Barriers and Facilitators to Participation in Health Screening: an Umbrella Review Across Conditions

Le Bonniec A, Sun S, Andrin A, Dima AL, Letrilliart L.

Prevention science June 2022 Epub ahead of print

Abstract

Screening is an essential prevention practice for a number of health conditions. However, screening coverage remains generally low. Studies that investigate determinants of screening participation are becoming more common, but oftentimes investigate screening for health conditions in an individualized rather than integrated fashion. In routine clinical practice, however, healthcare professionals are often confronted with situations in which several screening procedures are recommended for the same patient. The consideration of their common determinants may support a more integrated screening approach. The objectives of this umbrella review were therefore to examine: 1) the determinants (barriers and facilitators) that have been identified in relation to recommended health screening procedures; and 2) the modifiable determinants (in primary care) common across health conditions or specific to individual procedures. Results were presented through a narrative synthesis. PubMed, PsycInfo and Cochrane were searched up to January 2022. Systematic reviews reporting determinants of participation in health screening procedures with grade A or B recommendation according to the US Preventive Services Task Force were included. A total of 85 systematic reviews were included, most which contained both qualitative and quantitative studies on determinants that describe individual factors (961 occurrences), social factors (113 occurrences, healthcare professional factors (149 occurrences), health system factors (105 occurrences) and screening procedure factors (99 occurrences). The most studied screening procedures concerned cervical cancer/human papillomavirus (n = 33), breast cancer (n = 28), colorectal cancer (n = 25) and the human immunodeficiency virus (n = 12). Other conditions have been under-studied (e.g. cardiovascular problems, lung cancer, syphilis). The individual domain, including determinants such as knowledge, beliefs and emotions, was the most covered across health conditions. Healthcare professional's recommendations and the quality of patient-provider communication were identified to have a strong influence on screening participation in most conditions. The other three domains included determinants which were more specific to a condition or a population. Various determinants modifiable in primary care were found in the individual domain and in the health system, healthcare professional and screening procedure domains. Quality was assessed as low for most systematic reviews included. The identification of various modifiable determinants common across conditions highlights the potential of an integrated screening participation approach. Interventions may address common determinants in a broader person-centred framework within which tailoring to specific procedures or populations can be considered. This approach needs to be explored in intervention studies. The systematic review registration is PROSPERO CRD42019126709

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Why taking a screening test? Systematic review results highlight the importance of good communication in supporting patients decide on screening participation

A new systematic umbrella review by an international team led by Dr. Alice Le Bonniec, NUI Galway, and conducted with researchers in health psychology and primary care from University Claude Bernard (Lyon, France) and Sant Joan de Déu Research Institute (Barcelona, Spain) aimed to identify the key factors that primary care practitioners could prioritize in their practice to support screening participation across conditions and procedures.

 In this umbrella review, published in Prevention Science in June 2022, the authors examined results of 85 systematic reviews published since 1996, most looking into screening procedures for breast, cervical and colorectal cancer, and for HIV. Across conditions, screening participation was higher when the quality of patient-provider communication was better and when patients had adequate knowledge and positive beliefs about screening. Major barriers commonly cited were experiencing fear –of the discomfort of the testing procedure, of knowing the results and of disease-, feeling embarrassed, ashamed or stigmatized, and facing difficulties to access the procedure.

“These are reasons we encounter again and again in studies looking into the question of screening participation. Some are quantitative surveys, others include interviews with patients and their caregivers. When we see these reasons mentioned across conditions and populations, we can consider them a good starting point for interventions to support shared decision-making.” explained Dr. Le Bonniec.

According to Pr. Laurent Letrilliart, professor of general practice at University Claude Bernard Lyon who supervised the umbrella review: “In primary care, we do not deal with each health condition separately. In consultations, we meet with the individual person, who might benefit from several screening examinations and tests at a given moment in their lives. We need to discuss with each person what is most appropriate and help them decide what is best for them. This is why we need to find common factors that support these decisions across conditions, and see how we can tackle them. This study shows us that if we want to discuss about screening participation with a patient, it would be useful to start with what they know, what that procedure means to them, and how they feel about it. Before looking into the specificities of each procedure, we should look first at these three points. And invest in building a good relationship with the patient. In our teaching, we put a lot of emphasis on communication skills and shared decision making. They are the common basis for all prevention and treatment according to a patient-oriented approach”.

The article and its supplementary online materials represent a comprehensive resource for future intervention studies, and for training primary care professionals. The research was funded by the Chaire Prevent’Horizon and is part of an established prevention research programme (mon.dépistage) conducted by the RESHAPE research laboratory (INSERM and University Claude Bernard). Dr. Le Bonniec is currently working as postdoctoral researcher in the Health Behaviour Change Research Group at NUI Galway (Ireland), where she leads an interventional research aiming to increase participation in colorectal cancer screening.

Reference: Le Bonniec A, Sun S, Andrin A, Dima AL, Letrilliart L. Barriers and Facilitators to Participation in Health Screening: an Umbrella Review Across Conditions. Prev Sci. 2022 Jun 15. doi: 10.1007/s11121-022-01388-y. Epub ahead of print. PMID: 35705780.