Personalized cancer screening: helping primary care rise to the challenge

Selby, Kevin; Bartlett-Esquilant, Gillian; Cornuz, Jacques

doi:10.1186/s40985-018-0083-x

Cited by 26 publications

(24 citation statements)

References 20 publications

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“…In light of these inconsistencies in guidelines available to primary care providers, and the increasing evidence on the harms of overdiagnosis, the decision of whether or when to screen is no longer clinically or ethically obvious for average-risk women. Little is known about how primary care providers deal with these challenges in their clinical practice despite their important role in the promotion of preventive health services such as mammography screening [ 15 ]. Since primary care providers are known to influence the decision-making process of women considering screening programs [ 16 ], it is crucial to understand their perspectives regarding mammography screening and how they manage this decision-making in practice.…”

Section: Introductionmentioning

confidence: 99%

Scrutinizing screening: a critical interpretive review of primary care provider perspectives on mammography decision-making with average-risk women

2018

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ContextA decision to undertake screening for breast cancer often takes place within the primary care setting, but current controversies such as overdiagnosis and inconsistent screening recommendations based on evolving evidence render this a challenging process, particularly for average-risk women. Given the responsibility of primary care providers in counseling women in this decision-making process, it is important to understand their thoughts on these controversies and how they manage uncertainty in their practice.ObjectiveTo review the perspectives and approaches of primary care providers regarding mammography decision-making with average-risk women.Design and methodsThis study is a critical interpretive review of peer-review literature that reports primary care provider perspectives on mammography screening decision-making. Ovid MEDLINE®, Ovid PsycInfo, and Scopus databases were searched with dates from 2002 to 2017 using search terms related to mammography screening, uncertainty, counseling, decision-making, and primary health care providers.ResultsNine articles were included following a review process involving the three authors. Using an inductive and iterative approach, data were grouped into four thematic categories: (1) perceptions on the effectiveness of screening, screening initiation age, and screening frequency; (2) factors guiding primary care providers in the screening decision-making process, including both provider and patient-related factors, (3) uncertainty faced by primary care providers regarding guidelines and screening discussions with their patients; and (4) informed decision-making with average-risk women, including factors that facilitate and hinder this process.DiscussionThe discussion of results addresses several factors about the diversity of perspectives and practices of physicians counseling average-risk women regarding breast cancer screening. This has implications for the challenge of understanding and explaining evidence, what should be shared with average-risk women considering screening, the forms of knowledge that physicians value to guide screening decision-making, and the consent process for population-based screening initiatives. Within the data, there was little attention placed on how physicians coped with uncertainty in practice. Given the dual responsibility of physicians in caring for both individuals and the larger population, further research should probe more deeply into how they balance their duties to individual patients with those to the larger population they serve.

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Section: Introductionmentioning

confidence: 99%

Scrutinizing screening: a critical interpretive review of primary care provider perspectives on mammography decision-making with average-risk women

2018

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“…Personalized screening approaches can optimize the e ciency, equity, and safety of cancer screening, but will require precise and comprehensive patient information (34). Recent studies show that accurate and detailed information can support personalizes prevention strategies (24,35,36).…”

Section: Discussionmentioning

confidence: 99%

“…Recent studies show that accurate and detailed information can support personalizes prevention strategies (24,35,36). It has been emphasized that screening recommendations require comprehensive patient information (34). information is an integral part of the more e cient individual screening (22).…”

Section: Discussionmentioning

confidence: 99%

Development of Information Road map for Personalized Colorectal Cancer Screening in Iran

