大肠癌高危人群肠镜筛查顺应性影响因素的研究

目的:了解城市社区大肠癌高危居民对肠镜筛查的顺应性及其影响因素,为进行有针对性的护理干预,提高大肠癌高危人群肠镜筛查顺应性提供依据。方法：以天津市某社区自然人群中大肠癌筛查高危人群为研究对象,按是否接受肠镜检查分为病例组、对照组。自行设计大肠癌高危患者肠镜检查顺应性单因素调查问卷及拒绝肠镜原因调查问卷,运用德尔菲法最终确定问卷,获得影响大肠癌高危患者是否接受肠镜检查的影响因素。结果：组间人群的基本特征除是否具有医保有统计学差异（P＜0.05）,其他性别、婚姻、文化程度、家庭收入等无统计学差异(P＞0.05 ) 。两组在肠镜认知中具有统计学差异（P＜0.05）。同时“工作忙,没时间”、“认为肠镜意义不大”及“害怕疼痛”是拒绝肠镜检查的主要原因,占73%。结论：提高大肠癌筛查工作中肠镜的认知以及有针对性的干预患者拒绝肠镜的相关因素,可以提高大肠癌高危患者肠镜筛查顺应性,从而提高整个筛查工作的顺应性。     

北京大学首钢医院社区大肠癌筛查调查分析

目的总结本院社区大肠癌筛查及结肠镜检查结果,探讨进一步提高癌前病变和早期大肠癌检出率、减少大肠癌发病率的方法。方法2016年3月至2018年9月对本院所属四个社区卫生服务中心消化科就诊患者进行问卷调查及粪便潜血试验,针对高危人群进行结肠镜检查,对结肠镜检查结果进行分析。结果参与筛查及完成结肠镜检查的女性患者均多于男性;息肉总检出率为35.6%,男性检出率(42.6%)高于女性(31.7%)(P<0.05);腺瘤总检出率为29.3%,男性检出率(35.5%)高于女性(25.8%)(P<0.05)。结论对无明显症状的社区居民进行大肠癌筛查,尤其是男性居民,可提早发现并处理癌前病变和早期大肠癌,有效降低大肠癌的发病率。     

Use of preventive services by Medicare fee-for-service beneficiaries: does spillover from managed care matter?

BACKGROUND: Health care delivery varies with the level of managed care activity (MCA) in an area, potentially affecting health care for those not participating in managed care programs. However, the extent to which MCA is associated with the use of cancer screening by fee-for-service beneficiaries (FFS) is unclear. OBJECTIVE: We sought to study colorectal cancer screening among Medicare FFS beneficiaries in relation to levels of Medicare MCA. RESEARCH DESIGN: This study linked 1999 Medicare denominator and Part B claims data with the 1998 Area Resource File. After categorizing MCA as low (<10%), moderate (10-29.99%), or high (> or =30%), we assessed the association between colorectal cancer screening among FFS beneficiaries and MCA, controlling for individual demographic variables and county-level attributes of socioeconomic status and physician resources. SUBJECTS: We included Medicare FFS beneficiaries 65 years of age or older with both Part A and Part B coverage for the entire calendar year from large counties in the study. MEASURES: We measured the likelihood of undergoing fecal occult blood testing (FOBT), flexible sigmoidoscopy (FLEX), or colonoscopy (COL). RESULTS: Compared with Medicare FFS beneficiaries residing in counties with low MCA, those in high MCA counties were significantly more likely to undergo FOBT (adjusted odds ratio [AOR] 1.10, 95% confidence interval [CI] 1.04-1.16), FLEX (AOR 1.11, 95% CI 1.04-1.18), or colonoscopy, after receiving FOBT/FLEX (AOR 1.07, 95% CI 1.02-1.13). CONCLUSIONS: From a public health perspective, an association between higher levels of MCA and colorectal cancer screening among those not enrolled in managed care may translate into modest increases in use of colorectal cancer screening and possibly earlier detection.     

