The authors raise a very important problem of anticancer propaganda aimed at the early detection of cancer to be solved nowadays by means of screening and constructive interaction between oncologists and the public. To increase the level of knowledge of the population in this area it is necessary to expand the range of its adequate awareness of tumor diseases. Only joint efforts can limit the destructive effect of cancer on people's minds, so that every person would be responsible for his own health, clearly understanding the advantages of early visit to a doctor. This once again highlights the need of educational work with the public, motivational nature of which allows strengthening the value of screening in the whole complex of measures to fight cancer.
Integrated knowledge translation (IKT) interventions may be one solution to improving the uptake of clinical guidelines. IKT research initiatives are particularly relevant for breast cancer research and initiatives targeting the implementation of clinical guidelines and guideline implementation initiatives, where collaboration with an interdisciplinary team of practitioners, patients, caregivers, and policy makers is needed for producing optimum patient outcomes. The objective of this paper was to describe the process of developing an IKT strategy that could be used by guideline developers to improve the uptake of their new clinical practice guidelines on breast cancer screening. An interprofessional group of students as well as two faculty members met six times over three days at the KT Canada Summer Institute in 2011. The team used all of the phases of the action cycle in the Knowledge to Action Framework as an organizing framework. While the entire framework was used, the step involving assessing barriers to knowledge use was judged to be particularly relevant in anticipating implementation problems and being able to inform the specific KT interventions that would be appropriate to mitigate these challenges and to accomplish goals and outcomes. This activity also underscored the importance of group process and teamwork in IKT. We propose that an a priori assessment of barriers to knowledge use (i.e., level and corresponding barriers), along with the other phases of the Knowledge to Action Framework, is a strategic approach for KT strategy development, implementation, and evaluation planning and could be used in the future planning of KT strategies.
Breast cancer screening in Denmark is organised by the health services in the five regions. Although general practitioners (GPs) are not directly involved in the screening process, they are often the first point of contact to the health care system and thus play an important advisory role. No previous studies, in a health care setting like the Danish system, have investigated the association between GPs' attitudes towards breast cancer screening and women's participation in the screening programme.
Data on women's screening participation was obtained from the regional screening authorities. Data on GPs' attitudes towards breast cancer screening was taken from a previous survey among GPs in the Central Denmark Region. This study included women aged 50-69 years who were registered with a singlehanded GP who had participated in the survey.
The survey involved 67 singlehanded GPs with a total of 13,288 women on their lists. Five GPs (7%) had a negative attitude towards breast cancer screening. Among registered women, 81% participated in the first screening round. Multivariate analyses revealed that women registered with a GP with a negative attitude towards breast cancer screening were 17% (95% CI: 2-34%) more likely to be non-participants compared with women registered with a GP with a positive attitude towards breast cancer screening.
The GPs' attitudes may influence the participation rate even in a system where GPs are not directly involved in the screening process. However, further studies are needed to investigate this association.
