Increasing cervical cancer screening participation: a cluster-randomized pilot study at a department of gynaecology.

Background Cervical cancer is a preventable cancer due to vaccination and screening. In Spain 80% of new cases of cervical cancer are women that haven't ever participated in screening programmes. It is outlined if this participation is properly done and if cervical cancer screening is still a challenge for public health in Spain. Our aims are to estimate cervical cancer screening coverage, distinguishing female participation ever and participation every three years according to current recommendations, and to identify the associated factors with participation in the screening. Methods An analysis from a subpopulation of the European Health Survey in Spain in 2020 was conducted. Women between 25 and 65 years old that answered the Adult and Home questionnaires were included. Our main variables were “not participating ever in cervical cancer screening”, and “incorrect participation”. A descriptive analysis of the variables and logistic regression models were developed to identify the determinants for the participation in cervical cancer screening. Results 6924 women fulfilled the selection criteria. The percentage of not participating ever in cervical cancer screening was 11.7%. The percentage of incorrect regularity of participation was 18.0%. Young and elderly women, low socio-economic educational level, sedentary lifestyle, absence of private health insurance, good self-perceived health and working as informal carer were associated with deficient women's participation in screening. Conclusions Despite high percentage of participation in cervical cancer screening, the frequency of women that participate correctly can be improved. Socio-economic factors, health perception and assurance, lifestyle, and informal care, have an influence in producing disparities in women's participation and regularity in cervical cancer screening. Future studies are needed to analyse the association among lifestyles, role of carer women and coverage of cervical cancer screening. Key messages • Impact of social determinants of health have been recognised in cervical cancer screening. • Specific programs for vulnerable women are needed to improve their participation in cervical cancer screening.

An outpatient nursing nutritional intervention to prehabilitate undernourished patients planned for surgery: A multicentre, cluster-randomised pilot study.

ObjectivesDespite the possibility of early detection of cervical cancer, participation in screening programmes among young Koreans is low. We sought to identify associations between risk factors and participation in screening...

Compliance with cancer screening guidelines is crucial for the early diagnosis and prevention of cancer. We explored the association of suicidal ideation with participation in cancer screening programs. This cross-sectional analysis included a nationwide sample consisting of 22,554 Korean adults (9667 men and 12,887 women). Suicidal ideation in the past year was self-reported (yes or no). Participation in gastric, colorectal, cervical, and breast cancer screening within the past 2 years was assessed. Logistic regression models were employed to determine the association of suicidal ideation with participation in each cancer screening test. Odds ratios (ORs) and 95% confidence intervals (CIs) were estimated. Among men, the participation rates in gastric and colorectal cancer screening were 47.6% and 39.7%, respectively. Among women, the participation rates in gastric, colorectal, cervical, and breast cancer screening were 47.1%, 34.8%, 44.3%, and 50.8%, respectively. In the male sample, suicidal ideation was associated with reduced participation in gastric cancer screening (OR: 0.83, 95% CI: 0.69-0.99) and colorectal cancer screening (OR: 0.82, 95% CI: 0.67-1.00). Similarly, in the female sample, suicidal ideation was inversely associated with participation in gastric (OR: 0.74, 95% CI: 0.67-0.82), colorectal (OR: 0.71, 95% CI: 0.62-0.81), cervical (OR: 0.75, 95% CI: 0.68-0.84), and breast cancer screening (OR: 0.76, 95% CI: 0.68-0.84). This study suggests that individuals with suicidal ideation demonstrated reduced participation in cancer screening tests. This study highlights the need for targeted support to improve access to cancer screening programs for individuals with mental health problems.

BackgroundOlder adults often use complementary medicine; however, very few interventional studies have focused on them. The aim of this study was to evaluate the feasibility and to obtain preliminary data on effectiveness of an Integrative Medicine (IM) program compared to usual medical care.MethodsThe study consisted of older adults living in shared apartment communities including caregiving. The shared apartments were cluster-randomized to the IM program or Usual Care (UC). IM consisted of additional lifestyle modification (exercise and diet), external naturopathic applications, homeopathic treatment, and modification of conventional drug therapy for 12 months. The UC group received conventional care alone. The following outcomes were used: Nurses Observation Scale for Geriatric Patients (NOSGER); Assessment of Motor and Process Skills; Barthel Index; Qualidem; Profile of Wellbeing; and Mini-mental State Examination. Exploratory effect sizes (Cohen’s d, means adjusted for differences of baseline values) were calculated to analyze group differences.ResultsA total of eight shared apartment communities were included; four were allocated to IM (29 patients, median seven patients; [mean ± standard deviation] 82.7 ± 8.6 years) and four to UC (29 patients, median eight patients; 76.0 ± 12.8 years of age). After 12 months, effect sizes ≥0.3 were observed for activities of daily living on the NOSGER-Activities of Daily Living subscale (0.53), Barthel Index (0.30), Qualidem total sum score (0.39), Profile of Wellbeing (0.36), NOSGER-Impaired Social Behavior (0.47), and NOSGER-Depressed Mood subscales (0.40). Smaller or no effects were observed for all other outcomes. The intervention itself was found to be feasible, but elaborate and time consuming.DiscussionThis exploratory pilot study showed that for a full-scale trial, the outcomes of Activities of Daily Living and Quality of Life seem to be the most promising. The results have to be interpreted with care; larger confirmatory trials are necessary to validate the effects.

