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Book part
Publication date: 12 December 2007

Katherine S. Virgo, Mary P. Valentine, Lucille C. Dauz, Lan H. Marietta, Brandie S. Adams, Sangita Devarajan, Walter E. Longo and Frank E. Johnson

Many individuals are concurrently eligible for multiple sources of government-reimbursed health care services (e.g. Department of Veterans Affairs (VA) and Medicare)…

Abstract

Many individuals are concurrently eligible for multiple sources of government-reimbursed health care services (e.g. Department of Veterans Affairs (VA) and Medicare). Unclear is whether combined eligibility translates into increased access to care and/or improved outcomes of care. Alternatively continuity of care may suffer, promoting health inequalities when patients receive health services from multiple unrelated sources of care. The current study examines the impact of dual eligibility for government-reimbursed care on long-term outcomes of care for a population of veterans diagnosed with colorectal cancer and initially treated surgically at Department of Veterans Affairs Medical Centers.

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Inequalities and Disparities in Health Care and Health: Concerns of Patients, Providers and Insurers
Type: Book
ISBN: 978-0-7623-1474-4

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Article
Publication date: 7 May 2021

Muhanad Ahmed Ali, Farah Ahmad and Marina Morrow

While there is literature that examines factors associated with low participation in cancer screening among Canadian ethnic groups, there is limited understanding of black…

Abstract

Purpose

While there is literature that examines factors associated with low participation in cancer screening among Canadian ethnic groups, there is limited understanding of black visible minorities, particularly Somalis. Thus, the purpose of this study is to synthesize knowledge pertaining to the perceptions, beliefs and barriers of Somali women and men toward screening for breast, cervical and colorectal cancers in countries such as Canada.

Design/methodology/approach

The scoping review methodology was used to search for peer-reviewed articles that explicitly examined perceptions, beliefs and barriers among Somalis toward screening for breast, cervical and colorectal cancers in developed countries. The following electronic databases were searched without time frame restrictions, namely, OVID Medline, Embase, CINHAL, PubMed, Scopes and ProQuest. A total of 402 peer-reviewed articles were identified and screened. Three articles were identified through reference list screening (one eligible) and consultation with experts in the networks (two eligible). In total, 12 studies met the inclusion criteria for synthesis. Thematic analysis was used to analyze the selected articles for key themes and the synthesis was informed by the socio-ecological model.

Findings

The majority of studies originated from the USA and focused primarily on Somali women and cervical cancer screening. Themes that emerged from the literature include individual-level negative experiences and socio-cultural perceptions/beliefs; community-level barriers in cancer screening; and systemic challenges in navigating the health-care system. Many of the studies focused on individual and community-level determinants of cancer screening, with little attention to systemic level determinants. Other gaps identified include factors influencing Somali men’s low participation in cancer screening; limited studies on colorectal cancer and Somali women; and specific cancer-screening barriers faced by Somalis within the Canadian context.

Originality/value

The findings of the review reveal multiple cancer screening challenges for Somali communities and the gained insights should inform both health and social care practitioners and policymakers.

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International Journal of Migration, Health and Social Care, vol. 17 no. 2
Type: Research Article
ISSN: 1747-9894

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Article
Publication date: 14 October 2013

Nicola Jane Spalding, Fiona Mary Poland, Sheila Gregory, Jane McCulloch, Kevin Sargen and Penny Vicary

– The purpose of this paper is to understand and develop ways to enhance patients’ experiences of preoperative education received prior to surgery for colorectal cancer.

Abstract

Purpose

The purpose of this paper is to understand and develop ways to enhance patients’ experiences of preoperative education received prior to surgery for colorectal cancer.

Design/methodology/approach

Based in the UK, three-action research cycles were undertaken to evaluate preoperative education, identify changes seen by patients and staff as likely to improve the service and to re-evaluate such changes following implementation. Data in each cycle were collected from: observations of clinic interactions; patient questionnaires; individual semi-structured interviews with multidisciplinary colorectal unit staff; longitudinal semi-structured interviews with patients and carers pre-surgery, two weeks post-surgery and 12 weeks post-surgery; patient and carer focus groups post-surgery; and existing educational material.

Findings

In total, 138 participants shared their experiences of either giving or receiving preoperative education. Findings were themed into why patients want preoperative education, and patients’ views of the educational processes.

Practical implications

Patients emphasised the need for educational provision to be fully understandable, comprehensive and client-centred using a range of communication processes. Patients emphasised the need for educational provision to be more fully understandable, comprehensive and client-centred and that important messages should be reinforced using a range of media. At a time of many uncertainties for patients’ lives, such education needed to encompass the experiences patients could expect, delivered by confident healthcare professionals.

Originality/value

Contextualising understanding and facilitating their own actions, enabled patients to regain control in circumstances particularly disruptive of bodily and other life routines. Establishing a sense of control is confirmed as important for patient's wellbeing in preparing for surgery and postoperative rehabilitation.

