Magdalena Lagerlund

Sociodemographic predictors of non-attendance at invitational mammography screening: a population-based register study (Sweden)

Objective: To investigate the role of sociodemographic factors in predicting mammography uptake in an outreach screening program. Methods: Linkage of data from a regional population-based mammography program with four Swedish nationwide registers: the Population and Housing Census of 1990, the Fertility Register, the Cancer Register, and the Cause of Death Register. We computed odds ratios (OR) and 95% confidence intervals (CI) for non-attendance by sociodemographic factors. Non-attendance was defined as failure to attend in response to the two most recent invitations. Results: Multivariate analyses among 4198 non-attenders and 38,972 attenders revealed that both childless and high-parity women were more likely to be non-attenders (OR = 1.8, 95% CI: 1.6–2.0 and OR = 2.2, 95% CI: 1.8–2.7, respectively). Women living without a partner were less likely to attend (OR = 1.7, 95% CI: 1.5–1.9), as were non-employed women (OR = 2.1, 95% CI: 1.9–2.3). Those renting an apartment were more likely to be non-attenders compared with home-owners (OR = 1.8, 95% CI: 1.6–2.0), and immigrants from non-Nordic countries were more than twice as likely to be non-attenders compared with Swedish-born women (OR = 2.4, 95% CI: 2.0–2.8). Conclusions: There are identifiable subgroups in which mammography utilization can be increased. Special attention should be paid to women who have never attended, childless women, and non-Nordic immigrants.

Differences in cancer awareness and beliefs between Australia, Canada, Denmark, Norway, Sweden and the UK (the International Cancer Benchmarking Partnership): do they contribute to differences in cancer survival?

Background:There are wide international differences in 1-year cancer survival. The UK and Denmark perform poorly compared with other high-income countries with similar health care systems: Australia, Canada and Sweden have good cancer survival rates, Norway intermediate survival rates. The objective of this study was to examine the pattern of differences in cancer awareness and beliefs across these countries to identify where these might contribute to the pattern of survival.Methods:We carried out a population-based telephone interview survey of 19 079 men and women aged ⩾50 years in Australia, Canada, Denmark, Norway, Sweden and the UK using the Awareness and Beliefs about Cancer measure.Results:Awareness that the risk of cancer increased with age was lower in the UK (14%), Canada (13%) and Australia (16%) but was higher in Denmark (25%), Norway (29%) and Sweden (38%). Symptom awareness was no lower in the UK and Denmark than other countries. Perceived barriers to symptomatic presentation were highest in the UK, in particular being worried about wasting the doctors time (UK 34%; Canada 21%; Australia 14%; Denmark 12%; Norway 11%; Sweden 9%).Conclusion:The UK had low awareness of age-related risk and the highest perceived barriers to symptomatic presentation, but symptom awareness in the UK did not differ from other countries. Denmark had higher awareness of age-related risk and few perceived barriers to symptomatic presentation. This suggests that other factors must be involved in explaining Denmarks poor survival rates. In the UK, interventions that address barriers to prompt presentation in primary care should be developed and evaluated.

Predictors of non-attendance in a population-based mammography screening programme; socio-demographic factors and aspects of health behaviour

The aim of this study was to identify predictors of non-attendance in a population-based mammography-screening programme in central Sweden, on the basis of telephone interviews with 434 non-attendees and 515 attendees identified in a mammography register. Non-attendance was studied in relation to socio-demographic factors, indicators of general health behaviour, self-rated health and experience of cancer in others and own cancer or breast problems. Being single or being non-employed were the only important socio-demographic predictors of non-attendance. Non-attendance was more likely among women who never visited a dentist, had not visited a doctor in 5 years, had never used oral contraceptives or hormone replacement therapy, had never had cervical smear tests, never drank alcohol, smoked regularly, reported no breast cancer in family or friends or own breast problems. We conclude that socio-demographic factors alone do not appear to constitute strong predictors of non-attendance. General health behaviour and previous experience of cancer and breast disease seem to be more important factors. Our results suggest that in the setting of population-based outreach mammography programmes, previous contacts with the health care system and encouragement from health professionals represent determinants of attendance.