The mediating role of health professionals' recommendation in the uptake of colorectal cancer testing among older Chinese adults

The purpose of this study is to examine the mediating effect of health professionals' recommendations on the relationship between the characteristics of older Chinese adults and the use of colorectal cancer testing. This was a cross‐sectional population‐based telephone survey. A total of 2004 Chinese adults aged 50 or above were recruited between 2 and 28 May 2007 to complete an anonymous telephone survey. The survey covered demographics, perceived health status and susceptibility to cancer, utilization of complementary medicine, family history of cancer, and cancer screening behaviour. The uptake of flexible sigmoidoscopy/colonoscopy was 12%, of which only 3.4% had been recommended by health professionals. The effects of gender, a history of serious disease, perceptions related to health status and visiting doctor regularly on the flexible sigmoidoscopy/colonoscopy uptake were mediated by a health professional's recommendation. A health professional's recommendation can be a catalyst for the decision of undergoing a colorectal cancer screening test in older adult people, in particular for those who are more health‐conscious. As health professionals can play a crucial role in the development of successful population‐based colorectal cancer screening program, efforts should be made to facilitate them in making recommendations for colorectal cancer screening to targeted high‐risk group.     

Motives for non-adherence to colonoscopy advice after a positive colorectal cancer screening test result: a qualitative study

Setting Participants with a positive faecal immunochemical test (FIT) in screening programs for colorectal cancer (CRC) have a high risk for colorectal cancer and advanced adenomas. They are therefore recommended follow-up by colonoscopy. However, more than ten percent of positively screened persons do not adhere to this advice.Objective To investigate FIT-positive individuals’ motives for non-adherence to colonoscopy advice in the Dutch CRC screening program.Subjects Non-adherent FIT-positive participants of the Dutch CRC screening program.Design We conducted semi structured in-depth interviews with 17 persons who did not undergo colonoscopy within 6 months after a positive FIT. Interviews were undertaken face-to-face and data were analysed thematically with open coding and constant comparison.Results All participants had multifactorial motives for non-adherence. A preference for more personalised care was described with the following themes: aversion against the design of the screening program, expectations of personalised care, emotions associated with experiences of impersonal care and a desire for counselling where options other than colonoscopy could be discussed. Furthermore, intrinsic motives were: having a perception of low risk for CRC (described by all participants), aversion and fear of colonoscopy, distrust, reluctant attitude to the treatment of cancer and cancer fatalism. Extrinsic motives were: having other health issues or priorities, practical barriers, advice from a general practitioner (GP) and financial reasons.Conclusion Personalised screening counselling might have helped to improve the interviewees’ experiences with the screening program as well as their knowledge on CRC and CRC screening. Future studies should explore whether personalised screening counselling also has potential to increase adherence rates.

Key points

• Participants with a positive FIT in two-step colorectal cancer (CRC) screening programs are at high risk for colorectal cancer and advanced adenomas. Non-adherence after an unfavourable screening result happens in all CRC programs worldwide with the consequence that many of the participants do not undergo colonoscopy for the definitive assessment of the presence of colorectal cancer. Little qualitative research has been done to study the reasons why individuals participate in the first step of the screening but not in the second step. We found a preference for more personalised care, which was not reported in previous literature on this subject. Furthermore, intrinsic factors, such as a low risk perception and distrust, and extrinsic factors, such as the presence of other health issues and GP advice, may also play a role in non-adherence. A person-centred approach in the form of a screening counselling session may be beneficial for this group of CRC screening participants.

     

Comparison between African-American and white women in their beliefs about breast cancer and their health locus of control

The purpose of this study was to examine the health beliefs of African-American and white women about breast cancer and locus of control, using the health belief model and the health locus of control construct. The Health Screening Questionnaire, developed by Sugarek, Deyo, and Holmes, was used to collect self-report data about health beliefs related to breast cancer and health locus of control. Participants included 197 white and 152 African-American women, between the ages of 19 and 93, recruited from various settings in central Florida. Significant differences were found between the two groups on all of the health beliefs about cancer items. The African-American women were significantly more likely to believe in chance, or to depend on powerful others for their health. Perceived susceptibility to cancer, doubts about the value of early diagnosis, and beliefs about the seriousness of breast cancer all were significantly associated with powerful other scores among African-American women. There was no relation between health beliefs and years of education for African-American women, but for white women, those with the least education were more likely to believe that death was inevitable with a cancer diagnosis. These results add to the information needed for the development of effective programs aimed at increasing breast cancer screening among African-American women.     

