scholarly journals Assessing Barriers to and Facilitators of Designing a Feasible Colorectal Cancer Screening Program in Mexico City

2020 ◽  
Vol 6 (Supplement_1) ◽  
pp. 46-46
Author(s):  
Karla Unger-Saldaña ◽  
Minerva Saldaña-Tellez ◽  
Anabelle Bonvecchio ◽  
Michael B. Potter ◽  
Martin Lajous
Keyword(s):  
Public Health ◽  
Colorectal Cancer ◽  
Primary Care ◽  
Health Care ◽  
Mexico City ◽  
Screening Program ◽  
Average Risk ◽  
Culturally Competent ◽  
Educational Materials ◽  
Crc Screening

PURPOSE We undertook a formative qualitative research study to identify optimal participant recruitment, education, and follow-up strategies to facilitate colorectal cancer (CRC) screening in Mexico City. METHODS This study included semistructured individual and focus group interviews with different stakeholders: 36 average-risk laypeople, 16 public health care leaders, 10 primary care personnel, and 4 endoscopy unit personnel. The study protocol was approved by the National Institute of Public Health Institutional Review Board. Written informed consent was obtained from all participants. We analyzed data using the constant comparison method under the theoretical perspectives of the Consolidated Framework for Implementation Research and the Health Belief Model. Tailored CRC screening educational materials—video, postcard, poster, and brochure—were developed on the basis of our findings. Materials were then pretested in 6 additional focus groups and adjusted accordingly. RESULTS We found multiple barriers and facilitators in different dimensions of the CFIR for successful implementation of a FIT-based CRC screening program in this community. The main barriers were the following: inner context related: understaffing and personnel resistance to new programs; individual health care personnel related: CRC misinformation and work overload; outer setting related: underinvestment in primary care and public insecurity; lay individual related: a lack of CRC awareness, low risk perception, and fear of finding out about a serious disease; and intervention related: test costs. Among the principal facilitators were the following: inner setting: a shared perception of a good working environment and strong leadership at the selected clinic; intervention related: FIT test is perceived as easy to do, and potential users liked the idea that the sample can be obtained in the privacy of their homes. Educational materials we tailored on the basis of these findings and were found to be acceptable, understandable, and culturally competent by lay participants. CONCLUSION Our study allowed for the design of a feasible FIT-based CRC screening program and culturally competent materials that will be used to enhance participation.

scholarly journals Factors Influencing Colorectal Cancer Screening Participation

2012 ◽  
Vol 2012 ◽  
pp. 1-8 ◽  
Author(s):  
Antonio Z. Gimeno García
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Health Care System ◽  
Population Based ◽  
Average Risk ◽  
Major Health Problem ◽  
Crc Screening ◽  
Screening Uptake ◽  
Factors Influencing ◽  
Care System

Colorectal cancer (CRC) is a major health problem worldwide. Although population-based CRC screening is strongly recommended in average-risk population, compliance rates are still far from the desirable rates. High levels of screening uptake are necessary for the success of any screening program. Therefore, the investigation of factors influencing participation is crucial prior to design and launches a population-based organized screening campaign. Several studies have identified screening behaviour factors related to potential participants, providers, or health care system. These influencing factors can also be classified in non-modifiable (i.e., demographic factors, education, health insurance, or income) and modifiable factors (i.e., knowledge about CRC and screening, patient and provider attitudes or structural barriers for screening). Modifiable determinants are of great interest as they are plausible targets for interventions. Interventions at different levels (patient, providers or health care system) have been tested across the studies with different results. This paper analyzes factors related to CRC screening behaviour and potential interventions designed to improve screening uptake.

scholarly journals Integrated implementation of evidence-based interventions to increase colorectal cancer screening through public health-primary care partnerships

