Telephone risk-based eligibility assessment for low-dose CT lung cancer screening.

Eligibility for lung cancer screening (LCS) requires assessment of lung cancer risk, based on smoking history alongside demographic and medical factors. Reliance on individual face-to-face eligibility assessment risks inefficiency and costliness. The SUMMIT Study introduced a telephone-based lung cancer risk assessment to guide invitation to face-to-face LCS eligibility assessment, which significantly increased the proportion of face-to-face attendees eligible for LCS. However, levels of agreement between phone screener and in-person responses were lower in younger individuals and minority ethnic groups. Telephone-based risk assessment is an efficient way to optimise selection for LCS appointments but requires further iteration to ensure an equitable approach.

Stakeholder Research Priorities to Promote Implementation of Shared Decision-Making for Lung Cancer Screening: An American Thoracic Society and Veterans Affairs Health Services Research and Development Statement.

Rationale: Shared decision-making (SDM) for lung cancer screening (LCS) is recommended in guidelines and required by Medicare, yet it is seldom achieved in practice. The best approach for implementing SDM for LCS remains unknown, and the 2021 U.S. Preventive Services Task Force calls for implementation research to increase uptake of SDM for LCS. Objectives: To develop a stakeholder-prioritized research agenda and recommended outcomes to advance implementation of SDM for LCS. Methods: The American Thoracic Society and VA Health Services Research and Development Service convened a multistakeholder committee with expertise in SDM, LCS, patient-centered care, and implementation science. During a virtual State of the Art conference, we reviewed evidence and identified research questions to address barriers to implementing SDM for LCS, as well as outcome constructs, which were refined by writing group members. Our committee (n = 34) then ranked research questions and SDM effectiveness outcomes by perceived importance in an online survey. Results: We present our committee's consensus on three topics important to implementing SDM for LCS: 1) foundational principles for the best practice of SDM for LCS; 2) stakeholder rankings of 22 implementation research questions; and 3) recommended outcomes, including Proctor's implementation outcomes and stakeholder rankings of SDM effectiveness outcomes for hybrid implementation-effectiveness studies. Our committee ranked questions that apply innovative implementation approaches to relieve primary care providers of the sole responsibility of SDM for LCS as highest priority. We rated effectiveness constructs that capture the patient experience of SDM as most important. Conclusions: This statement offers a stakeholder-prioritized research agenda and outcomes to advance implementation of SDM for LCS.

Targeted encouragement of GP consultations for possible cancer symptoms: a randomised controlled trial.

BACKGROUND: For some common cancers, survival is lower in the UK than in comparable high-income countries. AIM: To assess the effectiveness of a targeted postal intervention (to promote awareness of cancer symptoms and earlier help seeking) on patient consultation rates. DESIGN AND SETTING: A two-arm randomised controlled trial was carried out on patients aged 50-84 years registered at 23 general practices in rural and urban areas of Greater London, Greater Manchester, and the North East of England. METHOD: Patients who had not had a consultation at their general practice in the previous 12 months and had at least two other risk factors for late presentation with cancer were randomised to intervention and control arms. The intervention consisted of a posted letter and leaflet. Primary outcome was the number of consultations at the practice with patients randomised to each arm in the 6 months subsequent to posting the intervention. All patients with outcome data were included in the intention-to-treat analyses. RESULTS: In total, 1513 patients were individually randomised to the intervention (n = 783) and control (n = 730) arms between Nov 2016 - May 2017; outcome data were available for 749 and 705 patients, respectively, with a statistically significantly higher rate of consultation in the intervention arm compared with the control arm: 436 versus 335 consultations (relative risk 1.40, 95% confidence interval = 1.11 to 1.77, P = 0.004). There was, however, no difference in the numbers of patients consulting. CONCLUSION: Targeted interventions of this nature can change behaviour; there is a need to develop interventions that can be more effective at engaging patients with primary care. This study demonstrates that targeted interventions promoting both awareness of possible cancer symptoms and earlier health seeking, can change behaviour. There is a need to develop and test interventions that can be more effective at engaging the most at-risk patients.

Examining Facilitators of HPV Vaccination Uptake in Men Who Have Sex with Men: A Cross-Sectional Survey Design.