Maserat

Mohammadzadeh

Zali

2020

Preprint

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Background A data-driven colorectal cancer screening strategy based on personalized approach can improve health outcomes, facilitate early stratification of at-risk patients and reduce health care costs. This study aims to develop an information road map for personalized colorectal cancer screening in Iran. Methods This study is a Mix-Method Research (MMR) which consisted of three phases: phase I, development of a checklist with 275-items for assessing required data elements of personalized colorectal cancer screening; phase II, situational analysis of colorectal cancer screening dataset according to the checklist; phase III, development of national information road map for personalized colorectal cancer screening with in-depth interview and focus groups. Results Personalized datasets of colorectal cancer screening were defined in four dimensions, including clinical dataset (5 sub-dimensions, 162 items), genetic dataset (2 sub-dimensions, 67 items), demographic dataset (1 sub-dimension, 6 items) and a social determinant dataset (3 sub-dimensions, 40 items). The next step data elements of colorectal cancer screening based on personalized datasets were analyzed. Of the 275-items, only 96 items are recorded. Only 17.8% of clinical dataset of screening program were entered. The highest data elements of clinical dimension were related to pathological datasets (53.6%) in the present screening program. The lowest data elements of the clinical dimensions were related to the clinical history dataset (3.4%). 73% of pedigree data elements and 15.33% of social determinant datasets were entered. In the final step, a national information road map of personalized CRC screening with 6 layers (information leadership, personalized datasets, data integration, data architecture, data descriptor, and screening program layers) was developed. Conclusion Personalized screening based on integration dataset play a key role for the successful implementation of the screening program. Eliminating data deficiencies can improve the quality of documentation and may lead to improved screening performance. Therefore, standard datasets and indicators can help to identify information gaps and facilitate precise decision-making. Entering data was inadequate and poor in this study. Implementation of national road map can assist to improve the quality of data in personalized screening.

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“…Recommendations are increasingly based on individual patient preferences, medical history, genetic and environmental risk factors, and level of interaction with the healthcare system. Current examples include choices between colonoscopy, fecal testing, and emerging tests for colorectal cancer screening; the use of genetic information and availability of home self-testing in cervical cancer screening; the integration of multiple risk factors and patient preferences to decide the intensity and length of breast cancer screening; and the issues of smoking cessation and finally, competing priorities when deciding whether or not to pursue lung cancer screening (Pernas et al 2017 ; Selby et al 2018 ).…”

Section: Future Directionsmentioning

confidence: 99%

THE FUTURE OF MEDICINE, healthcare innovation through precision medicine: policy case study of Qatar

Qoronfleh

Chouchane

Mifsud

et al. 2020

Life Sci Soc Policy

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In 2016, the World Innovation Summit for Health (WISH) published its Forum Report on precision medicine “PRECISION MEDICINE - A GLOBAL ACTION PLAN FOR IMPACT”. Healthcare is undergoing a transformation, and it is imperative to leverage new technologies to generate new data and support the advent of precision medicine (PM). Recent scientific breakthroughs and technological advancements have improved our disease knowledge and altered diagnosis and treatment approaches resulting in a more precise, predictive, preventative and personalized health care that is customized for the individual patient. Consequently, the big data revolution has provided an opportunity to apply artificial intelligence and machine learning algorithms to mine such a vast data set. Additionally, personalized medicine promises to revolutionize healthcare, with its key goal of providing the right treatment to the right patient at the right time and dose, and thus the potential of improving quality of life and helping to bring down healthcare costs. This policy briefing will look in detail at the issues surrounding continued development, sustained investment, risk factors, testing and approval of innovations for better strategy and faster process. The paper will serve as a policy bridge that is required to enhance a conscious decision among the powers-that-be in Qatar in order to find a way to harmonize multiple strands of activity and responsibility in the health arena. The end goal will be for Qatar to enhance public awareness and engagement and to integrate effectively the incredible advances in research into healthcare systems, for the benefit of all patients. The PM policy briefing provides concrete recommendations on moving forward with PM initiatives in Qatar and internationally. Equally important, integration of PM within a primary care setting, building a coalition of community champions through awareness and advocacy, finally, communicating PM value, patient engagement/empowerment and education/continued professional development programs of the healthcare workforce. Key recommendations for implementation of precision medicine inside and outside Qatar: Create Community Awareness and PM Education Programs Engage and Empower Patients Communicate PM Value Develop appropriate Infrastructure and Information Management Systems Integrate PM into standard Healthcare System and Ensure Access to Care PM is no longer futuristic. It is here. Implementing PM in routine clinical care does require some investment and infrastructure development. Invariably, cost and lack of expertise are cited as barriers to PM implementation. Equally consequential, are the curriculum and professional development of medical care experts. Policymakers need to lead and coordinate effort among stakeholders and consider cultural and faith perspectives to ensure success. It is essential that policymakers integrate PM approaches into national strategies to improve health and health care for all, and to drive towards the future of medicine precision health.

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Personalized cancer screening: helping primary care rise to the challenge

Cited by 26 publications

References 20 publications

Scrutinizing screening: a critical interpretive review of primary care provider perspectives on mammography decision-making with average-risk women

Scrutinizing screening: a critical interpretive review of primary care provider perspectives on mammography decision-making with average-risk women

Development of Information Road map for Personalized Colorectal Cancer Screening in Iran

THE FUTURE OF MEDICINE, healthcare innovation through precision medicine: policy case study of Qatar

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