2020 ◽  
Author(s):  
Cindy Soloe ◽  
Laura Arena ◽  
Dara Schlueter ◽  
Stephanie Melillo ◽  
Amy DeGroff ◽  
...  
Keyword(s):  
Public Health ◽  
Colorectal Cancer ◽  
Primary Care ◽  
Chronic Disease ◽  
Data Collection ◽  
Quality Data ◽  
Background Information ◽  
Evidence Based ◽  
Primary Care Clinics ◽  
Crc Screening

Abstract Background In 2015, the Centers for Disease Control and Prevention funded the Colorectal Cancer Control Program (CRCCP), which partners with health systems and primary care clinics to increase CRC screening uptake. We interviewed CRCCP stakeholders to explore factors that support an integrated implementation of evidence-based interventions and supporting activities to promote CRC screening with other screening and chronic disease management activities in primary care clinics. Methods Using the Consolidated Framework for Implementation Research, we conducted a literature review and identified constructs to guide data collection and analysis. We purposively selected four CRCCP awardees that demonstrated ongoing engagement with clinic partner sites, willingness to collaborate with CDC and other stakeholders, and availability of high-quality data. We gathered background information on the selected program sites and conducted primary data collection interviews with program staff and partners. We used NVivo QSR 11.0 to systematically pilot-code interview data, achieving a Kappa coefficient of 0.8 or higher, and then implemented a stepwise process to identify site-specific and cross-cutting emergent themes. Results Programs reported that they support clinic partners’ integrated implementation by providing coordinated application processes and braided funding streams, and by funding partner organizations to provide technical assistance to support efficient implementation of evidence-based interventions and supporting activities into existing clinic workflows. These actions, in turn, support clinics in implementing evidence-based interventions and supporting activities that promote both CRC screening and other chronic disease screening and management. Discussion The selected CRCCP programs and their partners implement activities to support the integration of evidence-based interventions and supporting activities with other clinic efforts. These integrated efforts support increased efficiency of clinic workflow, improved coordination of patient care, increased uptake of screening and improved patient outcomes. Conclusions The findings provide insights into how public health programs can support primary care clinics in integrating interventions and activities into existing workflows to support efficient, coordinated delivery of quality patient-centered care.

scholarly journals Colorectal Cancer Screening: Video-Reviewed Flexible Sigmoidoscopy by Nurse Endoscopists — A Canadian Community-Based Perspective

2001 ◽  
Vol 15 (7) ◽  
pp. 441-445 ◽  
Author(s):  
TF Shapero ◽  
PE Alexander ◽  
J Hoover ◽  
E Burgis ◽  
R Schabas
Keyword(s):  
Colorectal Cancer ◽  
Flexible Sigmoidoscopy ◽  
Screening Program ◽  
Early Stage ◽  
Community Setting ◽  
Average Risk ◽  
Crc Screening ◽  
Asymptomatic Patients ◽  
Incident Cancer

BACKGROUND: Colorectal cancer (CRC) is the third most common incident cancer and the second most fatal cancer in Canada. Flexible sigmoidoscopy (FS) is one of the modalities under consideration for CRC screening. The present series reports on a screening program of FS performed by nonphysician endoscopists in a Canadian community setting, with video review of procedures by physicians and recommendation of follow-up colonoscopy where polyps are identified.RESULTS: Five hundred twenty-five, average-risk, asymptomatic patients were examined. After exclusion of inappropriate referrals, 488 remained for analysis. The duration and extent of examination were comparable with those of previous studies elsewhere. Compliance with suggested follow-up was 97.3%. Polyps were identified at FS in 15.4% of examinees. In 8.2% of patients, the polyps were neoplastic at subsequent histology. Four malignant lesions were detected, all at an early stage. There were no complications of FS.INTERPRETATION: This report shows that FS can be carried out safely and effectively by nonphysician personnel in a community setting in Canada. The manpower cost for nonphysician operators is considerably less than that for specialist physician endoscopists. This approach deserves consideration in cost effectiveness analyses of CRC screening.