The importance of screening or repeat screening for cervical and breast cancer is well known to decrease the chance of death from cancer. Few data is avaliable regarding factors associated with participation in cervical and breast cancer screening and repeat screening examinations. This study was to investigate the associations of demographic factors, health status and cancer risk recognition, attitude to cancer screening, health behaviors, and inhibiting or facilitating factors to cervical and breast cancer screening with participation in the screening tests. Data was collected with self-administrated questionnaires from 342 women, aged 40 to 69 years. The cancer screenings were classified into have had or never groups and repeat or not repeated groups. In the case of cervical and breast cancer screening, the have had group was 90 (26.3%), and 82 (24.0%) and the repeat group was 17 (5.0%), and 13 (3.8%) respectively. According to logistic regression analysis, age ( : OR=3.25, 95% CI=1.27-8.26), breast cancer screening (Do vs Don't : OR=14.49, 95% CI=7.46-27.78) and other person's cancer (Yes vs No : OR=4.27, 95% CI=1.01-18.05) were statistically significantly associated with participation in screening for cervical cancer. Regular exercise (Do vs Don't : OR=2.76, 95% CI=1.30-5.88) and cervical cancer screening (Do vs Don't : OR=13.70, 95% CI=7.09-26.32) were statistically significantly related to participation in screening for breast cancer.

C72: Changing patterns of socioeconomic inequalities in women cancer screening in South Korea with ten years follow-up of nationwide cross-sectional study

Cervical cancer screening in the Canadian armed forces: An estimation of screening participation rates using the CF-HERO surveillance system

Self-reported data are prone to item non-response and misreporting. We investigated to what extent the use of self-reported data for participation in breast (BCS) and cervical cancer screening (CCS) impacted socioeconomic inequalities in cancer screening participation. We used data from a large population-based survey including information on cancer screening from self-reported questionnaire and administrative records (n = 14122 for BCS, n = 27120 CCS). For educational level, occupation class and household income per capita, we assessed the accuracy of self-reporting using sensitivity, specificity and both positive and negative predictive value. In addition, we estimated to what extent the use of self-reported data modified the magnitude of socioeconomic differences in BCS and CCS participation with age-adjusted non-screening rate difference, odds ratios and relative indices of inequality. Although women with a high socioeconomic position were more prone to report a date for BCS and CCS in questionnaires, they were also more prone to over-declare their participation in CCS if they had not undergone a screening test within the recommended time frame. The use of self-reported cancer screening data, when compared with administrative records, did not impact the magnitude of social differences in BCS participation but led to an overestimation of the social differences in CCS participation. This was due to misreporting rather than to item non-response. Women's socioeconomic position is associated with missingness and the accuracy of self-reported BCS and CCS participation. Social inequalities in cancer screening participation based on self-reports are likely to be overestimated for CCS.

While cervical cancer is one of the leading cancers among women worldwide, there are a number of effective early detection tests available. However, the participation rates in cervical cancer screening among Korean women remain low. After the nationwide efforts in 1988 and thereafter to encourage participation in cervical cancer screening, few studies have investigated the effects of socioeconomic inequality on participation in cervical cancer screening. The purpose of this study was to investigate 1) the level of socioeconomic disparities in receiving cervical cancer screening by age group and 2) if there was an improvement in reducing these disparities between 1995 and 2001. Using data from the Korean National Health Status, Health Behavior and Belief Survey in 1995, and the Korean National Health and Nutrition Examination Surveys from 1998 and 2001 (sample sizes of 2,297, 3,738, and 3,283), age-standardized participation rates were calculated according to education level, equivalized household income, and job status. Odds ratios and the relative inequality index (RII) were also calculated after controlling for age. Women with lower education levels were less likely to attend the screening test, and the disparities by education level were most pronounced among women aged 60 years and older. The RIIs among women 60 years and older were 3.64, 4.46, and 8.64 in 1995, 1998, and 2001, respectively. Higher rates of participation were reported among those in the highest income category, which was more notable among the middle aged women (40s and 50s). An inconsistent trend in the rate of participation in cervical cancer screening by occupational level was found. Indicators of socioeconomic position seem to have varying impacts on the inequalities in the rates of participation in cervical cancer screening according to age group. These results demonstrate the need for more aggressive and age-based interventions and policy programs to eliminate the remaining inequalities.

