Anne Miles

Psychologic predictors of cancer information avoidance among older adults: The role of cancer fear and fatalism

Little is known about the correlates of cancer information avoidance and whether people with negative feelings and beliefs about cancer are more likely to avoid cancer information, allowing such thoughts and feelings to persist unchallenged. Using the Extended Parallel Processing Model as a theoretical guide, we tested the hypothesis that cancer fear and fatalism would predict cancer information avoidance but that part of this effect would be mediated via cancer-specific threat and efficacy beliefs. A community sample of older adults, ages 50 to 70 years (n = 1,442), completed a postal questionnaire that included the Powe Fatalism Inventory and the Champion Cancer Fear scale along with other measures of cancer-specific beliefs and demographic variables. Higher levels of cancer fear were positively associated with higher levels of cancer information avoidance, and part of this relationship was mediated via perceived cancer severity. The relationship between cancer fatalism and cancer information avoidance was partly mediated by severity and response-efficacy beliefs. This research shows that people with negative views about cancer are more likely to avoid cancer information. This means people with higher levels of cancer fear and fatalism are less likely to learn about positive developments made in the field of cancer control, allowing such negative feelings and views to continue. Research needs to focus on how to get positive messages about improvements in cancer prevention and control through to people who are fearful of and fatalistic about the disease. (Cancer Epidemiol Biomarkers Prev 2008;17(8):1872–9)

Gender differences in utilization of colorectal cancer screening

Objectives: To assess the demographic and psychological mediators of gender differences in uptake of flexible sigmoidoscopy (FS) screening for colorectal cancer. Setting: A subsample (n=5462) from a large community trial of FS in the UK. Methods: Menand women randomized to screening as part of the UK Flexible Sigmoidoscopy Trial were sent a postal questionnaire assessing demographic characteristics and attitudes to screening six months before their screening appointment. Attendance at screening was recorded by the screening centres. Results:More men than women attended screening (73% versus 67%). The higher male attendance was partially explained by their lower levels of socioeconomic deprivation, higher levels of marital status and lower perceived barriers to screening. Conclusions: Contrary to expectations, men weremore likely than women to attend FS screening. This was partially explained by socioeconomic and attitudinal differences to screening, but additional research is needed to understand the key aspects of FS screening that will maximize screening uptake in men and women.

The launch of Cancer Research UK’s ‘Reduce the Risk’ campaign: Baseline measurements of public awareness of cancer risk factors in 2004

AIM This national survey sought to establish levels of awareness of cancer risk factors and awareness of what individuals could do to reduce their own risk status. METHOD Cross-sectional interview data comprising a national representative sample of 4,233 individuals aged 15 years or over across Great Britain. RESULTS There were high levels of awareness of the role of smoking in the development of cancer, but only modest awareness of alcohol intake, being overweight, physical inactivity and older age. Recognition of the role of viral infection in cancer risk was very poor. Although two-thirds of respondents thought that cancer risk could be modified through lifestyle changes, those most in need of making lifestyle changes were less likely to be aware of what they could do to reduce their cancer risk. CONCLUSION This survey highlights the need to increase awareness of overweight, alcohol, infections and exercise in the development of cancer, particularly amongst younger people and those from more socio-economically deprived backgrounds.

Marriage and cancer prevention: does marital status and inviting both spouses together influence colorectal cancer screening participation?

Objectives This study examined the influence of marital status and inviting both partners together on participation in colorectal cancer screening. Setting Data were from a subset of participants from the UK Flexible Sigmoidoscopy Trial (1996–1999). Methods Marital status was self-reported, and co-invitation of partner was obtained from the trial database. Screening intentions were assessed in 16,527 adults aged 55–64 years. Attendance was recorded in the 4130 respondents who were subsequently invited. Results Multivariate analyses, controlling for age and educational level, indicate that married (or cohabiting) people have more positive intentions (odds ratio [OR] 1.26; 95% confidence interval [CI] 1.14–1.38) and higher attendance rates at screening (OR = 1.23; 95% CI 1.04–1.45) than non-married people. After adjusting for the marriage effect, inviting partners together (co-invitation) significantly increased screening intentions among women (OR = 1.17; 95% CI 1.04–1.31) but not men (OR = 0.97; 95% CI 0.85–1.10). Co-invitation significantly increased attendance at screening in both genders (OR = 1.34; 95% CI 1.14–1.58). Conclusions In this age group, married adults are more likely to participate in colorectal cancer screening than the non-married, and inviting both members of a couple together further increases screening uptake. The positive effect of marriage was as strong for women as men.

