Implementation of risk stratification within bowel cancer screening: a community jury study exploring public acceptability and communication needs
Abstract Background Population-based cancer screening programmes are shifting away from age and/or sex-based screening criteria towards a risk-stratified approach. Any such changes must be acceptable to the public and communicated effectively. We aimed to explore the social and ethical consideration...
| Main Authors: | , , , , , , , |
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| Format: | Article |
| Language: | English |
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BMC
2023-09-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-023-16704-6 |
| _version_ | 1827581278582472704 |
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| author | Lily C. Taylor Rebecca A. Dennison Simon J. Griffin Stephen D. John Iris Lansdorp-Vogelaar Chloe V. Thomas Rae Thomas Juliet A. Usher-Smith |
| author_facet | Lily C. Taylor Rebecca A. Dennison Simon J. Griffin Stephen D. John Iris Lansdorp-Vogelaar Chloe V. Thomas Rae Thomas Juliet A. Usher-Smith |
| author_sort | Lily C. Taylor |
| collection | DOAJ |
| description | Abstract Background Population-based cancer screening programmes are shifting away from age and/or sex-based screening criteria towards a risk-stratified approach. Any such changes must be acceptable to the public and communicated effectively. We aimed to explore the social and ethical considerations of implementing risk stratification at three different stages of the bowel cancer screening programme and to understand public requirements for communication. Methods We conducted two pairs of community juries, addressing risk stratification for screening eligibility or thresholds for referral to colonoscopy and screening interval. Using screening test results (where applicable), and lifestyle and genetic risk scores were suggested as potential stratification strategies. After being informed about the topic through a series of presentations and discussions including screening principles, ethical considerations and how risk stratification could be incorporated, participants deliberated over the research questions. They then reported their final verdicts on the acceptability of risk-stratified screening and what information should be shared about their preferred screening strategy. Transcripts were analysed using codebook thematic analysis. Results Risk stratification of bowel cancer screening was acceptable to the informed public. Using data within the current system (age, sex and screening results) was considered an obvious next step and collecting additional data for lifestyle and/or genetic risk assessment was also preferable to age-based screening. Participants acknowledged benefits to individuals and health services, as well as articulating concerns for people with low cancer risk, potential public misconceptions and additional complexity for the system. The need for clear and effective communication about changes to the screening programme and individual risk feedback was highlighted, including making a distinction between information that should be shared with everyone by default and additional details that are available elsewhere. Conclusions From the perspective of public acceptability, risk stratification using current data could be implemented immediately, ahead of more complex strategies. Collecting additional data for lifestyle and/or genetic risk assessment was also considered acceptable but the practicalities of collecting such data and how the programme would be communicated require careful consideration. |
| first_indexed | 2024-03-08T22:34:08Z |
| format | Article |
| id | doaj.art-3199571ed5f2425397f089b2fa10d02b |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-03-08T22:34:08Z |
| publishDate | 2023-09-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-3199571ed5f2425397f089b2fa10d02b2023-12-17T12:32:27ZengBMCBMC Public Health1471-24582023-09-0123111410.1186/s12889-023-16704-6Implementation of risk stratification within bowel cancer screening: a community jury study exploring public acceptability and communication needsLily C. Taylor0Rebecca A. Dennison1Simon J. Griffin2Stephen D. John3Iris Lansdorp-Vogelaar4Chloe V. Thomas5Rae Thomas6Juliet A. Usher-Smith7Primary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of CambridgePrimary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of CambridgePrimary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of CambridgeDepartment of History and Philosophy of Science, University of CambridgeDepartment of Public Health, Erasmus University Medical CentreSchool of Health and Related Research, University of SheffieldDepartment of Public Health and Tropical Medicine, James Cook UniversityPrimary Care Unit, Department of Public Health and Primary Care, School of Clinical Medicine, University of CambridgeAbstract Background Population-based cancer screening programmes are shifting away from age and/or sex-based screening criteria towards a risk-stratified approach. Any such changes must be acceptable to the public and communicated effectively. We aimed to explore the social and ethical considerations of implementing risk stratification at three different stages of the bowel cancer screening programme and to understand public requirements for communication. Methods We conducted two pairs of community juries, addressing risk stratification for screening eligibility or thresholds for referral to colonoscopy and screening interval. Using screening test results (where applicable), and lifestyle and genetic risk scores were suggested as potential stratification strategies. After being informed about the topic through a series of presentations and discussions including screening principles, ethical considerations and how risk stratification could be incorporated, participants deliberated over the research questions. They then reported their final verdicts on the acceptability of risk-stratified screening and what information should be shared about their preferred screening strategy. Transcripts were analysed using codebook thematic analysis. Results Risk stratification of bowel cancer screening was acceptable to the informed public. Using data within the current system (age, sex and screening results) was considered an obvious next step and collecting additional data for lifestyle and/or genetic risk assessment was also preferable to age-based screening. Participants acknowledged benefits to individuals and health services, as well as articulating concerns for people with low cancer risk, potential public misconceptions and additional complexity for the system. The need for clear and effective communication about changes to the screening programme and individual risk feedback was highlighted, including making a distinction between information that should be shared with everyone by default and additional details that are available elsewhere. Conclusions From the perspective of public acceptability, risk stratification using current data could be implemented immediately, ahead of more complex strategies. Collecting additional data for lifestyle and/or genetic risk assessment was also considered acceptable but the practicalities of collecting such data and how the programme would be communicated require careful consideration.https://doi.org/10.1186/s12889-023-16704-6Bowel cancerRisk stratificationCancer screeningCommunity juryAcceptability |
| spellingShingle | Lily C. Taylor Rebecca A. Dennison Simon J. Griffin Stephen D. John Iris Lansdorp-Vogelaar Chloe V. Thomas Rae Thomas Juliet A. Usher-Smith Implementation of risk stratification within bowel cancer screening: a community jury study exploring public acceptability and communication needs BMC Public Health Bowel cancer Risk stratification Cancer screening Community jury Acceptability |
| title | Implementation of risk stratification within bowel cancer screening: a community jury study exploring public acceptability and communication needs |
| title_full | Implementation of risk stratification within bowel cancer screening: a community jury study exploring public acceptability and communication needs |
| title_fullStr | Implementation of risk stratification within bowel cancer screening: a community jury study exploring public acceptability and communication needs |
| title_full_unstemmed | Implementation of risk stratification within bowel cancer screening: a community jury study exploring public acceptability and communication needs |
| title_short | Implementation of risk stratification within bowel cancer screening: a community jury study exploring public acceptability and communication needs |
| title_sort | implementation of risk stratification within bowel cancer screening a community jury study exploring public acceptability and communication needs |
| topic | Bowel cancer Risk stratification Cancer screening Community jury Acceptability |
| url | https://doi.org/10.1186/s12889-023-16704-6 |
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