Implementation considerations for risk-tailored cancer screening in the population: A scoping review

Dunlop, Kate L.A.; Singh, Nehal; Robbins, Hilary A.; Zahed, Hana; Johansson, Mattias; Rankin, Nicole M.; Cust, Anne E.

doi:10.1016/j.ypmed.2024.107897

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Preventive Medicine

2024

DOI: 10.1016/j.ypmed.2024.107897

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Implementation considerations for risk-tailored cancer screening in the population: A scoping review

Kate L.A. Dunlop,

Nehal Singh,

Hilary A. Robbins

et al.

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2024

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Cited by 2 publications

References 96 publications

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Understanding the Preferences and Considerations of the Public Towards Risk‐Stratified Screening for Colorectal Cancer: Insights From Think‐Aloud Interviews Based on a Discrete Choice Experiment

Dennison,

Clune,

Morris

et al. 2024

Health Expectations

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ContextRisk stratification has been suggested as a strategy for improving cancer screening. Any changes to existing programmes must be acceptable to the public.ObjectiveThis study aimed to explore the preferences and considerations of individuals relating to the introduction of different risk‐based strategies to determine eligibility for colorectal cancer (CRC) screening.Study DesignParticipants completed a discrete choice experiment (DCE) within online interviews. Nine conjoint‐analysis tasks were created, each with two potential CRC screening programmes. The attributes included personal risk of CRC, screening invitation strategy and impact. Participants chose between programmes while thinking aloud and sharing their thoughts. Transcripts were analysed using codebook thematic analysis.ParticipantsTwenty participants based in England aged 40–79 years without previous cancer history or medical expertise.ResultsWhen choosing between programmes, participants first and primarily looked to prioritise saving lives. The harms associated with screening were viewed as a surprise but also felt by most to be inevitable; the benefits frequently outweighed, therefore, harms were considered less important. Risk stratification using individual characteristics was considered a nuanced approach to healthcare, which tended to be preferred over the age‐alone model. Detailed personal risk information could be taken more seriously than non‐personalised information to motivate behaviour change. Although it had minimal impact on decision‐making, not diverting resources for screening from elsewhere was valued. Individuals who chose not to provide health information were considered irresponsible, while it was important that those with no information to provide should not lose out.ConclusionRisk‐stratified CRC screening is generally aligned with public preferences, with decisions between possible stratification strategies dominated by saving lives. Even if attributes including risk factors, risk stratification strategy and risk communication contributed less to the overall decision to select certain programmes, some levels more clearly fulfilled public values; therefore, all these factors should be taken into consideration when redesigning and communicating CRC screening programmes.Patient or Public ContributionThe primary data source for this study is interviews with 20 members of the public (current, past or future CRC screening invitees). Two public representatives contributed to planning this study, particularly the DCE.

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Understanding the Preferences and Considerations of the Public Towards Risk‐Stratified Screening for Colorectal Cancer: Insights From Think‐Aloud Interviews Based on a Discrete Choice Experiment

Dennison,

Clune,

Morris

et al. 2024

Health Expectations

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Targeted Screening for Cancer: Learnings and Applicability to Melanoma: A Scoping Review

Zheng,

Smit,

Cust

et al. 2024

JPM

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This scoping review aims to systematically gather evidence from personalized cancer-screening studies across various cancers, summarize key components and outcomes, and provide implications for a future personalized melanoma-screening strategy. Peer-reviewed articles and clinical trial databases were searched for, with restrictions on language and publication date. Sixteen distinct studies were identified and included in this review. The studies’ results were synthesized according to key components, including risk assessment, risk thresholds, screening pathways, and primary outcomes of interest. Studies most frequently reported about breast cancers (n = 7), followed by colorectal (n = 5), prostate (n = 2), lung (n = 1), and ovarian cancers (n = 1). The identified screening programs were evaluated predominately in Europe (n = 6) and North America (n = 4). The studies employed multiple different risk assessment tools, screening schedules, and outcome measurements, with few consistent approaches identified across the studies. The benefit–harm assessment of each proposed personalized screening program indicated that the majority were feasible and effective. The establishment of a personalized screening program is complex, but results of the reviewed studies indicate that it is feasible, can improve participation rates, and screening outcomes. While the review primarily examines screening programs for cancers other than melanoma, the insights can be used to inform the development of a personalized melanoma screening strategy.

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Implementation considerations for risk-tailored cancer screening in the population: A scoping review

Cited by 2 publications

References 96 publications

Understanding the Preferences and Considerations of the Public Towards Risk‐Stratified Screening for Colorectal Cancer: Insights From Think‐Aloud Interviews Based on a Discrete Choice Experiment

Understanding the Preferences and Considerations of the Public Towards Risk‐Stratified Screening for Colorectal Cancer: Insights From Think‐Aloud Interviews Based on a Discrete Choice Experiment

Targeted Screening for Cancer: Learnings and Applicability to Melanoma: A Scoping Review

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