Men who have sex with men (MSM) in England are eligible for vaccination against human papillomavirus (HPV) via specialist sexual health services and HIV clinics. Uptake among clinic attendees is incomplete, but the reason for this is unclear. We do not know who is accessing and being offered the vaccine. This cross-sectional study conducted in England examined socio-demographic correlates of vaccine uptake for MSM and how frequently the vaccine is being offered in clinics. MSM completed an online questionnaire asking about socio-demographic characteristics, whether they had recently attended a sexual health or HIV clinic, and if so, whether they had been offered the vaccine, and vaccination status. Around 52% of MSM (N = 115; mean age = 30.2) had received at least one dose of the vaccine, and 70% of clinic attendees had been offered the vaccine. MSM were more likely to have initiated the vaccine series if they were homosexual (versus bisexual; OR: 5.22; 95% CI: 1.55-17.51) or had heard about the vaccine from one or two types of sources (versus no sources: OR: 14.70; 95% CI: 4.00-54.00 and OR: 26.00; 5.74-117.77 respectively). Initiation was not associated with age, ethnicity, education level, or number of sexual partners. Hepatitis B vaccination status was associated with vaccination initiation only in unadjusted models. The majority of eligible MSM are being offered the vaccine in clinics. Socio-demographic differences in uptake of the HPV vaccine among MSM may lead to inequalities in HPV-related disease.

Cancer Symptom Recognition and Anticipated Delays in Seeking Care Among U.S. Adults.

INTRODUCTION: Early stage diagnosis strongly predicts cancer survival. Recognition of potential symptoms of cancer may improve survival by reducing time to seeking care. METHODS: Telephone interviews with a population-representative sample of English-speaking adults (aged ≥50 years) in the U.S. (N=1,425) were conducted in 2014 using an instrument adapted from the International Cancer Benchmarking Partnership Awareness and Beliefs about Cancer survey. Anticipated time to seeking care for four cancer symptoms (persistent cough, rectal bleeding, mole changes, and breast changes) was assessed, and delay was defined as waiting >2 weeks. Recognition of symptoms as potential cancer signs was assessed dichotomously. Multivariate logistic regression models were used to assess associations between symptom recognition and anticipated delay, adjusting for demographics, cancer experience, self-reported health, and healthcare access. Analyses were weighted and conducted in 2017. RESULTS: Symptom recognition varied but was relatively high across all symptoms (76.9%-95.5%). Anticipated delay varied by symptom and was highest for persistent cough (41.2%) and lowest for rectal bleeding (9.1%). For rectal bleeding (AOR=2.65, 95% CI=1.31, 5.36) and mole changes (AOR=3.30, 95% CI=1.48, 7.33), anticipated delay was more likely among individuals who did not recognize the symptom as a warning sign. Adults with lower education levels (p<0.05) and African Americans (p<0.05) were less likely to delay for some symptoms. CONCLUSIONS: Lack of symptom recognition was associated with anticipated delay in seeking care for some cancer symptoms. Differences in recognition and delays by symptom could be driven partly by screening messaging or by ambiguity and functional impact of each symptom.

Socioeconomic inequalities in attitudes towards cancer: an international cancer benchmarking partnership study.

Socioeconomic status (SES) differences in attitudes towards cancer have been implicated in the differential screening uptake and the timeliness of symptomatic presentation. However, the predominant emphasis of this work has been on cancer fatalism, and many studies focus on specific community subgroups. This study aimed to assess SES differences in positive and negative attitudes towards cancer in UK adults. A population-based sample of UK adults (n=6965, age≥50 years) completed the Awareness and Beliefs about Cancer scale, including six belief items: three positively framed (e.g. 'Cancer can often be cured') and three negatively framed (e.g. 'A cancer diagnosis is a death sentence'). SES was indexed by education. Analyses controlled for sex, ethnicity, marital status, age, self-rated health, and cancer experience. There were few education-level differences for the positive statements, and overall agreement was high (all>90%). In contrast, there were strong differences for negative statements (all Ps<0.001). Among respondents with lower education levels, 57% agreed that 'treatment is worse than cancer', 27% that cancer is 'a death sentence' and 16% 'would not want to know if I have cancer'. Among those with university education, the respective proportions were 34, 17 and 6%. Differences were not explained by cancer experience or health status. In conclusion, positive statements about cancer outcomes attract near-universal agreement. However, this optimistic perspective coexists alongside widespread fears about survival and treatment, especially among less-educated groups. Health education campaigns targeting socioeconomically disadvantaged groups might benefit from a focus on reducing negative attitudes, which is not necessarily achieved by promoting positive attitudes.