Abstract
Background
Timely follow-up after an abnormal cancer screening test result is needed to maximize the benefits of screening, but is frequently not achieved. Little is known about patient experiences with the process of following up abnormal screening results.
Objective
Assess patient experiences and perceptions regarding the process of a diagnostic workup following abnormal breast, cervical, or colorectal cancer screening results.
Design
Survey of participating patients between April 2021 and June 2022 after reaching the primary outcome time point in a randomized controlled trial to improve follow-up of overdue abnormal screening results.
Participants
Patients from 44 participating practices in three primary care practice networks.
Main Measures
Self-reported ease of scheduling follow-up, perceived barriers or concerns, provider trust, and satisfaction with communication and care received for the follow-up of abnormal screening results.
Results
Overall, 241 (25.0%) patients completed the survey including 66 (32.8%) with breast, 79 (25.3%) with cervical, and 96 (21.3%) with colorectal screening test; median age 55 years, 79.7% women, 80.5% non-Hispanic white, and 51.0% did not complete recommended follow-up. Most patients were worried that the test would find cancer (63.1%), but fewer worried about discomfort or side effects (34.4%), and neither were associated with completing follow-up. However, 17% of patients did not think they needed follow-up tests or appointments and were less likely to complete follow-up (10.5% vs. 24.0%, respectively, p-value 0.009). Most patients were very satisfied with their overall care (71.0%), but only 50.2% strongly agreed that they trusted their provider to put their medical needs above all else when making recommendations.
Conclusions
Patients with overdue abnormal breast, cervical, and colorectal cancer screening test results reported important deficiencies in the management of recommended follow-up. Addressing patient concerns about fear of cancer and effectively communicating the need for follow-up procedures may improve timely follow-up after an abnormal cancer screening result.
Trial Registration
ClinicalTrials.gov NCT03979495.
Supplementary Information
The online version contains supplementary material available at 10.1007/s11606-024-09128-4.
KEY WORDS: cancer screening, cancer prevention, primary care, abnormal results, patient survey
INTRODUCTION
Screening for breast, cervical, colorectal, and lung cancer in eligible individuals is endorsed by the US Preventive Services Task Force (USPSTF) and other national organizations.1–5 Maximizing the societal benefits of screening, including reduced cancer-specific mortality, requires systematic approaches to identify and encourage eligible individuals to complete the screening continuum. Such screening efforts have been a focus of research and quality improvement efforts,6 but there has been less attention paid to systematically ensuring that those with abnormal cancer screening test results get timely and appropriate follow-up.7 Studies suggest that high rates of timely follow-up are not being routinely achieved.7–11
Barriers to completing timely follow-up after an abnormal screening result may involve the patient; the primary care practitioner (PCP) or specialist ordering, performing, or interpreting the test; the care team; or the health care system. For patients, barriers may include not receiving test results or follow-up recommendations, not understanding them, worry, or logistical issues such as transportation or time off from work.12 For follow-up that may not be required immediately, clinicians and practices may lack systems to identify, track, and notify when patients are overdue.13
To address barriers to follow-up of abnormal cancer screening test results, we performed a pragmatic clinical trial that included a multilevel intervention to improve the follow-up of abnormal screening results.14 As part of this trial, we surveyed participating patients to assess their experience with following up an abnormal result. Patients self-reported their ease of scheduling follow-up, perceived barriers or concerns, provider trust, and satisfaction with communication and care received. Our goal was to identify patient-perceived factors that may have affected whether they completed timely recommended follow-up or not.
METHODS
Overview
This study was conducted as part of an NCI-funded trial, mFOCUS (multilevel Follow-up of Cancer Screening).14,15 Eligible patients with USPSTF-recommended breast, cervical, colorectal, or lung cancer screening tests with abnormal results that were overdue for follow-up were enrolled and randomly assigned to one of three interventions or usual care based on the primary care practice where they received care. Definitions of the specific screening abnormalities and timing of diagnostic evaluation were based on guideline recommendations and expert opinion.14 Completion of the recommended follow-up at 120 days after study entry was the primary study outcome. After 120 days, a 10% stratified random sample of patients were invited to complete a survey to assess their experience with following up an abnormal result. The study was approved by the Mass General Brigham (MGB) Institutional Review Board (IRB) which served as the central IRB.