Cancer Fatalism and Poor Self-Rated Health Mediate the Association between Socioeconomic Status and Uptake of Colorectal Cancer Screening in England

Background: Little is known about the psychological predictors of colorectal screening uptake in England and mediators of associations between uptake and socioeconomic status (SES). This study tested the hypotheses that although higher threat and efficacy beliefs, lower cancer fatalism, lower depression, and better self-rated health would predict higher screening uptake, only efficacy beliefs, fatalism, depression, and self-rated health would mediate associations between uptake and SES. Methods: Data from 529 adults aged 60 to 69 who had completed a postal survey in 2005–2006 were linked with data on fecal occult blood test (FOBt) uptake recorded at the screening “hub” following its introduction in 2007, resulting in a prospective study. Results: Screening uptake was 56% and was higher among people with higher SES, better self-rated health, higher self-efficacy beliefs, and lower cancer fatalism in univariate analyses. Path analysis on participants with complete data (n = 515) showed that both better self-rated health and lower cancer fatalism were directly associated with higher uptake of FOBt screening and significantly mediated pathways from SES to uptake. Lower depression only had an indirect effect on uptake through better self-rated health. Efficacy beliefs did not mediate the relationship between SES and uptake. Conclusion: SES differences in uptake of FOBt in England are partially explained by differences in cancer fatalism, self-rated health, and depression. Impact: This is one of only a few studies to examine mediators of the relationship between SES and screening uptake, and future research could test the effectiveness of interventions to reduce fatalistic beliefs to increase equality of uptake. Cancer Epidemiol Biomarkers Prev; 20(10); 2132–40. ©2011 AACR.

Outpatient cognitive behavioral pain management programs: a randomized comparison of a group-based multidisciplinary versus an individual therapy model.

OBJECTIVE To compare the efficacy of 2 models of chronic pain management. DESIGN Randomized comparative trial with 2 active treatment arms. SETTING Outpatient pain management clinics. PARTICIPANTS A total of 113 adults with chronic pain of 0.5 to 38 years duration in (mean, 8.8y). INTERVENTIONS Cognitive behavioral therapy (including education, relaxation, use of cognitive coping strategies, pacing, exercise) delivered in group-based multidisciplinary program or in an individual therapy program. MAIN OUTCOME MEASURES Self-report of interference with daily activities and sense of control over pain (West Haven-Yale Multidimensional Pain Inventory [WHYMPI]) and depression (Beck Depression Inventory). Secondary outcome measures were state anxiety (Spielberger State-Trait Anxiety conventory), analgesic medication consumption, general activity, and pain severity (WHYMPI). Measurement points were 0 (before treatment), 2 months (end of treatment), and 3, 6 and 12 months (follow-up). RESULTS No significant differences were found between the 2 modes of treatment at any of the major time points (0, 2, 12mo). Both treatment conditions made significant and sustained improvements on all primary outcome measures, although sense of control over pain tended to decline by 1 year. Individually treated participants made slower gains in some areas, but showed a lesser tendency to rebound at the end of treatment. CONCLUSION The 2 programs appear to be equally efficacious for pain management in adults with chronic pain. In practical terms, the choice of model for service provision may rest more on local issues such as the availability of space and staff time.

SunSmart? Skin cancer knowledge and preventive behaviour in a British population representative sample

The incidence of skin cancer has risen rapidly in the UK over the last 20 years, prompting public health organizations to try and raise awareness of the dangers of sun exposure and the need to practice sun-safe behaviour. This study aimed to assess baseline levels of sun-safe knowledge and behaviour in a British population-representative sample, prior to the launch of Cancer Research UKs ‘SunSmart’ campaign. A face-to-face survey was conducted through the Office for National Statistics as part of their Omnibus survey. In total, 1848 men and women aged 18 and over were interviewed. Knowledge of what to do to reduce skin cancer risk was modest. Two-thirds mentioned avoiding the sun by seeking shade, 50% mentioned covering up and only 43% said to use high factor sunscreen. Practice of sun-safe behaviours was also poor, with only one-third saying they sought shade, covered up or used high factor sunscreen to protect themselves from the sun. Men and those from lower socioeconomic groups were least informed and least likely to report using sun-protective behaviours. Increases in both knowledge and use of appropriate sun-protective behaviours are needed if skin cancer incidence rates are to decrease.

