Implementation of risk stratification within bowel cancer screening: a community jury study exploring public acceptability and communication needs
Taylor, Lily C., Dennison, Rebecca A., Griffin, Simon J., John, Stephen D., Lansdorp-Vogelaar, Iris, Thomas, Chloe V., Thomas, Rae, and Usher-Smith, Juliet A. (2023) Implementation of risk stratification within bowel cancer screening: a community jury study exploring public acceptability and communication needs. BMC Public Health, 23. 1798.
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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.
| Item ID: | 80819 |
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| Item Type: | Article (Research - C1) |
| ISSN: | 1471-2458 |
| Keywords: | Acceptability, Bowel cancer, Cancer screening, Community jury, Risk stratification |
| Copyright Information: | © The Author(s) 2023, corrected publication 2023. Open Access This article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article’s Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data. |
| Date Deposited: | 16 Feb 2024 01:20 |
| FoR Codes: | 42 HEALTH SCIENCES > 4206 Public health > 420603 Health promotion @ 100% |
| SEO Codes: | 20 HEALTH > 2004 Public health (excl. specific population health) > 200407 Health status (incl. wellbeing) @ 100% |
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