Effectiveness of the extended parallel process model in promoting colorectal cancer screening.
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ABSTRACT:
SUBMITTER: Birmingham WC
PROVIDER: S-EPMC7161702 | biostudies-literature | 2015 Oct
REPOSITORIES: biostudies-literature
Publications
Effectiveness of the extended parallel process model in promoting colorectal cancer screening.
Birmingham Wendy C WC Hung Man M Boonyasiriwat Watcharaporn W Kohlmann Wendy W Walters Scott T ST Burt Randall W RW Stroup Antoinette M AM Edwards Sandie L SL Schwartz Marc D MD Lowery Jan T JT Hill Deirdre A DA Wiggins Charles L CL Higginbotham John C JC Tang Philip P Hon Shirley D SD Franklin Jeremy D JD Vernon Sally S Kinney Anita Y AY
Psycho-oncology 20150720 10
<h4>Objective</h4>Relatives of colorectal cancer (CRC) patients are at increased risk for the disease, yet screening rates still remain low. Guided by the Extended Parallel Process Model, we examined the impact of a personalized, remote risk communication intervention on behavioral intention and colonoscopy uptake in relatives of CRC patients, assessing the original additive model and an alternative model in which each theoretical construct contributes uniquely.<h4>Methods</h4>We collected inten ...[more]
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Project description:BackgroundMammography screening is the main method for early detection of breast cancer in Norway. Few studies have focused on psychological determinants of both attendance and non-attendance of publicly available mammography screening programs. The aim of the current study, guided by the Extended Parallel Process Model, was to examine how psychological factors influence defensive avoidance of breast cancer screening and intention to attend mammography.MethodsCross-sectional survey data from a community sample of women living in Norway aged ≥ 18 (N = 270), and without a history of breast cancer, was collected from September 2018 to June 2019 and used to investigate the relationships between the Extended Parallel Process Model (EPPM) constructs and two outcomes: defensive avoidance of breast cancer screening and intention to attend mammography within the next two years. After adjusting for confounding factors, the hierarchical multiple linear regression analyses was conducted to assess the ability of the independent variables based on the EPPM to predict the two outcome variables. Significance level was chosen at p < 0.05.ResultsMultivariate analyses showed that defensive avoidance of breast cancer screening was predicted by lower perceived susceptibility to breast cancer (β = - 0.22, p = 0.001), lower response efficacy of mammography screening (β = - 0.33, p = 0.001), higher breast cancer fear (β = 0.15, p = 0.014), and checking breasts for lumps (β = - 0.23, p = 0.001). Intention to attend mammography within the next two years was predicted by higher response efficacy of mammography screening (β = 0.13, p = 0.032), having a lower educational level (β = - 0.10, p = 0.041), and regular previous mammography attendance compared to never attending (β = 0.49, p = 0.001).ConclusionsThe study revealed that defensive avoidance of breast cancer screening and intention to attend mammography were not predicted by the same pattern of psychological factors. Our findings suggest future health promotion campaigns need to focus not only on the psychological factors that encourage women's decision to attend the screening, but also to counter factors that contribute to women's decision to avoid it.
| S-EPMC7885347 | biostudies-literature
Project description:ImportanceRandomized clinical screening trials have shown that sigmoidoscopy screening reduces colorectal cancer (CRC) incidence and mortality. Colonoscopy has largely replaced sigmoidoscopy for CRC screening, but long-term results from randomized trials on colonoscopy screening are still lacking.ObjectiveTo estimate the additional screening benefit of colonoscopy compared with sigmoidoscopy.Design, setting, and participantsThis comparative effectiveness simulation study pooled data on 358 204 men and women randomly assigned to sigmoidoscopy screening or usual care in 4 randomized sigmoidoscopy screening trials conducted in Norway, Italy, the US, and UK with inclusion periods in the years 1993 to 2001. The primary analysis of the study was conducted from January 19 to December 30, 2021.InterventionInvitation to endoscopic screening.Main outcomes and measuresPrimary outcomes were CRC incidence and mortality. Using pooled 15-year follow-up data, colonoscopy screening effectiveness was estimated assuming that the efficacy of colonoscopy in the proximal colon was similar to that observed in the distal colon in the sigmoidoscopy screening trials. The simulation model was validated using data from Norwegian participants in a colonoscopy screening trial.ResultsThis analysis included 358 204 individuals (181 971 women [51%]) aged 55 to 64 years at inclusion with a median follow-up time ranging from 15 to 17 years. Compared with usual care, colonoscopy prevented an estimated 50 (95% CI, 42-58) CRC cases per 100 000 person-years, corresponding to 30% incidence reduction (rate ratio, 0.70 [95% CI, 0.66-0.75]), and prevented an estimated 15 (95% CI, 11-19) CRC deaths per 100 000 person-years, corresponding to 32% mortality reduction (rate ratio, 0.68 [95% CI, 0.61-0.76]). The additional benefit of colonoscopy screening compared with sigmoidoscopy was 12 (95% CI, 10-14) fewer CRC cases and 4 (95% CI, 3-5) fewer CRC deaths per 100 000 person-years, corresponding to percentage point reductions of 6.9 (95% CI, 6.0-7.9) for CRC incidence and 7.6 (95% CI, 5.7-9.6) for CRC mortality. The number needed to switch from sigmoidoscopy to colonoscopy screening was 560 (95% CI, 486-661) to prevent 1 CRC case and 1611 (95% CI, 1275-2188) to prevent 1 CRC death.Conclusions and relevanceThe findings of this comparative effectiveness study assessing long-term follow-up after CRC screening suggest that there was an additional preventive effect on CRC incidence and mortality associated with colonoscopy screening compared with sigmoidoscopy screening, but the additional preventive effect was less than what was achieved by introducing sigmoidoscopy screening where no screening existed. The results probably represent the upper limit of what may be achieved with colonoscopy screening compared with sigmoidoscopy screening.