BackgroundWe aimed to determine participation rates and factors associated with participation in colorectal (fecal occul blood test) and cervical cancer (Pap-smear) screening among a population of women participating in breast cancer screening.MethodsFrom August to October 2015, a self-administered questionnaire was sent by post to 2 900 women aged 50–65, living in Côte-d’Or, France, and who were up to date with mammogram screening. Polytomic logistic regression was used to identify correlates of participation in both cervical and colorectal cancer screenings. Participation in all 3 screenings was chosen as the reference.ResultsStudy participation rate was 66.3% (n = 1856). Besides being compliant with mammogram, respectively 78.3% and 56.6% of respondents were up to date for cervical and colorectal cancer screenings, while 46.2% were compliant with the 3 screenings. Consultation with a gynecologist in the past year was associated with higher chance of undergoing the 3 screenings or female cancer screenings (p<10–4), when consultation with a GP was associated with higher chance of undergoing the 3 screenings or organized cancer screenings (p<0.05). Unemployment, obesity, age>59 and yearly flu vaccine were associated with a lower involvement in cervical cancer screening. Women from high socio-economic classes were more likely to attend only female cancer screenings (p = 0.009). Finally, a low level of physical activity and tobacco use were associated with higher risk of no additional screening participation (p<10–3 and p = 0.027).ConclusionsAmong women participating in breast screening, colorectal and cervical cancer screening rates could be improved. Including communication about these 2 cancer screenings in the mammogram invitation could be worth to explore.

IntroductionThe participation rate is higher in breast cancer screening than in cervical cancer (CCU) and colorectal cancer (CRC) screening. In this cluster-randomised study, we aim to evaluate an intervention offering...

Decision letter: A modelled evaluation of the impact of COVID-19 on breast, bowel, and cervical cancer screening programmes in Australia

Editor's evaluation: A modelled evaluation of the impact of COVID-19 on breast, bowel, and cervical cancer screening programmes in Australia

BackgroundIn 2019, Germany had the highest rate of hip replacement surgery and the fourth highest rate of knee replacement surgery among more than 30 OECD countries. The age-standardised rates were estimated at 174 hip joint and 137 knee joint replacements per 100,000 population. Against this background, the contrast between financial incentives for surgery and missing incentives for non-surgical treatment options is repeatedly discussed. Quality indicators (QIs) can serve to measure and transparently present the quality of evidence-based care. Comparing results in the form of audit and feedback has been shown to improve e.g. guideline-compliant ambulatory care. Existing QIs targeting the care of gon- and coxarthrosis mainly focus on discharge management after joint replacement surgery and/or require additional data collection. Therefore, as part of the MobilE-ARTH project, a set of QIs for ambulatory care prior to joint replacement surgery calculable based on routine data is being developed. The present study’s aim is to evaluate the impact of this QI set in terms of providing feedback on the quality of care.MethodsThe MobilE-ARTH project comprises (Phase 1) developing a QI set following the RAND/UCLA Appropriateness Method, (Phase 2) implementing the QIs in established physician networks of a German statutory health insurance (SHI) within a prospective, non-blinded, cluster-randomised pilot study, and (Phase 3) evaluating the QI set’s effectiveness. The physicians in the intervention networks will (a) receive feedback reports providing information about the routine data-based QIs of their gon- and/or coxarthrosis patients and aggregated results for their network, and (b) be invited to two voluntary, facilitated network meetings. In these network meetings, the physicians can use the information provided on the feedback reports to discuss multiprofessional care pathways for patients with gon- and/or coxarthrosis. Selected indicators of the QI set will serve as primary and secondary outcome measures. Routine data will be analysed within multi-level models using an intention-to-treat approach.DiscussionFeedback reports help maintaining clinical standards and closing the gap between evidence and medical practice, thus enabling an overall improvement in health care. Providing physicians with QI-based information on quality of care promotes identifying strengths and weaknesses in medical treatments.Trial registrationGerman Clinical Trials Register, number DRKS00027516, Registered 25th January 2022 – Prospectively registered.