What implementation interventions increase cancer screening rates? a systematic review

Abstract

BackgroundAppropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening. The interventions considered were: client reminders, client incentives, mass media, small media, group education, one-on-one education, reduction in structural barriers, reduction in out-of-pocket costs, provider assessment and feedback interventions, and provider incentives. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP) change in completed screening tests.MethodsOur first step was to conduct an iterative scoping review in the research area. This yielded three relevant high-quality systematic reviews. Serving as our evidentiary foundation, we conducted a formal update. Randomized controlled trials and cluster randomized controlled trials, published between 2004 and 2010, were searched in MEDLINE, EMBASE and PSYCHinfo.ResultsThe update yielded 66 studies new eligible studies with 74 comparisons. The new studies ranged considerably in quality. Client reminders, small media, and provider audit and feedback appear to be effective interventions to increase the uptake of screening for three cancers. One-on-one education and reduction of structural barriers also appears effective, but their roles with CRC and cervical screening, respectively, are less established. More study is required to assess client incentives, mass media, group education, reduction of out-of-pocket costs, and provider incentive interventions.ConclusionThe new evidence generally aligns with the evidence and conclusions from the original systematic reviews. This review served as the evidentiary foundation for an implementation guideline. Poor reporting, lack of precision and consistency in defining operational elements, and insufficient consideration of context and differences among populations are areas for additional research.

Get Screened: A Randomized Trial of the Incremental Benefits of Reminders, Recall, and Outreach on Cancer Screening

“…Numerous strategies exist to improve screening rates for colorectal and breast cancer, 2,3,5,6,[11][12][13][14][15][16][17][18][19][20] but the relative incremental benefit of these interventions have not been compared. 5 Using a pragmatic randomized trial, we examined the incremental benefit of several strategies to augment the effect of a patient reminder letter to improve cancer-screening rates.…”

“…2 Prior studies have demonstrated that a letter alone increased screening rates for BC by approximately 4.5-9 % and for CRC by 0.2-10.9 %. 2,3 More recently, several studies have examined the benefit of multimodal interventions, including the RRO model to remind patients and providers when screening is due, recall unscreened patients, and implement culturally appropriate outreach to patients in need of screening. [4][5][6] Although multifaceted interventions have been shown to improve cancer-screening rates, 5-7 the relative incremental impact of the specific components of these interventions have not been fully assessed.…”

The Role of Prospect Theory in Screening Behavior Decision-Making in a Health-Insured Population of South Africa

“…he use of incentives has become an increasingly popular means to entice positive changes in health behavior [31]. Although incentives show promising results in their eicacy in promoting preventive care activities, they have been shown to work best in highly structured environments when coupled with client reminders, and tends to promote behavior change only in the short term (32)(33)(34)(35). Very little evidence exists on the gender diferences in response to incentives, but some studies have shown that men tend to respond better when the incentive is monetary and of greater value [36,37].…”

Colorectal Cancer Prevention and Risk Counseling

“…Creating awareness: Various implications may be used in order to create awareness in the individuals about the importance of their protective behaviors in the prevention of CRC and their health. Evidence-based interventions recommended in the recent relevant studies are shown in Table 5 [10,25,[39][40][41][42][43][44]. Due to purpose of encouraging individuals take action to protective behaviors, it is important to give positive messages in materials (e.g., posters, banners) that it is possible to protect against CRC [11,36,37].…”

“…While facilitating effective participation in CRC screening initiatives, such as reminders, mass media and the media, group training, personal training, and assessments, are taken by reducing structural barriers to healthcare professionals and include initiatives such as feedback. The effectiveness of personal reminders, personal training, and counseling in improving CRC screening has been proven [10,25,[39][40][41][42][43][44]. Creating awareness: Various implications may be used in order to create awareness in the individuals about the importance of their protective behaviors in the prevention of CRC and their health.…”