| S-EPMC10905314 | biostudies-literature
Project description:BackgroundProvider recommendation is a predictor of colorectal cancer (CRC) screening.PurposeTo compare the effects of two clinic-based interventions on patient-provider discussions about CRC screening.DesignTwo-group RCT with data collected at baseline and 1 week post-intervention.Setting/participantsAfrican-American patients that were non-adherent to CRC screening recommendations (n=693) with a primary care visit between 2008 and 2010 in one of 11 urban primary care clinics.InterventionParticipants received either a computer-delivered tailored CRC screening intervention or a nontailored informational brochure about CRC screening immediately prior to their primary care visit.Main outcome measuresBetween-group differences in odds of having had a CRC screening discussion about a colon test, with and without adjusting for demographic, clinic, health literacy, health belief, and social support variables, were examined as predictors of a CRC screening discussion using logistic regression. Intervention effects on CRC screening test order by PCPs were examined using logistic regression. Analyses were conducted in 2011 and 2012.ResultsCompared to the brochure group, greater proportions of those in the computer-delivered tailored intervention group reported having had a discussion with their provider about CRC screening (63% vs 48%, OR=1.81, p<0.001). Predictors of a discussion about CRC screening included computer group participation, younger age, reason for visit, being unmarried, colonoscopy self-efficacy, and family member/friend recommendation (all p-values <0.05).ConclusionsThe computer-delivered tailored intervention was more effective than a nontailored brochure at stimulating patient-provider discussions about CRC screening. Those who received the computer-delivered intervention also were more likely to have a CRC screening test (fecal occult blood test or colonoscopy) ordered by their PCP.Trial registrationThis study is registered at www.clinicaltrials.gov NCT00672828.
| S-EPMC3601582 | biostudies-literature
Project description:INTRODUCTION:Low-income, low-literacy, limited English-proficient populations have low colorectal cancer (CRC) screening rates and experience poor patient-provider communication and decision-making processes around screening. The purpose of this study was to test the effect of a CRC screening decision aid on screening-related communication and decision making in primary care visits. STUDY DESIGN:RCT with data collected from patients at baseline and immediately after the provider encounter. SETTING/PARTICIPANTS:Patients aged 50-75 years, due for CRC screening, were recruited from two safety net clinics in North Carolina and New Mexico (data collection, January 2014-September 2015; analysis, 2015). INTERVENTION:Participants viewed a CRC screening decision aid or a food safety (control) video immediately before their provider encounter. MAIN OUTCOME MEASURES:CRC screening-related knowledge, discussion, intent, test preferences, and test ordering. RESULTS:The study population (N=262) had a mean age of 58.3 years and was 66% female, 61% Latino, 17% non-Latino black, and 16% non-Latino white. Among Latino participants, 71% preferred Spanish. Compared with controls, intervention participants had greater screening-related knowledge (on average 4.6 vs 2.8 of six knowledge items correct, adjusted difference [AD]=1.8, 95% CI=1.5, 2.1) and were more likely to report screening discussion (71.0% vs 45.0%, AD=26.1%, 95% CI=14.3%, 38.0%) and high screening intent (93.1% vs 84.7%, AD=9.0%, 95% CI=2.0%, 16.0%). Intervention participants were more likely to indicate a specific screening test preference (93.1% vs 68.0%, AD=26.5%, 95% CI=17.2%, 35.8%) and to report having a test ordered (56.5% vs 32.1%, AD=25.8%, 95% CI=14.4%, 37.2%). CONCLUSIONS:Viewing a CRC screening decision aid before a primary care encounter improves knowledge and shared decision making around screening in a racially, ethnically, and linguistically diverse safety net clinic population. TRIAL REGISTRATION:This study is registered at www.clinicaltrials.gov NCT02054598.
