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Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study.
Clin J Am Soc Nephrol. 2017 Apr 03; 12(4):568-576.CJ

Abstract

BACKGROUND AND OBJECTIVES

Bowel cancer is a leading cause of cancer-related death in people with CKD. Shared decision making regarding cancer screening is particularly complex in CKD and requires an understanding of patients' values and priorities, which remain largely unknown. Our study aimed to describe the beliefs and attitudes to bowel cancer screening in patients with CKD.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS

Face to face, semistructured interviews were conducted from April of 2014 to December of 2015 with 38 participants ages 39-78 years old with CKD stages 3-5, on dialysis, or transplant recipients from four renal units in Australia and New Zealand. Thematic analysis was used to analyze the transcripts.

RESULTS

Five themes were identified: invisibility of cancer (unspoken stigma, ambiguity of risk, and absence of symptomatic prompting); prioritizing kidney disease (preserving the chance of transplantation, over-riding attention to kidney disease, protecting graft survival, and showing loyalty to the donor); preventing the crisis of cancer (evading severe consequences and cognizant of susceptibility); cognitive resistance (reluctance to perform a repulsive procedure, intensifying disease burden threshold, anxiety of a positive test, and accepting the inevitable); and pragmatic accessibility (negligible financial effect, convenience, and protecting anonymity).

CONCLUSIONS

Patients with CKD understand the potential health benefits of bowel cancer screening, but they are primarily committed to their kidney health. Their decisions regarding screening revolve around their present health needs, priorities, and concerns. Explicit consideration of the potential practical and psychosocial burdens that bowel cancer screening may impose on patients in addition to kidney disease and current treatment is suggested to minimize decisional conflict and improve patient satisfaction and health care outcomes in CKD.

Authors+Show Affiliations

Sydney School of Public Health, University of Sydney, Sydney, Australia; laura.james@health.nsw.gov.au. Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.Sydney School of Public Health, University of Sydney, Sydney, Australia. Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.Sydney School of Public Health, University of Sydney, Sydney, Australia. Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.Sydney School of Public Health, University of Sydney, Sydney, Australia. Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.Sydney School of Public Health, University of Sydney, Sydney, Australia. Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia; and.Department of Nephrology, Christchurch Hospital, Christchurch, New Zealand.Sydney School of Public Health, University of Sydney, Sydney, Australia. Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28153937

Citation

James, Laura J., et al. "Beliefs and Attitudes to Bowel Cancer Screening in Patients With CKD: a Semistructured Interview Study." Clinical Journal of the American Society of Nephrology : CJASN, vol. 12, no. 4, 2017, pp. 568-576.
James LJ, Wong G, Craig JC, et al. Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study. Clin J Am Soc Nephrol. 2017;12(4):568-576.
James, L. J., Wong, G., Craig, J. C., Ju, A., Williams, N., Lim, W. H., Cross, N., & Tong, A. (2017). Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study. Clinical Journal of the American Society of Nephrology : CJASN, 12(4), 568-576. https://doi.org/10.2215/CJN.10090916
James LJ, et al. Beliefs and Attitudes to Bowel Cancer Screening in Patients With CKD: a Semistructured Interview Study. Clin J Am Soc Nephrol. 2017 Apr 3;12(4):568-576. PubMed PMID: 28153937.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study. AU - James,Laura J, AU - Wong,Germaine, AU - Craig,Jonathan C, AU - Ju,Angela, AU - Williams,Narelle, AU - Lim,Wai H, AU - Cross,Nicholas, AU - Tong,Allison, Y1 - 2017/02/02/ PY - 2016/09/25/received PY - 2016/12/19/accepted PY - 2017/2/6/pubmed PY - 2017/12/20/medline PY - 2017/2/4/entrez KW - Anxiety KW - Attention KW - Attitude KW - Australia KW - Cognition KW - Early Detection of Cancer KW - Graft Survival KW - Humans KW - Neoplasms KW - New Zealand KW - Patient Satisfaction KW - Renal Insufficiency, Chronic KW - Risk KW - Transplant Recipients KW - bowel cancer screening KW - chronic kidney disease KW - interview KW - kidney KW - kidney transplant recipient KW - qualitative research KW - renal dialysis KW - shared-decision making SP - 568 EP - 576 JF - Clinical journal of the American Society of Nephrology : CJASN JO - Clin J Am Soc Nephrol VL - 12 IS - 4 N2 - BACKGROUND AND OBJECTIVES: Bowel cancer is a leading cause of cancer-related death in people with CKD. Shared decision making regarding cancer screening is particularly complex in CKD and requires an understanding of patients' values and priorities, which remain largely unknown. Our study aimed to describe the beliefs and attitudes to bowel cancer screening in patients with CKD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Face to face, semistructured interviews were conducted from April of 2014 to December of 2015 with 38 participants ages 39-78 years old with CKD stages 3-5, on dialysis, or transplant recipients from four renal units in Australia and New Zealand. Thematic analysis was used to analyze the transcripts. RESULTS: Five themes were identified: invisibility of cancer (unspoken stigma, ambiguity of risk, and absence of symptomatic prompting); prioritizing kidney disease (preserving the chance of transplantation, over-riding attention to kidney disease, protecting graft survival, and showing loyalty to the donor); preventing the crisis of cancer (evading severe consequences and cognizant of susceptibility); cognitive resistance (reluctance to perform a repulsive procedure, intensifying disease burden threshold, anxiety of a positive test, and accepting the inevitable); and pragmatic accessibility (negligible financial effect, convenience, and protecting anonymity). CONCLUSIONS: Patients with CKD understand the potential health benefits of bowel cancer screening, but they are primarily committed to their kidney health. Their decisions regarding screening revolve around their present health needs, priorities, and concerns. Explicit consideration of the potential practical and psychosocial burdens that bowel cancer screening may impose on patients in addition to kidney disease and current treatment is suggested to minimize decisional conflict and improve patient satisfaction and health care outcomes in CKD. SN - 1555-905X UR - https://www.unboundmedicine.com/medline/citation/28153937/Beliefs_and_Attitudes_to_Bowel_Cancer_Screening_in_Patients_with_CKD:_A_Semistructured_Interview_Study_ L2 - https://cjasn.asnjournals.org/cgi/pmidlookup?view=long&pmid=28153937 DB - PRIME DP - Unbound Medicine ER -