scholarly journals Directly Mailing gFOBT Kits to Previous Responders Being Recalled for Colorectal Cancer Screening Increases Participation

2019 ◽  
Vol 3 (5) ◽  
pp. 197-203
Author(s):  
Jill Tinmouth ◽  
Jigisha Patel ◽  
Peter C Austin ◽  
Nancy N Baxter ◽  
Melissa C Brouwers ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
Care Provider ◽  
Primary Care Provider ◽  
Intervention Group ◽  
Absolute Difference ◽  
Control Group ◽  
Fecal Occult Blood ◽  
Average Risk ◽  
Crc Screening

Abstract Background Colorectal cancer (CRC) screening with guaiac fecal occult blood test (gFOBT) reduces CRC-related death. Average risk individuals should be recalled for screening with gFOBT every 2 years in order to maximize effectiveness. However, adherence with repeated testing is often suboptimal. Our aim was to evaluate whether adding a gFOBT kit to a mailed recall letter improves participation compared with a mailed recall letter alone, among previous responders to a mailed invitation. Methods We conducted a cluster randomized controlled trial, with the primary care provider as the unit of randomization. Eligible patients had completed a gFOBT and tested negative in an earlier pilot study and were now due for recall. The intervention group received a mailed CRC screening recall letter from their primary care provider plus a gFOBT kit (n = 431) while the control group received a mailed CRC screening mailed recall letter alone (n = 452). The primary outcome was the uptake of gFOBT or colonoscopy within 6 months. Results gFOBT uptake was higher in the intervention group (61.3%, n = 264) compared with the control group (50.4%, n = 228) with an absolute difference between the two groups of 10.8% (95% confidence interval [CI]: 1.4 to 20.2%, P = <0.01). Patients in the intervention group were more likely to complete the gFOBT compared with the control group (odds ratio [OR] = 1.4; 95% CI: 1.1 to 1.9). Conclusion Our findings show that adding gFOBT kits to the mailed recall letter increased participation among persons recalled for screening. Nine gFOBT kits would have to be sent by mail in order to screen one additional person.

scholarly journals Barriers and facilitators for colorectal cancer screening in a low-income urban community in Mexico City

2020 ◽  
Author(s):  
Karla Unger-Saldaña ◽  
Minerva Saldaña-Tellez ◽  
Michael B. Potter ◽  
Katherine Van Loon ◽  
Betania Allen-Leigh ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Screening Program ◽  
Barriers And Facilitators ◽  
Health Care Personnel ◽  
Crc Screening ◽  
Lay Beliefs ◽  
Incidence And Mortality ◽  
The Social

Abstract Background Colorectal cancer (CRC) incidence and mortality are increasing in many middle- and lower-income countries, possibly due to a combination of changing lifestyles and improved healthcare infrastructure that facilitates diagnosis. Unfortunately, a large proportion of cases may be diagnosed at advanced stages, resulting in poor outcomes. Decreasing trends in higher income countries are likely due to improved early detection combined with best practices in CRC treatment and management. More data on implementation of better quality CRC screening programs are needed for contexts where incidence is increasing. Therefore, we sought to identify potential barriers and facilitators for future implementation of fecal immunochemical test (FIT)-based CRC screening in a public healthcare system in a middle-income country with increasing CRC incidence and mortality. Methods. Qualitative study including semi-structured individual and focus group interviews with different stakeholders of colorectal cancer screening: 30 average-risk lay people, 13 health care personnel from a local public clinic, and 7 endoscopy unit personnel from a cancer referral hospital. All interviews were transcribed verbatim for analysis. Data was analyzed using the constant comparison method, under the theoretical perspectives of the Social Ecological Model (SEM), the PRECEDE-PROCEED Model, and the Health Belief Model. Results. We found multiple barriers and facilitators for implementation of a FIT-based CRC screening program at different levels of the SEM. The main barriers in each of the SEM levels, were: 1) at the social context level: poverty, health literacy and lay beliefs related to gender, cancer, allopathic medicine, and religion; 2) at the health services organization level: the lack of CRC knowledge among health care personnel and the community perception of poor quality of health care; 3) at the individual level: a lack of CRC awareness and therefore lack of risk perception, together with fear of participating in screening activities and finding out about a serious disease. The main facilitators perceived by the participants were CRC screening information and the free provision of screening tests.Conclusions. This study’s findings suggest the need for a multi-level CRC screening program that includes complementary strategies aimed at reducing perceived barriers and enhancing facilitators, starting with: 1) free provision of screening tests, 2) education of primary health care personnel, and 3) promotion of non fear-based CRC screening awareness among the target population, taking into account their lay beliefs.

