Department of Family and Community Medicine, Virginia Tech Carilion School of Medicine, Roanoke, Virginia, USA
Department of Family and Community Medicine, Carilion Clinic, Roanoke, Virginia, USA.
Fam Med Community Health. 2024 Sep 18;12(Suppl 2):e002933. doi: 10.1136/fmch-2024-002933.
'Sludge' refers to administrative burdens or frictions that preclude people from getting what they want or need (eg, duplicative forms, complicated instructions, long waiting times). This mixed methods study evaluated patients' perceptions of sludge in the colorectal cancer (CRC) screening process and some impacts of this sludge.
We employed an exploratory sequential mixed methods study design that comprised patient interviews and a patient survey. The interviews informed final survey revisions and captured contextual data about patients' experiences with sludge. Interview transcripts were inductively and deductively analysed to identify overarching themes. The survey quantified sludge, delayed or forgone screenings, screening experience (Net Promoter Score) and health system distrust (Health System Distrust Scale). We used χ or t-tests for univariable comparisons and logistic or linear regressions to evaluate the association between cumulative sludge score and delayed or forgone screenings, screening experience and health system distrust. Results were integrated for interpretation.
Southeastern United States.
Patients who were 45-75 years of age, at average risk for CRC and had either completed or been referred for CRC screening (colonoscopy or stool-based test) within the previous 12 months.
22 interview participants and 255 survey participants completed the study. 38 (15%) survey participants rated their screening experience as poor (Net Promoter Score=0-7 out of 10). The mean (SD) Health System Distrust Scale score was 22.4 (6.3) out of 45 possible points (higher score=greater distrust). Perceptions of sludge in the CRC screening process varied, with long waiting times and burdensome communication being the most common sources (58% and 35% of participants, respectively). Sludge was positively associated with delayed or forgone screenings (OR=1.42, 95% CI 1.28, 1.57, p<0.001), poor screening experience (OR=1.15, 95% CI 1.04, 1.28, p=0.009) and health system distrust (β=0.47, p<0.001). Qualitative findings add descriptive detail about sludge encountered, context to impacts experienced, and illustrate the heavy emotional impact of sludge: '.
Efforts to reduce sludge in the CRC screening process may improve timely completion of CRC screening, enhance patient experience and restore trust in the health system.
“Sludge”是指妨碍人们获得所需（例如，重复的表格、复杂的说明、长时间的等待）的行政负担或摩擦。本混合方法研究评估了患者在结直肠癌（CRC）筛查过程中对“Sludge”的看法，以及这种“Sludge”的一些影响。
我们采用了探索性序贯混合方法研究设计，包括患者访谈和患者调查。访谈为最终调查修订提供了信息，并获取了关于患者在 sludge 方面体验的背景数据。对访谈记录进行了归纳和演绎分析，以确定总体主题。该调查量化了 sludge、延迟或放弃筛查、筛查体验（净推荐值）和对卫生系统的不信任（卫生系统不信任量表）。我们使用 χ 或 t 检验进行单变量比较，使用逻辑或线性回归评估累积 sludge 评分与延迟或放弃筛查、筛查体验和对卫生系统的不信任之间的关联。结果进行整合解释。
美国东南部。
45-75 岁，平均结直肠癌风险，在过去 12 个月内完成或转介接受结直肠癌筛查（结肠镜检查或粪便检测）的患者。
22 名访谈参与者和 255 名调查参与者完成了研究。38 名（15%）调查参与者对其筛查体验评价较差（净推荐值=0-7 分，满分 10 分）。卫生系统不信任量表的平均（SD）得分为 22.4（6.3）分，满分为 45 分（得分越高表示不信任程度越高）。CRC 筛查过程中对 sludge 的看法各不相同，长时间的等待时间和繁琐的沟通是最常见的来源（分别为 58%和 35%的参与者）。Sludge 与延迟或放弃筛查（比值比[OR]=1.42，95%置信区间[CI]为 1.28-1.57，p<0.001）、较差的筛查体验（OR=1.15，95%CI 为 1.04-1.28，p=0.009）和对卫生系统的不信任（β=0.47，p<0.001）呈正相关。定性研究结果提供了关于遇到的 sludge 的详细描述，说明了所经历的影响的背景，并说明了 sludge 对患者情绪的巨大影响：“……”
减少 CRC 筛查过程中的 sludge 可能会提高 CRC 筛查的及时性，改善患者体验并恢复对卫生系统的信任。