Setting and Participants
Three primary care networks participated: two affiliated with MGB in Massachusetts, Brigham and Women’s Hospital (BWH) and Massachusetts General Hospital (MGH), and the third affiliated with Dartmouth Health (DH) in New Hampshire. Patients with abnormal cancer screening test results were identified for survey invitation using a random sampling strategy to select patients stratified by network site, type of cancer test, and completion of recommended follow-up within 120 days of enrollment (“completed follow-up”).
Recruitment Protocol
Patients were initially sent an invitation through a mailed letter. Embedded within the invitation was an email hyperlink and quick response (QR) barcode to the survey that the patient could directly access. Patients could also respond by phone or email to inquire about the survey or to decline participation. If patients did not complete the survey or respond about participation within 2 weeks, they would receive a reminder phone call from study staff. Up to five reminder phone calls at approximately weekly intervals were made.
Surveys were designed to be completed in 10 to 15 min and were self-administered using REDCap.16 Study staff also administered the survey by phone for participants who did not want to use the web-based survey instrument. As an incentive to participate in the survey, patients were offered a gift card upon completion of the survey. To improve response rates, the incentive was increased from $25 to $50 in November 2021.
Survey Content and Measures
The questionnaire content was adapted from prior work (see Supplementary Appendix 1). Topics included how patients were initially notified and reminded of their abnormal test result; perceptions of the ease of scheduling follow-up tests or visits for each cancer type; barriers to following up on the abnormal test result (and specifically those related to the practitioner’s relationship with the patient); satisfaction with the process of receiving the abnormal test result; how the coronavirus may have impacted receipt of follow-up test; and patient-reported demographic information.
Sample Size and Analyses
The study sought 330 completed patient surveys (30 per test [20 for lung] per site). The survey was sent to 1019 eligible patients between April 2021 and June 2022. Because few patients with abnormal lung cancer results were enrolled in the trial and despite oversampling, only 12 of 56 patients invited to complete the survey responded. Due to this small sample, we excluded patients with abnormal lung cancer screening results from further analysis. Overall, 244 (23.9%) breast, cervical, and colorectal patients completed the survey (Fig. 1). Among these 244 patients, 241 answered at least 50% of core response items. Reporting of survey response rates followed American Association for Public Opinion Research (AAPOR) guidelines for survey studies.17
Figure 1.
Flow diagram for the analysis population.
Characteristics of survey respondents were summarized with descriptive statistics by type of cancer. Questionnaire responses were analyzed in four categories: (a) notifications about abnormal results were compared between cancer types; (b) barriers were compared by cancer type, and also by patients who did and did not complete follow-up within 120 days; (c) perceptions of physicians were compared between practice networks; and (d) satisfaction with care was compared between cancer types. Fisher’s exact test was used for all comparisons. We also examined whether responses differed by treatment arms but found no substantial differences, and therefore none is reported. A two-sided p-value is shown for each question, and, within each of these four categories, we highlight the p-values that retain significance after family-wise Bonferroni adjustment (i.e., adjustment of the 0.05 threshold for all questions within that category). Secondary analyses compared characteristics of survey responders and non-responders using t-tests and chi-square tests, as well as responses to survey questions about scheduling follow-up, which were compared between patients who completed follow-up in 120 days and those who did not using Fisher’s exact test. We also examined whether responses differed by the severity of the screening abnormality. Finally, survey questions about the impact of COVID-19 were compared between cancer types using Fisher’s exact test. No adjustment of p-values was done for secondary analyses. All analyses used SAS version 9.4 (Cary, NC).
