Impact of provider-patient communication on cancer screening adherence: A systematic review

Peterson, Emily; Ostroff, Jamie S.; DuHamel, Katherine N.; D’Agostino, Thomas A.; Hernandez, Marisol; Canzona, Mollie Rose; Bylund, Carma L.

doi:10.1016/j.ypmed.2016.09.034

Cited by 209 publications

(156 citation statements)

References 74 publications

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“…An expanded menu of screening options may lead to increased CRC screening, and previous research has shown greater screening uptake when patients are offered a choice of test options that is consistent with their preferences (Inadomi et al, 2012; Smith et al, 2017). Additional strategies to boost CRC screening rates have also been described by others and emphasize the importance of identifying unscreened individuals in a systematic way; implementing evidence-based strategies for CRC screening; addressing barriers to screening such as cost, access to a primary care provider, and access to CRC treatment; and providing clear recommendations and guidance for screening (Gupta et al, 2014; Peterson et al, 2016; Yabroff et al, 2011; Goebel et al, 2015). In particular, others have called for targeted efforts to improve screening rates among underserved populations who may lack a usual source of care and experience unique financial barriers to screening, particularly in the case of the uninsured and individuals who live in states where colorectal cancer screening is not covered by Medicaid (Gupta et al, 2014; Goebel et al, 2015).…”

Section: Discussionmentioning

confidence: 99%

Colorectal cancer screening in the United States: Trends from 2008 to 2015 and variation by health insurance coverage

Moor

Cohen

Shapiro

et al. 2018

Preventive Medicine

124

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Regular colorectal cancer (CRC) screening is recommended for reducing CRC incidence and mortality. This paper provides an updated analysis of CRC screening in the United States (US) and examines CRC screening by several features of health insurance coverage. Recommendation-consistent CRC screening was calculated for adults aged 50–75 in 2008, 2010, 2013 and 2015 using data from the National Health Interview Survey. CRC screening prevalence in 2015 was described overall and by sociodemographic subgroups. CRC screening by health insurance coverage was further examined using multivariable logistic regression, stratified by age (50–64 years and 65–75 years) and adjusted for age, race/ethnicity, sex, education, income, time in US, and comorbid conditions. Recommendation-consistent screening increased from 51.6% in 2008 to 58.3% in 2010 (p < 0.001). Use plateaued from 2010 to 2013 but increased to 61.3% in 2015 (p < 0.001). In 2015, adults aged 50–64 years with traditional employer-sponsored private insurance were more likely to be screened (62.2%) than those with traditional private direct purchase plans (50.9%) and the uninsured (24.8%) (p < 0.01, respectively). After multivariable adjustment, differences between traditional employer-sponsored private insurance and the uninsured remained statistically significant. Adults aged 65–75 with Medicare and private insurance were more likely to be screened (76.3%) than those with Medicare, no supplemental insurance (68.8%) or Medicare and Medicaid (65.2%) (p < 0.001). After multivariable adjustment, the differences between Medicare and private insurance and Medicare no supplemental insurance remained statistically significant. CRC screening rates have increased over time, but certain segments of the population, especially the uninsured, continue to screen below recommended levels.

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Section: Discussionmentioning

confidence: 99%

Colorectal cancer screening in the United States: Trends from 2008 to 2015 and variation by health insurance coverage

Moor

Cohen

Shapiro

et al. 2018

Preventive Medicine

124

View full text Add to dashboard Cite

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“…A systematic review of the impact of clinician-patient communication on cancer screening showed that whether or not a clinician recommended screening only explained some of the screening behavior; the quality and content of the communication were also influential. 28 Currently, clinicians use a variety of approaches to discuss cessation of screening without clear best practices. 41 Our results add to the literature by showing that many participants preferred explanations that included individualized health status but disliked explanations that mentioned life expectancy with a negative framing (“you may not live long enough to benefit from this test”).…”