Differences in Colorectal Cancer (CRC) patients who did and did not undergo screening

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
J Thompson ◽  
J Ng ◽  
B Armstrong ◽  
E Feletto ◽  
T Ha
Keyword(s):  
Physical Activity ◽  
Colorectal Cancer ◽  
Cohort Study ◽  
Screening Program ◽  
Barriers And Facilitators ◽  
Average Risk ◽  
Physical Activity Guidelines ◽  
Crc Screening ◽  
Female Patients ◽  
Screening Participation

Abstract Background The Australian National Bowel Cancer Screening Program (NBSCP) is a free population-based screening program which aims to identify precancerous lesions and early colorectal cancer (CRC) using an immunochemical faecal occult blood test in average risk Australians. Formally commencing in 2006, NBCSP participation rate in eligible 50-74-year-old people was 42% in 2018. The barriers and facilitators of participation in the NBCSP have been explored for the general, at-risk population but not in a population of CRC patients. This is the first study to assess a population of CRC patients, post diagnosis, who would have been eligible for CRC screening to determine the barriers and facilitators to screening. Methods A cross sectional study nested within a cohort study. Data from CRC patients who participated in the 45 and Up Study; the largest cohort study in Australia and southern hemisphere, were analysed to compare those who had and had not participated in CRC screening. Logistic regression analyses were conducted using RStudio (version 3.5.2, Boston, Massachusetts, USA.). Multiple Imputation (MI), was used to handle missing values assumed to be missing at random. Results A total of 339 CRC patients were included. Patients who were female, overweight (≥25kg/m2), consumed less than the recommended five servings of vegetables per day, consumed less than or equal to fourteen standard drinks per week (compared to non-drinkers) or did not meet physical activity guidelines were significantly less likely to have participated in screening. Conclusions Our study has taken a unique approach to identifying a high-risk group by exploring factors to screening participation in CRC patients. CRC patients with less healthy lifestyles were less likely to participate in screening. In contrast to previous studies, female patients were less likely to participate in screening than males were. This was an unexpected finding and should be replicated. Key messages Not surprising that those with less healthy lifestyle practices also reflected less than ideal screening practices. Surprising that female patients participated less in screening than males. Future interventions to improve CRC screening participation rates should consider specialised messaging for average-risk females who are overweight not meeting dietary or physical activity guidelines.

scholarly journals Barriers and facilitators for colorectal cancer screening in a low-income urban community in Mexico City

2020 ◽  
Author(s):  
Karla Unger-Saldaña ◽  
Minerva Saldaña-Tellez ◽  
Michael B. Potter ◽  
Katherine Van Loon ◽  
Betania Allen-Leigh ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Health Care ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Screening Program ◽  
Barriers And Facilitators ◽  
Health Care Personnel ◽  
Crc Screening ◽  
Lay Beliefs ◽  
The Social