Colorectal cancer screening behaviour and associated factors among Chinese aged 50 and above in Hong Kong – A population-based survey

PurposeThis study reports the uptake rate of colorectal cancer screening among Chinese people aged 50 or above and the identified factors associated with the likelihood of undergoing such screening.MethodsA cross-sectional population-based telephone survey was conducted in Hong Kong during the period 2 to 28 May 2007. The survey covered demographics, perceived health status and susceptibility to cancer, utilisation of complementary medicine, family history of cancer and cancer screening behaviour.ResultsThe survey was completed by 2004 Hong Kong Chinese residents aged 50 or older (response rate = 66.6%). The uptake rate of a fecal occult blood test and a colonoscopy was 12% and 19% respectively. Factors associated with colorectal cancer screening behaviour included: male participants, ex-smokers, with cancer or other serious disease, a family history of cancer, perceived health status fair or poor, regular visits to a doctor to look after health, and utilisation of complementary medicine.ConclusionsThe uptake rate of this study population was low though an increasing trend did appear. Heath education and promotion programmes may focus on these identified factors to facilitate colorectal cancer screening in a Chinese population.     

A national survey of nursing education and practice of newly licensed nurses

The Institute of Medicine recommended establishing evidence-based teaching methods and curricula in health professions' education to meet the needs of the changing healthcare system. In an attempt to provide evidence-based information for nursing education, this study was designed to identify educational elements that best prepare nurses for practice. The study employed a two-tiered survey process for collecting and combining data from programs of nursing education and the graduates of those programs. Administrators of 410 nursing programs responded to questions related to elements of education in their programs (response rate = 51%), whereas 7,497 RN (76.5%) and LPN (23.5%) graduates of respondent programs answered questions related to the adequacy of educational preparation for practice, difficulty with current client care assignments, and other professional and practice issues (response rate = 45.4%). The majority of the nurses reported that their education had adequately prepared them to perform many, but not all, essential areas of the nursing functions examined. Nearly 20% of the RNs and 18% of the LPNs reported having difficulty with client care assignments. Inadequate preparation of several nursing functions were identified as predictive of difficulty with patient care assignments. These areas include working effectively within the healthcare team, administering medications to groups of patients, analyzing multiple types of data when making client-related decisions, delegating tasks to others, and understanding the pathophysiology underlying a client's conditions. In addition, it was found that the graduates were more likely to feel adequately prepared when nursing programs taught them use of information technology and evidence-based practice; integrated pathophysiology and critical thinking throughout the curriculum; taught content related to the care of client populations as independent courses; and had a higher percentage of faculty teaching both didactic and clinical components of the curriculum. The findings of this study are significant in broadening our understanding of the relationships between educational elements and preparedness of new nurses for practice.     

Academic administrators' attitudes towards interprofessional education in Canadian schools of health professional education