Cites: Prev Med. 2000 Oct;31(4):417-2811006068
Cites: Eur J Cancer Prev. 2011 Jan;20 Suppl 1:S39-4121245680
Cites: J Am Board Fam Pract. 2001 Sep-Oct;14(5):352-6111572540
Cites: Lancet. 2001 Oct 20;358(9290):1340-211684218
Cites: Cancer Causes Control. 2002 Feb;13(1):73-8211899121
Cites: Eur J Cancer Prev. 2003 Jun;12(3):213-2212771560
Cites: Am J Epidemiol. 2004 Apr 1;159(7):702-615033648
Cites: BMC Med Res Methodol. 2003 Oct 20;3:2114567763
Cites: J Gen Intern Med. 1997 Jan;12(1):34-439034944
Cites: J Med Screen. 1999;6(2):82-810444726
Cites: Cancer Causes Control. 2007 Feb;18(1):61-7017186422
Cites: J Womens Health (Larchmt). 2008 Nov;17(9):1477-9818954237
Cites: Cancer. 2009 Oct 15;115(20):4828-3819645031
Cites: Health Educ Behav. 2009 Dec;36(6):1012-2519233947
Cites: Cancer Causes Control. 2009 Oct;20(8):1339-5319449107
Cites: J Womens Health (Larchmt). 2010 Mar;19(3):433-4120141384
Cites: Acta Oncol. 2010 Jun;49(5):532-4420491522
Cites: Breast Cancer Res Treat. 2010 Nov;124(2):509-1920364401
Cites: Lancet. 2011 Jan 8;377(9760):127-3821183212
Cites: Health Educ Behav. 2001 Apr;28(2):200-1611265829
Organized screening for breast cancer in Canada began in 1988 and has been implemented in all provinces and 2 of the 3 territories. Quality initiatives are promoted through national guidelines which detail best practices in various areas, including achieving quality through a client-service approach, recruitment and capacity, retention, quality of mammography, reporting, communication of results, follow-up and diagnostic workup, and program evaluation; it also offers detailed guidelines for the pathological examination and reporting of breast specimens. The Canadian Breast Cancer Data Base is a national breast cancer screening surveillance system whose objective is to collect information from provincial-screening programs. These data are used to monitor and evaluate the performance of programs and allow comparison with national and international results. A series of standardized performance indicators and targets for the evaluation of performance and quality of organized breast cancer screening programs have been developed from the data base. Although health care is a provincial responsibility in Canada, the collective reporting and comparison of results both nationally and internationally is beneficial in evaluating and refining both screening programs and individual radiologist performance. The results of Canadian performance indicators compare favourably with those of other well-established international screening programs. There are variations in performance indicators across the provinces and territories, but these differences are not extreme.
Comment In: Can Assoc Radiol J. 2006 Jun;57(3):192-316881479
Erratum In: Can Assoc Radiol J. 2006 Apr;57(2):67Doyle, Gregory P [added]
To describe physician practices with regard to opportunistic screening for breast cancer in women aged 35 to 49 years and 70 years of age and older, and to identify the determinants associated with the practice of prescribing screening mammography.
Simple random sample of 1400 general practitioners practising in Quebec in 2009.
Five cancer screening practices among 4 types of female clientele and the factors influencing physicians in their practice of prescribing screening mammography.
The response rate was 36%. For women aged 35 to 49 years, more than 80% of physicians reported using practices judged adequate, except for the teaching of breast self-examination and referrals to genetic counseling (60% and 54%). For women 70 years of age and older with good life expectancy, only 50% of general practitioners prescribed screening mammography. For the 70 years of age and older age group without good life expectancy, for whom screening is not indicated, nearly half of physicians continued to do the clinical breast examination and more than one-third reviewed family history. The main determinants for the practice of prescribing mammography are a favourable attitude to screening, screening skills, peer support, belief in the efficacy of mammography, and sufficient knowledge of the issue and of recommendations.
Improvements are needed in the practice of teaching breast self-examination to women aged 35 to 49 years and referring them to genetic counseling, as well as in prescribing mammography for women 70 years of age and older who are in good health. Public health actions to improve these practices should focus on physician attitudes and skills and on communicating clearer recommendations.
Cites: Prev Med. 1999 Nov;29(5):391-40410564631
Cites: J Immigr Minor Health. 2008 Jun;10(3):239-4617653863
Cites: CMAJ. 2001 Jun 26;164(13):1837-4611450279
Cites: J Am Board Fam Pract. 2001 Sep-Oct;14(5):352-6111572540
Cites: Swiss Med Wkly. 2001 Jun 2;131(21-22):311-911584693
Cites: J Womens Health (Larchmt). 2003 Jan-Feb;12(1):61-7112639370
Cites: Cancer. 2003 Nov 1;98(9):1811-2114584062
Cites: Health Educ Q. 1992 Summer;19(2):157-751618625
Cites: Ann Intern Med. 1994 Apr 1;120(7):602-88117000