MHealth approach to promote Oral HIV self-testing among men who have sex with men in China: a qualitative description.
Zhao Yue,Zhu Xiaofang,Pérez Ashley E,Zhang Wenhan,Shi Anxia,Zhang Zhihua,Gao Pan,Wang Jun,Yang Cui,Zaller Nickolas,Sun Yehuan,Operario Don,Zhang Hongbo
BMC public health
BACKGROUND:HIV self-testing (HIVST) has demonstrated potential to expand HIV testing among key populations, including men who have sex with men (MSM) in China who have low testing rates. However, due to the autonomous nature of self-testing, people who undergo HIVST may lack access to relevant information and counseling support typically provided by in-person HIV testing counselors. WeChat, a popular smartphone application in China, offers a potential source of mobile health (mHealth) information and support for individuals using HIVST. This paper aimed to explore the opinions of MSM in China about the feasibility and potential concerns of using WeChat to support HIVST and reduce risk for HIV infection. METHODS:We conducted in-depth interviews with 36 MSM about their mobile smartphone usage and the use of WeChat for helping MSM self-administer HIVST kits in Hefei, China. Each interview was digitally recorded and transcribed. Transcripts were analyzed used content analysis method according to Elo and Kyngas. RESULTS:MSM described their use of WeChat and expressed cautious endorsement about using this platform to promote HIVST and disseminate HIV-related information. They described their preferences about the implementation features of an mHealth intervention to promote HIVST, including the delivery source of intervention messages, as well as message timing, frequency, form, tone, and content. Participants also described privacy-related concerns about receiving messages via WeChat and offered potential solutions. CONCLUSIONS:Findings from this study show the potential utility of WeChat app-based messaging for engaging MSM in HIV self-testing and prevention. Future research is needed to integrate the concerns expressed in this analysis and evaluate a WeChat-based intervention to promote oral HIV self-testing, risk reduction, and health promotion among MSM in China.
Promoting routine syphilis screening among men who have sex with men in China: study protocol for a randomised controlled trial of syphilis self-testing and lottery incentive.
Cheng Weibin,Wang Cheng,Tang Weiming,Ong Jason J,Fu Hongyun,Marks Michael,Smith M Kumi,Li Changchang,Nie Juan,Zhao Peizhen,Zheng Heping,Yang Bin,Tucker Joseph D
BMC infectious diseases
BACKGROUND:Men who have sex with men (MSM) bear a high burden of syphilis infection. Expanding syphilis testing to improve timely diagnosis and treatment is critical to improve syphilis control. However, syphilis testing rates remain low among MSM, particularly in low- and middle-income countries. We describe the protocol for a randomised controlled trial (RCT) to assess whether provision of syphilis self-testing services can increase the uptake of syphilis testing among MSM in China. METHODS:Four hundred forty-four high-risk MSM will be recruited online and randomized in a 1:1:1 ratio to (1) standard syphilis self-testing arm; (2) a self-testing arm program enhanced with crowdsourcing and a lottery-based incentive, and (3) a standard of care (control). Self-testing services include a free syphilis self-test kit through the mail at monthly intervals. Participants in the lottery incentive arm will additionally receive health promotion materials generated from an open crowdsourcing contest and be given a lottery draw with a 10% chance to win 100 RMB (approximately 15 US Dollars) upon confirmed completion of syphilis testing. Syphilis self-test kits have step-by-step instructions and an instructional video. This is a non-blinded, open-label, parallel RCT. Participants in each arm will be followed-up at three and 6 months through WeChat (a social media app like Facebook messenger). Confirmation of syphilis self-test use will be determined by requiring participants to submit a photo of the used test kit to study staff via secure data messaging. Both self-testing and facility-based testing will be ascertained by sending a secure photographic image of the completed kit through an existing digital platform. The primary outcome is the proportion of participants who tested for syphilis in the past 3 months. DISCUSSION:Findings from this study will provide much needed insight on the impact of syphilis self-testing on promoting routine syphilis screening among MSM. The findings will also contribute to our understanding of the safety, effectiveness and acceptability of syphilis self-testing. These findings will have important implications for self-testing policy, both in China and internationally. TRIAL REGISTRATION:ChiCTR1900022409 (10 April, 2019).
The value of WeChat application in chronic diseases management in China.
Chen Xin,Zhou Xi,Li Huan,Li Jinlan,Jiang Hua
Computer methods and programs in biomedicine
The prevalence of chronic diseases in China has increased rapidly in recent decades. Although the management rate of chronic diseases has improved, there is still no unified and effective management measure for chronic diseases at present. This highlights the importance of effectively managing chronic diseases. With the development of e-health, the ways of getting medical consultation have changed. WeChat is an extremely popular social application in China. It is easy to operate and can offer multiple functions. Many researches have reported the effectiveness of WeChat in chronic diseases management. Based on the status of WeChat application in chronic diseases management and the characteristics of WeChat technology, we firstly focused on the WeChat application on the management of chronic diseases such as hypertension, diabetes, coronary heart disease and cancer. Then we discussed the value of WeChat in chronic diseases management and analyzed the potential reasons. Lastly, we discussed the limitations of present researches. WeChat can be an effective tool for the management of chronic diseases, but the promotion of this mode needs support and efforts from various aspects to eventually realize improving public health.
Revised Australian national guidelines for colorectal cancer screening: family history.
Jenkins Mark A,Ait Ouakrim Driss,Boussioutas Alex,Hopper John L,Ee Hooi C,Emery Jon D,Macrae Finlay A,Chetcuti Albert,Wuellner Laura,St John D James B
The Medical journal of Australia
INTRODUCTION:Screening is an effective means for colorectal cancer prevention and early detection. Family history is strongly associated with colorectal cancer risk. We describe the rationale, evidence and recommendations for colorectal cancer screening by family history for people without a genetic syndrome, as reported in the 2017 revised Australian guidelines. Main recommendations: Based on 10-year risks of colorectal cancer, people at near average risk due to no or weak family history (category 1) are recommended screening by immunochemical faecal occult blood test (iFOBT) every 2 years from age 50 to 74 years. Individuals with moderate risk due to their family history (category 2) are recommended biennial iFOBT from age 40 to 49 years, then colonoscopy every 5 years from age 50 to 74 years. People with a high risk due to their family history (category 3) are recommended biennial iFOBT from age 35 to 44 years, then colonoscopy every 5 years from age 45 to 74 years. Changes in management as a result of the guidelines: By 2019, the National Bowel Cancer Screening Program will offer all Australians free biennial iFOBT screening from age 50 to 74 years, consistent with the recommendations in these guidelines for category 1. Compared with the 2005 guidelines, there are some minor changes in the family history inclusion criteria for categories 1 and 2; the genetic syndromes have been removed from category 3 and, as a consequence, colonoscopy screening is now every 5 years; and for categories 2 and 3, screening begins with iFOBT for people aged 40 and 35 years, respectively, before transitioning to colonoscopy after 10 years.
Determinants of adherence to screening by colonoscopy in individuals with a family history of colorectal cancer.
Bronner Karen,Mesters Ilse,Weiss-Meilik Ahuva,Geva Ravit,Rozner Guy,Strul Hana,Inbar Moshe,Halpern Zamir,Kariv Revital
Patient education and counseling
OBJECTIVE:Although first-degree relatives (FDRs) of colorectal cancer (CRC) patients, as a high-risk population, have the most to gain from colonoscopy screening, their adherence is suboptimal. Thus, an assessment of the determinants of adherence to screening is of potential importance. METHODS:A cross-sectional study was conducted among 318 FDRs of 164 CRC patients treated at Tel-Aviv Sourasky Medical Center. Interviews were conducted with a questionnaire using I-Change Model. RESULTS:Adherence to interval colonoscopy was low with only 73 FDRs (23.0%). Greater adherence was associated with socio-demographic variables (older age, siblings, having spouse, higher level of education and income) and behavioral variables (healthier lifestyle, utilization of preventive health services). Family physicians and kin were identified as the most influential figures on uptake. Intention, affective barriers, positive attitudes, social support, cues to action, age, and health maintenance were the strongest determinants of participation in CRC screening. CONCLUSION:Adherence to colonoscopy is determined by multiple variables. Medical staff can play a key role in increasing adherence to colonoscopy. PRACTICE IMPLICATIONS:Future interventions should focus on fostering positive attitudes, overcoming barriers, enhancing social support and providing a medical recommendation. Special efforts should be invested in young FDRs, those of low socio-economic status and those who underutilize preventive medicine.
Effect of WeChat and short message service on bowel preparation: an endoscopist-blinded, randomized controlled trial.
Wang Shu-Ling,Wang Qian,Yao Jun,Zhao Sheng-Bing,Wang Li-Sheng,Li Zhao-Shen,Bai Yu
European journal of gastroenterology & hepatology
OBJECTIVE:Adequate bowel preparation is essential for a successful colonoscopy; clinical studies suggest reinforced education can improve the preparation process. However, there have been no trials to compare WeChat directions (the most widely used social media app in China) with those of the short message service (SMS). This study was aimed to assess the effect of WeChat and SMS on the bowel preparation quality. PARTICIPANTS AND METHODS:This was a single-center, prospective, endoscopically blinded, randomized, controlled study. Patients in reinforced education groups received additional reminder messages by WeChat and SMS 2 days before colonoscopy. The primary outcome was bowel preparation quality evaluated by the Boston bowel preparation scale (BBPS) score and the rate of adequacy (BBPS score ≥6). Secondary outcomes included polyp detection rate, adenoma detection rate, and mean total adenomas detected. Patient tolerance level and subjective feelings were also evaluated. RESULTS:The total BBPS score and the percentage of adequacy were significantly higher in the reinforced education groups compared with the control (WeChat vs. control, P<0.001; SMS vs. control, P<0.001). Moreover, statistically significant differences between the two interventions were found in the total BBPS score but not in the rate of adequacy (P=0.007 and 0.561, respectively). The detection of adenomas, using multiplicity detection rate, advanced adenoma detection rate, and mean total adenomas detected, was much higher in the intervention groups (P=0.039, 0.037, and 0.019, respectively). CONCLUSION:WeChat was superior to SMS for bowel preparation, although both of them may help improving the detection of adenomas.
Cost-effectiveness of patient mailings to promote colorectal cancer screening.
Sequist Thomas D,Franz Calvin,Ayanian John Z
BACKGROUND:Programs to promote colorectal cancer screening are common, yet information regarding the cost-effectiveness of such efforts is limited. OBJECTIVE:To assess the cost-effectiveness of patient mailings to increase rates of colorectal cancer screening. RESEARCH DESIGN:Incremental cost-effectiveness analysis of a randomized, controlled trial. The intervention involved 21,860 patients aged 50 to 80 years across 11 health centers overdue for colorectal cancer screening. Patients were randomized to receive a mailing that included a tailored letter, educational brochure, and fecal occult blood test kit at baseline and 6 months follow-up. MEASURES:We calculated the incremental cost-effectiveness of these mailings to promote colorectal cancer screening by fecal occult blood testing, flexible sigmoidoscopy, or colonoscopy using internal cost estimates of labor and supplies. RESULTS:Colorectal cancer screening rates were higher for patients in the intervention compared with control patients (44% vs. 38%, P < 0.001). The total cost of the intervention was approximately $5.48 per patient, resulting in a cost-effectiveness ratio of $94 per additional patient screened. This estimate ranged from $69 to $156, based on assumptions of the cost of the intervention components, magnitude of intervention effect, age range, and size of the targeted patient population. CONCLUSION:Tailored patient mailings are a cost-effective approach to improve rates of colorectal cancer screening.
Effect of Sequential or Active Choice for Colorectal Cancer Screening Outreach: A Randomized Clinical Trial.