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Health Education, vol. 113 no. 6
Type: Research Article
ISSN: 0965-4283

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Article
Publication date: 6 January 2012

Nenna Ndukwe, David W. Borowski, Angela Lee, Anne Orr, Sarah Dexter‐Smith and Anil K. Agarwal

There has been considerable interest in the “two‐week rule” referral pathway efficacy for patients with suspected colorectal cancer. This study aims to explore the…

Abstract

Purpose

There has been considerable interest in the “two‐week rule” referral pathway efficacy for patients with suspected colorectal cancer. This study aims to explore the psychological impact on these patients.

Design/methodology/approach

Consecutive patients referred for urgent investigations under the “two‐week rule” were invited to take part in semi‐structured interviews using interpretative phenomenological analysis (IPA). Interviews were audio‐taped, transcribed verbatim and analysed using investigator triangulation to enhance data trustworthiness.

Findings

Ten out of 23 (43.5 per cent) patients consented to interviews; none were diagnosed with cancer. Four super‐ordinate themes were explored, referring to the “making sense of the threat to health”, impact on self, impact on others, reflections on the “two‐week rule” referral, and its investigative process. Participants reported their anxiety, fear, vulnerability and coping mechanisms, but also raised concerns about the communication received during the “two‐week rule” referral process. Female participants preferred a female endoscopist.

Originality/value

This study is the first of its kind exploring the psychological effects of the “two‐week rule” process for colorectal cancer, highlighting potential areas for improvement in patient information, and satisfaction with the referral process.

Details

International Journal of Health Care Quality Assurance, vol. 25 no. 1
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 31 October 2008

Abstract

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Nutrition & Food Science, vol. 38 no. 6
Type: Research Article
ISSN: 0034-6659

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Book part
Publication date: 20 May 2017

Eline Aas, Tor Iversen and Geir Hoff

Misinterpretation of a negative test results in health screening may initiate less preventive effort and more future lifestyle-related disease. We predict that…

Abstract

Misinterpretation of a negative test results in health screening may initiate less preventive effort and more future lifestyle-related disease. We predict that misinterpretation occurs more frequently among individuals with a low level of education compared with individuals with a high level of education.

The empirical analyses are based on unique data from a randomized controlled screening experiment in Norway, NORCCAP (NORwegian Colorectal Cancer Prevention). The dataset consists of approximately 50,000 individuals, of whom 21,000 were invited to participate in a once only screening with sigmoidoscopy. For all individuals, we also have information on outpatient consultations and inpatient stays and education. The result of health behaviour is mainly measured by lifestyle-related diseases, such as COPD, hypertension and diabetes type 2, identified by ICD-10 codes.

The results according to intention-to-treat indicate that screening does not increase the occurrence of lifestyle related diseases among individuals with a high level of education, while there is an increase for individuals with low levels of education. These results are supported by the further analyses among individuals with a negative screening test.

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Human Capital and Health Behavior
Type: Book
ISBN: 978-1-78635-466-2

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Article
Publication date: 1 August 2000

Wynnie Chan

Outlines the main proven dietary links for various forms of cancer – breast, colorectal, lung, prostate, bladder, gastric, cervical and ovarian, endometrial, pancreatic…

Abstract

Outlines the main proven dietary links for various forms of cancer – breast, colorectal, lung, prostate, bladder, gastric, cervical and ovarian, endometrial, pancreatic, oesophageal, laryngeal, oral and pharyngeal, testicular and melanoma. Provides some practical dietary advice in line with the UK Government’s recommendations.

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Nutrition & Food Science, vol. 30 no. 4
Type: Research Article
ISSN: 0034-6659

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Article
Publication date: 15 June 2015

Joanne Crawford, Farah Ahmad, Dorcas E. Beaton and Arlene S. Bierman

The purpose of this paper is to gain an in-depth understanding of beliefs, attitudes, and reasons for decision making about colorectal cancer (CRC) screening among South…

Abstract

Purpose

The purpose of this paper is to gain an in-depth understanding of beliefs, attitudes, and reasons for decision making about colorectal cancer (CRC) screening among South Asian (SA) immigrants.

Design/methodology/approach

Six focus groups conducted in English, Punjabi, and Urdu were held with 42 SA immigrants, 50-74 years old and at average risk for CRC, from November 2012 to May 2013. All focus group discussions were audio-taped and transcribed verbatim. Data analysis used an inductive and systematic approach employing constant comparison techniques.

Findings

Three dominant themes emerged. Beliefs and attitudes towards cancer and screening represented SA immigrant’s perceptions that early detection was beneficial; screening was not necessary in the absence of symptoms; cancer was scary; and the loss of previously established bowel practices upon immigration as potential risks for CRC. Knowledge and awareness focused on unscreened participants’ cancer stories; screened participants’ knowledge of CRC, risk factors, and screening; experiential learning from focus groups; and screened participants’ strategies to promote screening. Support and accessibility concentrated on physician support and responsibility to provide information, explanation, and recommend screening to facilitate access.