Abstract Background. Colorectal cancer (CRC) incidence and mortality are increasing in many middle- and lower-income countries, possibly due to a combination of changing lifestyles and improved healthcare infrastructure that facilitates diagnosis. Unfortunately, a large proportion of cases may be diagnosed at advanced stages, resulting in poor outcomes. Decreasing trends in higher income countries are likely due to improved early detection combined with best practices in CRC treatment and management. More data on implementation of better quality CRC screening programs are needed for contexts where incidence is increasing. Therefore, we sought to identify potential barriers and facilitators for future implementation of fecal immunochemical test (FIT)-based CRC screening in a public healthcare system in a middle-income country with increasing CRC incidence and mortality.Methods. Qualitative study including semi-structured individual and focus group interviews with different stakeholders of colorectal cancer screening: 30 average-risk lay people, 13 health care personnel from a local public clinic, and 7 endoscopy unit personnel from a cancer referral hospital. All interviews were transcribed verbatim for analysis. Data was analyzed using the constant comparison method, under the theoretical perspectives of the Social Ecological Model (SEM), the PRECEDE-PROCEED Model, and the Health Belief Model. Results. We found multiple barriers and facilitators for implementation of a FIT-based CRC screening program at different levels of the SEM. The main barriers in each of the SEM levels, were: 1) at the social context level: poverty, health literacy and lay beliefs related to gender, cancer, allopathic medicine, and religion; 2) at the health services organization level: the lack of CRC knowledge among health care personnel and the community perception of poor quality of health care; 3) at the individual level: a lack of CRC awareness and therefore lack of risk perception, together with fear of participating in screening activities and finding out about a serious disease. The main facilitators perceived by the participants were CRC screening information and the free provision of screening tests.Conclusions. This study’s findings suggest the need for a multi-level CRC screening program that includes complementary strategies aimed at reducing perceived barriers and enhancing facilitators, starting with: 1) free provision of screening tests, 2) education of primary health care personnel, and 3) promotion of non fear-based CRC screening awareness among the target population, taking into account their lay beliefs.

scholarly journals National Colorectal Cancer Screening Program in Lithuania: Description of the 5-Year Performance on Population Level

Cancers ◽  
2021 ◽  
Vol 13 (5) ◽  
pp. 1129
Author(s):  
Audrius Dulskas ◽  
Tomas Poskus ◽  
Inga Kildusiene ◽  
Ausvydas Patasius ◽  
Rokas Stulpinas ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Quality Assurance ◽  
Cancer Screening ◽  
Colorectal Cancer Screening ◽  
Screening Program ◽  
Histopathological Examination ◽  
Insurance Fund ◽  
Crc Screening ◽  
Cancer Screening Program ◽  
The Impact

We aimed to report the results of the implementation of the National Colorectal Cancer (CRC) Screening Program covering all the country. The National Health Insurance Fund (NHIF) reimburses the institutions for performing each service; each procedure within the program has its own administrative code. Information about services provided within the program was retrieved from the database of NHIF starting from the 1 January 2014 to the 31 December 2018. Exact date and type of all provided services, test results, date and results of biopsy and histopathological examination were extracted together with the vital status at the end of follow-up, date of death and date of emigration when applicable for all men and women born between 1935 and 1968. Results were compared with the guidelines of the European Union for quality assurance in CRC screening and diagnosis. The screening uptake was 49.5% (754,061 patients) during study period. Participation rate varied from 16% to 18.1% per year and was higher among women than among men. Proportion of test-positive and test-negative results was similar during all the study period—8.7% and 91.3% annually. Between 9.2% and 13.5% of test-positive patients received a biopsy of which 52.3–61.8% were positive for colorectal adenoma and 4.6–7.3% for colorectal carcinoma. CRC detection rate among test-positive individuals varied between 0.93% and 1.28%. The colorectal cancer screening program in Lithuania coverage must be improved. A screening database is needed to systematically evaluate the impact and performance of the national CRC screening program and quality assurance within the program.

scholarly journals Assessing the clinical utility of genetic risk scores for targeted cancer screening

