Clifton Abigail, Burgess Caroline, Clement Sarah, Ohlsen Ruth, Ramluggun Pras, Sturt Jackie, Walters Paul, Barley Elizabeth A
Florence Nightingale Faculty of Nursing and Midwifery, King's College London, 57 Waterloo Road, London, SE1 8WA, UK.
Division of Health and Social Care Research, Faculty of Life Sciences & Medicine, King's College London, Addison House, Guy's Campus, London Bridge, London, SE1 1UL, UK.
BMC Health Serv Res. 2016 Jul 12;16:257. doi: 10.1186/s12913-016-1505-4.
Cancers are a leading cause of death worldwide. People with mental illness are 30 % more likely to die from cancer than the general population. One reason for this may be low uptake of nationally offered cancer screening tests by people with mental illness. We aimed to identify barriers and facilitators for breast, cervical and bowel cancer screening uptake by people with mental illness in order to inform interventions to promote equal access.
The interview study was conducted in both urban and rural settings. The study was informed by the Theoretical Domains Framework, using framework analysis and triangulation across participant groups. Participants included 45 mental health service users (service users) eligible for cancer screening, 29 mental health professionals and 11 professionals involved in cancer screening.
Themes emerging from the data that affected uptake included knowledge of screening programmes by both service users and healthcare providers; knowledge of, and attitudes towards, mental illness; health service-delivery factors; service users' beliefs and concerns about cancer screening, and practical issues. These are relevant to different stages of the screening process. Service users do not receive invitations to screening or cancer testing kits if they are admitted to hospital. They are not routinely invited for screening if they are not registered with a general practitioner (GP). Lack of integrated care means that mental health staff do not know if someone is overdue for a test and cancer screening is often not considered during health promotion. Barriers including information processing problems, the extent to which the screening process aggravates symptoms, poor staff client relationships and travel difficulties vary between individuals. Screening professionals are motivated to help, but may lack time or training to manage mental health needs. Reactive measures are available, but service users must request help which they may find difficult.
There are specific barriers to cancer screening uptake for mental health service users that prevent equality of care. Interventions that can be personalised are needed at individual, policy and service-delivery levels. Primary and secondary care staff and policy-makers should work together to develop an integrated approach to cancer screening in this population.
癌症是全球主要死因之一。患有精神疾病的人死于癌症的可能性比普通人群高30%。其原因之一可能是患有精神疾病的人对国家提供的癌症筛查测试接受率较低。我们旨在确定患有精神疾病的人接受乳腺癌、宫颈癌和肠癌筛查的障碍及促进因素，以便为促进平等获取筛查服务的干预措施提供依据。
访谈研究在城市和农村地区均有开展。该研究以理论领域框架为依据，采用框架分析法并在不同参与群体间进行三角互证。参与者包括45名符合癌症筛查条件的精神卫生服务使用者（服务对象）、29名精神卫生专业人员以及11名参与癌症筛查的专业人员。
数据中出现的影响筛查接受率的主题包括服务对象和医疗服务提供者对筛查项目的了解；对精神疾病的了解及态度；卫生服务提供因素；服务对象对癌症筛查的信念和担忧以及实际问题。这些与筛查过程的不同阶段相关。服务对象住院时不会收到筛查或癌症检测试剂盒的邀请。若未在全科医生处登记，他们通常不会被常规邀请进行筛查。缺乏综合护理意味着精神卫生工作人员不知道某人是否逾期未进行检测，且在健康促进过程中往往不会考虑癌症筛查。包括信息处理问题、筛查过程使症状加重的程度、医患关系不佳以及出行困难等障碍因人而异。筛查专业人员有提供帮助的积极性，但可能缺乏时间或培训来满足精神卫生需求。有一些应对措施，但服务对象必须主动寻求帮助，而这可能对他们来说很困难。
精神卫生服务对象在接受癌症筛查方面存在特定障碍，这妨碍了医疗服务的平等性。需要在个体、政策和服务提供层面采取个性化的干预措施。初级和二级护理人员以及政策制定者应共同努力，为这一人群制定综合的癌症筛查方法。
