Daffodil Centre, University of Sydney, a joint venture with Cancer Council NSW, Sydney, Australia; Melanoma Institute Australia, University of Sydney, NSW;
Centre for Health Policy, Melbourne School of Population and Global Health, University of Melbourne, Victoria, Australia.
Public Health Res Pract. 2023 Jul 5;33(2):32232213. doi: 10.17061/phrp32232213.
Risk-stratified approaches to cancer screening aim to provide tailored risk advice to individuals, rather than the mostly one-size-fits-all approach designed for the average person that is currently used in Australia. Stratified cancer screening has the potential to increase the benefits and reduce the harms of screening. Initial risk assessment is a crucial first step for screening programs that use risk stratification. We report findings from a qualitative study exploring the views of the Australian public on how to best deliver risk-stratified cancer screening in the population to help inform future implementation.
Qualitative interview study.
We conducted semistructured interviews with participants from a previous study, half of whom had received personal genomic risk information and half of whom had not. We asked how and where they would like to see risk-stratified screening delivered and how they felt about different health professionals assessing their cancer risk. Data were analysed thematically.
Forty interviews were conducted. The age range of participants was 21-68 years; 58% were female. Themes included: 1) Convenience is a priority; 2) General practice is a good fit for some; 3) Web-based technology is part of the process; and 4) "I would want to know why [I was being stratified]". Similar views were expressed by both groups. Our findings suggest that although health professionals were identified as having an important role, there were mixed preferences for delivery by general practitioners, medical specialists or nurses. Participants were less concerned about who undertook the risk assessment than whether the health professional had the appropriate skill set and availability. Clear communication and evidence of the need for change in screening eligibility and frequency were key factors in the successful delivery of risk-stratified screening.
We identified that convenience and good communication, including clear explanations to the public with convincing evidence for change, will enable the successful delivery of risk-stratified cancer screening in the population, including organised and opportunistic screening approaches. Health professional education and upskilling across disciplines will be key facilitators. Engagement and further consultation with primary care and other key stakeholders will be central.
旨在为个体提供量身定制的风险建议，而不是目前在澳大利亚用于大多数人的一刀切的方法。分层癌症筛查有可能增加筛查的益处并减少危害。初始风险评估是使用风险分层的筛查计划的关键第一步。我们报告了一项定性研究的结果，该研究探讨了澳大利亚公众对如何在人群中最佳提供分层癌症筛查的看法，以帮助为未来的实施提供信息。
定性访谈研究。
我们对半结构访谈的参与者进行了访谈，其中一半参与者接受了个人基因组风险信息，另一半参与者没有接受。我们询问了他们希望在哪里看到分层筛查的交付方式，以及他们对不同的健康专业人员评估其癌症风险的看法。对数据进行了主题分析。
共进行了 40 次访谈。参与者的年龄范围为 21-68 岁；女性占 58%。主题包括：1）便利性是重中之重；2）一般实践适合某些人；3）基于网络的技术是该过程的一部分；4）“我想知道为什么[我被分层]”。两组都表达了类似的观点。我们的研究结果表明，尽管健康专业人员被认为具有重要作用，但对于由全科医生，医学专家或护士提供的服务，存在着不同的偏好。参与者对进行风险评估的人员的关注程度不如对健康专业人员是否具有适当的技能组合和可用性的关注程度。清晰的沟通和对改变筛查资格和频率的需求的证据是成功进行分层风险筛查的关键因素。
我们发现，便利性和良好的沟通，包括对公众进行清晰的解释，并提供令人信服的证据证明需要进行改变，将使分层癌症筛查在人群中的成功交付成为可能，包括有组织的和机会性的筛查方法。跨学科的健康专业人员教育和技能提升将是关键的促进因素。与初级保健和其他主要利益相关者的参与和进一步协商将是核心。