Originality/value

Findings provide novel insights on socio-cultural context, beliefs, and barriers to CRC screening among SA immigrants. Culturally appropriate community-based strategies included story-telling, the use of social networks, and greater physician engagement. Enhancing collaborative partnerships with physicians and public health may minimize structural barriers and reduce health disparities. Future research could explore effectiveness of outreach strategies including these collaborations.

Details

International Journal of Migration, Health and Social Care, vol. 11 no. 2
Type: Research Article
ISSN: 1747-9894

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Article
Publication date: 12 June 2017

David W. Borowski, Sarah Cawkwell, Syed M. Amir Zaidi, Matthew Toward, Nicola Maguire and Talvinder S. Gill

Higher caseloads are associated with better outcomes for many conditions treated in secondary and tertiary care settings, including colorectal cancer (CRC). There is…

Abstract

Purpose

Higher caseloads are associated with better outcomes for many conditions treated in secondary and tertiary care settings, including colorectal cancer (CRC). There is little known whether such volume-outcome relationship exist in primary care settings. The purpose of this paper is to examine general practitioner (GP) CRC-specific caseload for possible associations with referral pathways, disease stage and CRC patients’ overall survival.

Design/methodology/approach

The paper retrospectively analyses a prospectively maintained CRC database for 2009-2014 in a single district hospital providing bowel cancer screening and tertiary rectal cancer services.

Findings

Of 1,145 CRC patients, 937 (81.8 per cent) were diagnosed as symptomatic cancers. In total, 210 GPs from 44 practices were stratified according to their CRC caseload over the study period into low volume (LV, 1-4); medium volume (MV, 5-7); and high volume (HV, 8-21 cases). Emergency presentation (LV: 49/287 (17.1 per cent); MV: 75/264 (28.4 per cent); HV: 105/386 (27.2 per cent); p=0.007) and advanced disease at presentation (LV: 84/287 (29.3 per cent); MV: 94/264 (35.6 per cent); HV: 144/386 (37.3 per cent); p=0.034) was more common amongst HV GPs. Three-year mortality risk was significantly higher for HV GPs (MV: (hazard ratio) HR 1.185 (confidence interval=0.897-1.566), p=0.231, and HV: HR 1.366 (CI=1.061-1.759), p=0.016), but adjustment for emergency presentation and advanced disease largely accounted for this difference. There was some evidence that HV GPs used elective cancer pathways less frequently (LV: 166/287 (57.8 per cent); MV: 130/264 (49.2 per cent); HV: 182/386 (47.2 per cent); p=0.007) and more selectively (CRC/referrals: LV: 166/2,743 (6.1 per cent); MV: 130/2,321 (5.6 per cent); HV: 182/2,508 (7.3 per cent); p=0.048).

Originality/value

Higher GP CRC caseload in primary care may be associated with advanced disease and poorer survival; more work is required to determine the reasons and to develop targeted intervention at local level to improve elective referral rates.

Details

International Journal of Health Care Quality Assurance, vol. 30 no. 5
Type: Research Article
ISSN: 0952-6862

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Article
Publication date: 13 August 2018

Mansoor Akhtar, Mohamed Boshnaq and Sathyan Nagendram

Delay in histologically confirming rectal cancer may lead to late treatment as histological confirmation is required prior to chemo-radiotherapy or surgical intervention…

Abstract

Purpose

Delay in histologically confirming rectal cancer may lead to late treatment as histological confirmation is required prior to chemo-radiotherapy or surgical intervention. Multidisciplinary colorectal meetings indicate that there are patients who require multiple tissue biopsy episodes prior to histologically confirming rectal cancer. The purpose of this paper is to examine a quality improvement (QI) measure’s impact on tissue biopsy process diagnostic yield.

Design/methodology/approach

The authors performed the study in two phases (pre- and post-QI), between February 2012 and April 2014 in a district general hospital. The QI measures were derived from process mapping a rectal cancer diagnostic pathway. The primary outcome was to assess the tissue biopsy process diagnostic yield. The secondary outcome included total breaches for a 62-day target in the pre- and post-QI study phases.

Findings

There was no significant difference in demographics or referral mode in both study phases. There were 81 patients in the pre-QI phase compared to 38 in the post-QI phase, 68 per cent and 74 per cent were referred via the two-week wait urgent pathway, respectively. Diagnostic tissue biopsy process yield improved from 58.1 to 77.6 per cent after implementing the QI measure (p=0.02). The 62-day target breach was reduced from 14.8 to 3.5 per cent (p=0.42).

Practical implications

Simple QI measures can achieve significant improvements in rectal cancer diagnostic tissue biopsy process yields. A multidisciplinary approach, involving process mapping and cause and effect modelling, proved useful tools.

Originality/value

A process mapping exercise and QI measures resulted in significant improvements in diagnostic yield, reducing the episodes per patient before histological diagnosis was confirmed.

Details

International Journal of Health Care Quality Assurance, vol. 31 no. 7
Type: Research Article
ISSN: 0952-6862

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1 – 10 of 419