RESULTS
Study Population
Overall, survey responses were available from 241 of 963 patients (25.0%) including 66 (32.8%) with abnormal breast cancer, 79 (25.3%) with abnormal cervical cancer, and 96 (21.3%) with abnormal colorectal cancer screening test results. Patients had a median age of 55 (interquartile range, 42, 64) years, 79.7% were female, 80.5% were white, and 17% were insured through Medicaid (Table 1). The severity of the screening test abnormality was low (125, 51.9%), moderate (71, 29.5%), and high (45, 18.7%). Overall, 123 (51.0%) did not complete recommended 120-day follow-up. Compared to invited patients who did not complete the survey, those completing the survey were younger (median age 55 vs. 58 years), more likely to have an abnormal breast result (27% vs. 19%), and less likely to have an abnormal colorectal result (40% vs. 49%) (Supplementary Appendix 2: Table 1).
Table 1.
Characteristics for Participants Who Were Invited and Responded to the Survey
| Characteristics | Participants | Breast | Cervical | Colorectal |
|---|---|---|---|---|
| (n = 241) | (n = 66) | (n = 79) | (n = 96) | |
| Age, median (q1, q3), years | 55 (42, 64) | 54 (47, 59) | 36 (33, 45) | 63 (58, 70) |
| Sex | ||||
| Female | 192 (79.7%) | 66 (100.0%) | 79 (100.0%) | 47 (49.0%) |
| Male | 49 (20.3%) | 0 (0.0%) | 0 (0.0%) | 49 (51.0%) |
| Race* | ||||
| Asian | 5 (2.1%) | 2 (3.0%) | 3 (3.8%) | 0 (0.0%) |
| Black or African American | 23 (9.5%) | 9 (13.6%) | 9 (11.4%) | 5 (5.2%) |
| Other | 16 (6.6%) | 2 (3.0%) | 9 (11.4%) | 5 (5.2%) |
| White | 194 (80.5%) | 52 (78.8%) | 57 (72.2%) | 85 (88.5%) |
| Ethnicity, Hispanic or Latino | 19 (7.9%) | 5 (7.6%) | 9 (11.4%) | 5 (5.2%) |
| Primary language Spanish | 6 (2.5%) | 2 (3.0%) | 3 (3.8%) | 1 (1.0%) |
| Marital status, married/life partner | 117 (48.5%) | 40 (60.6%) | 19 (24.1%) | 58 (60.4%) |
| Primary insurance | ||||
| Commercial | 154 (63.9%) | 45 (68.2%) | 55 (69.6%) | 54 (56.2%) |
| Medicare | 44 (18.3%) | 8 (12.1%) | 1 (1.3%) | 35 (36.5%) |
| Dual/Medicaid | 41 (17%) | 13 (19.7%) | 22 (27.8%) | 6 (6.2%) |
| Other/uninsured/unknown | 2 (0.8%) | 0 (0.0%) | 1 (1.3%) | 1 (1.0%) |
| Charlson score† | ||||
| 0 | 136 (56.4%) | 38 (57.6%) | 56 (70.9%) | 42 (43.8%) |
| 1 | 50 (20.7%) | 13 (19.7%) | 12 (15.2%) | 25 (26.0%) |
| 2 + | 55 (22.8%) | 15 (22.7%) | 11 (13.9%) | 29 (30.2%) |
| Severity of screening test abnormality‡ | ||||
| Low | 125 (51.9%) | 60 (90.9%) | 5 ( 6.3%) | 60 (62.5%) |
| Moderate | 71 (29.5%) | 6 ( 9.1%) | 36 (45.6%) | 29 (30.2%) |
| High | 45 (18.7%) | 0 ( 0.0%) | 38 (48.1%) | 7 (7.3%) |
| Primary care visit in past year§ | 171 (71%) | 45 (68.2%) | 51 (64.6%) | 75 (78.1%) |
| Completed 120-day recommended follow-up | 118 (49%) | 42 (63.6%) | 33 (41.8%) | 43 (44.8%) |
Values presented are median (q1, q3), or numbers (%)
*Race and ethnicity description: Patient demographic variables including gender, race, ethnicity, and marital status were patient self-reported in open-ended questions collected as part of routine care during patient registration
†Charlson scores by calculating it from diagnosis codes (ICD-10) pulled for dates 2 years prior to the patient’s enrollment.18
‡Risk of the screening abnormality was based on guidelines or specialist consensus. For example, a BIRADs 3 mammogram was considered low risk, a BIRADs 4 was considered medium risk, and a BIRADs 5 was considered high risk.14
§Visit occurring in same health system as testing
Notification About Abnormal Results
