Encouraging Underscreened Women to Have Cervical Cancer Screening: The Effectiveness of a Computer Strategy

Campbell, Elizabeth; Peterkin, Danna; Abbott, R R; Rogers, John

doi:10.1006/pmed.1997.0195

Cited by 36 publications

(33 citation statements)

References 6 publications

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“…Fifteen were quasi randomised (Baele 1998;Chumworathayi 2007;Hicks 1997;Hou 2002;Hou 2005;Lantz 1995;Lantz 1996;Levine 2003;Marcus 1992;Margolis 1998;Maxwell 2003;Park 2005;Paskett 1990;Ward 1999;Yancey 1995), three studies included participants who may have been screened before receiving the intervention (Dignan 1996;Dignan 1998;Gotay 2000), ten studies used an intervention aimed at either the physician or both the physician and patient (Boissel 1995;Bonevski 1999;Campbell 1997;Cecchini 1989;Hillman 1998;Litzelman 1993;Manfredi 1998;Nguyen 2000;Roetzheim 2004;Roetzheim 2005), seven studies used an intervention or an outcome that was not strictly concerned with increasing uptake (Brewster 2002;Del Mar 1995;Holloway 2003;Katz 2007;Paul 2003;Philips 2006;Sankaranarayanan 2003;), nine studies concerned intervention aimed at improving follow-up of an abnormal smear results rather than initial Pap screening uptake (Engelstad 2005;Lauver 1990;Marcus 1998;Miller 1999;Paske...…”

Section: Assessment Of Risk Of Bias In Included Studies-the Risk Of Bmentioning

confidence: 99%

Interventions targeted at women to encourage the uptake of cervical screening

Forbes

Jepson

Martin-Hirsch

2002

Cochrane Database of Systematic Reviews

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Section: Assessment Of Risk Of Bias In Included Studies-the Risk Of Bmentioning

confidence: 99%

Interventions targeted at women to encourage the uptake of cervical screening

Forbes

Jepson

Martin-Hirsch

2002

Cochrane Database of Systematic Reviews

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“…Additional methodologic weaknesses in some studies included small sample sizes and therefore potentially underpowered trials, 28,30,31 poor recruitment rates [22][23][24]26,[29][30][31] lack of clinician engagement in the intervention, 29 and patient-reported outcomes that may be influenced by social desirability bias. 28 The unit of randomization was not a clear source of heterogeneity despite greater risk of contamination in the patient-randomized trials.Previous systematic reviews have examined the effect of patient-oriented decision aids in screening 33 and also communication of risks in screening programs. 34 Our review differs in terms of the nature of the interventions and the populations studied, although the findings are consistent: communication of risks is associated with increased intention to screen, and patient-oriented decision aids can increase knowledge.…”

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confidence: 99%

“…28 We examined the unit of randomization as a possible source of heterogeneity of the results and found no clear trends (Table 3).…”

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confidence: 99%

“…[24][25][26]30,31 More successful recruiting (93% to 95% of eligible participants) was achieved with a dedicated research assistant or practice nurse recruiting eligible patients in the primary care waiting room before their appointment. 28,32 Similarly, when the intervention was delivered by a practice nurse, 75% of patients completed a risk assessment, 28 but when clinicians were required to complete training, engagement was low (12% of intervention general practitioners attended). …”

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confidence: 99%

“…22,23,28,30,31 One study randomized patients by clinic days to reduce potential contamination. 28 We examined the unit of randomization as a possible source of heterogeneity of the results and found no clear trends (Table 3).Recruitment proportions of eligible study participants varied from very low (14% to 25%) [24][25][26]30,31 to very high (93% to 95%). 28,32 Contacting eligible patients by mail and following them up with a telephone call yielded a low recruitment.…”

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Cancer Risk Assessment Tools in Primary Care: A Systematic Review of Randomized Controlled Trials