Section: Discussionmentioning

confidence: 99%

Older Adults’ Views and Communication Preferences About Cancer Screening Cessation

et al. 2017

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IMPORTANCE Older adults with limited life expectancy are frequently screened for cancer even though it exposes them to risks of screening with minimal benefit. Patient preferences may be an important contributor to continued screening.OBJECTIVE To examine older adults' views on the decision to stop cancer screening when life expectancy is limited and to identify older adults' preferences for how clinicians should communicate recommendations to cease cancer screening. DESIGN, SETTING, AND PARTICIPANTSIn this semistructured interview study, we interviewed 40 community-dwelling older adults (Ն 65 years) recruited at 4 clinical programs affiliated with an urban academic medical center. MAIN OUTCOMES AND MEASUREWe transcribed the audio recorded discussions and analyzed the transcripts using standard techniques of qualitative content analysis to identify major themes and subthemes. RESULTSThe participants' average age was 75.7 years. Twenty-three participants (57.5%) were female; 25 (62.5%) were white. Estimated life expectancy was less than 10 years for 19 participants (47.5%). We identified 3 key themes. First, participants were amenable to stopping cancer screening, especially in the context of a trusting relationship with their clinician. Second, although many participants supported using age and health status to individualize the screening decision, they did not often understand the role of life expectancy. All except 2 participants objected to a Choosing Wisely statement about not recommending cancer screening in those with limited life expectancy, often believing that clinicians cannot accurately predict life expectancy. Third, participants preferred that clinicians explain a recommendation to stop screening by incorporating individual health status but were divided on whether life expectancy should be mentioned. Specific wording of life expectancy was important; many felt the language of "you may not live long enough to benefit from this test" was unnecessarily harsh compared with the more positive messaging of "this test would not help you live longer." CONCLUSIONS AND RELEVANCEAlthough research and clinical practice guidelines recommend using life expectancy to inform cancer screening, older adults may not consider life expectancy important in screening and may not prefer to hear about life expectancy when discussing screening. The described communication preferences can help inform future screening discussions. Better delineating patient-centered approaches to discuss screening cessation is an important step toward optimizing cancer screening in older adults.

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“…For both screening tests, a recent systematic review highlighted the importance of a physician's recommendation for screening to increase cancer screening rates (Peterson et al, 2016). Although it is unknown how effective these recommendations are for women with ID it has been documented that communication between obstetric and gynecologic providers and women with ID is problematic (Phillips et al, 2004; Dovey and Webb, 2000), and therefore, education of physicians about effective communication with women who have ID may have the potential to reduce disparities.…”

Section: Discussionmentioning

confidence: 99%

A longitudinal assessment of adherence to breast and cervical cancer screening recommendations among women with and without intellectual disability

McDermott

Mann

et al. 2017

Preventive Medicine

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Each year in the United States, about 4000 deaths are attributed to cervical cancer, and over 40,000 deaths are attributed to breast cancer (U.S. Cancer Statistics Working Group, 2015). The purpose of this study was to identify predictors of full, partial, and no screening for breast and cervical cancer among women with and without intellectual disability (ID) who are within the age group for screening recommended by the U.S. Preventive Service Task Force (USPSTF), while accounting for changes in recommendations over the study period. Women with ID and an age matched comparison group of women without ID were identified using merged South Carolina Medicaid and Medicare files from 2000 to 2010. The sample consisted of 9406 and 16,806 women for mammography screening and Papanicolaou (Pap) testing adherence, respectively. We estimated multinomial logistic regression models and determined that women with ID were significantly less likely than women without ID to be fully adherent compared to no screening with mammography recommendations (adjusted odds ratio [AOR]: 0.63, 95% confidence interval [CI] 0.55–0.72), and Pap testing recommendations (AOR: 0.17, 95% CI 0.16–0.19). For the 70% of women with ID for whom we had residential information, those who lived in a group home, medical facility, or supervised community living setting were more likely to be fully adherent with both preventive services than those living alone or with family members. For both outcomes, women residing in a supervised nonmedical community living setting had the highest odds of full adherence, adjusting for other covariates.

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Impact of provider-patient communication on cancer screening adherence: A systematic review

Cited by 209 publications

References 74 publications

Colorectal cancer screening in the United States: Trends from 2008 to 2015 and variation by health insurance coverage

Colorectal cancer screening in the United States: Trends from 2008 to 2015 and variation by health insurance coverage

Older Adults’ Views and Communication Preferences About Cancer Screening Cessation

A longitudinal assessment of adherence to breast and cervical cancer screening recommendations among women with and without intellectual disability

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