| S-EPMC5501711 | biostudies-other
Project description:BACKGROUND:Screening for colorectal cancer (CRC) has been successful in decreasing the incidence and mortality from CRC. Although new screening tests have become available, their relative impact on CRC outcomes remains unexplored. This study compares the outcomes of various screening strategies on CRC outcomes. METHODS:A Markov model representing the natural history of CRC was built and validated against empiric data from screening trials as well as the Microstimulation Screening Analysis (MISCAN) model. Thirteen screening strategies based on colonoscopy, sigmoidoscopy, computed tomographic colonography, as well as fecal immunochemical, occult blood, and stool DNA testing were compared with no screening. A simulated sample of the US general population ages 50 to 75 years with an average risk of CRC was followed for up to 35 years or until death. Effectiveness was measured by discounted life years gained and the number of CRCs prevented. Discounted costs and cost-effectiveness ratios were calculated. A discount rate of 3% was used in calculations. The study took a societal perspective. RESULTS:Colonoscopy emerged as the most effective screening strategy with the highest life years gained (0.022 life years) and CRCs prevented (n = 1068) and the lowest total costs ($2861). These values were 0.012 life years gained, 574 CRCs prevented, and a total cost of $3164, respectively, for FOBT; and 0.011 life years gained, 647 CRCs prevented, and a total cost of $4296, respectively, for DNA testing. Improved sensitivity or specificity of a screening test for CRC detection was not sufficient to close the outcomes gap compared with colonoscopy. CONCLUSIONS:Improvement in CRC-detection performance is not sufficient to improve screening outcomes. Special attention must be directed to detecting precancerous adenomas. Cancer 2017;123:1516-1527. © 2017 American Cancer Society.
| S-EPMC6879196 | biostudies-literature
Project description:BackgroundPublished decision analyses show that screening for colorectal cancer is cost-effective. However, because of the number of tests available, the optimal screening strategy in Canada is unknown. We estimated the incremental cost-effectiveness of 10 strategies for colorectal cancer screening, as well as no screening, incorporating quality of life, noncompliance and data on the costs and benefits of chemotherapy.MethodsWe used a probabilistic Markov model to estimate the costs and quality-adjusted life expectancy of 50-year-old average-risk Canadians without screening and with screening by each test. We populated the model with data from the published literature. We calculated costs from the perspective of a third-party payer, with inflation to 2007 Canadian dollars.ResultsOf the 10 strategies considered, we focused on three tests currently being used for population screening in some Canadian provinces: low-sensitivity guaiac fecal occult blood test, performed annually; fecal immunochemical test, performed annually; and colonoscopy, performed every 10 years. These strategies reduced the incidence of colorectal cancer by 44%, 65% and 81%, and mortality by 55%, 74% and 83%, respectively, compared with no screening. These strategies generated incremental cost-effectiveness ratios of $9159, $611 and $6133 per quality-adjusted life year, respectively. The findings were robust to probabilistic sensitivity analysis. Colonoscopy every 10 years yielded the greatest net health benefit.InterpretationScreening for colorectal cancer is cost-effective over conventional levels of willingness to pay. Annual high-sensitivity fecal occult blood testing, such as a fecal immunochemical test, or colonoscopy every 10 years offer the best value for the money in Canada.
| S-EPMC2934796 | biostudies-literature
Project description:ObjectivesThere is high risk of contamination with COVID-19 virus during routine dental procedures and infection control is crucial. The aim of this study was to determine the factors associated with Covid-19 preventive behaviors among oral health care providers using an extended parallel process model (EPPM).MethodsIn a cross-sectional study, short text message invite surveys were sent to 870 oral health care providers in west part of Iran. Data were collected through validated self-report EPPM questionnaires. Descriptive statistics, Chi-square and Fishers exact tests were used for data analysis.ResultsIn total, 300 completed questionnaires were received and the mean age of respondents was 29.89 ± 11.17 years (range: 20-75 years). Among the study population, 284 (94.67%) perceived the threat of infection highly. Washing hands frequently with water and soap and use of hand sanitizer was reported by 93.33%, of participants. Age (P = 0.010), sex (P = 0.002) and occupation field (P = 0.010) were significantly associated with danger control responses. Data identified that those oral health care providers that were on the danger control response adopted preventive behaviors more strictly than those on fear control response.ConclusionThe results of this study showed how degrees of perceived threat and perceived efficacy influenced oral health providers' willingness to perform recommended health behaviors. These findings can assist public health agencies in developing educational programs specifically designed for promoting preventive behaviors among oral health providers in pandemic situations.
