'Carroll
- Department of Psychology, University of Stirling, Stirling, United Kingdom.
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Abstract
Follicle-derived thyroid cancer is rare in the young. The authors examined a population with a low rate of radiation exposure and who were treated at a single institution. The records of 56 patients diagnosed before the age of 25 years were analyzed. The majority of patients presented with an asymptomatic thyroid mass. All patients were treated surgically and half received postoperative ablation with 131I. Recurrent disease was detected in 29%. The presence of local metastases at initial surgery was a predictor of recurrence. No patient presented with distant metastases and no patient died of thyroid cancer. Although radiation exposure remains a risk factor for thyroid cancer in the young, only a minority of patients with thyroid cancer have a known history of exposure. Patients who are diagnosed at a young age have a high rate of long-term recurrence, and should be followed closely throughout their lives.
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MESH Headings
- Adenocarcinoma, Follicular/diagnosis
- Adenocarcinoma, Follicular/etiology
- Adenocarcinoma, Follicular/therapy
- Adenocarcinoma, Papillary/diagnosis
- Adenocarcinoma, Papillary/etiology
- Adenocarcinoma, Papillary/therapy
- Adolescent
- Adult
- Child
- Child, Preschool
- Combined Modality Therapy
- Environmental Exposure
- Female
- Humans
- Male
- Neoplasms, Radiation-Induced/diagnosis
- Neoplasms, Radiation-Induced/etiology
- Neoplasms, Radiation-Induced/therapy
- Prognosis
- Recurrence
- Retrospective Studies
- Thyroid Neoplasms/diagnosis
- Thyroid Neoplasms/etiology
- Thyroid Neoplasms/therapy
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Affiliation(s)
- L M McGregor
- Department of Pediatrics, Division of Pediatric Hematology-Oncology, Duke University Medical Center, Durham, NC 27710, USA
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Slebos RJ, Hoppin JA, Tolbert PE, Holly EA, Brock JW, Zhang RH, Bracci PM, Foley J, Stockton P, McGregor LM, Flake GP, Taylor JA. K-ras and p53 in pancreatic cancer: association with medical history, histopathology, and environmental exposures in a population-based study. Cancer Epidemiol Biomarkers Prev 2000; 9:1223-32. [PMID: 11097231] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/18/2023] Open
Abstract
Pancreatic cancer is a highly fatal cancer with few identified risk factors. Increased risk of pancreatic cancer in tobacco smokers and among diabetic patients is well established, and some reports have suggested associations with coffee consumption and occupational exposure to organochlorines. At present, there is little information regarding the possible association of these risk factors with the known genetic alterations found in pancreatic cancers, such as activation of the K-ras oncogene and inactivation of the p53 tumor suppressor gene. Knowledge of such relationships may help to understand the molecular pathways of pancreatic tumorigenesis. We investigated the association between these molecular defects and risk factors for pancreatic cancer in 61 newly diagnosed patients identified through an ongoing study of pancreatic cancer in the San Francisco Bay Area. Interview information was obtained regarding environmental exposures, medical history, and demographic factors. Serum levels of dichlorodiphenyltrichloroethylene (DDE) and polychlorinated biphenyls were available on a subset of 24 patients. Tumor blocks were located from local hospitals and used for K-ras mutational analysis at codon 12 and for p53 protein immunohistochemistry. The molecular analyses were facilitated through the use of laser capture microdissection, which provides a reliable method to obtain almost pure populations of tumor cells. Mutations in K-ras codon 12 were found in 46 (75%) of 61 pancreatic cancers. A prior diagnosis of diabetes was significantly associated with K-ras negative tumors (P = 0.002, Fisher's exact test). The absence of this mutation was also associated with increased serum levels of DDE, although this association was not statistically significant (P = 0.16, Wilcoxon's test). There was no difference in polychlorinated biphenyl levels between the K-ras wild-type and mutant groups. Immunohistochemical staining for p53 protein did not differ by patient characteristics or clinical history, but significant associations were found with poor glandular differentiation (P = 0.002, chi2 trend test), severe nuclear atypia (P = 0.0007, chi2 trend test), and high tumor grade (P = 0.004, chi2 trend test). Our results are suggestive of the presence of K-ras codon 12 mutation-independent tumorigenesis pathways in patients with prior diabetes and possibly in patients with higher serum levels of DDE. Our results also support a role for the p53 tumor suppressor protein in the maintenance of genomic integrity.
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Affiliation(s)
- R J Slebos
- Laboratory of Molecular Carcinogenesis, National Institute of Environmental Health Sciences, Research Triangle Park, North Carolina 27709, USA
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Abstract
A case report is presented of an 8-year-old boy who underwent resection of a thyroglossal duct cyst to illustrate a rare, but significant, complication of a common clinical problem. Pathological examination revealed that it contained a papillary adenocarcinoma of the thyroid, presumably arising from ectopic glandular tissue in the cyst. Thyroglossal duct cysts are a common cause of midline neck masses in children. Occult thyroid carcinoma is a rare co-morbid finding. It infrequently leads to death, but thyroglossal duct cysts may also contain the only functioning, albeit ectopic, thyroid tissue. Patients with clinical thyroglossal duct cysts should be carefully evaluated preoperatively for the presence of tumor and other functioning thyroid tissue prior to excision of the cyst.
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Affiliation(s)
- P M Rosoff
- Division of Hematology-Oncology, Duke University Medical Center, Durham, NC 27710, USA.