Mehta Shivan J,Induru Vikranth,Santos David,Reitz Catherine,McAuliffe Timothy,Orellana Charles,Volpp Kevin G,Asch David A,Doubeni Chyke A
JAMA network open
Importance:Colonoscopy and fecal immunochemical testing (FIT) are considered top-tier tests for colorectal cancer (CRC) screening. Behavioral economic insights about "choice architecture" suggest that participation could be influenced by how people are presented test options. Objective:To investigate response rates for offering colonoscopy only compared with sequential choice (colonoscopy and then FIT) or active choice (colonoscopy or FIT) through mailed outreach. Design, Setting, and Participants:Three-arm pragmatic randomized clinical trial conducted between November 14, 2017, and May 14, 2018. The setting was primary care practices at an academic health system. Patients aged 50 to 74 years with at least 2 primary care visits in the 2-year preenrollment period were included if they were eligible but not up to date on CRC screening. Interventions:Eligible patients received mailed outreach about CRC screening. Equal numbers of eligible patients were randomly assigned to 3 outreach groups to receive mailings about CRC screening with the following options: (1) direct phone number to call for scheduling colonoscopy (colonoscopy only), (2) direct phone number to call for colonoscopy and a mailed FIT kit if no response within 4 weeks (sequential choice), or (3) direct phone number to call for colonoscopy and a mailed FIT kit offered at the same time (active choice). Main Outcomes and Measures:The primary outcome was CRC screening completion (FIT or colonoscopy) within 4 months of initial outreach. The secondary outcomes were CRC screening completion within 6 months of outreach and the choice of colonoscopy as a screening test. Results:In total, 438 patients were included in the intent-to-treat analysis, with a median age of 56 years (interquartile range, 52-63 years); 55.0% were women. At 4 months, the CRC screening completion rates were 14.4% (95% CI, 8.7%-20.1%) in the colonoscopy-only arm, 17.1% (95% CI, 11.0%-23.2%) in the sequential choice arm, and 19.9% (95% CI, 13.4%-26.4%) in the active choice arm. Neither choice arm achieved a screening rate statistically greater than that in the colonoscopy-alone arm. Among those who completed CRC screening at 4 months, 90.5% (95% CI, 78.0%-103.0%) chose colonoscopy in the colonoscopy-only arm, which was significantly higher than the 52.0% (95% CI, 32.4%-71.6%; P = .005) and 37.9% (95% CI, 20.2%-55.6%; P < .001) in the sequential choice and active choice arms, respectively. Conclusions and Relevance:There was no significant increase in CRC screening when offering sequential or active choice, but there was a lower rate of colonoscopy in the choice arms than in the colonoscopy-only arm. Subtle changes in sequencing or defaults can alter patient decision making related to preventive health. Trial Registration:ClinicalTrials.gov identifier: NCT03246438.
Mailed Letter Versus Phone Call to Increase Uptake of Cancer Screening: A Pragmatic, Randomized Trial.
Kiran Tara,Davie Sam,Moineddin Rahim,Lofters Aisha
Journal of the American Board of Family Medicine : JABFM
BACKGROUND:There is good evidence that cancer-specific patient outreach improves rates of cervical, breast, and colorectal cancer screening. However, it is unclear how primary care practices should implement integrated outreach for all 3 types of cancer screening. We aimed to understand whether integrated outreach using mailed letters or phone calls were more effective at increasing screening uptake in a primary care organization. METHOD:We conducted a pragmatic randomized trial comparing outreach by mailed letter or personalized phone call for patients overdue for cervical, breast, or colorectal cancer screening. The study was conducted at 6 clinics within an academic primary care organization in Toronto, Canada. Our primary outcome was an uptake of at least 1 screening test for which the patient was overdue. Our primary analysis was an intention-to-treat, unadjusted comparison of proportions, using a χ test. We also compared costs per additional patient screened. All analyses were stratified by sex. RESULTS:A total of 3733 females and 1537 males were randomized to receive 1 of the interventions. Among women, 33.0% allocated to receive a reminder letter and 41.2% allocated to receive a reminder phone call received at least 1 screening test for which they were due (absolute difference, 8.1%; 95% CI, 5.1%-11.2%, < .001). Among men, 24.8% allocated to receive a reminder letter and 28.8% allocated to a reminder phone call received screening for colorectal cancer (absolute difference, 4.1%; 95% CI, -0.4% to 8.5%, = .073). For women and men, the letters cost approximately CaD $5.07 and CaD $7.16, respectively, for each completed screening test compared with CaD $8.71 and CaD $12.00 for the phone calls. CONCLUSIONS:Phone calls were more effective than mailed letters at increasing uptake for cervical, breast, and colorectal cancer screening among women. However, phone calls were more expensive than letters. Primary care practices should consider integrating phone call reminders into their practice, possibly as part of a targeted or staged approach to outreach for cancer screening.
Mailed Outreach Is Superior to Usual Care Alone for Colorectal Cancer Screening in the USA: A Systematic Review and Meta-analysis.
Jager Mark,Demb Josh,Asghar Ali,Selby Kevin,Mello Evelyn Marquez,Heskett Karen M,Lieberman Alicea J,Geng Zhuo,Bharti Balambal,Singh Siddharth,Gupta Samir
Digestive diseases and sciences
Mailed outreach promoting colorectal cancer (CRC) screening with a stool blood test kit may increase participation, but magnitude and consistency of benefit of this intervention strategy is uncertain. Our aim was to conduct a systematic review and meta-analysis of randomized controlled trials (RCTs) comparing mailed outreach offering stool tests to usual care, clinic-based screening offers on CRC screening uptake in the USA. We performed a systematic literature search of five databases for RCTs of mailed outreach from January 1980 through June 2017. Primary outcome was screening completion, summarized using random-effects meta-analysis as pooled differences in proportion completing the screening and relative risk of achieving screening compared to control. Subgroup analyses by test type offered-fecal immunochemical test (FIT) or guaiac fecal occult blood test (gFOBT), the presence of telephone reminders, and the presence of predominant underserved/minority population within study were performed. Quality of evidence was evaluated using the GRADE framework. Seven RCTs which enrolled 12,501 subjects were included (n = 5703 assigned mailed outreach and n = 6798 usual care). Mailed outreach resulted in a 28% absolute (95% CI 25-30%; I = 47%) and a 2.8-fold relative (RR 2.65, 95% CI 2.03-3.45; I = 92%) increase in screening completion compared to usual care, with a number needed to invite estimated to be 3.6. Similar outcomes were observed across subgroups. Overall body of evidence was at moderate quality. Mailed outreach offering a gFOBT or FIT is associated with a large and consistent increase in CRC screening completion and should be considered for more widespread implementation for improving screening rates nationwide.
A scoping review of WeChat to facilitate professional healthcare education in Mainland China.
Luan Hui,Wang Miao,Sokol Rebeccah L,Wu Shiyou,Victor Bryan G,Perron Brian E
Medical education online
AIM:WeChat is the most popular social media platform in mainland China, with over 1 billion active users. Although social media is widely used in professional healthcare education in western countries, research on WeChat-based education in healthcare in mainland China is disparate and not systematic. The current study seeks to address this gap. METHOD:A scoping review was conducted to systematically describe studies of WeChat use in professional healthcare education. A comprehensive search involving three international databases in English and Chinese literature was conducted in April 2019. Articles were retained in this study if they were original studies that used WeChat as a tool to facilitate healthcare education in mainland China. RESULTS:25 studies met the inclusion criteria and the majority of studies were either experimental or quasi-experimental. WeChat was used in both university settings and hospital settings. Hybrid education-which integrates WeChat education and face-to-face education-was more common in university settings, whereas hospitals used a combination of hybrid and WeChat-only strategies. Significant heterogeneity was observed regarding the type of accounts and methods for delivering content and facilitating online conversations. A majority of studies found positive outcomes with WeChat education. CONCLUSIONS:This scoping review addressed a large gap in knowledge about the usage of WeChat in professional healthcare education. Of the existing studies identified, we observed considerable promise for future practice. We provide additional suggestions for conducting future research involving patients and other helping professionals in healthcare education to expand the usage of WeChat.
Colonoscopy Screening Behaviour and Associated Factors Amongst First-Degree Relatives of People with Colorectal Cancer in China: Testing the Health Belief Model Using a Cross-Sectional Design.
Bai Yang,Wong Cho Lee,Peng Xiaolin,So Winnie K W
International journal of environmental research and public health
Colonoscopy is the best screening choice for at-risk persons, because it offers prevention through the removal of preneoplastic lesions in addition to early detection. This study aims to report the participation rate of colonoscopy screening and examine its associated factors amongst Chinese first-degree relatives of people with colorectal cancer based on the health belief model (HBM). A cross-sectional study was conducted in Shenzhen, China from March to May 2019. Demographic characteristics, family history, variables derived from the HBM and colonoscopy screening behaviours were measured through online surveys as the independent variables of interest. A total of 186 online surveys were returned, with a final response rate of 57.0%. The participation rate of colonoscopy was 15.6%. Univariate analysis (independent -test/chi-square test/Fisher test) was applied first to identify the candidate independent variables. Then, multivariate logistic regression was used to examine the association between independent variables and uptake of colonoscopy. Perceived barriers and cues to action were identified as factors associated with undergoing colonoscopy. The participation rate of colonoscopy in the study population was low. Health communication to promote colonoscopy screening for the Chinese at-risk population should include components in reducing barriers to colonoscopy tests, family history information and health professional recommendations on screening. Future studies with large sample size are suggested to examine perceived susceptibility, fatalism and other characteristics considering family history (treatment and outcome of patients) and their potential impacts on cancer screening behaviours for Chinese at-risk populations due to family history.
Diagnostic accuracy of faecal immunochemical test for screening individuals with a family history of colorectal cancer.
Ng S C,Ching J Y L,Chan V,Wong M C S,Suen B Y,Hirai H W,Lam T Y T,Lau J Y W,Ng S S M,Wu J C Y,Chan F K L,Sung J J Y
Alimentary pharmacology & therapeutics
BACKGROUND:The role of a faecal immunochemical test (FIT) in screening individuals with a positive family history of colorectal cancer (CRC) is not clear. AIM:To assess the diagnostic accuracy of FIT using colonoscopy findings as the gold standard in identifying colorectal neoplasms. METHODS:We analysed data from 4539 asymptomatic subjects aged 50-70 years who had both colonoscopy and FIT (Hemosure; W.H.P.M., Inc, El Monte, CA, USA) at our bowel cancer screening centre between 2008 and 2012. A total of 572 subjects (12.6%) had a family history of CRC. Our primary outcome was the sensitivity of FIT in detecting advanced neoplasms and cancers in subjects with a family history of CRC. A family history of CRC was defined as any first-degree relative with a history of CRC. RESULTS:Among 572 subjects with a family history of CRC, adenoma, advanced neoplasm and cancer were found at screening colonoscopy in 29.4%, 6.5% and 0.7% individuals, respectively. The sensitivity of FIT in detecting adenoma, advanced neoplasm and cancer was 9.5% [95% confidence interval (CI), 5.7-15.3], 35.1% (95% CI, 20.7-52.6) and 25.0% (95% CI, 1.3-78.1), respectively. Among FIT-negative subjects who have a family history of CRC, adenoma was found in 152 (29.6%), advanced neoplasm in 24 (4.7%) and cancer in 3 (0.6%) individuals. CONCLUSION:Compared with colonoscopy, FIT is more likely to miss advanced neoplasms or cancers in individuals with a family history of CRC.
General practitioner and specialist views on colonoscopic screening of first-degree relatives of colorectal cancer patients.
