The Public’s Intended Uptake of Hypothetical Esophageal Adenocarcinoma Screening Scenarios:A Nationwide Survey

INTRODUCTION: Screening for early esophageal adenocarcinoma (EAC) may potentially reduce EAC-related mortality and morbidity. This study aimed to examine the Dutch population’s intended uptake of 3 hypothetical EAC screening test scenarios and preferences for potential future organization. METHODS: A total of 8,350 Dutch individuals aged 45–75 years were invited, of whom 2,258 completed a web-based survey. Participants were randomly assigned to 1 of 3 hypothetical screening test scenarios (i.e., transnasal endoscopy, ingestible cell collection device, or breath analysis). The primary outcome was intended uptake. Secondary outcomes included acceptance of screening eligibility criteria and preferences regarding invitation, counseling, and diagnostic follow-up. We performed exploratory univariable and multivariable regression analyses to assess which determinants were associated with EAC screening intent. RESULTS: Intended uptake of screening was highest in the breath analysis scenario (95%), followed by conventional upper endoscopy (78%), an ingestible cell collection device (75%), and transnasal endoscopy (68%) (P &lt; 0.001). Anticipating discomfort was most strongly associated with decreased intention to undergo transnasal endoscopy (odds ratio 0.18, 95% confidence interval 0.11–0.29) or swallow a cell collection device (odds ratio 0.20, 95% confidence interval 0.13–0.32). Cancer worry and high acceptance of test sensitivity/ specificity were consistently associated with a positive intention to participate in screening. Inviting persons for screening based on gastroesophageal reflux disease symptoms, age, or the output of a risk prediction model was acceptable to 74%, 69%, and 66%, respectively. Inviting only men was acceptable for only 41% of women. The majority (58%) preferred to be invited by a public health organization, and 32% of the participants preferred to discuss their decision to participate with a healthcare professional. DISCUSSION: Participants in this study self-selected through a web-based survey, potentially introducing selection bias. Participants generally intended to participate in EAC screening, although the level of intent depended on the discomfort and performance associated with the offered screening test. Determining eligibility based on gastroesophageal reflux disease symptoms, age, or a risk calculator, but not sex, would be acceptable to most individuals.</p

Qualitative analysis of professionals’ views on the justification for esophageal adenocarcinoma screening.

This project aims to explore professionals’ views on justification for esophageal adenocarcinoma screening and how this developed over time. We performed a systematic literature review and included articles reporting health care professionals’ views on screening for this type of cancer. The dataset contains text units that were extracted from the included articles. Professionals' views were mapped on pre-existing principles that are commonly used to assess whether a screening policy is medically and ethically justified. Each tab in the Excel file addresses 1 screening principle, including a brief description of the screening principle and the extracted text units that address this topic

Dutch, UK and US professionals’ perceptions of screening for Barrett’s esophagus and esophageal adenocarcinoma: a concept mapping study

