Interventions for patients, providers, and health care organizations

Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Cancer (Impact Factor: 4.9). 09/2004; 101(5 Suppl):1165-87. DOI: 10.1002/cncr.20504
Source: PubMed

ABSTRACT Clinicians and the organizations within which they practice play a major role in enabling patient participation in cancer screening and ensuring quality services. Guided by an ecologic framework, the authors summarize previous literature reviews and exemplary studies of breast, cervical, and colorectal cancer screening intervention studies conducted in health care settings. Lessons learned regarding interventions to maximize the potential of cancer screening are distilled. Four broad lessons learned emphasize that multiple levels of factors-public policy, organizational systems and practice settings, clinicians, and patients-influence cancer screening; that a diverse set of intervention strategies targeted at each of these levels can improve cancer screening rates; that the synergistic effects of multiple strategies often are most effective; and that targeting all components of the screening continuum is important. Recommendations are made for future research and practice, including priorities for intervention research specific to health care settings, the need to take research phases into consideration, the need for studies of health services delivery trends, and methods and measurement issues.

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Available from: Stephenie C Lemon, Nov 10, 2014
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    • "In some countries, shared decision-making can take place in a primary care consultation before screening (Miles A. et al, 2004; Zapka and Lemon, 2004; Price et al, 2010; Zapka et al, 2011), but in the UK, which has an organised programme of cancer screening (NHS, 2012), information is mailed out with screening invitations, and the decision about whether to participate must be made by the individual. Although there is some variation between the breast, cervical and bowel screening programmes, and between the nations of the UK, in general the programmes encourage people to use the information provided to weigh up the pros and cons of screening. "
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    ABSTRACT: Background: Informed decision-making approaches to cancer screening emphasise the importance of decisions being determined by individuals' own values and preferences. However, advice from a trusted source may also contribute to autonomous decision-making. This study examined preferences regarding a recommendation from the NHS and information provision in the context of colorectal cancer (CRC) screening. Methods: In face-to-face interviews, a population-based sample of adults across Britain (n=1964; age 50–80 years) indicated their preference between: (1) a strong recommendation to participate in CRC screening, (2) a recommendation alongside advice to make an individual decision, and (3) no recommendation but advice to make an individual decision. Other measures included trust in the NHS and preferences for information on benefits and risks. Results: Most respondents (84%) preferred a recommendation (47% strong recommendation, 37% recommendation plus individual decision-making advice), but the majority also wanted full information on risks (77%) and benefits (78%). Men were more in favour of a recommendation than women (86% vs 81%). Trust in the NHS was high overall, but the minority who expressed low trust were less likely to want a recommendation. Conclusion: Most British adults want full information on risks and benefits of screening but they also want a recommendation from an authoritative source. An ‘expert' view may be an important part of autonomous health decision-making.
    British Journal of Cancer 11/2012; 107(12). DOI:10.1038/bjc.2012.512 · 4.82 Impact Factor
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    • "Despite numerous patient and provider barriers to CRCS, the most influential factor determining adherence to the CRCS guidelines is provider recommendation [17] [18] [19] [20] [21] [22]. Yet, due to those barriers, providers often miss CRCS opportunities for their patients [23] [24]. Combining multiple provider-directed with officesystem-directed interventions in the primary care setting shows the most potential to increase CRCS rates [15] [25] [26] [27]. "
    Journal of Cancer Therapy 01/2012; 03(06):866-873. DOI:10.4236/jct.2012.326111
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    • "Thus, the HBF represents a synthesis of some of the major theoretical formulations in the area of health behavior, such as Social Cognitive Theory (Bandura et al., 1989, 2004), the Health Belief Model (Becker, Maiman, 1974), the Theory of Planned Behavior (Ajzen 2002, Madden et al., 1992, Ajzen, Madden, 1986; Fishbein, Ajzen, 1975), the Transtheoretical Model of Change (Prochaska, DiClemente, 1983; Prochaska, 1992), and Social Influence Theory (Greer, 1988; Lomas & Haynes, 1988; Mittman et al., 1992). In addition, the model considers the context within which the desired behavior and behavior change are enacted, including characteristics of the provider and the health care setting (Wagner, 1998; Zapka & Lemon, 2004), as well as larger community and societal influences (Ponce et al., 2005; Babey et al., 2008). "
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    ABSTRACT: Mitigating the unequal burden of cancer often involves conducting community-based trials to develop effective intervention strategies to promote cancer-related health behaviors. However, this is challenging due to the simultaneous influence of numerous factors, at multiple levels in the socio-ecological context, on health behavior. A sound conceptual framework can bring order to this complex environment and provide a roadmap for systematically addressing the multiple determinants of the behavior in question. This paper describes the application of The Health Behavior Framework, an integrative conceptual model, in an ongoing Program Project, "Liver Cancer Control Interventions for Asian-Americans." The Framework has been integral to shaping all aspects of the three component research trials from selection of the study designs to development of the interventions and data collection instruments. We advocate universal adoption of theory into community-based intervention research as a way to accelerate our ability to develop effective interventions and facilitate synthesis of study results across populations and behavioral outcomes: critical steps in advancing the field of health disparities research.
    Preventive Medicine 09/2009; 50(1-2):63-7. DOI:10.1016/j.ypmed.2009.08.010 · 2.93 Impact Factor
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