Ingrand Isabelle,Dujoncquoy Sarah,Beauchant Michel,Letard Jean-Christophe,Migeot Virginie,Ingrand Pierre
INTRODUCTION:Barriers to targeted colonoscopic screening of first-degree relatives of colorectal cancer patients have been the subject of considerable literature, always as seen from the patient's viewpoint. In the specific context of screening individuals with a family history, physicians may also play a predominant role in motivating their colorectal cancer patients to pass on screening information to their relatives. The aim of this study was to examine the views of general practitioners and specialists regarding barriers and facilitators affecting participation of relatives in colonoscopic screening. METHODS:A qualitative study was conducted to collect and analyse information from two focus groups of 4 general practitioners and 9 gastroenterologists respectively, and from semi-structured individual interviews with 10 general practitioners, 2 surgeons and 3 oncologists. An extended focus group of 36 gastroenterologists was organized to validate the results. RESULTS:The main barriers to colonoscopic screening of FDRs were associated with lack of direct communication between physicians and FDRs. Physicians needed support in the task of informing index patients and persuading them to transfer information on screening to their FDRs. The general practitioners spoke of their expectations in terms of training in and motivation for promoting screening and the gastroenterologists expressed the wish for patient education material specific to colonoscopy and for systematic post-colonoscopy consultations to inform patients about their results, follow-up and screening their relatives. CONCLUSION:The findings, notably the need for specific education materials and for training to improve the motivation of physicians, will help to develop effective interventions intended to increase participation in screening.
Interactions among physicians, patients, and first-degree relatives in the familial screening of colorectal cancer in France.
Ingrand Isabelle,Dujoncquoy Sarah,Migeot Virginie,Ghadi Véronique,Beauchant Michel,Ingrand Pierre
Patient preference and adherence
AIMS:To characterize determining factors for compliance with colonoscopy recommendations in the familial screening of colorectal cancer through exploration of individual psychosociological factors and issues relating to patient/physician/sibling communication. METHODS:A qualitative approach involving a review of the literature and interviews with general practitioners, specialists, patients, and their siblings. RESULTS:A confrontation of the content of interviews with data from the literature made it possible to confirm the relevance of classic prevention models, the Health Belief Model and the Theory of Planned Behavior in the French cultural and healthcare environments, as well as their ability to identify the main individual factors liable to motivate or to discourage familial screening. The family network plays a decisive part in the transmission of information from the patient towards siblings. Physicians have expectations relating to communication aids and backup. This study above all highlights the difficulty in determining who is best suited to giving information to the patient, and when and how to relay this information to first-degree relatives. CONCLUSION:In view of the many difficulties in establishing interaction between patient, physician and siblings that is liable to lead on to efficient screening, we propose the study of the usefulness of a health-counseling intervention aimed to tailor and follow-up the delivery of screening information to the first-degree relatives.
Examining intrafamilial communication of colorectal cancer risk status to family members and kin responses to colonoscopy: a qualitative study.
McGarragle Kaitlin M,Hare Crystal,Holter Spring,Facey Dorian Anglin,McShane Kelly,Gallinger Steven,Hart Tae L
Hereditary cancer in clinical practice
Background:First-degree relatives (FDRs) of probands with colorectal cancer (CRC) may be at increased risk of CRC and require colonoscopy. Proband disclosure about this risk and need for colonoscopy is essential for FDRs to take appropriate action. Low colonoscopy rates are reported among FDRs and little is known about the proband disclosure process. A better understanding of the barriers surrounding colonoscopy and disclosure is needed. Methods:CRC probands ( = 16) and FDRs ( = 9), recruited from a Canadian CRC Consortium, completed interviews to determine barriers to disclosure and colonoscopy, respectively. Interviews were analyzed using thematic analysis and participants' motivation to disclose to FDRs or undertake colonoscopy was categorized into Stages of Change (i.e., Precontemplation, Contemplation, Preparation, Action, or Maintenance) using the transtheoretical model. Results:25% of probands had not disclosed to any first-degree kin and were categorized in the Precontemplation or Contemplation Stage of Change. Barriers to disclosure included lack of information, negative expectations about familial reaction, assuming FDRs were aware of risk or already being screened, dysfunctional family dynamics, and cultural barriers. 75% of FDRs were categorized in the Precontemplation or Contemplation Stage of Change. Barriers included negative perceptions about colonoscopy, health-care provider related factors, practical concerns, and lack of information about CRC, risk, and colonoscopy. Conclusions:In the absence of barriers such as cost and accessibility, this Canadian sample still reported several challenges to disclosure and colonoscopy adherence. Future research should explore interventions such as motivational interviewing to improve proband disclosure and to increase FDR adherence to colonoscopy.
Uncovering the barriers to undergoing screening among first degree relatives of colorectal cancer patients: a review of qualitative literature.
Tan Ker-Kan,Lopez Violeta,Wong Mee-Lian,Koh Gerald Choon-Huat
Journal of gastrointestinal oncology
First degree relatives (FDRs) of colorectal cancer (CRC) patients are at higher risks of developing the disease, but screening rates amongst this group remains dismal. We undertook a systematic review of qualitative studies to identify the barriers surrounding CRC screening among FDRs from both the FDRs' and the healthcare professionals' perspectives. A comprehensive search of major bibliographic databases from January 2000 till February 2017 was performed to answer the above research questions. Pre-determined inclusion and exclusion criteria were applied. Thematic analysis was used to derive the commonalities across the studies. COREQ checklist was used to evaluate the quality of the included studies. Eight qualitative studies were included. Some of the barriers reported by FDRs included the fear of diagnosis of cancer and socio-cultural barriers. The most important barrier was the FDRs' negative perceptions towards screening test such as discomfort, embarrassment, cost of procedure and accessibility to healthcare resources. Likewise, the lack of awareness amongst FDRs that they are at increased risk of developing CRC was also found to be a barrier. On the other hand, healthcare providers are keen for patients themselves to be advocates for CRC screening of their family members as constraints posed by their daily workload impede their time to advocate screening. Lack of knowledge of the physicians on CRC screening guidelines is another notable barrier. A lack of awareness of being at higher risk of developing CRC coupled with negative attitude towards colonoscopy are the main barriers faced by the FDRs of CRC patients. Healthcare providers are more comfortable with patients being the advocates of screening among their family members.
Getting the first degree relatives to screen for colorectal cancer is harder than it seems-patients' and their first degree relatives' perspectives.
Tan Ker-Kan,Lim Tian-Zhi,Chan Dedrick Kok Hong,Chew Emily,Chow Wen-Min,Luo Nan,Wong Mee-Lian,Koh Gerald Choon-Huat
International journal of colorectal disease
INTRODUCTION:First degree relatives (FDR) of colorectal cancer (CRC) patients are at increased risk of CRC compared to the general population. However, screening colonoscopy rates amongst the FDRs remain dismal. The aim of the study was to explore the various issues amongst the patients and their FDR precluding their adoption of screening colonoscopy. METHODS:A qualitative study of CRC patients and their FDRs was performed. Semi-structured interviews were conducted with participants using open-ended questions until data saturation was achieved. These qualitative data were then thematically analysed. RESULTS:Fifty CRC patients and thirty-one FDRs were recruited between June 2015 and December 2015. For the patients, three main themes emerged, which include (i) poor understanding of the CRC screening guidelines for their FDRs, (ii) recommendations are lacking amongst medical professionals and (iii) numerous barriers are hindering patients from being advocates for screening colonoscopy for their FDRs. For the FDRs, three main themes emerged. These include (i) poor understanding of the exact CRC screening guidelines amongst the FDRs, (ii) the lack of health promotion efforts amongst medical professionals and (iii) barriers to the uptake of screening colonoscopy such as fear of colonoscopy, high cost of the procedure, its associated inconvenience and perceived invulnerability of the individual. CONCLUSIONS:Patients and FDRs are not aware of the increased risks of developing CRC amongst the family members. Guidelines regarding screening are also not clearly understood. The numerous barriers that are present amongst the CRC patients and their FDRs can be addressed.
Creating an mHealth App for Colorectal Cancer Screening: User-Centered Design Approach.
Griffin Lauren,Lee Donghee,Jaisle Alyssa,Carek Peter,George Thomas,Laber Eric,Lok Benjamin,Modave François,Paskett Electra,Krieger Janice
JMIR human factors
BACKGROUND:Patients are increasingly using mobile health (mHealth) apps to monitor their health and educate themselves about medical issues. Despite the increasing popularity of such apps, poor design and usability often lead to suboptimal continued use of these apps and subsequently to poor adherence to the behavior changes at which they are aimed. One solution to these design problems is for app developers to use user-centered design (UCD) principles to consider the context and needs of users during the development process. OBJECTIVE:This study aimed to present a case study on the design and development process for an mHealth app that uses virtual human technology (VHT) to encourage colorectal cancer (CRC) screening among patients aged 50 years and above. METHODS:We have first provided an overview of the project and discussed its utilization of VHT. We have then reviewed UCD principles and how they can be incorporated into the development of health apps. We have described how we used UCD processes during the app's development. We have then discussed the unique roles played by communication researchers, computer scientists, clinicians, and community participants in creating an mHealth app that is credible, usable, effective, and accessible to its target audience. RESULTS:The principles of UCD were woven throughout the project development, with researchers collecting feedback from patients and providers at all stages and using that feedback to improve the credibility, usability, effectiveness, and accessibility of the mHealth app. The app was designed in an iterative process, which encouraged feedback and improvement of the app and allowed teams from different fields to revisit topics and troubleshoot problems. CONCLUSIONS:Implementing a UCD process contributed to the development of an app, which not only reflected cross-disciplinary expertise but also the needs, wants, and concerns of patients.
Direct-to-member mailed colorectal cancer screening outreach for Medicaid and Medicare enrollees: Implementation and effectiveness outcomes from the BeneFIT study.
Coronado Gloria D,Green Beverly B,West Imara I,Schwartz Malaika R,Coury Jennifer K,Vollmer William M,Shapiro Jean A,Petrik Amanda F,Baldwin Laura-Mae
BACKGROUND:Colorectal cancer screening uptake is low, particularly among individuals enrolled in Medicaid. To the authors' knowledge, little is known regarding the effectiveness of direct-to-member outreach by Medicaid health insurance plans to raise colorectal cancer screening use, nor how best to deliver such outreach. METHODS:BeneFIT is a hybrid implementation-effectiveness study of 2 program models that health plans developed for a mailed fecal immunochemical test (FIT) intervention. The programs differed with regard to whether they used a centralized approach (Health Plan Washington) or collaborated with health centers (Health Plan Oregon). The primary implementation outcome of the current study was the percentage of eligible enrollees to whom the plans delivered each intervention component. The primary effectiveness outcome was the rate of FIT completion within 6 months of mailing of the introductory letter. RESULTS:The health plans identified 12,000 eligible enrollees (8551 in Health Plan Washington and 3449 in Health Plan Oregon). Health Plan Washington mailed an introductory letter and FIT kit to 8551 enrollees (100%) and delivered a reminder call to 839 (10.3% of the 8132 attempted). Health Plan Oregon mailed an introductory letter, and a letter and FIT kit plus a reminder postcard to 2812 enrollees (81.5%) and 2650 enrollees (76.8%), respectively. FIT completion rates were 18.2% (1557 of 8551 enrollees) in Health Plan Washington. In Health Plan Oregon, completion rates were 17.4% (488 of 2812 enrollees) among enrollees who were mailed an introductory letter and 18.3% (484 of 2650 enrollees) among enrollees who also were mailed a FIT kit plus reminder postcard. CONCLUSIONS:The implementation of mailed FIT outreach by health plans may be effective and could reach many individuals at risk of developing colorectal cancer.
Unmet needs of patients with cancer in their last year of life as described by caregivers in a developing world setting: a qualitative study.
