- Title
- Strategies to improve adherence to colorectal cancer screening
- Creator
- Dodd, Natalie
- Relation
- University of Newcastle Research Higher Degree Thesis
- Resource Type
- thesis
- Date
- 2019
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- Colorectal cancer (CRC) is an important health problem globally and nationally. In Australia, every week, over 300 people are diagnosed with CRC, and 80 will die from this disease. When CRC is detected and treated early, there are high survival rates. CRC is amenable to screening as it has a long latency period during which microscopic traces of blood can be detected using a simple test called a faecal occult blood test (FOBT). To support CRC screening, Australians are offered biennial FOBT through the National Bowel Cancer Screening Program (NBCSP). Despite the proven benefits and accessibility of CRC screening in Australia, only 41% of those invited to screen by the NBCSP return completed FOBTs. Data collected from Australian general-practice- and population-based community surveys also suggest CRC screening rates are low. However, the most recent data were collected in 2011. Additionally, not all research assessed whether screening was adherent to Australian CRC screening guidelines. Examining correlates of CRC screening behaviour can illuminate which groups are least likely to adhere to screening guidelines. Those in younger age groups, i.e. 50-59 years, are consistently reported to have higher rates of under-screening compared to those in older age groups. However, other correlates of under-screening for CRC vary depending on the source of data. For example, the NBCSP reports higher rates of under-screening for males, a finding that is contrary to general-practice- and population-based community studies which have reported that females are more likely to be under-screened. Ascertaining correlates of under-screening from healthcare settings can contribute to the current body of evidence and may be used to design targeted interventions to increase CRC screening in those least likely to adhere to guidelines. General practitioner (GP) endorsement of CRC screening is a positive predictor of screening behaviour, and GPs have a recognised role in promoting preventive health activities, including CRC screening. GPs can be integrated into population-based programs, thus potentially having a positive effect on uptake of screening within the program. This thesis by publication consists of an introduction, six papers, a discussion of the key findings, implications and future directions, a review of the strengths and limitations of the research, and conclusions. The data-based papers report data collected from healthcare settings. The studies reported in papers 1 to 3 report new cross-sectional data on CRC screening practices of individuals attending these settings, and include both under- and over-screening, as well as knowledge of CRC risk factors and screening recommendations. Paper 4 reports a review of trends in general-practice-based research into CRC screening prevalence, using descriptive or intervention methodology, over time. The studies reported in papers 5 and 6 describe the protocol and delivery of a general-practice-based randomised controlled trial which aims to increase CRC screening uptake. The results of this thesis suggest that there is an evidence-practice gap for CRC screening adherence in those attending healthcare settings in Australia, with both under- and over-screening reported. Males and those in younger age groups were more likely to report under-screening. Levels of knowledge of CRC risk factors and screening recommendations were low; less than one-third knew the correct age to commence CRC screening, and 40% knew that FOBT was the recommended test. This suggests that strategies may be required to reinforce CRC screening recommendations among patients attending healthcare settings. A review of the peer-reviewed literature reveals that a high proportion of research effort has consistently been directed toward the evaluation of interventions to increase CRC screening in general practice, using robust study designs. Despite this, under-screening in this setting remains an area requiring improvement, suggesting that future research should focus on effectiveness trials, to determine which interventions are likely to be adopted into routine practice. Finally, we found that an intervention involving GP endorsement, and provision of point-of-care FOBT and printed information significantly increased CRC screening uptake among general practice patients. There is potential for the role of GPs in promoting CRC screening to be better integrated into the NBCSP. Effective general-practice-based interventions could be incorporated into routine practice to boost CRC screening participation rates.
- Subject
- colorectal cancer; general practice; cancer screening; preventive care; thesis by publication
- Identifier
- http://hdl.handle.net/1959.13/1406243
- Identifier
- uon:35607
- Rights
- Copyright 2019 Natalie Dodd
- Language
- eng
- Full Text
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| Thumbnail | File | Description | Size | Format | |||
|---|---|---|---|---|---|---|---|
| View Details Download | ATTACHMENT01 | Thesis | 4 MB | Adobe Acrobat PDF | View Details Download | ||
| View Details Download | ATTACHMENT02 | Abstract | 310 KB | Adobe Acrobat PDF | View Details Download |