Patients most commonly reported that they were notified about the abnormal results by letter or through the online patient portal (141 [58.5%]) and were notified by the provider who performed the test (126 [52.3%]) (Table 2). Patients who had a cervical abnormality were less likely to be notified by the provider who performed the test (29 [36.7%]) than for those with breast (39 [59.1%]) or colorectal abnormalities (58 [60.4%]) (p-value 0.003). Reminders that patients were due for tests or appointments also differed by cancer type with breast and cervical patients more likely to receive non-visit-based reminders (47 [71.2%] and 48 [60.8%], respectively) than colorectal patients (44 [45.8%]) (p-value 0.005). Overall, 41 (17.0%) did not recall receiving a reminder. When patient responses were stratified by severity of the screening abnormality, results were similar to that seen for cancer type (Supplementary Appendix 2: Table 2).
Table 2.
Patient Notification by Health Care Provider Involved with Follow-Up of Abnormal Screening Result by Cancer Type Among 241 Respondents
| All (n = 241) | Breast (n = 66) | Cervical (n = 79) | Colorectal (n = 96) | p-value | |
|---|---|---|---|---|---|
| How were you notified about the results of your [cancer screening test]? | |||||
| At an office visit | 71 (29.5%) | 40 (60.6%) | 4 (5.1%) | 27 (28.1%) | < 0.001* |
| Phone call | 68 (28.2%) | 13 (19.7%) | 45 (57.0%) | 10 (10.4%) | < 0.001* |
| Letter/Patient Gateway | 141 (58.5%) | 31 (47.0%) | 48 (60.8%) | 62 (64.6%) | 0.07 |
| I don’t remember | 22 (9.1%) | 6 (9.1%) | 4 (5.10%) | 12 (12.5%) | 0.24 |
| Who notified you about the results of your [cancer screening test]? | |||||
| My primary care provider or a care team member from my provider’s office during an office visit | 67 (27.8%) | 14 (21.2%) | 26 (32.9%) | 27 (28.1%) | 0.29 |
| Provider who performed the test | 126 (52.3%) | 39 (59.1%) | 29 (36.7%) | 58 (60.4%) | 0.003* |
| Member of the provider’s office staff like a nurse | 35 (14.5%) | 12 (18.2%) | 16 (20.3%) | 7 (7.3%) | 0.024 |
| I don’t remember | 41 (17.0%) | 12 (18.2%) | 12 (15.2%) | 17 (17.7%) | 0.89 |
| How were you reminded that you were due for tests or appointments that were part of the workup for your [cancer screening test]? | |||||
| By my provider or a care team member from my provider’s office during an office visit | 95 (39.4%) | 20 (30.3%) | 31 (39.2%) | 44 (45.8%) | 0.14 |
| By letter, email, automated phone call, text or electronic health record (Patient Gateway) | 139 (57.7%) | 47 (71.2%) | 48 (60.8%) | 44 (45.8%) | 0.005 |
| I did not receive a reminder/I don’t remember | 41 (17.0%) | 9 (13.6%) | 10 (12.7%) | 22 (22.9%) | 0.16 |
For each question, asked to check all that apply. All comparisons were conducted using Fisher’s exact test
*Remains significant after adjustment for multiple testing, allowing for a family-wise Bonferroni adjustment for 11 tests
Barriers to Follow-Up Overdue Abnormal Results
Over 60% of patients reported they were worried about whether the follow-up test would find cancer, with fewer worried about discomfort or a side effect of the test (83 [34.4%]) (Table 3). Patients with a colorectal cancer abnormality were less likely to worry about finding cancer (46 [47.9%]) than patients with breast (48 [72.7%]) or cervical cancer (58 [73.4%]) (p-value < 0.001). Less than 20% of patients were worried about the costs of follow-up tests or did not think they needed any more tests or appointments, but those who did not complete follow-up were more likely to report not needing follow-up (29 [24.0%]) than those who completed follow-up (12 [10.5%]) (p-value 0.009). Patient report barriers were similar when responses were stratified by the severity of the screening abnormality (Supplementary Appendix 2: Table 3).