Walker

Licqurish

Chiang

et al. 2015

The Annals of Family Medicine

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PURPOSEWe conducted this review to identify published randomized controlled trials (RCTs) of cancer risk assessment tools used in primary care and to determine their impact on clinical utility (clinicians), screening uptake (patients), and psychosocial outcomes (patients). METHODSWe searched EMBASE, PubMed and the Cochrane databases for RCTs of cancer risk assessment tools in primary care up to May 2014. Only studies set in primary care, with patients eligible for screening, and English-language articles were included. RESULTSThe review included 11 trials of 7 risk tools. The trials were heterogeneous with respect to type of tool that was used, type(s) of cancer assessed, and outcomes measured. Evidence suggested risk tools improved patient risk perception, knowledge, and screening intentions, but not necessarily screening behavior. Overall, uptake of a tool was greater if initiated by patients, if used by a dedicated clinician, and when combined with decision support. There was no increase in cancer worry. Health promotion messages within the tool had positive effects on behavior change. Trials were limited by low-recruitment uptake, and the heterogeneity of the findings necessitated a narrative review rather than a meta-analysis.CONCLUSIONS Risk tools may increase intentions to have cancer screening, but additional interventions at the clinician or health system levels may be needed to increase risk-appropriate cancer screening behavior. INTRODUCTIONC ancer screening programs have been introduced in many countries for breast, 1 colorectal, 2 and cervical 3 cancer. With the growing recognition of the potential harms from population-based cancer screening programs, 4 risk-stratified screening is being proposed as a way of reducing harm and focusing on populations at higher risk of cancer. This concept can also be applied to primary preventive measures, especially as the evidence to support chemoprevention for common cancers such as breast and colorectal builds. 5,6 If risk-stratified cancer prevention is to be implemented, it requires risk assessment tools that can be used in primary care to identify those most likely to benefit from tailored prevention. 7 Cancer risk prediction models, based on epidemiologic data, calculate an individual's likelihood of developing cancer, identify an individual's risk of carrying a genetic mutation for a specific cancer (eg, BRCA 1 or BRCA 2), or both. 8,9 Newer risk models are beginning to incorporate genomic profiles and environmental exposures, 10 a trend that is likely to grow with the movement toward precision medicine.11 Risk assessment tools facilitate the translation of these risk models to estimate an individual's likelihood of developing different cancers by assessing the combination of risk factors including genetic, environmental 12,13 Primary care has an important role in the delivery of cancer screening programs and can increase screening uptake.18 Successful implementation of risk assessment tools into primary care is needed if risk-stratified cancer p...

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Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes

Arditi

Rège‐Walther

Durieux

et al. 2012

Cochrane Database of Systematic Reviews

119

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Background Clinical practice does not always reflect best practice and evidence, partly because of unconscious acts of omission, information overload, or inaccessible information. Reminders may help clinicians overcome these problems by prompting them to recall information that they already know or would be expected to know and by providing information or guidance in a more accessible and relevant format, at a particularly appropriate time. This is an update of a previously published review. Objectives To evaluate the effects of reminders automatically generated through a computerized system (computer-generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition). Search methods We searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers up to 21 September 2016 together with reference checking, citation searching and contact with study authors to identify additional studies. Selection criteria We included individual-or cluster-randomized and non-randomized trials that evaluated the impact of computer-generated reminders delivered on paper to healthcare professionals, alone (single-component intervention) or in addition to one or more co-interventions (multi-component intervention), compared with usual care or the co-intervention(s) without the reminder component. Data collection and analysis Review authors working in pairs independently screened studies for eligibility and abstracted data. For each study, we extracted the primary outcome when it was defined or calculated the median effect size across all reported outcomes. We then calculated the median improvement and interquartile range (IQR) across included studies using the primary outcome or median outcome as representative outcome. We assessed the certainty of the evidence according to the GRADE approach.

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Encouraging Underscreened Women to Have Cervical Cancer Screening: The Effectiveness of a Computer Strategy

Cited by 36 publications

References 6 publications

Interventions targeted at women to encourage the uptake of cervical screening

Interventions targeted at women to encourage the uptake of cervical screening

Cancer Risk Assessment Tools in Primary Care: A Systematic Review of Randomized Controlled Trials

Computer-generated reminders delivered on paper to healthcare professionals; effects on professional practice and health care outcomes

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