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McGregor LM, McCune BK, Graff JR, McDowell PR, Romans KE, Yancopoulos GD, Ball DW, Baylin SB, Nelkin BD. Roles of trk family neurotrophin receptors in medullary thyroid carcinoma development and progression. Proc Natl Acad Sci U S A 1999; 96:4540-5. [PMID: 10200298 PMCID: PMC16368 DOI: 10.1073/pnas.96.8.4540] [Citation(s) in RCA: 104] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
Although initiating mutations in the ret protooncogene have been found in familial and sporadic medullary thyroid carcinoma (MTC), the molecular events underlying subsequent tumor progression stages are unknown. We now report that changes in trk family neurotrophin receptor expression appear to be involved in both preneoplastic thyroid C cell hyperplasia and later tumor progression. Only a subset of normal C cells expresses trk family receptors, but, in C cell hyperplasia, the affected cells consistently express trkB, with variable expression of trkA and trkC. In later stages of gross MTC tumors, trkB expression was substantially reduced, while trkC expression was increased and often intense. In a cell culture model of MTC, exogenous trkB expression resulted in severely impaired tumorigenicity and was associated with 11-fold lower levels of the angiogenesis factor vascular endothelial growth factor. These results suggest that trk family receptor genes participate in MTC development and progression, and, in particular, that trkB may limit MTC tumor growth by inhibition of angiogenesis.
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MESH Headings
- Animals
- Carcinoma, Medullary/genetics
- Carcinoma, Medullary/pathology
- Carcinoma, Medullary/physiopathology
- Disease Progression
- Female
- Gene Expression Regulation
- Gene Expression Regulation, Neoplastic
- Humans
- Hyperplasia
- Mice
- Mice, Nude
- Pregnancy
- Proto-Oncogene Proteins/genetics
- Receptor Protein-Tyrosine Kinases/genetics
- Receptor, Ciliary Neurotrophic Factor
- Receptor, trkA
- Receptor, trkC
- Receptors, Nerve Growth Factor/genetics
- Thyroid Gland/cytology
- Thyroid Gland/metabolism
- Thyroid Gland/pathology
- Thyroid Neoplasms/genetics
- Thyroid Neoplasms/pathology
- Thyroid Neoplasms/physiopathology
- Transplantation, Heterologous
- Tumor Cells, Cultured
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Affiliation(s)
- L M McGregor
- Oncology Center, Johns Hopkins Medical Institutions, Baltimore, MD 21231, USA
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Yamashiro DJ, Liu XG, Lee CP, Nakagawara A, Ikegaki N, McGregor LM, Baylin SB, Brodeur GM. Expression and function of Trk-C in favourable human neuroblastomas. Eur J Cancer 1997; 33:2054-7. [PMID: 9516852 DOI: 10.1016/s0959-8049(97)00309-2] [Citation(s) in RCA: 48] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Human neuroblastomas express the neurotrophin receptors trk-A and trk-B. Favourable outcome is associated with expression of trk-A, while unfavourable, MYCN amplified tumours express trk-B. In this study we examined the expression of trk-C in primary neuroblastoma tumour-derived cell lines. We found by Northern blot analysis that trk-C mRNA is expressed in 14 of 55 (25%) primary tumours. Trk-C was expressed in significantly more lower stage tumours (stage 1, 2, 4S) than higher stage tumours (stage 3, 4, P < 0.04). The expression of trk-C was correlated positively with survival and negatively correlated with MYCN amplification. We also studied the function of trk-C in transfected cell lines and found that NT-3 promotes both cell survival and differentiation. Our results suggest that trk-C is involved in the biology of favourable neuroblastomas.
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Affiliation(s)
- D J Yamashiro
- Division of Oncology, Children's Hospital of Philadelphia, Pennsylvania 19104-4318, USA
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McGregor LM, Baylin SB, Griffin CA, Hawkins AL, Nelkin BD. Molecular cloning of the cDNA for human TrkC (NTRK3), chromosomal assignment, and evidence for a splice variant. Genomics 1994; 22:267-72. [PMID: 7806211 DOI: 10.1006/geno.1994.1383] [Citation(s) in RCA: 32] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
TrkC is a receptor tyrosine kinase that is activated by neurotrophin-3, a factor important in the development of certain areas of the central nervous system. We have cloned and sequenced the human trkC cDNA and found that the predicted amino acid sequence is 97 to 98% homologous to the rat and porcine trkC sequences, respectively. The rat trkC has several isoforms due to alternative splicing in the tyrosine kinase domain. We cloned one human splice variant that has a nucleic acid sequence identical to the rat isoform with an insert of 14 amino acids. The human trkC cDNA also has a (CGG)n repeat in the 5'-untranslated region. This sequence was not highly polymorphic in that 79 of 80 chromosomes examined had eight repeats, while 1 chromosome had four repeats. By PCR analysis of a somatic cell hybrid panel and fluorescence in situ hybridization with the cDNA clone, human trkC was mapped to chromosome 15q24-q25.
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Affiliation(s)
- L M McGregor
- Oncology Center, Johns Hopkins Medical Institutions, Baltimore, Maryland 21231
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Abstract
The genome of human cytomegalovirus (HCMV) contains three genes with homology to cellular G protein-coupled receptors (GCRs). Evidence is presented here that all three HCMV GCR genes are transcribed during infection, that they are transcribed as two sets of 3'-coterminal mRNAs, and that their transcription is restricted to the late phase of infection.
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Affiliation(s)
- A R Welch
- Department of Pharmacology and Molecular Sciences, Johns Hopkins School of Medicine, Baltimore, Maryland 21205
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