Table 3.
Patient-Reported Barriers with Follow-Up of Abnormal Screening Results
| Agree or strongly agree, N (%) | All (n = 241) | Cancer type | Completed follow-up within 120 days | |||||
|---|---|---|---|---|---|---|---|---|
| Breast (n = 66) | Cervical (n = 79) | Colorectal (n = 96) | p-value | No (n = 123) | Yes (n = 118) | p-value | ||
| I worried about whether the test would find cancerb | 152 (63.1%) | 48 (72.7%) | 58 (73.4%) | 46 (47.9%) | < 0.001* | 70 (56.9%) | 82 (69.5%) | 0.046 |
| I worried about discomfort or a side effect from the test | 83 (34.4%) | 23 (34.8%) | 37 (46.8%) | 23 (24.0%) | 0.006* | 43 (35.0%) | 40 (33.9%) | 0.89 |
| I worried about the costs of the test or appointmenta | 46 (19.3%) | 15 (23.4%) | 13 (16.7%) | 18 (18.8%) | 0.60 | 28 (23.0%) | 18 (15.5%) | 0.19 |
| I didn’t think I needed any more tests or appointments | 41 (17.4%) | 8 (12.7%) | 13 (16.9%) | 20 (21.1%) | 0.39 | 29 (24.0%) | 12 (10.5%) | 0.009* |
Question wording: “Thinking about the workup that was recommended to you after your [cancer_screening] result, please indicate how much you agree or disagree with each of the following statements:” All comparisons were conducted using Fisher’s exact test
*Remains significant after adjustment for multiple testing, allowing for a family-wise Bonferroni adjustment for four tests
Ease of Scheduling Follow-Up Tests or Referrals
The majority of patients reported that it was very easy to schedule the appropriate follow-up test or appointment for their abnormal breast, cervical, or colorectal cancer screening result (Supplementary Appendix 2: Table 4). Patients who completed cervical and colorectal cancer follow-up tests were more likely than non-completers to report that it was very easy to schedule testing, but differences were not statistically different due to small sample sizes.
Patient Perceptions of Provider Involvement in Follow-Up of Abnormal Results
Only about half of patients strongly agreed with statements about the health care provider listening carefully; encouraging questions; understanding background, values, and concerns; and trusting them to put their medical needs above all else when making recommendations (Table 4).
Table 4.