Cox-Seignoret Karen,Maharaj Rohan G
BMC palliative care
BACKGROUND:Palliative care is in its infancy in most of the developing world. We set out to explore the lived experiences of families and caregivers of recently deceased cancer patients in Trinidad and Tobago and to determine the unmet needs of the patients and what recommendations could be derived to improve the current services. METHODS:A phenomenological approach with purposeful sampling was used. Participants were referred by key health professionals. Face-to-face interviews were conducted. Interviews were transcribed verbatim, with analysis and data collection occurring concurrently. Thematic content analysis was used to determine common domains, themes and sub-themes. RESULTS:Interviews were completed with 15 caregivers. All were spouses or children of the deceased. Ages of the deceased ranged from 43 to 93, the average being 65.5 years. The deceased experienced a variety of cancers including lung, colorectal and oesophageal. Unmet needs were identified under 4 domains of institutions, community, the family unit and the wider society. Institutional unmet needs were delayed diagnosis and treatment and poor inter-institution coordination. Medical and nursing care failed in the areas of health care providers' attitudes, pain management and communication. The family unit lacked physical and psychosocial support for the caregiver and financial aid for the family unit. Societal needs were for public education to address myths and cultural beliefs around cancer. CONCLUSION:There is need for systemic interventions to improve the care of those dying from cancer in Trinidad and Tobago. Stakeholders need to commit to palliative care as a public health priority, implementing education, planning services and mobilizing community resources.
Factors affecting encouragement of relatives among families with Lynch syndrome to seek medical assessment.
Ishii Noriko,Arai Masami,Koyama Yurie,Ueno Masashi,Yamaguchi Toshiharu,Kazuma Keiko,Muto Tetsuichiro
Lynch syndrome (HNPCC) is an autosomal dominant hereditary cancer syndrome, and members of affected families are at-risk for developing colorectal and other associated tumors. Such individuals should disseminate familial genetic information, so they can seek specific medical assessment or genetic testing to reduce mortality and morbidity rates by early detection. Since published results have been encouraging, we explored which factors influence the likelihood of good communication within families regarding medical assessment. We studied 40 individuals from 33 families who satisfied the Japanese clinical criteria for Lynch syndrome and their relatives at our hospital. We determined the status of relatives of the 40 individuals after genetic counseling and testing using questionnaires and semi-structured interviews based on pedigree charts. We also examined their knowledge or perception of colorectal cancer syndrome, levels of intimacy and whether or not they encouraged their relatives to have specific medical assessments. We found that 75% of the individuals advised their relatives to seek medical assessment, and any significant background factors that promoted such encouragement were observed. They tended to encourage first degree relatives and discuss the issue with other family members such as spouses before undertaking such attempts at encouragement. The reasons and methods of imparting encouragement were essentially identical. We also found that genetic testing for at-risk or more distant relatives was not encouraged so often. Therefore, providing individuals who have been tested for Lynch syndrome with opportunities for disseminating familial genetic information through appropriate genetic counseling is important.
Difference of Opinion: Spousal Influence on Cancer Risk-reducing Behavior.
Birmingham Wendy C,Reblin Maija,Kohlmann Wendy,Graff Tyler C
American journal of health behavior
Marriage is consistently associated with better health outcomes. Spouses' attempts to influence partners' lifestyle and general health behaviors may contribute to this effect, although partners may not be aware of this influence. Spousal worry of a cancer diagnosis for an at-risk partner may factor into attempts to influence. An examination of spousal worry and influence on lifestyle choices, general health behaviors, and cancer screening adherence for partners at higher risk of colorectal cancer may shed light on spousal influence and partners' perceptions of influence. A mixed-method design assessed cancer worry and spousal influence for risk-reducing behavior in first-degree relatives of colorectal cancer patients following personalized genetic counseling. Couples discussed current and future ways to reduce risk. Both the at-risk partner and the spouses had moderately high cancer worries. Spouses reported exerting influence for healthier behavior and cancer screening adherence but at-risk partners did not always recognize it. Qualitative data demonstrated partners' perceptions of spousal influence toward better health decisions, and against better health decisions. Future research should examine how and when spouses choose to exert influence, type of influence, what strategies they use, and to what effect.
Feasibility of family based screening for colorectal neoplasia: experience in one general surgical practice.
Stephenson B M,Murday V A,Finan P J,Quirke P,Dixon M F,Bishop D T
Relatives of patients with colorectal cancer have on average a two to threefold increased risk for developing bowel neoplasia although in some families the risk is much higher. This study examined the compliance for endoscopic screening and faecal occult blood testing among first degree relatives of patients with colorectal cancer to determine the feasibility of offering a screening service in a surgical practice. The endoscopic method (flexible sigmoidoscopy or colonoscopy) offered depended upon the extent of family history. Spouses of patients were offered flexible sigmoidoscopy as a group for comparison. Compliance in first degree relatives was significantly higher than in spouses (69% v 47%, p < 0.01) and among those relatives of patients who had died recently from colorectal cancer but time since diagnosis in the index case had no effect. Adenomas were found in 14 of 92 (15%) relatives and three of 30 (10%) spouses. It is estimated that, under our screening guidelines, every 100 patients with colorectal cancer would generate a list of 35-40 relatives who would be screened once by flexible sigmoidoscopy and perhaps 75, who because of their young age, might be screened twice in their lifetime. Also, from this same 100 patients, about 12-15 relatives would merit entry in a colonoscopic screening programme because of their more extensive family history. These results indicate that endoscopic screening of relatives of patients with colorectal cancer is feasible within a practice.
Colon cancer screening among older women caregivers.
Sarna L,Chang B L
UNLABELLED:Colorectal cancers are common causes of morbidity and mortality among women in the United States. Many of these deaths are unnecessary because of the availability of effective early detection methods. The demands of caregiving may limit older women's participation in screening. The purposes of this exploratory study were to describe the participation in colorectal cancer screening of older women (n = 52; mean age 65 years) who were the primary caregivers for an ill spouse or parent, and to investigate the relationship of the caregiving burden and perceptions of health to participation in recommended colorectal cancer screening tests. RESULTS:Only 36% of the older women (n = 16) had been screened with both fecal occult blood testing (FOBT) and sigmoidoscopy. A number of women had never participated in colorectal cancer screening: 10 (21%) had never undergone FOBT and 22 (47%) had never undergone sigmoidoscopy. Only 20% (n = 9) had received all of the recommended cancer screening tests: mammogram, Papanicalaou smear, FOBT, and sigmoidoscopy. Those who did not participate in cancer screening with sigmoidoscopy had significantly worse health perceptions than those who did participate. Caregiver burden was not significantly associated with differences in cancer screening participation. Only 14 of these older women felt that they would have a good chance of survival if they received a diagnosis of colon cancer. Further research is needed to investigate strategies to increase participation of older women in colon cancer screening.
[Colorectal cancer in spouses of colorectal cancer patients].
Matsumata T,Shikada Y,Hasuda S,Kishihara F,Suehiro T,Funahashi S,Nagamatsu Y,Iso Y,Shima I,Koga C,Osamura S,Ueda M,Furuya K,Sakino I
Fukuoka igaku zasshi = Hukuoka acta medica
Married couples share home environments and life style for years. In the case of colorectal cancer, an association with insulin resistance was reported. We determined the presence of the insulin-resistance syndrome (IRS, 1 or more of the following: body mass index of > 25 kg/m2, diabetes, or hyperlipidemia) in 84 colorectal cancer patients, of whom 61 patients (73%) had IRS. The incidence of the distal colorectal cancer, which has been declining in the United States, was significantly higher in the IRS group than in the non-IRS group (75.4 vs 52.2%, p = 0.0400). Some mechanisms may promote the progression of mucosal lesions to invasive cancers in the distal colorectum. There were no significant differences with respect to the age (64.6 +/- 9.4 vs 64.3 +/- 11.3 yr, p = 0.8298), height (159 +/- 9 vs 157 +/- 8 cm, p = 0.1375), and body mass index (22.2 +/- 3.6 vs 22.4 +/- 2.7 kg/m2, p = 0.6364) between the patients and their spouses. In 84 couples in whom colorectal cancer develops at least in one may then not illustrate the nursery rhyme: "Jack Sprat could eat no fat, His wife could eat no lean...". The spouses had been married for an average of 38 years, and in 30 spouses who had been followed in a colorectal cancer screening, 5 developed colorectal cancer. To diminish the incidence of colorectal cancer in Japan, we might advise screening colonoscopy to the spouses of colorectal cancer patients, or déjà vu all over again?
Behavioral risk factors and use of preventive screening services among spousal caregivers of cancer patients.
Son Ki Young,Park Sang Min,Lee Chi Hoon,Choi Geum Jeong,Lee DaeGeun,Jo SeoungHee,Lee Se Hoon,Cho BeLong
Supportive care in cancer : official journal of the Multinational Association of Supportive Care in Cancer
PURPOSE:Caregiving of cancer patients is burdensome and is likely to affect health behavior and outcome of caregivers. However, there are only a small number of studies on lifestyle behavior and use of preventive services by caregivers of cancer patients, especially in Asian populations. The aim of this study was to compare the status of lifestyle behavior and use of preventive services in spousal caregivers of cancer patients and controls. METHODS:One hundred pairs of cancer patients and their spousal caregivers who visited the Cancer Daycare Center of Seoul National University Hospital were requested to fill out constructed self-administered questionnaires. Four age- and sex-matched controls were selected randomly for each caregiver from the Korea National Health and Nutritional Examination Survey III (KNHANES III) (n = 400) in order to compare adherence to recommended health behavior and use of preventive services. RESULTS:Compared to controls, caregivers were more likely to receive all types of cancer screening: gastric (adjusted proportion, 53.8% vs 37.1%, p = 0.011), colorectal (adjusted proportion, 54.3% vs 20.5%, p = 0.002), cervical (adjusted proportion, 66.4% vs 46.5%, p = 0.006), and breast cancer (adjusted proportion, 62.9% vs 40.6%, p = 0.003). However, no differences were observed for health risk behaviors (current smoking, high-risk drinking, and physical inactivity) and screening for chronic diseases (hypertension, diabetes mellitus, and hypercholesterolemia). CONCLUSION:Although spousal caregivers of cancer patients were more likely to use cancer screening services, their health behavior with regard to other aspects were not different from controls. There is a need to improve other types of health behaviors, especially lifestyle behavior, and balance these with cancer screenings in caregivers.
Differences between husbands and wives in colonoscopy use: Results from a national sample of married couples.
Kotwal Ashwin A,Lauderdale Diane S,Waite Linda J,Dale William
Marriage is linked to improved colorectal cancer-related health, likely in part through preventive health behaviors, but it is unclear what role spouses play in colorectal cancer screening. We therefore determine whether self-reported colonoscopy rates are correlated within married couples and the characteristics of spouses associated with colonoscopy use in each partner. We use US nationally-representative 2010 data which includes 804 male-female married couples drawn from a total sample of 3137 community-dwelling adults aged 55-90years old. Using a logistic regression model in the full sample (N=3137), we first find married men have higher adjusted colonoscopy rates than unmarried men (61% versus 52%, p=0.023), but women's rates do not differ by marital status. In the couples' sample (N=804 couples), we use a bivariate probit regression model to estimate multiple regression equations for the two spouses simultaneously as a function of individual and spousal covariates, as well as the adjusted correlation within couples. We find that individuals are nearly twice as likely to receive a colonoscopy if their spouse recently has had one (OR=1.94, 95% CI: 1.39, 2.67, p<0.001). Additionally, we find that husbands have higher adjusted colonoscopy rates whose wives are: 1) happier with the marital relationship (65% vs 51%, p=0.020); 2) more highly educated (72% vs 51%, p=0.020), and 3) viewed as more supportive (65% vs 52%, p=0.020). Recognizing the role of marital status, relationship quality, and spousal characteristics on colonoscopy uptake, particularly in men, could help physicians increase guideline adherence.
Mutual Support and Challenges Among Chinese Couples Living With Colorectal Cancer: A Qualitative Study.