Understanding Intentions and Action in Colorectal Cancer Screening

BackgroundFactors involved in forming intentions to attend cancer screening may be different from those involved in translating intentions into action.PurposeTo test the hypotheses that social cognition variables predict intention better than action, and that life difficulty variables predict action better than intention, in colorectal screening.MethodsParticipants from one center in the UK Flexible Sigmoidoscopy Trial (n = 2,969) were categorized according to their screening intention, measured at baseline, and their subsequent attendance at screening (recorded at the clinic). Differences in factors related to life difficulty (socioeconomic deprivation, health, stress, social support) and social cognition variables were examined, and discriminant analysis was used to identify sets of variables that best differentiated the groups.ResultsSocial cognition variables were strongly associated with intention but only weakly with action. In contrast, factors related to life difficulties (socioeconomic deprivation, poor health status) were better predictors of action than intention.ConclusionSocial cognition variables appeared to be important determinants of screening intentions. Other variables—that may be markers of barriers to implementing plans—were more strongly associated with action. To maximize colorectal screening participation, research is needed to identify a wider range of determinants of attendance.

Socioeconomic inequalities in colorectal cancer screening uptake: does time perspective play a role?

OBJECTIVE This study examined the role of time perspective in explaining inequalities in colorectal cancer screening attendance. We tested a path model predicting that (a) socioeconomic status (SES) would be associated with consideration of future consequences (CFC), (b) CFC would be associated with perceived benefits/barriers, and (c) barriers and benefits would be associated longitudinally with screening attendance. METHOD Data for these analyses came from the control arm (n = 809) of an intervention to increase screening uptake. Participants between 55 and 64 years were offered screening as part of the U.K. Flexible Sigmoidoscopy (FS) Trial. They completed a questionnaire that included demographic and psychological variables. Subsequent screening attendance was recorded. RESULTS There was clear evidence of SES differences in attendance, with 56% in the most deprived tertile attending their FS appointment, compared with 68% in the middle tertile and 71% in the least deprived tertile (p < .01). Lower SES was associated with lower CFC, higher perceived barriers, and lower perceived benefits (p < .05 for all). Higher CFC, higher perceived benefits, and lower perceived barriers were associated with attendance (p < .01 for all). CFC mediated the association between SES and perceived benefits/barriers, while perceived benefits/barriers mediated the association between CFC and attendance. CONCLUSION SES differences in CFC contribute to SES differences in the perceived barriers and benefits of screening, which, in turn, contribute to differences in attendance. Interventions that take CFC into account, for example, by emphasizing short-term benefits, could promote equality in screening participation.

Uptake of population-based flexible sigmoidoscopy screening for colorectal cancer: a nurse-led feasibility study

Objective: To assess uptake of once-only flexible sigmoidoscopy (FS) in a community sample to determine whether FS would be viable as a method of population-based screening for colorectal cancer. Methods: All adults aged 60–64 years registered at three General Practices in North West London, UK (510 men and women) were sent a letter of invitation to attend FS screening carried out by an experienced nurse, followed by a reminder if they did not make contact to confirm or decline the invitation. The primary outcome was attendance at the endoscopy unit for a FS test. Results: Of the 510 people invited to attend, 280 (55%) underwent FS. Among non-attenders, 91 (18%) were ineligible for screening or did not receive the invitation, 19 (4%) accepted the offer of screening but were unable to attend during the study period, 52 (10%) declined the offer, 41 (8%) did not respond to the invitation, and 27 (5%) accepted the offer of screening but did not attend. Attendance among those eligible to be screened, who had received the invitation, was 67%. People from more socioeconomically deprived neighbourhoods were less likely to attend (odds ratio [OR] = 0.90; confidence interval [CI] = 0.84–0.96; P = 0.003). Women were more likely to attend than men (OR = 1.44; CI = 1.01–2.05; P = 0.041). Conclusions: Attendance rates in this pilot for nurse-led, population-based FS screening were higher than those reported in other FS studies, and comparable with adherence to fecal occult blood testing (FOBT) in the UK FOBT pilot. Having a female nurse endoscopist may have been responsible for increasing female uptake rates but this warrants confirmation in a larger study.