Patient Perception about Health Care Provider Involved with Follow-Up of Abnormal Screening Result by Primary Care Network Among 241 Respondents
| Reporting strongly agree, N (%) | All (n = 241) | Practice network A (n = 84) | Practice network B (n = 71) | Practice network C (n = 86) | p-value |
|---|---|---|---|---|---|
| I trusted my health care provider to put my medical needs above all else when making recommendations for me | 120 (50.2%) | 51 (60.7%) | 37 (52.1%) | 32 (38.1%) | 0.01 |
| I felt that my health care provider listened carefully to me | 110 (46.4%) | 41 (50.6%) | 36 (50.7%) | 33 (38.8%) | 0.22 |
| I felt that my health care provider encouraged me to ask any questions that I had | 121 (51.1%) | 46 (56.8%) | 40 (56.3%) | 35 (41.2%) | 0.08 |
| I felt that my health care provider understood my background, concerns and values | 109 (46.0%) | 45 (54.9%) | 37 (52.1%) | 27 (32.1%) | 0.006* |
Question wording: “Thinking about the workup that was recommended to you after your cancer screening test result, please indicate how much you agree or disagree with each of the following statements:” All comparisons were conducted using Fisher’s exact test
*Remains significant after adjustment for multiple testing, allowing for a family-wise Bonferroni adjustment for four tests
Satisfaction with the Management of Abnormal Results
Most patients reported that they were very satisfied with various aspects of their care including communication, questions answered, information given, and ease of scheduling follow-up (Table 5). Overall satisfaction with care was high (171 [71.0%]) and did not differ by cancer type.
Table 5.
Satisfaction with Care for Follow-Up of Abnormal Screening Result by Cancer Type Among 241 Respondents
| Reporting very satisfied, N (%) | All (n = 241) | Breast cancer (n = 66) | Cervical cancer (n = 79) | Colorectal cancer (n = 96) | p-value |
|---|---|---|---|---|---|
| Communication with my primary care provider/team | 147 (61.3%) | 36 (54.5%) | 50 (63.3%) | 61 (64.2%) | 0.43 |
| Communication with any specialists involved in my care | 157 (66.5%) | 38 (59.4%) | 56 (71.8%) | 63 (67.0%) | 0.29 |
| How well all my questions were answered | 166 (69.5%) | 46 (69.7%) | 53 (67.9%) | 67 (70.5%) | 0.92 |
| Information that I was given to make the best possible choices for me | 150 (62.5%) | 39 (60.0%) | 52 (65.8%) | 59 (61.5%) | 0.75 |
| How easy it was to schedule any additional tests or visits | 159 (66.8%) | 48 (72.7%) | 55 (69.6%) | 56 (60.2%) | 0.20 |
| My overall satisfaction with the care that I received for this problem | 171 (71.0%) | 48 (72.7%) | 55 (69.6%) | 68 (70.8%) | 0.90 |
Question wording: “How would you rate your satisfaction with the process you went through to receive your workup?” All comparisons were conducted using Fisher’s exact test
Impact of the COVID-19 Pandemic on the Follow-Up of Abnormal Results
About a quarter of patients reported that their workup was delayed or postponed because of the pandemic (Supplementary Appendix 2: Table 5). However, more colorectal patients reported delayed or postponed workups (33 [34.4%]) than for breast (14 [21.2%]) or cervical cancer (15 [19.0%]) (p-value 0.045). For most patients, the pandemic did not change their thinking about the importance of having a workup for the screening test result (“Same importance as before,” 186 [77.5%]).
DISCUSSION
Most studies examining patient perspectives about cancer screening focus on the process of completing guideline-recommended screening for a single type of cancer.19 We surveyed patients from three large primary care practice networks in New England who were enrolled in a trial to improve timely follow-up of overdue abnormal breast, cervical, and colorectal cancer screening test results.14 How patients were notified about abnormal results and by whom varied among the different cancer tests. Patients with abnormal colorectal cancer results were less worried about finding cancer than patients with abnormal breast or cervical results, but those with abnormal cervical results were more worried about the side effects of follow-up testing. Though only a small percentage of patients did not think they needed follow-up tests or appointments, they were much less likely to complete timely follow-up. These findings offer insights into how to improve follow-up across a range of abnormal screening test results.
To improve cancer screening rates, studies have examined factors associated with individuals completing USPSTF-recommended testing.20–22 However, considerably less attention has focused on the follow-up after an abnormal cancer screening test result.15,23 Since these individuals have already completed screening and given that the screening result is abnormal, one may expect high rates of appropriate follow-up, but studies suggest that this is not routinely happening.7 We surveyed patients enrolled in a clinical trial to improve follow-up after an abnormal result to examine their experiences and to identify barriers that may have affected whether they completed recommended follow-up or not.