| S-EPMC7425864 | biostudies-literature
Project description:This study applied the extended parallel process model (EPPM) to investigate the factors affecting people's preventive behaviors against COVID-19, and thereby, draw relevant policy implications for current and future other epidemics. The EPPM was used to examine the danger control and fear control responses, along with the separate effects of their sub-factors (perceived susceptibility, perceived severity, response efficacy, and self-efficacy) on personal hygiene behaviors, social distancing measures, and fatalism. In total, data from an online survey of 813 adults were analyzed. The results of multiple regression analysis showed a strong effect of self-efficacy on danger control (ß = 0.23 for personal hygiene behaviors, β = 0.26 for social distancing) and fear control responses (ß = -0.13 for fatalism). However, based on the type of control response, the effect of perceived susceptibility and perceived severity, which were the main factors in threat appraisal, was insignificant or marginally significant. Further, a higher perceived severity was associated with higher fatalism in the fear control response (ß = 0.09). Those who were currently employed performed fewer social distancing measures compared to those who did not (ß = -0.11), whereas there was no difference in personal hygiene behaviors. These results suggest that risk communication in emerging infectious disease crises should provide customized information on people who are hard to comply with social distancing. Besides delivering the message of self-efficacy, policies should be implemented to create a social environment in which individuals can practice social distancing without constraints.
| S-EPMC8903272 | biostudies-literature
Project description:BackgroundClear evidence on the benefit-harm balance and cost effectiveness of population-based screening for colorectal cancer (CRC) is missing. We aim to systematically evaluate the long-term effectiveness, harms and cost effectiveness of different organized CRC screening strategies in Austria.MethodsA decision-analytic cohort simulation model for colorectal adenoma and cancer with a lifelong time horizon was developed, calibrated to the Austrian epidemiological setting and validated against observed data. We compared four strategies: 1) No Screening, 2) FIT: annual immunochemical fecal occult blood test age 40-75 years, 3) gFOBT: annual guaiac-based fecal occult blood test age 40-75 years, and 4) COL: 10-yearly colonoscopy age 50-70 years. Predicted outcomes included: benefits expressed as life-years gained [LYG], CRC-related deaths avoided and CRC cases avoided; harms as additional complications due to colonoscopy (physical harm) and positive test results (psychological harm); and lifetime costs. Tradeoffs were expressed as incremental harm-benefit ratios (IHBR, incremental positive test results per LYG) and incremental cost-effectiveness ratios [ICER]. The perspective of the Austrian public health care system was adopted. Comprehensive sensitivity analyses were performed to assess uncertainty.ResultsThe most effective strategies were FIT and COL. gFOBT was less effective and more costly than FIT. Moving from COL to FIT results in an incremental unintended psychological harm of 16 additional positive test results to gain one life-year. COL was cost saving compared to No Screening. Moving from COL to FIT has an ICER of 15,000 EUR per LYG.ConclusionsOrganized CRC-screening with annual FIT or 10-yearly colonoscopy is most effective. The choice between these two options depends on the individual preferences and benefit-harm tradeoffs of screening candidates.
| S-EPMC6896501 | biostudies-literature
Project description:BACKGROUND: With 14.234 diagnoses and over 4047 deaths reported in 2007, colorectal cancer (CRC) is the second most common cancer and second most common cause of cancer-related mortality in Australia. The direct treatment cost has recently been estimated to be around AU$1.2 billion for the year 2011, which corresponds to a four-fold increase, compared the cost reported in 2001. Excluding CRCs due to known rare genetic disorders, 20% to 25% of all CRCs occur in a familial aggregation setting due to genetic variants or shared environmental risk factors that are yet to be characterised. A targeted screening strategy addressed to this segment of the population is a potentially valuable tool for reducing the overall burden of CRC. METHODS: We developed a Markov model to assess the cost-effectiveness of three screening strategies offered to people at increased risk due to a strong family history of CRC. The model simulated the evolution of a cohort of 10,000 individuals from age 50 to 90 years. We compared screening with biennial iFOBT, five-yearly colonoscopy and ten-yearly colonoscopy versus the current strategy of the Australian National Bowel Cancer Screening Programme (i.e. base case). RESULTS: Under the NBCSP scenario, 6,491 persons developed CRC with an average screening lifetime cost of AU$3,441 per person. In comparison, screening with biennial iFOBT, colonoscopy every ten years, and colonoscopy every five years reduced CRC incidence by 27%, 35% and 60%, and mortality by 15%, 26% and 46% respectively. All three screening strategies had a cost under AU$50,000 per life year gained, which is regarded as the upper limit of acceptable cost-effectiveness in the Australian health system. At AU$12,405 per life year gained and an average lifetime expectancy of 16.084 years, five-yearly colonoscopy screening was the most cost-effective strategy. CONCLUSION: The model demonstrates that intensive CRC screening strategies targeting people at increased risk would be cost-effective in the Australian context. Our findings provide evidence that substantial health benefits can be generated from risk-based CRC screening at a relatively modest incremental cost.
| S-EPMC4021190 | biostudies-other