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. 2024 Apr:181:107897.
doi: 10.1016/j.ypmed.2024.107897. Epub 2024 Feb 18.

Implementation considerations for risk-tailored cancer screening in the population: A scoping review

Kate L A Dunlop  1 , Nehal Singh  2 , Hilary A Robbins  3 , Hana Zahed  3 , Mattias Johansson  3 , Nicole M Rankin  4 , Anne E Cust  5
Affiliations

Implementation considerations for risk-tailored cancer screening in the population: A scoping review

Kate L A Dunlop et al. Prev Med. 2024 Apr.

Abstract

Background: Risk-tailored screening has emerged as a promising approach to optimise the balance of benefits and harms of existing population cancer screening programs. It tailors screening (e.g., eligibility, frequency, interval, test type) to individual risk rather than the current one-size-fits-all approach of most organised population screening programs. However, the implementation of risk-tailored cancer screening in the population is challenging as it requires a change of practice at multiple levels i.e., individual, provider, health system levels. This scoping review aims to synthesise current implementation considerations for risk-tailored cancer screening in the population, identifying barriers, facilitators, and associated implementation outcomes.

Methods: Relevant studies were identified via database searches up to February 2023. Results were synthesised using Tierney et al. (2020) guidance for evidence synthesis of implementation outcomes and a multilevel framework.

Results: Of 4138 titles identified, 74 studies met the inclusion criteria. Most studies in this review focused on the implementation outcomes of acceptability, feasibility, and appropriateness, reflecting the pre-implementation stage of most research to date. Only six studies included an implementation framework. The review identified consistent evidence that risk-tailored screening is largely acceptable across population groups, however reluctance to accept a reduction in screening frequency for low-risk informed by cultural norms, presents a major barrier. Limited studies were identified for cancer types other than breast cancer.

Conclusions: Implementation strategies will need to address alternate models of delivery, education of health professionals, communication with the public, screening options for people at low risk of cancer, and inequity in outcomes across cancer types.

Keywords: Acceptability; Feasibility; Implementation; Risk-stratified screening; Risk-tailored screening; cancer screening.

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Conflict of interest statement

Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig 1:
Fig 1:
PRISMA flowchart
Fig 2.
Fig 2.
Barriers and Facilitators to risk-tailored cancer screening at individual, provider and system levels
See this image and copyright information in PMC

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