Given differences among breast, cervical, and colorectal cancer screening tests, it is not surprising that we found differences in how patients with results were notified and by whom. Since most cancer screening is ordered by PCPs and most PCPs report feeling responsible for managing test results,24 system-based approaches to notification after an abnormal result may decrease the variation reported by patients.
Patients reported worries about follow-up tests after an abnormal result causing discomfort or side effects, but they were especially worried about subsequent testing finding cancer. Moreover, almost 20% reported that they did not think they needed any more tests or follow-up. Other studies have also found deficiencies in patient understanding.25 This suggests that interventions to systematize the notification of patients after an abnormal result may also offer the opportunity to ensure patients are educated about the abnormal result, the nature of the recommended follow-up, and why it is needed. Such efforts need to strike a balance between needless worry about how likely it is that a cancer may be diagnosed and motivating patients to complete the recommended follow-up.23
Most patients reported that they were very satisfied with the care they received regardless of the screening test abnormality. However, fewer than half of patients strongly agreed that the health care provider involved with follow-up of the abnormal result listened carefully, encouraged questions, and understood the patient’s background, concerns, and values. These humbling results also suggest the need to better communicate results, improve patient understanding, and elicit preferences as part of a shared decision-making process.26,27
Limitations
These results may not be generalizable to patients in other practice networks. Given that the resources available in the studied networks may exceed those in other practices, it is possible that these results may overstate the reported support available to patients and their PCPs. Thus, our findings are more likely to understate the nature of the deficiencies identified. Our response rate is similar to or lower than other surveys of patients, and lower rates decrease the validity of the reported findings.28 Our findings are based on patient perceptions, and patients may not know all the resources available to them. It is also possible that responses may have overestimated available reminder processes since patients may consider support for routine screening efforts to be applicable to managing an abnormal result, even if this is not the case. Due to the sampling strategy and size, we were not able to assess the potential interaction between cancer type and the severity of abnormal results. Finally, the study took place during the COVID-19 pandemic, and patient-reported deficiencies may have been magnified. Regardless of whether this is true or not, such deficiencies support the need for improved systems to decrease barriers to follow-up of abnormal results.
Conclusions
Patients with overdue abnormal breast, cervical, and colorectal cancer screening test results reported considerable variability in how they were notified and a number of concerns about the follow-up of guideline recommended care. Patients expressed worries about finding cancer and side effects of testing that differed among the cancer types. Patients who did not think they needed follow-up tests or appointments were less likely to complete follow-up. These results suggest that improving follow-up after an abnormal result requires identifying and addressing patient concerns about fear of cancer, and effectively communicating the need for follow-up across the range of cancer screening tests.
Supplementary Information
Below is the link to the electronic supplementary material.
Acknowledgements:
The authors wish to thank Erica Breslau, PhD, MPH, for her contribution to this study.
Funding
This work is supported by the National Cancer Institute (NCI, U01CA225451) and the American Cancer Society (CRP-22–080-01-CTPS).
Data Availability:
Requests for data or study materials can be made to the corresponding author (SJA) and will be considered based on available resources.
Declarations:
Conflict of Interest:
The authors report no conflicts of interest relevant to this study.
Design and Conduct of the Study:
The study was designed and conducted solely by the study investigators.
Collection, Management, Analysis, and Interpretation of the Data:
The collection, management, analysis, and interpretation of the data were under the direction and performed solely by the study investigators.
Preparation, Review, or Approval of the Manuscript:
The manuscript was prepared and reviewed by the study investigators.
Decision to Submit the Manuscript for Publication:
The decision to submit the manuscript for publication was solely made by the study investigators.
Access to Data:
Dr. Atlas had full access to all the data in the study and takes responsibility for the integrity of the data and the accuracy of the data analysis.
Footnotes
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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