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 A growing body of behavioral and health services research has developed and tested the efficacy and effectiveness of strategies within health care settings to improve cancer screening rates. This article summarizes lessons learned from interventions based in health care settings to improve screening for breast cancer (mammography), cervical cancer (Papanicolaou [Pap] tests), and colorectal cancer (CRC) (with fecal occult blood test [FOBT], sigmoidoscopy, and colonoscopy).
Conceptual FrameworkAn ecologic framework, 1-3 as depicted in Figure 1, guides the conceptual model of this report. This model highlights ways that factors at the public policy level, the community level, and the organization and practice setting levels interact in a synergistic manner to hinder or enhance providers' delivery and patients' utilization of prevention services. This multisectorial, multilevel approach-congruent with the Behavioral Model of Utilization, 4 the Quality in the Continuum of Cancer Care (QCCC) model, 5 and the Chronic Care Model 6 -illustrates the need to recognize and understand the complexity of the context in which processes of care occur. Figure 2 describes organizational strategies that affect clinician behavior and patient screening participation, which are the focus of numerous studies reported in this article.
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