Kew Guan Sen, Koh Calvin Jianyi
Division of Gastroenterology and Hepatology, Department of Medicine, National University Hospital, Singapore.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore.
Gut Liver. 2020 Sep 15;14(5):546-552. doi: 10.5009/gnl19306.
Colorectal cancer is a major cause of morbidity and mortality, and screening has been shown to reduce morbidity and mortality. This review highlights pertinent aspects of adherence to screening including the various options available and key concepts to consider in any systematic program. Persistent adherence, which is key to an efficacious screening program, is the compliance with repeated screening tests over a period of time. A "chain of survival" mindset emphasizes the stepwise, sequential and persistent approach to screening and is a helpful concept to drive the message of persistent adherence. A framework for the patient and physician interactions that support screening intervention is examined, and various factors that impact both patient and physician adoption and screening modality recommendations are reviewed. While systems-based approaches to screening have great utility in automation and monitoring in a surveillance program, some emerging data suggests that the human touch is still an essential driver for active participation in these programs. Finally, the proportion of time concept is discussed as a useful index for monitoring persistent adherence in both individuals and populations.
结直肠癌是发病和死亡的主要原因，而筛查已被证明可降低发病率和死亡率。本综述重点介绍了坚持筛查的相关方面，包括可用的各种选项以及在任何系统计划中需考虑的关键概念。持续坚持是有效筛查计划的关键，即一段时间内对重复筛查测试的依从性。“生存链”思维强调筛查的逐步、顺序和持续方法，是推动持续坚持信息的有益概念。研究了支持筛查干预的患者与医生互动框架，并回顾了影响患者和医生采用及筛查方式推荐的各种因素。虽然基于系统的筛查方法在监测计划的自动化和监测方面有很大作用，但一些新数据表明，人际关怀仍是积极参与这些计划的重要驱动力。最后，讨论了时间比例概念作为监测个体和人群持续坚持情况的有用指标。
