Zapka JG, Lemon SCInterventions for patients, providers, and health care organizations. Cancer 101(Suppl S5): 1165-1187

Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, Massachusetts 01655, USA.
Cancer (Impact Factor: 4.89). 09/2004; 101(5 Suppl):1165-87. DOI: 10.1002/cncr.20504
Source: PubMed


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.

Download full-text


Available from: Stephenie C Lemon, Nov 10, 2014
21 Reads
  • Source
    • "The passive approach depends on public awareness the potential participant is made aware of (that screening is available) and approaches the screening center on their own volition or upon the recommendation of their physician; in this case, recruitment is enhanced by media coverage, as well as by advertisement [8]. Two active recruitment methods include mailing a letter of invitation to the subject or a phone call from a trained staff member [9,10]. It has been shown that the mailed invitation approach is less expensive than direct active recruitment (telephone call), however it may be less effective [11,12] and may not be cost-effective in terms of the actual number of subjects recruited successfully. "
    [Show abstract] [Hide abstract]
    ABSTRACT: The effectiveness of a genetics-based public health screening programs depend on the successful recruitment of subjects who qualify for intensified screening by virtue of a positive genetic test. Herein we compare the effectiveness of a mailed invitation and follow-up phone call for non-responding subjects and an initial invitation by telephone addressed to male BRCA1 mutation carriers for prostate screening. The final participation rate was 75% (42 of 56) for men who were initially contacted by mail (and follow-up phone call) and 81% (30 of 37) for men who were initially contacted by telephone. Among the men who were initially contacted by mail, it was necessary to telephone 54% of these patients (30 of 56). After a calculation of the cost-effectiveness related to these results, we conclude that if the costs of the phone call were to exceed the costs of the letter by 2.5 times or more, then savings would be arranged by initiating contact with a mailed invitation.
    Hereditary Cancer in Clinical Practice 12/2013; 11(1):17. DOI:10.1186/1897-4287-11-17 · 1.47 Impact Factor
  • Source
    • "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. "
    [Show abstract] [Hide abstract]
    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 · 4.84 Impact Factor
  • Source
    • "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
Show more