Li Qiuping,Lin Yi,Chen Ying,Loke Alice Yuen
BACKGROUND:A diagnosis of cancer and its treatment affect couples as a unit, and they must cope and give each other mutual support as dyads. Few studies have focused explicitly on understanding mutual support among couples coping with colorectal cancer (CRC). OBJECTIVE:The aim of this study was to explore the mutual support of couples in their journey of coping together with CRC. METHODS:This is a qualitative descriptive study with purposeful sampling. A total of 11 couples in which 1 partner has been diagnosed with CRC were recruited for in-depth interviews. RESULTS:Three themes and 8 subthemes emerged from a conventional content analysis. The 3 themes were mutual support and reciprocity, challenges confronted in the provision of support, and experiencing adjustments/outcomes. CONCLUSION:The findings of this study provide insights to healthcare professionals on the process by which couples coping with CRC give each other mutual support and the related challenges. This will aid in the development of an intervention program to support such couples, through enhancing their mutual support, overcoming challenges, and improving their adjustment/outcomes. IMPLICATIONS FOR PRACTICE:Healthcare professionals need to (1) include the spouse of the cancer patients in their care and provide them with support, (2) encourage the couples to share their concerns with each other, (3) encourage spousal caregivers to take good care of themselves while providing support to their loved ones with CRC, and (4) develop a couple-based intervention program in providing support to couples coping with cancer as dyads.
A pilot evaluation of the efficacy of a couple-tailored print intervention on colorectal cancer screening practices among non-adherent couples.
Manne Sharon L,Kashy Deborah A,Weinberg David S,Boscarino Joseph A,Bowen Deborah J,Worhach Sara
Psychology & health
The objective of this study was to evaluate the efficacy of a couple-tailored print (CTP) intervention on colorectal cancer screening (CRCS), CRCS intentions, and on knowledge and attitudes among couples in which neither partner is on schedule with regard to CRCS. A total of 168 married couples with both members non-adherent with CRCS were randomly assigned to receive either a CTP pamphlet accompanied by a generic print (GP) pamphlet or a GP pamphlet only. Couples completed measures of CRCS, intentions, relational perspective on CRCS, discussions about CRCS, spouse support for CRCS, spouse influence strategies, CRC knowledge, perceived CRC risk, and CRCS benefits and barriers. Results indicated there was no significant benefit of CTP vs. GP on CRCS, but there was a significant increase in CRCS intentions in CTP compared with GP. There was also a significant increase in relationship perspective on CRCS, a significant increase in husbands' support of their wives' CRCS, and a significant increase in CRCS benefits in CTP. In summary, CTP did not increase CRCS practices but increased intentions and perceived benefits of CRCS as well as improving couples' ability to view CRCS as having benefit for the marital relationship.
Using the interdependence model to understand spousal influence on colorectal cancer screening intentions: a structural equation model.
Manne Sharon,Kashy Deborah,Weinberg David S,Boscarino Joseph A,Bowen Deborah J
Annals of behavioral medicine : a publication of the Society of Behavioral Medicine
BACKGROUND:Although it is widely thought that the marital relationship plays a role in individuals' decisions to have colorectal cancer screening, few studies have evaluated partner influences. PURPOSE:We evaluated the role of marital relationship factors such as a relational perspective on the frequency of spouse discussions about screening and screening intentions. Individual-level factors were also evaluated. METHODS:One hundred sixty-eight couples with both members non-adherent with screening completed measures of perceived risk, screening benefits and barriers, marital quality, relational perspective, discussion frequency, and screening intentions. RESULTS:Couples' attitudes about screening were interdependent and one partner's attitudes and behavior were associated with the other partner's intention. There was also evidence of joint effects in that intentions were associated with both one's partner's attitudes and one's own attitudes. CONCLUSIONS:Colorectal screening intentions are associated with both partners' attitudes as well as whether or not couples have discussed screening with one another.
A Mobile App to Increase Informed Decisions About Colorectal Cancer Screening Among African American and Caucasian Women: A Pilot Study.
Brittain Kelly,Kamp Kendra,Cassandras Christos,Salaysay Zachary,Gómez-Márquez José
Gastroenterology nursing : the official journal of the Society of Gastroenterology Nurses and Associates
At this time, there are no interactive mobile apps designed to increase informed decisions about colorectal cancer screening among women. Colorectal cancer is the third leading cause of cancer death among women. The study's purpose was to explore the usability, acceptability, and satisfaction with a mobile app designed to increase colorectal cancer screening informed decisions among 50- to 64-year-old women. Using previous research, an interactive mobile app to increase informed decisions about colorectal cancer screening was developed and pilot tested among African American and Caucasian women (N = 41). In total, 80.6% of women strongly agree/agreed that the mobile app made them think about colorectal cancer screening, 83.8% strongly agree/agreed that the mobile app provided enough information to make a decision about colorectal cancer screening, and 86.1% strongly agree/agreed that the mobile app could help them talk to their provider about colorectal cancer screening. Participants (63.2%) identified family/spouse as who they would talk to about their colorectal cancer screening decision. Participants found the mobile app easy to use and useful in making colorectal cancer screening decisions. Social support is important when making decisions about colorectal cancer screening. Healthcare professionals need new strategies, such as mobile apps, that engage patients, have the potential to increase patient-provider communication, and increase colorectal cancer screening adherence.
A qualitative analysis of couples' communication regarding colorectal cancer screening using the Interdependence Model.
Manne Sharon,Etz Rebecca S,Hudson Shawna V,Medina-Forrester Amanda,Boscarino Joseph A,Bowen Deborah J,Weinberg David S
Patient education and counseling
OBJECTIVE:Colorectal cancer screening (CRCS) uptake in the US remains low. The purpose of this study was to use qualitative methods to characterize partner support and influence regarding CRCS decisions among couples who were both either adherent or non-adherent with CRCS. METHODS:Eighteen couples were interviewed regarding their discussions about CRCS and support and influence strategies used. Analyses were guided by the Interdependence Model. RESULTS:Direct and indirect partner effects were found. Direct partner effects were evidenced when the impact of one spouse on the CRCS decision of the other was clearly defined and intended. Three direct partner effect themes were leadership, persuasion, and partnership. Indirect partner effects were evidenced by one spouse considering the information, experience, or actions of the other in ways that informed CRCS decision-making, even if that influence was not intentional or specifically directed at CRCS. Three indirect partner effect themes were companionship, support, and peer socialization. CONCLUSION:Spouse influence plays a role in CRCS decisions. Individuals view CRCS as being important to the health and quality of their relationship. PRACTICE IMPLICATIONS:With this increased understanding of the interpersonal context of CRCS, it may be possible to include close others in interventions to improve CRCS.
Minimal social network effects evident in cancer screening behavior.
Keating Nancy L,O'Malley A James,Murabito Joanne M,Smith Kirsten P,Christakis Nicholas A
BACKGROUND:Social networks may influence screening behaviors. We assessed whether screening for breast, prostate, or colorectal cancer is influenced by the actual screening behaviors of siblings, friends, spouses, and coworkers. METHODS:We conducted an observational study using Framingham Heart Study data to assess screening for eligible individuals during the late 1990s. We used logistic regression to determine whether the probability of screening for breast, prostate, or colorectal cancer was influenced by the proportion of siblings, friends, and coworkers who had the same screening, as well as spouse's screening for colorectal cancer, adjusting for other factors that might influence screening rates. RESULTS:Among 1660 women aged 41-70 years, 71.7% reported mammography in the previous year; among 1217 men aged 51-70 years, 43.3% reported prostate-specific antigen testing in the previous year; and among 1426 men and women aged 51-80 years, 46.9% reported stool blood testing and/or sigmoidoscopy in the previous year. An increasing proportion of sisters who had mammography in the previous year was associated with mammography screening in the ego (odds ratio [OR], 1.034; 95% confidence interval [CI], 1.000-1.065 for each 10% increase). A spouse with recent screening was associated with more colorectal cancer screening (OR, 1.65; 95% CI, 1.39-1.98 vs unmarried). Otherwise, screening behaviors of siblings, friends, and coworkers were not associated with screening in the ego. CONCLUSIONS:Aside from a slight increase in breast cancer screening among women whose sisters were screened and colorectal cancer screening if spouses were screened, the screening behavior of siblings, friends, or coworkers did not influence cancer screening behaviors.
Screening in spouses of colorectal cancer patients: a missed opportunity.
Tan Ker-Kan,Lim Tian-Zhi,Chew Emily,Chow Wen-Min,Luo Nan,Wong Mee-Lian,Koh Gerald Choon-Huat
International journal of colorectal disease
BACKGROUND:Spouses of colorectal cancer (CRC) patients could be at increased risk of developing CRC due to shared lifestyle habits with the patients which is a notable risk factor. This study explores the various issues surrounding CRC screening among these spouses. METHODS:A mixed method study comprising in-depth qualitative semi-structured interviews followed by structured quantitative questionnaire was administered to spouses who accompanied CRC patients during their appointments, from January 2016 to February 2017. RESULTS:Fifty spouses of CRC patients, median age of 60 (range, 41-82) years, were qualitatively interviewed but 5 of them did not complete the questionnaire. Only 26 (57.8%) of them were current with CRC screening. Data saturation was reached at the 48th participant. Four main themes emerged from the qualitative interviews. These included (i) adequacy of knowledge and attitudes about CRC screening, (ii) suboptimal public health promotion efforts of CRC screening, (iii) barriers of CRC screening, and (iv) need for mutual spousal support. From the questionnaires, spouses who were not current with CRC screening were more likely to report more barriers and have different cues to actions than those who are current. The majority of the spouses demonstrated high levels of knowledge on CRC, understood its severity and their susceptibility. CONCLUSION:Spouses exhibit high levels of knowledge and awareness of the implications of CRC. Apart from addressing psychological issues during the acute phases, targeted interventions should be considered to improve their screening rates and to use them as advocates for CRC screening among family and community.
[Using the FOCUS Family Intervention in Caring for a Patient-Spouse Dyad With Advanced Colorectal Cancer].
Kuo Hsuan-Ju,Jhang Sin-Yuan,Shun Shiow-Ching
Hu li za zhi The journal of nursing
The care-related burdens of the spouses of advanced cancer patients often impact negatively on their physical health, emotional well-being, social functioning, and quality of life. Thus, dyad interventions have been created to meet the demands of advanced cancer patients and their spouses. However, the application of dyadic care in clinical settings is currently rather limited in Taiwan. The present case study involved a patient with advanced colorectal cancer and malignant bowel obstruction whose disease-related demands had eroded the patient's physical, psychological, and spiritual health. The patient's condition placed overwhelming stress on the spouse, jeopardizing the relationship of the dyad. This article elaborates the implementation of the FOCUS program with the goal of helping the dyad achieve better disease adjustment through family involvement, optimistic attitude, effective coping, better symptom management, and uncertainty reduction. Through this delineated experience, the authors hope to help healthcare providers achieve a higher quality of care while caring for patient-family dyads with colorectal cancer.
Support and negation of colorectal cancer risk prevention behaviors: analysis of spousal discussions.
Reblin Maija,Birmingham Wendy C,Kohlmann Wendy,Graff Tyler
Psychology, health & medicine
The shared social context created in a marriage may be important in motivating engagement in health behaviors, but spousal influence may not be uniformly applied. Our goal was to examine how spouses discuss health behaviors relevant for colorectal cancer (CRC) risk-reduction to better understand how spouses exert or fail to exert influence. In this pilot study, first degree relatives of CRC patients and their spouses completed demographic and self-reported health questionnaires. After a genetic counseling session regarding risk and risk reduction, couples engaged in a semi-structured discussion task to discuss lifestyle choices they currently undertake or could undertake to reduce risk. Demographic and health data was analyzed using descriptive statistics. Using a directed content analysis based on the transtheoretical model of behavior change, we coded discussion transcripts for depth and direction of talk for seven behavioral CRC risk factors. Spouses engaged in several strategies to reduce their risk for CRC, and problem-solved together to increase these preventative efforts. All couples mentioned diet and exercise as important factors in CRC risk; however, other risk factors received less attention. Despite evidence of support and encouragement, spouses ignored, minimized, or negated the importance of some health behaviors. Spousal influence could be an important tool to improve participation in health behaviors, but more guidance may be necessary to hold couples accountable to evidence-based guidelines to reduce risk. Health care providers should address couples as a unit to assess and address health behaviors.
