Sociodemographic factors and strategies in colorectal cancer screening: a narrative review and practical recommendations.

Background: Worldwide colorectal cancer is a frequently occurring cancer with a high disease burden. It is the second most frequent cancer in women and the third in men. The incidence of colorectal cancer is increasing because of ageing and unhealthy lifestyles.Aim: We aimed to perform a narrative literature review on methods and strategies for screening for colorectal cancer prior to colonoscopy.Design: Narrative literature review.Methods: The databases PubMed, Web of Science, Embase and The Cochrane Library were searched using keywords: 'colorectal cancer', '(mass) screening', 'occult blood', 'prevention', 'socioeconomic status', 'early diagnosis', 'Europe' and 'ethnicity'/'ethnic groups'.Results: 18 articles were included. Multiple randomised controlled trials have shown that screening programmes with faecal occult blood tests (FOBT), guaiac-FOBT (gFOBT) and immunochemical FOBT (iFOBT) represent a valid prevention strategy. Most studies favour iFOBT, because of ease to use, resulting in a higher uptake of screening, as well as a higher detection rate. A higher uptake is also achieved by mailing of the test. Overall the uptake of screening is higher in women, although more cancers are diagnosed in men. This can be explained by a lower sensitivity of FOBT in women. Furthermore, a strong correlation was found between a low socio-economic status and a low uptake of screening. The screening age lies between 50-74 years.Conclusion: Colorectal cancer is characterized by a significant incidence, morbidity and mortality. Systematic screening is effective for early detection. A non-selective test with iFOBT currently has the best validity with a higher sensitivity in men.

Patient perspectives on electronic health record accessibility and patient participation: a questionnaire survey.

Objectives To explore patient perceptions on personal comfort with participation in their own care process and on support of this patient participation through electronic health record (EHR) accessibility. Methods Explorative quantitative questionnaire study in ambulatory patients visiting the departments of General Internal Medicine or Head, Neck and Maxillo-Facial Surgery of a Belgian tertiary referral center. Results Patients were recruited by convenience sampling of 438 out of the total of 1270 patients visiting either one of these departments within a time period of two weeks. Overall response rate was 97.3% (n = 426; 45.3% male; mean age 42.5 ± 15.4 years). Most patients (89.7%) indicated a desire to make healthcare decisions in partnership with their physician. They were in need of transparent and comprehensible health information. The EHR was perceived as a suitable and effective means to inform patients about their health and to increase involvement in care and treatment (77.6%). Furthermore, access to the EHR was perceived to result in a more effective communication transfer between physician and patient (65.5%), increased patient compliance (64.3%), and satisfaction (57.4%). Conclusion Patients indicate a desire for proactive participation in their individual care process. They felt that medical record accessibility could support decision-making and assist in managing and coordinating individual and personalized care choices.

Seen through the patients' eyes: Safety of chronic illness care.

OBJECTIVE: Due to the increasing burden of chronic diseases, a considerable part of care delivery will continue to shift from secondary to primary care, and home care settings. Despite the growing importance of primary care, concerns about the safety of patients in hospitals have thus far driven most research in the field. Therefore, the present study sought to explore patients' perceptions and experiences of the safety of primary chronic care. DESIGN: An observational, cross-sectional study design was applied. PARTICIPANTS: Participants were recruited from the Flemish Patients' Platform, an independent organization that defends patients' rights and strives for more care quality. MAIN OUTCOME MEASURE(S): An online questionnaire was designed to assess: socio-demographic characteristics, medical consumption and patients' perspectives of the quality and safety of chronic care. RESULTS: Respondents (n = 339) had positive perceptions of the safety of primary chronic care as they indicated to receive safe care at home (68.1%), receive enough care support at home (70.8%) and experience good communication between their healthcare professionals (51.6%). Almost one quarter of respondents experienced an incident, mainly related to self-reported fall incidents (50.4%), wrong diagnoses or treatments (37.8%) and adverse drug events (11.8%). Also, more than half of respondents who experienced an incident (64.9%) indicated that poor communication between their healthcare professionals was the main cause. CONCLUSIONS: Information on patients' experiences is critical to identify patient safety incidents and to ultimately reduce patient harm. More research is needed to fully understand patient safety in primary chronic care to further improve patient safety.

Undiagnosed and comorbid disorders in patients with presumed chronic fatigue syndrome.

OBJECTIVE: To assess undiagnosed and comorbid disorders in patients referred to a tertiary care center with a presumed diagnosis of chronic fatigue syndrome (CFS). METHODS: Patients referred for chronic unexplained fatigue entered an integrated diagnostic pathway, including internal medicine assessment, psychodiagnostic screening, physiotherapeutic assessment and polysomnography+multiple sleep latency testing. Final diagnosis resulted from a multidisciplinary team discussion. Fukuda criteria were used for the diagnosis of CFS, DSM-IV-TR criteria for psychiatric disorders, ICSD-2 criteria for sleep disorders. RESULTS: Out of 377 patients referred, 279 (74.0%) were included in the study [84.9% female; mean age 38.8years (SD 10.3)]. A diagnosis of unequivocal CFS was made in 23.3%. In 21.1%, CFS was associated with a sleep disorder and/or psychiatric disorder, not invalidating the diagnosis of CFS. A predominant sleep disorder was found in 9.7%, 19.0% had a psychiatric disorder and 20.8% a combination of both. Only 2.2% was diagnosed with a classical internal disease. In the total sample, a sleep disorder was found in 49.8%, especially obstructive sleep apnea syndrome, followed by psychophysiologic insomnia and periodic limb movement disorder. A psychiatric disorder was diagnosed in 45.2%; mostly mood and anxiety disorder. CONCLUSIONS: A multidisciplinary approach to presumed CFS yields unequivocal CFS in only a minority of patients, and reveals a broad spectrum of exclusionary or comorbid conditions within the domains of sleep medicine and psychiatry. These findings favor a systematic diagnostic approach to CFS, suitable to identify a wide range of diagnostic categories that may be subject to dedicated care.