Interprofessional education is an approach to educating and training students and practitioners from different health professions to work in a collaborative manner in providing client and/or patient-centred care. The introduction and successful implementation of this educational approach is dependent on a variety of factors, including the attitudes of students, faculty, senior academic administrators (e.g., deans and directors) and practitioners. The purpose of this study was to examine attitudes towards interprofessional teamwork and interprofessional education amongst academic administrators of post-secondary health professional education programs in Canada. A web-based questionnaire in English and French was distributed via e-mail messaging during January 2004 to academic administrators in Canada representing medicine, nursing, pharmacy, social work, occupational therapy and physiotherapy post-secondary educational programs. Responses were sought on attitudes towards interprofessional teamwork and interprofessional education, as well as opinions regarding barriers to interprofessional education and subject areas that lend themselves to interprofessional education. In general, academic administrators responding to the survey hold overall positive attitudes towards interprofessional teamwork and interprofessional education practices, and the results indicate there were no significant differences between professions in relation to these attitudinal perspectives. The main barriers to interprofessional education were problems with scheduling/calendar, rigid curriculum, turf battles and lack of perceived value. The main pre-clinical subject areas which respondents believed would lend themselves to interprofessional education included community health/prevention, ethics, communications, critical appraisal, and epidemiology. The results of this study suggest that a favourable perception of both interprofessional teamwork and interprofessional education exists amongst academic administrators of Canadian health professional education programs. If this is the case, the post-secondary system in Canada is primed for the introduction of interprofessional education initiatives which support the development of client and patient-centred collaborative practice competencies.     

Colonoscopy services in the United Kingdom.

BACKGROUND AND STUDY AIMS: Provision of a reasonable colonoscopy service requires approximately 160 procedures per 100000 population per year. The aim of the present study was to document current levels of colonoscopy service, the use of guidelines in surveillance practice and the capacity for expansion in endoscopy units throughout the United Kingdom. MATERIAL AND METHODS: A postal questionnaire was sent to 294 endoscopy units. RESULTS: Replies were received from 164 units (60 %). Of the units, 49 % have reached the calculated target figure. In units not meeting the target, 22% have only one colonoscopist, and 31% have one colonoscopy session a week. Overall, 50 % of units are working at full capacity. Out of all units, 70 % are unable to expand their service further, because of lack of nursing support in 81%, non-availability of endoscopist in 72 % and lack of physical space in 51%. Guidelines for surveillance colonoscopy were a problem: 51% of units reported that guidelines were available for surveillance of ulcerative colitis, 28 % for Crohn's disease, 59 % for polyp follow-up, and 44 % for follow-up of resected colorectal cancer. The majority of units (>70%) had no protocols for their surveillance practice. Nonetheless, 92% of units performed surveillance colonoscopy for ulcerative colitis, 34% for Crohn's disease, and 76% for resected colorectal cancer. CONCLUSIONS: The colonoscopy service has expanded, but there are constraints on further growth. There is a pressing need for national guidelines on surveillance colonoscopy.     

Ethical issues in practice: A survey of home‐visiting nurses in Japan

Aim: The purposes of this study were to identify specific components and frequencies of ethical issues that home‐visiting nurses encountered in their practice, relationships between ethical issues and demographic data, and experience of ethics education and workplace environment. Methods: A self‐administered questionnaire was distributed to home‐visiting nurses in Japan. Usable data (1961) were analyzed. Results: Item and exploratory factor analysis for the frequency of encountering ethical issues revealed: (i) concern about respecting client or relationships with relevant professionals; (ii) differences in treatment or care‐taking views among home‐visiting nurse and client and family, or relevant professionals; and (iii) discrepancy of intention between family and client or home‐visiting nurse. All factors were significantly positively related to the current position, duration of working experience as a home‐visiting nurse, and type of nursing education; age was significantly negatively related. Home‐visiting nurses noted that programmed continuing education systems and staff‐training programs were not sufficiently available. Conclusion: The findings of this study indicated the characteristics of ethical issues that home‐visiting nurses encountered in their practice and insufficient continuing education system including ethics education. Ethics education programs tailored to home‐visiting nurses ethical concerns and traits and continuing education systems are needed.     

Practical uses of chromoendoscopy and magnification at colonoscopy

New technologies in the form of high-magnification or zoom colonoscopy complemented by chromoscopic agents permits early detection of neoplastic colorectal lesions, particularly flat and depressed types. Establishing suitability for endoscopic resection or surgical excision can be enhanced using these techniques. Chromoscopic colonoscopy may play an important role in the routine endoscopic colorectal cancer surveillance programs in patients assuming a high risk of colorectal neoplasia. This article summarizes recent data regarding the prevalence and histopathologic characteristics of flat and depressed colorectal lesion in Western cohorts and describes how their detection and management can be improved by chromoscopy and magnification technology. The techniques required for chromoscopic colonoscopy and magnification imaging are outlined along with a review of the literature on these subjects.     