An international measure of awareness and beliefs about cancer: development and testing of the ABC

Objectives To develop an internationally validated measure of cancer awareness and beliefs; the awareness and beliefs about cancer (ABC) measure. Design and setting Items modified from existing measures were assessed by a working group in six countries (Australia, Canada, Denmark, Norway, Sweden and the UK). Validation studies were completed in the UK, and cross-sectional surveys of the general population were carried out in the six participating countries. Participants Testing in UK English included cognitive interviewing for face validity (N=10), calculation of content validity indexes (six assessors), and assessment of test–retest reliability (N=97). Conceptual and cultural equivalence of modified (Canadian and Australian) and translated (Danish, Norwegian, Swedish and Canadian French) ABC versions were tested quantitatively for equivalence of meaning (≥4 assessors per country) and in bilingual cognitive interviews (three interviews per translation). Response patterns were assessed in surveys of adults aged 50+ years (N≥2000) in each country. Main outcomes Psychometric properties were evaluated through tests of validity and reliability, conceptual and cultural equivalence and systematic item analysis. Test–retest reliability used weighted-κ and intraclass correlations. Construction and validation of aggregate scores was by factor analysis for (1) beliefs about cancer outcomes, (2) beliefs about barriers to symptomatic presentation, and item summation for (3) awareness of cancer symptoms and (4) awareness of cancer risk factors. Results The English ABC had acceptable test–retest reliability and content validity. International assessments of equivalence identified a small number of items where wording needed adjustment. Survey response patterns showed that items performed well in terms of difficulty and discrimination across countries except for awareness of cancer outcomes in Australia. Aggregate scores had consistent factor structures across countries. Conclusions The ABC is a reliable and valid international measure of cancer awareness and beliefs. The methods used to validate and harmonise the ABC may serve as a methodological guide in international survey research.

Long-term inequalities in breast cancer survival a ten year follow-up study of patients managed within a National Health Care System (Sweden)

Introduction. Converging epidemiological evidence based on studies of different designs in a variety of populations and settings show that cancer survival tends to be poorer in low compared to high socioeconomic groups. In an extension of an earlier register-based study, we examined the influence of socioeconomic factors on long-term survival in women with a first diagnosis of invasive breast cancer in 1993 in Sweden, a country with a policy of providing equal access to health care to all at nominal cost within a National Health Care System. Material and methods. The study was based on data set generated by record linkages between the Swedish Cancer Register, Census databases and the Cause of Death Register. Four different categorical variables were used as indicators of socioeconomic standing. Cox proportional hazard regression models were used to estimate the effects of socioeconomic status on risk of death. Results. Of 4 645 eligible women with breast cancer, 1 016 had died from breast cancer at the end of follow-up on December 31, 2003. After adjustment for tumour size and age at diagnosis, risk of death was 19% lower among women belonging to a household of high compared to low socioeconomic status (HR high versus low 0.81; 95% CI: 0.67–0.97). Discussion. These findings indicate that social inequalities in breast cancer survival persist at least up to ten years after an initial diagnosis. While social gradients detected shortly after diagnosis may mainly reflect an influence of socioeconomic differences in overall health status and frailty, differentials persisting beyond five years rather point to a long-term influence of disparities in management of both primary tumours and recurrences. Further studies are needed to explore whether the present findings reflect amendable inequalities in access to state-of- the-art treatment. For all calendar periods, observed survival in the most privileged groups sets the goal for what is achievable for all breast cancer patients.

Rationales for attending or not attending mammography screening--a focus group study among women in Sweden.

Quantitative findings regarding factors that affect attendance in population-based outreach mammography programmes need to be complemented by descriptive data. The aim of this study was to obtain descriptive insights into the meanings that Swedish women attach to mammograms and their rationales for attending or not attending mammography screening. For this purpose a total of 31 women were recruited to eight focus group discussions. Through inductive analysis, six main themes were identified as important issues in reasoning about attendance or non-attendance in mammography screening: negative experiences, perceived risk factors, knowledge of ones own body, perceived problems with mammography, political, ideological and moral reasoning, and involuntary non-attendance, due to the inability of the screening programme to cover some women (e.g. those with breast implants). In conclusion, there is a need to reinforce the information that mammography is an examination aiming at detecting lumps at an asymptomatic stage. However, the nature and amount of information the women themselves desire is inconsistent. Furthermore, the personal encounter between the individual woman and the staff seems to be of particular importance. An improved dialogue appears an attractive way of adapting the screening situation to meet the varied needs and expectations of the women who are invited.

