Can you un-ring the bell? A qualitative study of how affect influences cancer screening decisions

Abstract

BackgroundThe belief that early detection is the best protection against cancer underlies cancer screening. Emerging research now suggests harms associated with early detection may sometimes outweigh the benefits. Governments, cancer agencies, and organizations that publish screening guidelines have found it is difficult to “un-ring the bell” on the message that “early detection is your best protection” because of its widespread communication and enduring resonance. This study explores affective factors—and their interplay with relevant analytical factors—in public/laypersons’ decision making about cancer screening.MethodsA total of 93 people (47 men, 46 women) attended focus groups about, respectively, prostate cancer screening and breast cancer screening in two Canadian cities.ResultsAffective factors were a major influence on many focus group participants’ decision making about cancer screening, including fear of cancer and a generalized enthusiasm for prevention/screening, and they were often inspired by anecdotes about the cancer experiences of family and friends. Affect also existed alongside more analytical factors including assessments of reduced risk in the management of any cancer diagnosis if caught early, and, for men, the belief that an unreliable test is “better than nothing,” and that men deserve prostate cancer screening because women have breast and cervical cancer screening. Affective factors were particularly noticeable in the sub-groups most supportive of screening and the “early detection” message: older women who felt that mammogram screening should begin at age 40 rather than 50, and older men who felt that prostate cancer screening should be expanded beyond its current unorganized, opportunistic usage. In contrast, younger participants displayed less affective attachments to “early detection” messages and had greater concerns about harms of screening and were more receptive to nuanced messages informed by evidence.ConclusionPolicymakers attempting to communicate more nuanced versions of the “early detection” message need to understand the role of affect alongside other judgments brought into laypersons’ decision making processes and anticipate how affective responses to their messages will be shaped, transformed, and potentially subverted by external forces beyond their control. Particularly overt external factors are campaigns by cancer advocacy organizations actively promoting breast and prostate cancer awareness and screening to younger women and men using affectively-charged messages.Electronic supplementary materialThe online version of this article (10.1186/s12885-017-3596-7) contains supplementary material, which is available to authorized users.

Predicting women's intentions to screen for breast cancer based on the health belief model and the theory of planned behavior

“…Scientific evidence indicates that breast screening can detect breast disease at an earlier stage and pre‐symptomatic tumors, which not only enables patients to receive timely and effective treatment but also reduces medical costs and decreases patient mortality by up to 35% . The belief that early detection is the best way to prevent cancer underlies cancer screening …”

Prevenção do câncer de mama: conhecimento de mulheres de uma unidade saúde da família

“…No Canadá, um grupo de mulheres considerou a mamografia como um ponto positivo no rastreamento do câncer de mama, manifestando que esse exame é a melhor forma de se proteger contra a doença, especialmente por a temerem e ter empatia com quem já a teve. 19 No Reino Unido, em pesquisa qualitativa com 22 mulheres que faziam o rastreamento para o câncer de mama e com 18 profissionais entre radiologistas e técnicos em radiologia, as mulheres não percebiam qualquer risco relacionado ao exame mamográfico, conferindo a ideia de que os desconfortos ocasionados era algo inevitável para uma razão importante, levando em conta o ditado popular: "É melhor prevenir, do que remediar". Declararam que faltava preparo para iniciarem a experiência do rastreio mamográfico, salientando que seria válido um encontro com o profissional anteriormente ao exame a fim de conhecerem e terem orientações adequadas sobre o procedimento, embora tenham percebido ajustes nos mamógrafos que as deixavam mais confortáveis.…”

“…Em um estudo, o medo esteve relacionado com o desconforto e com as radiações do exame mamográfico. 19 Outra pesquisa evidenciou que mulheres mencionavam a dor com frequência na experiência com a mamografia, relacionada à compressão da mama, sendo que algumas participantes chegaram a referir que tinham que "lutar" para suportar a dor. 20 Em uma revisão sistemática meta-síntese qualitativa, que objetivou identificar as barreiras para o rastreamento do câncer de mama, foi evidenciado o medo da dor e a possibilidade de o exame apontar a doença.…”

Changes in the uptake of screening for prostate cancer with prostate-specific antigen in Ontario between 2003 to 2012

“…Non opportunistic was defined as meeting the Ontario PSA guidelines and included men who reported having had a PSA test within one year of survey participation (Driedger et al, 2017). We then used the newly created variable (opportunistic yes/no) as a dichotomous dependent variable and fitted logistic regression models in order to examine the influence of selected factors on the likelihood of opportunistic and non-opportunistic PSA testing.…”

“…Studies suggest that men are passive information gatherers when seeking PC screening, rather than active information seekers. Key sources of information included the Internet for active information-seekers and their family doctor and healthcare professionals for passive information-gatherers (Beaulac, Fry & Onysko, 2006;Driedger et al, 2017;Jamies et al, 2017;McAlpine et al, 2018;Saab et al, 2018). Nurses are in a unique Some post-sec 2274 2388 0.9 (0.6-0.9) 1.4 (1.1-1.7) 88 1643 0.9 (0.7-1.1) 1.9 (1.3-2.6) Post-sec grad 180 205 0.9 (0.7-0.9) 1.5 (1.3-1.5) 2554 300 0.9 (0.7-0.9) 2.…”