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Workshop Report Abstract The Advisory Committee on Cancer Control funded a one-day workshop to
discuss the surveillance of knowledge, attitudes/beliefs and behaviours
concerning early cancer detection in Canada. Participants considered the
need for such national surveillance and related methodological issues.
Some exploratory work has been conducted in this regard. Results were
presented from an inventory of existing survey questions and a summary
of established cancer screening guidelines. There was overall agreement
on the utility of collecting details of early cancer detection behaviours
and their determinants. Explicitly, participants identified a need for
site-specific information, highlighting cancers of the prostate and colon/rectum,
as well as recognizing a need for qualitative information regarding the
determinants that enable early cancer detection behaviours. Background Over the past year, the Advisory Committee on Cancer Control (ACOCC) and the Laboratory Centre for Disease Control (LCDC) of Health Canada have discussed and initiated exploratory work to investigate the early cancer detection behaviours of Canadians as well as the knowledge, attitudes and beliefs that determine those behaviours. Two working documents have been developed: an inventory of existing population-based survey questions used in North America and a summary of established cancer screening guidelines. Very few population-based surveys have been conducted that focus on cancer-related information. Furthermore, neither a consistent nor a complete series of questions was found concerning cancer and early cancer detection. Prevalence data on early detection behaviours for several cancer sites have been collected periodically. Consequently, there is a small array of early cancer detection questions that are not necessarily comparable over time or across instruments. Current cancer screening guidelines fall into one of two categories: those that are evidence-based (e.g. The Canadian Task Force on the Periodic Health Examination and the US Preventive Services Task Force) or those of professional organizations. Wide variation exists in the statements for many cancer sites. A workshop, funded by the ACOCC, was held in Toronto on March 18, 1997, to discuss the above issues in the context of surveillance of knowledge, attitudes/beliefs and behaviours (KAB) concerning early cancer detection in Canada. The objectives were to question the need for KAB surveillance of cancer screening; to consider the short-term and long-term priorities of KAB surveillance activities; to discuss the methodological issues and options of national surveillance versus special studies; and, given that the previous objectives were met, to agree on a core set of questions. Participants represented varied expertise from national health agencies in Canada and the United States, provincial governmental and non-governmental organizations, and academic institutions. A complete listing of participants is appended. Summary This one-day workshop commenced with brief presentations: Drs Heather Bryant and Isra Levy introduced key discussion areas and summarized the exploratory work mentioned above; Dr Fred Ashbury offered perspectives on key issues surrounding a surveillance decision framework; Ms Cynthia Jorgensen from the Centers for Disease Control and Prevention shared the details of KAB surveillance implemented in the United States. Her presentation was complemented by Mr Gary Catlin, who provided insight into the Canadian National Population Health Survey. Drs Vivek Goel and Fred Ashbury and Ms Tricia Kindree presented the results of a KAB instrument development exercise. These presentations were followed by discussion in plenary and a priority-ranking exercise. It was agreed that certain criteria ought to be considered in the establishment of the surveillance of cancer detection behaviours. KAB surveillance information could place health issues on the agendas of various sectors. It could address public concern, support evidence-based decisions and aid in the description of the burden of disease. Knowledge about early cancer detection behaviours and their determinants could facilitate the planning, implementation and evaluation of programs and research. Cancer detection information has been collected for some cancer sites. In the United States, the Centers for Disease Control and Prevention co-ordinate the Behavioral Risk Factor Surveillance System (BRFSS) and the National Health Interview Survey (NHIS). Both of these systems have collected information about people's screening behaviours for cervical, breast and colorectal cancers. The BRFSS is an annual telephone interview consisting of core questions used throughout the United States and standard modules that individual states may implement. The NHIS collects information on an ongoing basis through personal interviews. A cancer supplement was included as part of the NHIS in 1992. In Canada, there are similar population-based data collection procedures in place. The National Population Health Survey (NPHS) is a biennial survey consisting of both telephone and personal interviews. Supplemental NPHS questions for specified sample size can be purchased. Some Canadian cancer detection data exist regarding breast, cervical and prostate cancers. Breast cancer detection information was collected in two provincial health surveys (Ontario, Quebec), one focused provincial survey (Alberta) and the NPHS. Data regarding cervical cancer detection came from two provincial health surveys (Ontario, Quebec) and the NPHS. What is known about prostate cancer detection behaviours was obtained from a national, site-specific telephone survey. Workshop participants discussed the potential benefit of data triangulation, that is, the use of multiple existing data sources including administrative databases and special surveys to address different issues. There already is some activity in this area. Participants in the NPHS have enabled linkage studies to be implemented by granting permission to use their provincial health numbers. Such studies have been initiated in Ontario, Manitoba and Saskatchewan. The key issue in data triangulation is that most existing data sources tend to be administrative and therefore contain scant information pertaining to early cancer detection behaviours and their determinants. Although existing sources of information were acknowledged, these sources were felt to provide inconsistent information for some cancer sites and no information about others. The results of a two-phase instrument development exercise were presented [see previous article, "Development of an Instrument to Measure Cancer Screening Knowledge, Attitudes and Behaviours"]. In the first phase, a comprehensive instrument had been developed from existing surveys. It was designed to take 20-30 minutes to complete and addressed personal and family history of cancer, sources of health information and early detection procedures for nine cancer sites. The second part of the instrument development exercise was based on focus groups. Respondents had provided suggestions to improve the comprehensibility and feasibility of the instrument. Workshop participants suggested that such an omnibus instrument may not be appropriate due to the potential of providing diluted information, although it was felt to be a worthwhile exercise in providing the basis of cancer site-specific module development. Recommendations
Acknowledgements Thanks to those individuals who compiled background documentation and to those from the National Cancer Institute of Canada (NCIC) and the Laboratory Centre for Disease Control who helped organize the workshop. The expertise, experiential contributions and insightful comments of all workshop participants are greatly appreciated. Participants Dr Fred Ashbury (Centre for Behavioural Research and Program Evaluation, NCIC); Dr Steve Brown (University of Waterloo); Dr Sharon Buehler (Memorial University of Newfoundland); Dr Heather Bryant (Alberta Cancer Board); Mr Gary Catlin (Statistics Canada); Ms Robin Futcher (Canadian Cancer Society [CCS]/NCIC); Ms Laurie Gibbons (LCDC); Dr Vivek Goel (Institute for Clinical Evaluative Sciences); Dr Greg Hislop (British Columbia Cancer Agency); Ms Cynthia Jorgensen (Centers for Disease Control and Prevention); Ms Lisa Kan (Screening Mammography Program of British Columbia); Ms Tricia Kindree (CCS/NCIC); Dr Isra Levy (LCDC); Dr Nancy Lightfoot (Northeastern Ontario Regional Cancer Centre); Ms Tammy Lipskie (LCDC); Ms Elizabeth McGregor (Alberta Cancer Board); Dr Christina Mills (LCDC); Dr Brent Moloughney (Ontario Ministry of Health); Dr Annette O'Connor (Ottawa Civic Hospital); Dr Barbara Whylie (CCS/NCIC) Author References |
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Last Updated: 1998-10-20 |  |
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