Abstract
BackgroundAppropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. Several high-quality systematic reviews and practice guidelines exist to inform the most effective screening options. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. We developed an implementation guideline to answer the question: What interventions have been shown to increase the uptake of cancer screening by individuals, specifically for breast, cervical, and colorectal cancers?MethodsA guideline panel was established as part of Cancer Care Ontario's Program in Evidence-based Care, and a systematic review of the published literature was conducted. It yielded three foundational systematic reviews and an existing guidance document. We conducted updates of these reviews and searched the literature published between 2004 and 2010. A draft guideline was written that went through two rounds of review. Revisions were made resulting in a final set of guideline recommendations.ResultsSixty-six new studies reflecting 74 comparisons met eligibility criteria. They were generally of poor to moderate quality. Using these and the foundational documents, the panel developed a draft guideline. The draft report was well received in the two rounds of review with mean quality scores above four (on a five-point scale) for each of the items. For most of the interventions considered, there was insufficient evidence to support or refute their effectiveness. However, client reminders, reduction of structural barriers, and provision of provider assessment and feedback were recommended interventions to increase screening for at least two of three cancer sites studied. The final guidelines also provide advice on how the recommendations can be used and future areas for research.ConclusionUsing established guideline development methodologies and the AGREE II as our methodological frameworks, we developed an implementation guideline to advise on interventions to increase the rate of breast, cervical and colorectal cancer screening. While advancements have been made in these areas of implementation science, more investigations are warranted.
Highlights
Cancer screening has the capacity to reduce morbidity and mortality from disease [1]
The Cancer Screening Uptake Expert Panel in partnership with the practice guidelines program of the Ontario cancer system, Cancer Care Ontario’s Program in Evidence-based Care, came together to develop an implementation guideline to identify and recommend appropriate interventions to increase the uptake of screening for breast, cervical, and colorectal cancers (CRCs)
Three foundational systematic reviews [10-12], additional trial data [16-89] and the original recommendations of the United States (US) Task Force [13] served as the evidentiary foundation to inform the guideline recommendations reported here
Summary
Cancer screening has the capacity to reduce morbidity and mortality from disease [1]. National, and regional guidelines exist that provide recommendations on which screening manoeuvres are to identify and recommend appropriate interventions to increase the uptake of screening for breast, cervical, and colorectal cancers (CRCs). The specific guideline question we asked was: What interventions have been shown to increase the uptake of cancer screening by individuals, for breast, cervical, and CRCs?. Population-based interventions aimed to increase the demand for cancer screening, including client reminders, client incentives, mass media, small media, group education, and one-on-one education. Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. We developed an implementation guideline to answer the question: What interventions have been shown to increase the uptake of cancer screening by individuals, for breast, cervical, and colorectal cancers?
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