Beliefs about AIDS, health, and illness among low-income Latina women.

The purposes of this study were to describe (a) the health beliefs of Latina women about acquired immunodeficiency syndrome (AIDS); and (b) the relationship of these beliefs to the subjects' traditional beliefs about illness and its treatment. The sample consisted of 59 low-income Latina women attending nutrition programs in Los Angeles. A qualitative approach was used to gather the data in semi-structured focus group interviews. Content analysis was used to classify data according to causes of AIDS and prevention and treatment of AIDS. Causes of AIDS included all of the current biomedical and public health explanations of transmission, current popular beliefs and misconceptions about transmission, and long-standing traditional beliefs about the causes of illness. Prevention and treatment of AIDS reflected these same three perspectives. The women's beliefs consisted of accurate, inaccurate, and incomplete information about AIDS. Implications were drawn from the findings for AIDS education and prevention programs which are congruent with the participants' cultural beliefs, values, attitudes, and expectations.     

Adaptation and validation of the health belief model scale for colorectal cancer screening

Korea has the second highest incidence of colorectal cancer in the world. Instruments that are culturally and contextually sensitive, as well as valid and reliable, for determining health beliefs regarding colorectal cancer screening are essential for obtaining accurate information. The purpose of this study was to adapt and validate the health belief model scale for Koreans regarding colorectal cancer and fecal occult blood test utilization. Individual and cognitive interviews (also known as cognitive debriefing) with 33 Koreans, expert reviews with seven nursing practitioners and professors, and a pilot test with 18 Koreans were conducted to make the existing health belief model scale culturally and contextually sensitive. Subsequently, a cross‐sectional survey with 728 Koreans aged > 50 years was conducted. Exploratory and confirmatory factor analyses of the construct validity and internal consistency reliability supported the adapted health belief model scale. The adapted and validated health belief model scale in this study could contribute to the assessment of health beliefs regarding the fecal occult blood test among Koreans with a greater degree of accuracy with respect to Korean culture and context.     

Trends in colonoscopy for colorectal cancer screening

BACKGROUND: A major health priority is to increase colorectal cancer screening, and colonoscopy has become an increasingly important method of screening. The Medicare program began coverage for colonoscopy for average risk individuals in 2001. OBJECTIVES: We sought to examine whether overall colorectal cancer screening increased over time and whether these increases were a result of increased utilization of all methods or a result of greater use of colonoscopy but reduced use of other methods, whether the enactment of Medicare coverage was associated with an increase in colonoscopy among Medicare enrollees, and whether these trends equally affected subpopulations. METHODS: We used nationally representative data from the 2000 and 2003 National Health Interview Surveys and analyzed data using used chi, difference-in-differences tests, and logistic regression analyses to examine whether screening rates differed between 2000 and 2003. RESULTS: The percentage of individuals being screened for colorectal cancer using any method increased modestly from 2000 to 2003 (3%), with increases a result of increased use of colonoscopy and a reduction in the use of other methods. Increases in colonoscopy use were significant among all populations except the insured, non-Medicare population with low incomes. Among Medicare enrollees with high/middle incomes, colonoscopy use increased 14% from 2000 to 2003 compared with an increase of only 7% among low-income groups, which was a significant difference (P < 0.01). Similarly, among insured, non-Medicare enrollees with high/middle incomes, colonoscopy use increased 11% from 2000 to 2003 compared with an increase of only 4% among low-income groups, which also was a significant difference (P < 0.01). CONCLUSIONS: Colorectal cancer screening utilization increased modestly from 2000 to 2003, with the increases that primarily were the result of increased colonoscopy use. Increases in colonoscopy use, however, were primarily among high/middle income groups. Although Medicare coverage may have indirectly facilitated the increase in colonoscopy, we could not determine that coverage directly increased screening rates. Screening rates remain modest and lower income individuals continue to be screened less. Topics for future research include approaches to facilitating screening among low-income individuals and evaluating the impact of policy coverage decisions.     