An examination of the psychosocial factors influencing colorectal cancer patients' communication of colorectal cancer patient risk with their siblings.
Lawsin Catalina,Duhamel Katherine,Itzkowitz Steven,Brown Karen,Lim Helen,Jandorf Lina
Cancer epidemiology, biomarkers & prevention : a publication of the American Association for Cancer Research, cosponsored by the American Society of Preventive Oncology
This study examined psychosocial factors influencing colorectal cancer (CRC) patients' communication with their first-degree relatives regarding their CRC risk. Among a sample of CRC patients who were members of a colon registry in New York (n = 127), 60% reported discussing CRC risk with their siblings. These discussions were related to the CRC patients' age of diagnosis, such that those diagnosed before age 45 years were more likely to communicate with their siblings about CRC risk. Despite advances made in CRC prevention, compliance with screening recommendations among individuals who may be at familial risk for the disease is low. Perhaps this underrepresentation reflects how CRC patients communicate with their first-degree relatives about their potential risk for the disease. This study examined the psychosocial factors influencing whether CRC patients communicate with their siblings about CRC risk. The sample included CRC patients with siblings who enrolled in a colon disease registry at a NYC metropolitan hospital. Participants completed questionnaires regarding their current psychosocial functioning, perceived risk of sibling's development of CRC, and communication of CRC risk with their siblings. Patients were predominantly Caucasian, with a mean age of 60.4 years. Of the 127 patients, 60% engaged in discussions with their siblings regarding their CRC risk. Patients diagnosed with CRC before the age of 45 years were more likely to discuss the risk of CRC with their siblings (P < 0.01). These data suggest that CRC patients may serve as an effective vehicle to promote CRC screening and support the need for health care providers to not only educate patients of the familial risk of CRC, but to also encourage these patients to communicate this information with their siblings.
A Process Evaluation of the Alaska Native Colorectal Cancer Family Outreach Program.
Redwood Diana,Provost Ellen,Lopez Ellen D S,Skewes Monica,Johnson Rhonda,Christensen Claudia,Sacco Frank,Haverkamp Donald
Health education & behavior : the official publication of the Society for Public Health Education
This article presents the results of a process evaluation of the Alaska Native (AN) Colorectal Cancer (CRC) Family Outreach Program, which encourages CRC screening among AN first-degree relatives (i.e., parents, siblings, adult children; hereafter referred to as relatives) of CRC patients. Among AN people incidence and death rates from CRC are the highest of any ethnic/racial group in the United States. Relatives of CRC patients are at increased risk; however, CRC can be prevented and detected early through screening. The evaluation included key informant interviews (August to November 2012) with AN and non-AN stakeholders and program document review. Five key process evaluation components were identified: program formation, evolution, outreach responses, strengths, and barriers and challenges. Key themes included an incremental approach that led to a fully formed program and the need for dedicated, culturally competent patient navigation. Challenges included differing relatives' responses to screening outreach, health system data access and coordination, and the program impact of reliance on grant funding. This program evaluation indicated a need for more research into motivating patient screening behaviors, electronic medical records systems quality improvement projects, improved data-sharing protocols, and program sustainability planning to continue the dedicated efforts to promote screening in this increased risk population.
Persisting Racial Disparities in Colonoscopy Screening of Persons with a Family History of Colorectal Cancer.
Tsai Meng-Han,Xirasagar Sudha,de Groen Piet C
Journal of racial and ethnic health disparities
With 23 and 47% higher colorectal cancer (CRC) incidence and mortality, respectively, among African Americans vs. Whites, CRC screening studies are important. Screening guidelines recommend 5-yearly colonoscopy screening of persons with a family history of CRC (first-degree relatives, FDRs), beginning at 40 years of age. For this elevated-risk group, colonoscopy screening is preferred because of the risk of more aggressive cancer that may elude early detection by other methods. African Americans with a family history of CRC are at the intersection of two elevated risk demographics, race and FDR status. This study explored racial disparities in colonoscopy screening of FDRs using 2005, 2010, and 2015 national survey data on 3220 Whites and 466 African Americans.Despite increasing colonoscopy rates among FDRs (72.3 and 62.2% in 2015 among Whites and African Americans, respectively), the 40-49 age group showed substantial racial disparities each year, persisting through 2015 (58.8, 31.7, and 35.3% lower among African Americans in 2005, 2010, and 2015, respectively). Adjusted analysis of the pooled 3-year sample showed that FDRs aged 40-49 years had one-third the colonoscopy likelihood of the 50-plus age group. African Americans without college education were 40 and 60% less likely than Whites without college and with college education, respectively, to have had a colonoscopy. The sustained, high screening disparity, and low colonoscopy rates in the 40-49 age group overall, call for novel approaches to reduce CRC mortality disparities, such as, patient navigation programs to reach out to younger FDRs, particularly, less educated African Americans.
Adherence to colonoscopy recommendations for first-degree relatives of young patients diagnosed with colorectal cancer.
Garcia Guilherme H,Riechelmann Rachel P,Hoff Paulo M
Clinics (Sao Paulo, Brazil)
OBJECTIVES:Colorectal cancer is the third leading cause of cancer death in the United States. The American College of Gastroenterology recommends screening for first-degree relatives of patients diagnosed with colorectal cancer before the age of 50. A colonoscopy is one of the most commonly recommended exams due to its specificity and the possibility to resect pre-malignant lesions. Nevertheless, the rate of physician adherence to this recommendation is unknown. METHODS:This transversal study was performed at a major cancer center in Brazil with 62 patients, aged 18 to 50, who completed a questionnaire on information received from their physicians regarding screening their first-degree relatives. We used the answers from patients who provided explicit consent. RESULTS:Two hundred and three patients were eligible to participate and 93 (45.8%) agreed to complete the questionnaire. Twenty-three questionnaires (24.73%) were returned and 39 were completed by telephone. Of the patients who answered the questionnaire, 39 (62.9%) had received a colonoscopy recommendation for their first-degree relatives and 23 (37.1%) were not informed of the recommendation. Among the patients who received the recommendations, 20.51% affirmed that all relatives completed the exam and 51.28% stated that no relatives completed the exam. DISCUSSION:The adherence rate of our physicians to the ACG guideline recommendations was 62.9%. Considering that our study was performed at a leading center for cancer treatment in Latin America, we had expected better adherence. The results show that adherence to the colorectal cancer screening recommendations for high-risk patients must be improved.
Effectiveness of tailored communication intervention in increasing colonoscopy screening rates amongst first-degree relatives of individuals with colorectal cancer: A systematic review and meta-analysis.
Bai Yang,Wong Cho Lee,He Xiaole,Wang Changyi,So Winnie K W
International journal of nursing studies
OBJECTIVES:Ensuring that the first-degree relatives of patients with colorectal cancer are properly screened is critical to reduce disease incidence and mortality rate. Tailored communication intervention is a promising method to induce health-related behavioural changes. However, evidence of the effects of tailored communication interventions on the screening rate of populations at an increased familial risk of colorectal cancer is lacking. This review aimed to identify, appraise and examine existing evidence of the effectiveness of tailored communication interventions in increasing colonoscopy screening rates amongst the first-degree relatives of people with colorectal cancer. DESIGN:Systematic review and meta-analysis. DATA SOURCES:Twelve electronic English and Chinese databases [Medline, EMBASE, PubMed, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Review, CINAHL, Scopus, Global Health, British Journal Index, China National Knowledge Infrastructure (CNKI), Wan Fang Data and China Biology Medicine (CBM)] were searched to identify eligible clinical trials that were published over period of 1995 to October 2018. REVIEW METHODS:Studies were selected by using key words, such as 'colorectal cancer', 'screening', 'colonoscop*', 'first degree relative*', 'uptake or adhere*' and 'cost'. Two reviewers independently assessed the eligibility of each study and extracted the data. The Cochrane Risk of Bias Tool was applied to evaluate the risk of bias amongst included studies. Meta-analysis was performed when possible. Subgroup analysis was performed for types of communication channels. Sensitivity analysis was conducted to explore the influence of random units on the primary outcome. RESULTS:Four studies that adopted tailored communication interventions to increase colonoscopy screening rates were identified. Pooled analysis showed that tailored communication had a beneficial effect on improving colonoscopy use in the colorectal cancer screening context (OR: 2.21, 95% CI: 1.71-2.85, p < 0.01). Furthermore, subgroup analysis showed that repeated tailored communication delivered via print plus telephone call had a significant effect on increasing colonoscopy screening rates (OR: 2.39, 95% CI: 1.78-3.21, p < 0.01). The results of sensitivity analysis indicated that types of randomisation units did not influence outcomes. CONCLUSION:Tailored communication is a beneficial approach for increasing colonoscopy screening rates amongst first-degree relatives who are at increased familial risk of colorectal cancer. The effective components of tailored communication were repeated contacts, combined verbal and written communication and important tailored variables. Future studies with rigorous designs are recommended to develop an integrated tailoring assessment decision system with the support of Internet-based communication channels.
What is the effectiveness of various invitation methods to a colonoscopy in the early detection and prevention of colorectal cancer? Protocol of a systematic review.
Stark Undine Antonia,Frese Thomas,Unverzagt Susanne,Bauer Alexander
BACKGROUND:Colorectal cancer, a prevalent malignancy worldwide, is associated with numerous modifiable and non-modifiable risk factors that play a role in the early detection and successful treatment of cancer. Despite improvements in the availability and quality of screening methods, especially colonoscopy, and the substantial survival benefits of the early detection of colorectal cancer, patient participation remains low due to clinical reasons and patient barriers. Studies around the world have used various methods of invitation in order to promote patient uptake of colonoscopies. The main objective of this systematic review is to analyze the association between certain invitation procedures, the participation in colonoscopies, and important patient outcomes in the early detection and prevention of colorectal cancer. METHOD:We will systematically search in electronic databases including Medline via PubMed and Ovid, Cumulative Index of Nursing and Allied Health Literature (CINAHL), and the Cochrane Library. All studies will be described in a table of study characteristics with a risk of bias assessment. In addition, two authors will independently rate the overall quality of evidence for the critical outcomes using the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) Working Group approach. Discrepancies regarding the inclusion of studies, data extraction, or risk of bias assessment will be resolved independently by one other reviewer. Due to the heterogeneous design of the studies that will be evaluated in this review, synthesizing data from these studies in the form of a meta-analysis may not be possible. In this instance, we can conduct a descriptive synthesis of data from these studies. DISCUSSION:The results that arise from this systematic review will reflect the influence that various invitation procedures to a colonoscopy have on patient participation in these screenings. Drawing conclusions about the efficiency of various invitation methods to a colonoscopy can provide valuable information to both clinicians and patients and may not only improve future invitation-based patient recruitment to colonoscopy screenings, but also shape guidelines regarding prevention of colorectal cancer. SYSTEMATIC REVIEW REGISTRATION:PROSPERO CRD42019128645.
Randomized controlled trial comparing telephone and mail follow-up for recruitment of participants into a clinical trial of colorectal cancer screening.
