Report in English with a Dutch summary (KCE reports 45A)

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94 Screening for Colorectal Cancer KCE reports vol.45 prior 5 yr, and 3% were younger than 50 yr of age. Overall, 35% of the patients had at least one reason that the FOBT was inappropriate and at least 19% of the patients should not have undergone any colorectal cancer test for screening or diagnosis. In addition, data suggested that FOBT was actually being used for diagnosis instead of screening. Screening patients unlikely to live long enough to develop and die from colorectal cancer provides no benefit and places these individuals at unjustifiable risk. Additionally, inappropriate screening utilizes resources that could be used to improve screening and follow-up for eligible individuals. 5.7 SCREENING ACCEPTABILITY, ADHERENCE AND COMPLIANCE Ultimately, the effectiveness of any screening program depends on patients risk perception and hence perceived acceptability of the proposed test and its consequences in case of positive testing, starting in principle with a colonoscopy. All those factors decisively influence patient compliance 401. Lieberman 402 compared the cost-effectiveness of five screening programs for CRC and concluded that compliance was the most important determinant of program effectiveness in all five programs. 5.7.1 Definitions The terms adherence, compliance and coverage are used interchangeably in the literature 403, and in the economic literature participation is often used with the same meaning. Adherence in a general sense refers to the completion of a colorectal cancer screening test or procedure. Compliance refers to completion of all tests or examinations when sequential offers are made to the same persons regardless of whether they completed a prior test. Coverage g refers to completion of at least one test or examination when sequential offers are made to the same people, regardless of whether they completed a prior test. Continuous screening is defined as the periodic provision of an opportunity for diagnostic testing to a population of individuals who are asymptomatic and at increased risk for disease (or a perception of increased risk) 404. With regard to continuous screening we have to distinguish: Sequential screening: refers to rescreening offers made to the same persons regardless of whether they completed a prior test. Repeat screening: refers to rescreening offers made only to persons completing a prior test or examination and who remain eligible, e.g. are still alive, still reside in the geographic area, and are free of CRC. g Definitions for coverage and compliance are from a summary of an NCI preapplication meeting for an RFA (CA-89-05) on worksite health promotion interventions (January 1989).
KCE reports vol.45 Screening for Colorectal Cancer 95 5.7.2 Effects of risk perception and risk communication on cancer screening behaviors Perceived risk has been used to explain cancer screening behaviors as well as in interventions to promote cancer screenings. However, the literature on perceived risk in relation to cancer screening behaviors has not been examined systematically across cancer sites and the following terms have been used synonymously: perceived risk, risk perception, perceived susceptibility, perceived vulnerability, and subjective risk. As noted by several authors 405, 406, perceived risk is a central construct in a number of theories of health behavior 407, e.g., the Health Belief Model 408-413, the Precaution Adoption Model 414, 415, the Transactional Model of Stress and Coping 416-421, the Self-regulation Model of Health Behavior 422, and the Protection Motivation Theory 423-428. Risk perception derives from threat appraisal, which is considered to be a major motivating factor in preventive and protective health behaviors. Threat appraisal is based on beliefs about disease risk and severity 429, 430. As defined by Weinstein and Klein 431, perceived risk relates to one s belief about the likelihood of personal harm. Because risk perception may be an important motivator of a number of health-related behaviors, it is important to understand both the determinants of risk perception and the patterns of association between perceived risk and specific health-related behaviors to develop effective risk communication messages to encourage the adoption of behaviors that will improve health status. In the case of screening tests or procedures with established efficacy and effectiveness, the goal of risk communication is to encourage or persuade persons to be tested. For screening procedures in which the risks and benefits are uncertain, e.g., mammography screening for women in their forties or prostate-specific antigen testing, the goal of risk communication is informed decision making. Risk communication about screening behaviors will take different forms, depending on the strength of the scientific evidence establishing the risks and benefits associated with the tests or procedures in question. In a very elaborate 1999 JNCI Monograph review, Vernon 432 summarizes and synthesizes research findings on risk perception and risk communication as they relate to cancer screening behaviors. The focus was on cancers for which there is evidence that screening reduces mortality, i.e., cervical, breast, and colorectal cancers. The following questions were addressed in Vernon s review: 1. Is perceived risk associated with relevant cancer screening behaviors? 2. What factors are associated with perceived risk? 3. Is the relationship between perceived risk and cancer screening behaviors modified by other factors? 4. Have interventions to change perceived risk been effective in modifying risk perceptions? 5. Are these changes related to subsequent cancer screening behaviors? There was consistent evidence that perceived risk was associated with mammography screening, but there were insufficient data on these associations for cervical or colorectal cancer screening behaviors. There was some evidence that perceived risk mediated the association between other variables and
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KCE reports 1. Effectiviteit en kos
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