Characteristics of non-urgent patients: Cross-sectional study of emergency department and primary care patients

Objective. To describe characteristics of patients seeking medical attention for non-urgent conditions at an emergency department (ED) and patients who use non-scheduled services in primary healthcare. Design. Descriptive cross-sectional study. Setting. Primary healthcare centres and an ED with the same catchment area in Stockholm, Sweden. Patients. Non-scheduled primary care patients and non-referred non-urgent ED patients within a defined catchment area investigated by structured face-to-face interviews in office hours during a nine-week period. Main outcome measures. Sociodemographic characteristics, chief complaints, previous healthcare use, perception of symptoms, and duration of symptoms before seeking care. Results. Of 924 eligible patients, 736 (80%) agreed to participate, 194 at the ED and 542 at nine corresponding primary care centres. The two groups shared demographic characteristics except gender. A majority (47%) of the patients at the primary care centres had respiratory symptoms, whereas most ED patients (52%) had digestive, musculoskeletal, or traumatic symptoms. Compared with primary care patients, a higher proportion (35%) of the ED patients had been hospitalized previously. ED patients were also more anxious about and disturbed by their symptoms and had had a shorter duration of symptoms. Both groups had previously used healthcare frequently. Conclusions. Symptoms, previous hospitalization and current perception of symptoms seemed to be the main factors discriminating between patients studied at the different sites. There were no substantial sociodemographic differences between the primary care centre patients and the ED patients.

Intention to leave the workplace among nurses working with cancer patients in acute care hospitals in Sweden

PURPOSE To examine associations between perceived leadership and intention to leave the workplace due to job dissatisfaction among registered nurses (RNs) who care for patients with cancer. We also examine intention to leave in relation to proportion of cancer patients, length of time in practice, perceived adequacy of cancer care education, and burnout. METHODS AND SAMPLE The data originated from the Swedish component of RN4CAST, based on a survey of RNs working with in-patient care in all acute care hospitals in Sweden. The 7412 RNs reporting ≥10% patients with cancer on their unit were included in this analysis. Data were collected on perceptions of work environment, burnout, future employment intentions, and demographic characteristics. Additional questions related to cancer care. KEY RESULTS About 1/3 of all RNs intended to leave their workplace within the next year. Intention to leave was more prevalent among RNs reporting less favourable perceptions of leadership, who had worked ≤ two years as RN, who reported having inadequate cancer care education, and with higher burnout scores. Associations between leadership and intention to leave were stronger among RNs in the profession > two years, who reported having adequate cancer care education, and with lower burnout scores. CONCLUSIONS Perception of leadership is strongly associated with intention to leave among RNs in both specialized and general cancer care. This suggests a crucial area for improvement in order to reduce turnover rates.

Cancer screening in the context of women?s health: Perceptions of body and self among women of different ages in urban Sweden.

Most research on cervical cancer screening from the perspective of the involved women tends to focus on issues specifically related to screening participation, knowledge and information needs or experiences. Our previous research in this area indicated a need to investigate womens perspectives on cancer screening within a broader framework. Therefore, in this study, we aim to understand better, how women reason about health, ill health, health maintenance and disease prevention, in relation to cancer prevention and screening. We conducted twelve focus group discussions in Sweden with 49 women between the ages of 21 and 74 years. The findings indicate that womens reasoning about different aspects of “control”—physical, physiological, emotional and social—was central in understanding their view on cancer prevention and screening. The desire for and burden of maintaining control appeared to affect their decisions and attitudes toward cervical cancer screening, with health maintenance described as having a “high price”. Whereas some women motivated their screening attendance as a means of maintaining control, others described abstaining from screening which appeared to threaten their sense of control. It was also found that women reason differently about mammography and cervical cancer screening, which is contrary to assumptions guiding research in this area.

Use of healthcare information and advice among non-urgent patients visiting emergency department or primary care

Background Healthcare information provided by telephone service and internet sources is growing but has not been shown to reduce inappropriate emergency department (ED) visits. Objective To describe the use of advice or healthcare information among patients with non-urgent illnesses seeking care before attendance at an ED, or primary care (PC) centres in an urban region in Sweden. Design Patients with non-urgent illnesses seeking care at an ED or patients attending the PC were followed up with a combination of patient interviews, a questionnaire to the treating physician and a prospective follow-up of healthcare use through a population-based registry. Results Half of the non-urgent patients attending the ED had used healthcare information or advice before the visit, mainly from a healthcare professional source. In PC, men were more likely to have used information or advice compared with women (OR 2.5 95% CI 1.3 to 5.0), whereas the situation was reversed among ED patients (OR=0.4 95% CI 0.2 to 0.9). Men with no previous healthcare experience attending the ED had the lowest use of healthcare information (p<0.01). Very few in both groups had utilised healthcare information on the internet in a case of perceived emergency. Conclusion ED patients rated as non-urgent by the triage nurse used more advice and healthcare information than PC patients, irrespective of the physician-rated urgency of the symptoms. The problem seems not to be lack of information about appropriate ED use, but to find ways to direct the information to the right target group.