Wong Arthur D,Kirby John,Guyatt Gordon H,Moayyedi Paul,Vora Parag,You John J
BACKGROUND:Investigators often face challenges when recruiting participants into randomized controlled trials (RCTs). Some data suggest that telephone reminders may lead to greater participant enrollment. METHODS:Patients aged 50 to 70 years from family practice rosters were initially mailed invitations to participate in an RCT of colorectal cancer screening. Patients who did not respond were randomly allocated to follow-up invitations by either telephone or mail four weeks after the initial invitation. The primary outcome was attendance for eligibility screening with the study nurse. RESULTS:After mailing invitations to 1,348 patients, 104 patients were initially enrolled in the RCT of colon cancer screening. Of 952 patients who did not respond to the initial mailed invitation, we randomly allocated 480 to follow-up invitation by telephone and 472 to follow-up invitation by mail. Attendance for eligibility screening with the study nurse was more frequent when non-responders were followed-up by telephone (84/480, 17.5%) than by mail (43/472, 9.1%) (relative risk (RR) 1.92, 95% confidence interval (CI) 1.36 to 2.71, P < 0.001). Enrollment into the RCT was also greater among patients followed-up by telephone (59/480, 12.3%) compared to those followed-up by mail (35/472, 7.4%) (RR 1.66, 95% CI 1.11 to 2.47, P=0.01). CONCLUSIONS:Telephone-based follow-up results in greater enrollment compared to a mail-based method. Our findings should be of interest to investigators conducting RCTs, particularly trials of screening interventions involving asymptomatic participants for which volunteer participation may be challenging. TRIAL REGISTRATION:Clinicaltrials.gov NCT00865527.
Screening behaviors, health beliefs, and related factors of first-degree relatives of colorectal cancer patients with ongoing treatment in Turkey.
Koc Serife,Esin Melek Nihal
BACKGROUND:Colorectal cancer (CRC) is one of the most common cancers. Family history is an important risk factor; first-degree relatives (FDRs) are most at risk. Studies are needed to determine the screening behavior of FDRs and factors affecting their health behaviors. OBJECTIVE:The purpose of this study was to investigate the screening behaviors, health beliefs, and related factors of FDRs (parent, sibling, or child) of CRC patients undergoing treatment. METHODS:A cross-sectional design was used with 400 FDRs of patients undergoing treatment at 2 hospitals in Turkey. Data were collected using the Colorectal Cancer Risk Questionnaire and the Turkish Colorectal Cancer Health Belief Model Scale. RESULTS:A slight majority of the participants were male (51.3%), with a mean of age 37.7 years. The rate of having at least 1 colonoscopy in FDRs was 22.2%. First-degree relatives reported high perceived confidence-benefits scores on average (mean, 48.4 ± 5.2) and high perceived barrier scores on average (mean, 15.5 ± 3.8). Health motivation of FDRs was the strongest predictor of their having a colonoscopy (odds ratio, 7.50; 95% confidence interval, 3.40-16.5). CONCLUSIONS:First-degree relatives have a low rate of having a colonoscopy but are more likely to have had this procedure if they have strong health motivation. IMPLICATIONS FOR PRACTICE:Nurses working with CRC patients must develop strategies to increase FDRs' knowledge of, awareness of, and motivation for CRC screening tests. Risk counseling of FDRs during the treatment period might increase screening rates.
Factors influencing colorectal cancer screening in rural southern Taiwan.
Lin Yu-Hua,Kao Chia-Chan
BACKGROUND:Colorectal cancer (CRC) is the most common cancer in Taiwan. Colorectal cancer screening can prevent or detect cancer early, but the acceptance rate in rural southern Taiwan is unknown. OBJECTIVE:The purpose of this study was to explore the prevalence of CRC screening and related factors in rural south Taiwan. METHODS:Cross-sectional study was conducted. Sample population was recruited from 2 rural areas in southern Taiwan. A structured questionnaire was completed by 635 participants. The following outcomes were studied: sociodemographic characteristics, knowledge of CRC screening, acceptance of CRC screening, and the reasons for having or not having CRC screening. RESULTS:The results indicated that 4.7% of the respondents had undergone a fecal occult blood test, 3.1% had undergone a sigmoidoscopy, and 2.7% had undergone a colonoscopy. For overall CRC screening, knowledge that CRC was the most common form of cancer was significant (P < .01). Among participants who knew that CRC was the most common form of cancer, the odds of undergoing CRC screening were 4.20-fold greater than among participants who did not know that CRC was the most common form of cancer (P < .01; confidence interval, 1.62-10.89). CONCLUSIONS:This study demonstrates that the acceptance of CRC screening among men remains higher than among women in rural southern Taiwan. Efforts to improve CRC screening in rural areas should focus on increasing community residents' knowledge about cancer incidence and prevention. IMPLICATIONS FOR PRACTICE:Colorectal cancer screening is a useful cancer prevention measure, and community health center nurses should assess and promote rural residents' acceptance for CRC screening.
Tailored telephone counseling increases colorectal cancer screening.
Rawl Susan M,Christy Shannon M,Monahan Patrick O,Ding Yan,Krier Connie,Champion Victoria L,Rex Douglas
Health education research
To compare the efficacy of two interventions to promote colorectal cancer screening participation and forward stage movement of colorectal cancer screening adoption among first-degree relatives of individuals diagnosed with adenomatous polyps. One hundred fifty-eight first-degree relatives of individuals diagnosed with adenomatous polyps were randomly assigned to receive one of two interventions to promote colorectal cancer screening. Participants received either a tailored telephone counseling plus brochures intervention or a non-tailored print brochures intervention. Data were collected at baseline and 3 months post-baseline. Group differences and the effect of the interventions on adherence and stage movement for colorectal cancer screening were examined using t-tests, chi-square tests, and logistic regression. Individuals in the tailored telephone counseling plus brochures group were significantly more likely to complete colorectal cancer screening and to move forward on stage of change for fecal occult blood test, any colorectal cancer test stage and stage of the risk-appropriate test compared with individuals in the non-tailored brochure group at 3 months post-baseline. A tailored telephone counseling plus brochures intervention successfully promoted forward stage movement and colorectal cancer screening adherence among first-degree relatives of individuals diagnosed with adenomatous polyps.
Evaluation of Interventions Intended to Increase Colorectal Cancer Screening Rates in the United States: A Systematic Review and Meta-analysis.
Dougherty Michael K,Brenner Alison T,Crockett Seth D,Gupta Shivani,Wheeler Stephanie B,Coker-Schwimmer Manny,Cubillos Laura,Malo Teri,Reuland Daniel S
JAMA internal medicine
Importance:Colorectal cancer screening (CRC) is recommended by all major US medical organizations but remains underused. Objective:To identify interventions associated with increasing CRC screening rates and their effect sizes. Data Sources:PubMed, Cumulative Index to Nursing and Allied Health Literature, the Cochrane Library, and ClinicalTrials.gov were searched from January 1, 1996, to August 31, 2017. Key search terms included colorectal cancer and screening. Study Selection:Randomized clinical trials of US-based interventions in clinical settings designed to improve CRC screening test completion in average-risk adults. Data Extraction and Synthesis:At least 2 investigators independently extracted data and appraised each study's risk of bias. Where sufficient data were available, random-effects meta-analysis was used to obtain either a pooled risk ratio (RR) or risk difference (RD) for screening completion for each type of intervention. Main Outcomes and Measures:The main outcome was completion of CRC screening. Examination included interventions to increase completion of (1) initial CRC screening by any recommended modality, (2) colonoscopy after an abnormal initial screening test result, and (3) continued rounds of annual fecal blood tests (FBTs). Results:The main review included 73 randomized clinical trials comprising 366 766 patients at low or medium risk of bias. Interventions that were associated with increased CRC screening completion rates compared with usual care included FBT outreach (RR, 2.26; 95% CI, 1.81-2.81; RD, 22%; 95% CI, 17%-27%), patient navigation (RR, 2.01; 95% CI, 1.64-2.46; RD, 18%; 95% CI, 13%-23%), patient education (RR, 1.20; 95% CI, 1.06-1.36; RD, 4%; 95% CI, 1%-6%), patient reminders (RR, 1.20; 95% CI, 1.02-1.41; RD, 3%; 95% CI, 0%-5%), clinician interventions of academic detailing (RD, 10%; 95% CI, 3%-17%), and clinician reminders (RD, 13%; 95% CI, 8%-19%). Combinations of interventions (clinician interventions or navigation added to FBT outreach) were associated with greater increases than single components (RR, 1.18; 95% CI, 1.09-1.29; RD, 7%; 95% CI, 3%-11%). Repeated mailed FBTs with navigation were associated with increased annual FBT completion (RR, 2.09; 95% CI, 1.91-2.29; RD, 39%; 95% CI, 29%-49%). Patient navigation was not associated with colonoscopy completion after an initial abnormal screening test result (RR, 1.21; 95% CI, 0.92-1.60; RD, 14%; 95% CI, 0%-29%). Conclusions and Relevance:Fecal blood test outreach and patient navigation, particularly in the context of multicomponent interventions, were associated with increased CRC screening rates in US trials. Fecal blood test outreach should be incorporated into population-based screening programs. More research is needed on interventions to increase adherence to continued FBTs, follow-up of abnormal initial screening test results, and cost-effectiveness and other implementation barriers for more intensive interventions, such as navigation.
Access to Health Care, Beliefs, and Behaviors about Colorectal Cancer Screening among Korean Americans
Lee Shin Young,Lee Eunice E
Asian Pacific journal of cancer prevention : APJCP
Background: Colorectal cancer (CRC) is one of the most common cancers among Korean Americans (KAs) andtheir CRC screening rates are low. To raise the rates of CRC screening among KAs, it is necessary to improve ourunderstanding of factors that influence their CRC screening behaviors. This study examined socio-demographics,access to health care, health and cultural beliefs, and behaviors about the fecal occult blood test (FOBT) for CRCscreening among KAs aged 50 and older. Methods: Based on the health belief model, the cultural assessment modelfor health, and the Powe fatalism model, this study measured socio-demographics (age, gender, years in the U.S.,marital status, education, employment, income, and acculturation), health care access (health insurance, having aregular doctor, physician recommendation, and trust in doctor), health beliefs (susceptibility, severity, benefits, barriers,and self-efficacy), and cultural beliefs (physical space, health temporal orientation, personal control, and fatalism)and FOBT. A cross-sectional survey (n=202) was conducted. Data analysis was conducted using descriptive analysis,Pearson correlation, and multivariate logistic regression. Results: This study found that physician recommendationwas the strongest factor in lifetime FOBT utilization in KAs. The results also revealed a positive association amonghealth temporal orientation, health fatalism, and lifetime FOBT among KAs, while previous research found a negativeassociation between fatalism and cancer screening. Years in the U.S., employment, and having a regular doctor weresignificantly associated with having had a FOBT in the previous year. Conclusion: Study results suggested the need forpublic education programs to increase physician recommendation among KAs. Furthermore, the positive relationshipsamong health temporal orientation, health fatalism, and FOBT utilization in KAs suggests that KAs have a desire tomaintain health and find cancer early despite their fatalistic view on health.
Health literacy levels and views about being invited to a colorectal cancer screening program.
Wangmar Johanna,Jervaeus Anna,Fritzell Kaisa,Wångdahl Josefin,Hultcrantz Rolf,Wengström Yvonne
Acta oncologica (Stockholm, Sweden)
BACKGROUND:Sweden has not yet implemented a national screening program for colorectal cancer, but a nationwide study is ongoing; the Screening of Swedish Colons (SCREESCO). Previous research shows that the use of health care services, together with several health-related outcomes, is associated with an individual's level of health literacy. However, the relation between health literacy and participation in colorectal cancer screening has produced varying results reported within the few studies addressing this issue and therefore, further research is warranted. MATERIAL AND METHODS:The aim was to explore health literacy and views about being invited to screening, among participants and non-participants in a national colorectal cancer screening program. They were randomly sampled to fecal immunochemical test or colonoscopy and a mixed methods approach was applied, using questionnaires, focus group discussions and interviews. RESULTS:The majority of individuals, whether they were participants or non-participants in the SCREESCO program, had an acceptable level of health literacy and no significant differences in health literacy levels between the groups were found. Participants expressed that it was important and appreciated to be able to choose information sources on an individual basis. Among non-participants, the importance of receiving invitations with a clear message that quickly draws one's attention was highlighted. However, both groups expressed a positive outlook towards the invitation. The mixed methods approach revealed that findings from interviews and focus group discussions corresponded to items in the health literacy scales. CONCLUSION:A majority of individuals displayed acceptable levels of health literacy, regardless of whether they chose to participate or not. Similarities between the groups were seen in the qualitative findings regarding views of the invitation. Currently, the SCREESCO invitation letter is distributed by regular mail, but in the future a more dynamic approach could be valuable to increase clarity in the message about importance of screening.