Pratique de la coloscopie en France en 2011 : résultats de l’enquête électronique « une semaine d’endoscopie en France »

Context

There is little data available on colonoscopy practices and its diagnostic performance in Europe. We have carried out a national prospective study, evaluating colonoscopy practices and the diagnostic performance of this examination.

Method

An online questionnaire was sent to 2,600 French gastroenterologists. Information from healthcare professionals who responded was collected and compared with national data from the Ordre des Médecins (French equivalent of the General Medical Council in the UK). Over a one week period, data on all gastrointestinal endoscopies carried out, including histological results, were recorded online. The results were extrapolated for a whole year of endoscopy in France, and factors linked to adenoma detection rates (ADR), polyps or colorectal cancer (CRC) were determined.

Results

342 gastroenterologists representing the speciality provided data on 3,266 colonoscopies. In 90% of cases, this was a full colonoscopy. 48% percent of patients were male, aged over 50 years in 77% of cases. Colonoscopy was indicated to investigate colorectal cancer in 40% of cases, gastrointestinal symptoms in 39% of cases and following a positive Hemoccult® test in 5% of cases. Polyp resection was performed in 31.3% of cases, with lesions being > 10 mm in 21% of cases, n > 3 in 14% of cases and occurring in the right colon in 47% of cases. Adenoma and adenocarcinoma detection rates were 17.7% and 2.9% of cases respectively. Factors associated with an increased ADR were: being male (p < 0.0001), being > 50 years old (p < 0.0001), family risk factors of colorectal cancer (p = 0.0002), a previous personal history of polyps or colorectal cancer (p < 0.001) and a positive Hemoccult® test (p = 0.0008). CCR rates were three times higher for patients who had never had a colonoscopy before (4.2% vs 1.4%, p < 0.0001).

Conclusion

This prospective national data on colonoscopy practices, including for the first time in France histological results, underlines the importance of improvements to colon preparation, resulting in an overall ADR of 17.7% and confirming the preventive role of colonoscopic monitoring in the appearance of CRC.     

Colonoscopy and multidetector-array computed-tomographic colonography: detection rates and feasibility

BACKGROUND AND STUDY AIMS: Computed-tomographic (CT) colonography has been introduced as a minimally invasive colon examination for the detection of colorectal neoplasms. The aim of this study was to compare the performance characteristics of multidetector-array CT colonography (MDCTC) and conventional colonoscopy in a prospective, blinded design. PATIENTS AND METHODS: Sixty-six symptomatic patients, 75 patients undergoing polyp and cancer surveillance, and seven patients undergoing preoperative colonoscopy due to colorectal cancer (CRC) were examined with MDCTC and subsequent colonoscopy. The gold standard was colonoscopy. If MDCTC was positive and the first-pass colonoscopy was negative, a second-pass colonoscopy served as the gold standard. RESULTS: Complete colonoscopy was achieved in 91% of the patients, while technically satisfying MDCTC was obtained in 76% of the patients (P < 0.01), insufficient air distension in the sigmoid colon being the main problem. MDCTC and colonoscopy both detected all 11 carcinomas. Overall detection rates for polypoid lesions 6 mm or larger in size were 81% (95% CI, 70% to 90%) for MDCTC and 87% (95% CI, 77% to 94%) for colonoscopy (P = 0.52), with a significant difference with regard to the detection of polyps 6-9 mm in size in favor of colonoscopy (P = 0.008). The specificity of MDCTC at a 6-mm level was 97% (95% CI, 92% to 99%). CONCLUSIONS: MDCTC and colonoscopy show equal overall sensitivity for the detection of polypoid lesions 6 mm or larger in size, but more patients are inadequately examined when MDCTC is used.