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Carly A. Conran ◽  
Zhuqing Shi ◽  
William Kyle Resurreccion ◽  
Rong Na ◽  
Brian T. Helfand ◽  
...  
Keyword(s):  
Colorectal Cancer ◽  
Primary Care ◽  
High Risk ◽  
Risk Score ◽  
Genetic Risk ◽  
Clinical Utility ◽  
Low Risk ◽  
Risk Scores ◽  
Average Risk ◽  
Genetic Risk Scores

Abstract Background Genome-wide association studies have identified thousands of disease-associated single nucleotide polymorphisms (SNPs). A subset of these SNPs may be additively combined to generate genetic risk scores (GRSs) that confer risk for a specific disease. Although the clinical validity of GRSs to predict risk of specific diseases has been well established, there is still a great need to determine their clinical utility by applying GRSs in primary care for cancer risk assessment and targeted intervention. Methods This clinical study involved 281 primary care patients without a personal history of breast, prostate or colorectal cancer who were 40–70 years old. DNA was obtained from a pre-existing biobank at NorthShore University HealthSystem. GRSs for colorectal cancer and breast or prostate cancer were calculated and shared with participants through their primary care provider. Additional data was gathered using questionnaires as well as electronic medical record information. A t-test or Chi-square test was applied for comparison of demographic and key clinical variables among different groups. Results The median age of the 281 participants was 58 years and the majority were female (66.6%). One hundred one (36.9%) participants received 2 low risk scores, 99 (35.2%) received 1 low risk and 1 average risk score, 37 (13.2%) received 1 low risk and 1 high risk score, 23 (8.2%) received 2 average risk scores, 21 (7.5%) received 1 average risk and 1 high risk score, and no one received 2 high risk scores. Before receiving GRSs, younger patients and women reported significantly more worry about risk of developing cancer. After receiving GRSs, those who received at least one high GRS reported significantly more worry about developing cancer. There were no significant differences found between gender, age, or GRS with regards to participants’ reported optimism about their future health neither before nor after receiving GRS results. Conclusions Genetic risk scores that quantify an individual’s risk of developing breast, prostate and colorectal cancers as compared with a race-defined population average risk have potential clinical utility as a tool for risk stratification and to guide cancer screening in a primary care setting.

scholarly journals To do or not to do – a survey study on factors associated with participating in the Danish screening program for colorectal cancer

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jesper Bo Nielsen ◽  
Gabriele Berg-Beckhoff ◽  
Anja Leppin
Keyword(s):  
Colorectal Cancer ◽  
Screening Program ◽  
Demographic Data ◽  
Survey Study ◽  
Stepwise Logistic Regression ◽  
Willingness To Participate ◽  
Cross Sectional Survey ◽  
Screening Programs ◽  
Crc Screening ◽  
Screening Participation

Abstract Background Screening programs for colorectal cancer (CRC) exist in many countries, and with varying participation rates. The present study aimed at identifying socio-demographic factors for accepting a cost-free screening offer for CRC in Denmark, and to study if more people would accept the screening offer if the present fecal test was replaced by a blood test. Methods We used a cross-sectional survey design based on a representative group of 6807 Danish citizens aged 50–80 years returning a fully answered web-based questionnaire with socio-demographic data added from national registries. Data were analyzed in STATA and based on bivariate analyses followed by regression models. Results Danes in general have a high level of lifetime participation (+ 80%) in the national CRC screening program. The results of the stepwise logistic regression model to predict CRC screening participation demonstrated that female gender, higher age, higher income, and moderate alcohol intake were positively associated with screening participation, whereas a negative association was observed for higher educational attainment, obesity, being a smoker, and higher willingness to take health risks. Of the 1026 respondents not accepting the screening offer, 61% were willing to reconsider their initial negative response if the fecal sampling procedure were replaced by blood sampling. Conclusion The CRC screening program intends to include the entire population within a certain at-risk age group. However, individual factors (e.g. sex, age obesity, smoking, risk aversity) appear to significantly affect willingness to participate in the screening program. From a preventive perspective, our findings indicate the need for a more targeted approach trying to reach these groups.

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