Effects of Promotional Materials on Attitudes and Fear towards Colorectal Cancer Screening among Chinese Older Adults: An Experimental Study.
Leung Doris Y P,Chen Joanne M T,Lou Vivian W Q,Wong Eliza M L,Chan Aileen W K,So Winnie K W,Chan Carmen W H
International journal of environmental research and public health
Colorectal cancer (CRC) screening is a cost-effective prevention and control strategy. However, the promotion of CRC screening for older adults may be difficult because reading CRC prevention information may evoke embarrassment, fear, and anxiety towards the screening procedure and cancer diagnosis. This study aims to (1) examine the effects of three promotional materials for CRC screening on the attitudes toward CRC screening tests (screening interest, screening effectiveness, and trust in the screening results) and cancer fear, and (2) to explore the interaction effect of cancer fear with screening effectiveness and trust in the screening results on screening interest of the three screening tests (fecal occult blood test (FOBT), flexible sigmoidoscopy, and colonoscopy) among Chinese older adults. A total of 114 community-dwelling older adults were asked to look at the corresponding promotional materials (pamphlet, cartoon, and video) of one of the three study groups. The pamphlet and video represent convention strategies and the cartoon represents an innovative strategy. No significant difference was observed in the screening interest and cancer fear across groups. FOBT was the most preferred screening modality. The video group has a large proportion agreed screening effectiveness of flexible sigmoidoscopy than pamphlet and cartoon groups and trusted in the screening results for FOBT and flexible sigmoidoscopy than the pamphlet group. Logistic regression results showed that the effect of trust in the screening results on screening interest for colonoscopy was greater among participants with higher cancer fear than those with lower cancer fear level. In conclusion, the three promotional groups had produced similar results in their attitudes toward CRC screening and cancer fear. The use of cartoons may be a comparable approach with conventional methods in the promotion of CRC screening. Additional components that can arouse fear and boost response efficacy simultaneously might also be useful for the effective promotion of colonoscopy among Chinese older adults.
Use of Evidence-Based Interventions and Implementation Strategies to Increase Colorectal Cancer Screening in Federally Qualified Health Centers.
Adams Swann Arp,Rohweder Catherine L,Leeman Jennifer,Friedman Daniela B,Gizlice Ziya,Vanderpool Robin C,Askelson Natoshia,Best Alicia,Flocke Susan A,Glanz Karen,Ko Linda K,Kegler Michelle
Journal of community health
While colorectal cancer (CRC) screening rates have been increasing in the general population, rates are considerably lower in Federally Qualified Health Centers (FQHCs), which serve a large proportion of uninsured and medically vulnerable patients. Efforts to screen eligible patients must be accelerated if we are to reach the national screening goal of 80% by 2018 and beyond. To inform this work, we conducted a survey of key informants at FQHCs in eight states to determine which evidence-based interventions (EBIs) to promote CRC screening are currently being used, and which implementation strategies are being employed to ensure that the interventions are executed as intended. One hundred and forty-eight FQHCs were invited to participate in the study, and 56 completed surveys were received for a response rate of 38%. Results demonstrated that provider reminder and recall systems were the most commonly used EBIs (44.6%) while the most commonly used implementation strategy was the identification of barriers (84.0%). The mean number of EBIs that were fully implemented at the centers was 2.4 (range 0-7) out of seven. Almost one-quarter of respondents indicated that their FQHCs were not using any EBIs to increase CRC screening. Full implementation of EBIs was correlated with higher CRC screening rates. These findings identify gaps as well as the preferences and needs of FQHCs in selecting and implementing EBIs for CRC screening.
The Effect of a Health Education Intervention on Jordanian Participants' Colorectal Cancer Knowledge, Health Perceptions, and Screening Practices.
Abuadas Fuad H,Petro-Nustas Wasileh J,Abuadas Mohammad H
BACKGROUND:Globally, colorectal cancer (CRC) is the second and third most commonly diagnosed cancer in women and men, respectively. OBJECTIVES:The aim of this study is to test the effectiveness of a health education intervention on the current level of Jordanians' CRC knowledge, health perceptions, and screening practices. METHODS:A convenience sampling method was used to recruit a sample of 197 average-risk Jordanian adults aged 50 to 75 years. The sample was collected from outpatient departments of Jordan University and Al-Basheer Hospitals in Amman. This study used quasi-experimental design, and a rolling enrollment method was implemented to randomly assign the participants into intervention and control groups. RESULTS:Baseline results indicated that Jordanian average-risk participants were not well informed about CRC and screening recommendations. One-fourth perceived themselves to be susceptible to CRC. About one-third comprehended the seriousness of CRC, most recognized the benefits of CRC screening, and fewer than half believed there were barriers preventing them from participating in CRC screening. Four weeks after intervention implementation, there was a significantly higher level of knowledge, as well as increased susceptibility and severity perceptions, screening via fecal occult blood test, and intentions to undergo screening via colonoscopy or sigmoidoscopy. CONCLUSION:The findings support the implementation of a health education intervention as an effective way to enhance levels of knowledge and promote positive health perceptions regarding CRC and screening recommendations. IMPLICATIONS FOR PRACTICE:This study may provide Jordanian and other nurses with a theory-based educational intervention to improve the quality of nursing care and reduce costs.
Follow-up approaches to a health literacy intervention to increase colorectal cancer screening in rural community clinics: A randomized controlled trial.
Arnold Connie L,Rademaker Alfred W,Morris James D,Ferguson Laurie Anne,Wiltz Gary,Davis Terry C
BACKGROUND:Significant disparities exist in colorectal cancer (CRC) screening rates among those of low socioeconomic status, with fewer years of education, lacking health insurance, or living in rural areas. METHODS:A randomized controlled trial was conducted to compare the effectiveness of 2 follow-up approaches to a health literacy intervention to improve CRC screening: automated telephone call or personal call. Patients aged 50 to 75 years residing in 4 rural community clinics in Louisiana were given a structured interview that assessed demographic, health literacy and CRC screening barriers, knowledge, and attitudes. All were given health literacy-informed CRC education, a patient-friendly CRC screening pamphlet, simplified fecal immunochemical test (FIT) instructions, and a FIT kit, and a "teach-back" method was used to confirm understanding. Patients were randomized to 1 of 2 telephone follow-up arms. If they did not mail their FIT kit within 4 weeks, they received a reminder call and were called again at 8 weeks if the test still was not received. RESULTS:A total of 620 patients were enrolled. Approximately 55% were female, 66% were African American, and 40% had limited literacy. The overall FIT completion rate was 68%: 69.2% in the automated telephone call arm and 67% in the personal call arm. Greater than one-half of the patients (range, 58%-60%) returned the FIT kit without receiving a telephone call. There was no difference noted with regard to the effectiveness of the follow-up calls; each increased the return rate by 9%. CONCLUSIONS:Providing FIT kits and literacy-appropriate education at regularly scheduled clinic visits with a follow-up telephone call when needed was found to increase CRC screening among low-income, rural patients. The lower cost automated call was just as effective as the personal call.
The effect of knowledge and health beliefs about colorectal cancer on screening behaviour.
Taş Ferdane,Kocaöz Semra,Çirpan Rabiye
Journal of clinical nursing
AIMS AND OBJECTIVES:To determine the effect of the knowledge and health beliefs of individuals about colorectal cancer on their screening behaviour. BACKGROUND:Colorectal cancer ranks third among the most common cancers both worldwide and in Turkey. Colorectal cancer plays an important role in cancer mortality but can be prevented by promoting healthy behaviour and participation in early screening programmes. DESIGN:This descriptive study was completed with 114 women and 121 men. METHODS:The study data were collected using the 'Data collection form' and 'Health Belief Model Scale for Protection from Colorectal Cancer'. Potential risk factors were investigated using logistic regression analyses. The AGREE checklist was completed. RESULTS:The colorectal cancer screening tests were known by 23.0% of the subjects and 17% had undergone one of these tests. The score medians obtained from the confidence-benefit subscale of Health Belief Model Scale for Protection from Colorectal Cancer were found to be significantly higher in those who had undergone colorectal cancer screening. Logistic regression analysis revealed that having knowledge of the relevant tests was associated with undergoing colorectal cancer screening. CONCLUSIONS:Having knowledge on colorectal cancer screening tests increases the relevant confidence-benefit perception regarding the tests and the behaviour of participating in screening programmes. Regular training on colorectal cancer and early diagnosis should therefore be provided by healthcare professionals to both women and men aged 50-70 years to increase the rate of undergoing early screening tests. RELEVANCE TO CLINICAL PRACTICE:Increasing the rate of early screening is among the responsibilities of health workers working in primary health centres. Therefore, problems that prevent individuals from participating in these programmes need to be identified. In this way, health workers will develop suggestions and initiatives that change the individual's health beliefs and increase motivation.
Contributing Factors to Colorectal Cancer Screening among Chinese People: A Review of Quantitative Studies.
Leung Doris Y P,Chow Ka Ming,Lo Sally W S,So Winnie K W,Chan Carmen W H
International journal of environmental research and public health
Colorectal cancer (CRC) is a major health problem in Asia. It has been reported that the Chinese are more susceptible to CRC than many other ethnic groups. Screening for CRC is a cost-effective prevention and control strategy; however, the screening rates among the Chinese are sub-optimal. We conducted a review to identify the factors associated with CRC screening participation among Chinese people. Twenty-two studies that examined the factors related to CRC screening behaviors among the Chinese were identified through five databases. Seven factors were consistently reported to influence CRC screening behaviors in at least one of the studies: socio-demographic characteristics (educational level, health insurance, and knowledge about CRC and its screening); psychological factors (perceived severity of CRC, susceptibility of having CRC, and barriers to screening); and contact with medical provider (physician recommendation). The evidence base for many of these relationships is quite limited. Furthermore, the associations of many factors, including age, gender, income, cancer worry/fear, and self-efficacy with CRC screening behaviors, were mixed or inconsistent across these studies, thereby indicating that more studies are needed in this area.
Effects of a health education and telephone counseling program on patients with a positive fecal occult blood test result for colorectal cancer screening: A randomized controlled trial.
Chiu Hui-Chuan,Hung Hsin-Yuan,Lin Hsiu-Chen,Chen Shu-Ching
OBJECTIVE:Our purpose was to evaluate the effects of a health education and telephone counseling program on knowledge and attitudes about colorectal cancer and screening and the psychological impact of positive screening results. METHODS:A randomized controlled trial was conducted with 2 groups using a pretest and posttest measures design. Patients with positive colorectal cancer screening results were selected and randomly assigned to an experimental (n = 51) or control (n = 51) group. Subjects in the experimental group received a health education and telephone counseling program, while the control group received routine care only. Patients were assessed pretest before intervention (first visit to the outpatient) and posttest at 4 weeks after intervention (4 weeks after first visit to the outpatient). RESULTS:Patients in the experimental group had a significantly better level of knowledge about colorectal cancer and the psychological impact of a positive screening result than did the control group. Analysis of covariance revealed that the health education and telephone counseling program had a significant main effect on colorectal cancer knowledge. CONCLUSIONS:A health education and telephone counseling program can improve knowledge about colorectal cancer and about the psychological impact in patients with positive colorectal cancer screening results. The health education and telephone counseling program is an easy, simple, and convenient method of improving knowledge, improving attitudes, and alleviating psychological distress in patients with positive colorectal cancer screening results, and this program can be expanded to other types of cancer screening.