1. Study Title: Dutch, UK and US professionals’ perceptions of screening for Barrett’s esophagus and esophageal adenocarcinoma: a concept mapping study 2. Date of Data Collection: March 2021 - October 2021. 3. Data Collection Methods: Individual digital brainstorm session for statement generation, submitted by e-mail. GroupWisdom platform for sorting statements based on thematic similarity and rating statements on perceived relevance. 4. Data Description: Brainstorm Statements Data: File Name: NL_Statements Description: List of unique statements about Barrett's esophagus and esophageal adenocarcinoma screening, generated by Dutch professionals during individual digital brainstorm sessions. Format: XLSX (Excel). Dimensions: 123 statements. File Name: UK_Statements Description: List of unique statements about Barrett's esophagus and esophageal adenocarcinoma screening, generated by UK professionals during individual digital brainstorm sessions. Format: XLSX (Excel). Dimensions: 106 statements. File Name: US_Statements Description: List of unique statements about Barrett's esophagus and esophageal adenocarcinoma screening, generated by US professionals during individual digital brainstorm sessions. Format: XLSX (Excel). Dimensions: 101 statements. Similarity Matrix Data: File Name: NL_SimilarityMatrix Description: Matrix representing pairwise similarity scores between statements based on participants' input. Rows and columns correspond to specific statements, and values represent similarity scores. Format: XLSX (Excel). Dimensions: 123 x 123 (123 statements assessed by professionals). File Name: UK_SimilarityMatrix Description: Matrix representing pairwise similarity scores between statements based on participants' input. Rows and columns correspond to specific statements, and values represent similarity scores. Format: XLSX (Excel). Dimensions: 106 x 106 (106 statements assessed by professionals). File Name: US_SimilarityMatrix Description: Matrix representing pairwise similarity scores between statements based on participants' input. Rows and columns correspond to specific statements, and values represent similarity scores. Format: XLSX (Excel). Dimensions: 101 x 101 (101 statements assessed by professionals). Rating Data of Statements: File Name: Ratings_NL Description: Dutch professionals' ratings for each statement regarding relevance in evaluating acceptability of screening for Barrett's esophagus and esophageal adenocarcinoma. Each column corresponds to a statement, and rows represent ratings by different participants. Format: XLSC (Excel). Dimensions: 123 statements x 23 professionals. File Name: Ratings_UK Description: Britisch professionals' ratings for each statement regarding relevance in evaluating acceptability of screening for Barrett's esophagus and esophageal adenocarcinoma. Each column corresponds to a statement, and rows represent ratings by different participants. Format: XLSC (Excel). Dimensions: 106 statements x 18 professionals. File Name: Ratings_US Description: American professionals' ratings for each statement regarding relevance in evaluating acceptability of screening for Barrett's esophagus and esophageal adenocarcinoma. Each column corresponds to a statement, and rows represent ratings by different participants. Format: XLSC (Excel). Dimensions: 101 statements x 14 professionals. 5. Data Collection Instruments: Concept Systems software version 4.0175. 6. Ethical Considerations: Informed consent obtained from all participants. Anonymity and confidentiality ensured. 7. Research Team: Principal Investigators: Prof. Peter Siersema and prof. Mireille Broeders Co-Investigators: Dr.Linda Rainey, dr. Yonne Peters, prof. Sachin Wani, prof. Rebecca Fitzgerald, dr. Jennifer Kolb Coordinating investigator: Jasmijn Sijben 8. Funding Source: Netherlands Organization for Health Research and Development (ZonMw) (grant 555004206). 9. Data Usage Policy: Data is available for research purposes only. Proper attribution to the original study required. 10. Contact Information: Dr. Jasmijn Sijben Email: [email protected] Institution: Radboudum

Dutch individuals’ views of screening for oesophageal cancer: a focus group study

Objective Screening for early oesophageal adenocarcinoma (OAC), including its precursor Barrett’s oesophagus (BO), can potentially reduce OAC-related morbidity and mortality. This study explores Dutch at-risk individuals’ views of screening an at-risk population for BO/OAC.Design We invited 372 individuals with risk factors for OAC from primary care practices, 73 individuals with surveillance experience, and 221 participants of previous studies (BO/OAC screening trial or survey) to participate in focus groups. Transcripts were inductively and thematically analysed by two independent researchers.Results A total of 50 individuals (42% with gastro-oesophageal reflux symptoms) of 50–75 years participated. Themes that were raised included: theme 1 ‘screening intentions’ describing participants’ motivation to be screened (eg, early diagnosis, potential reassurance, physician recommendation, and knowing someone with cancer) or decline screening (eg, anticipated discomfort or suboptimal accuracy of the test); theme 2 ‘risk-based eligibility’ describing the tension between effectiveness (eg, targeting high-risk individuals) and inclusivity (eg, making screening available for everyone); theme 3 ‘distributive justice’, in which the pressure of a potential new screening programme on healthcare resources was discussed; and theme 4 ‘information needs’ describing the perceived lack of information access and individuals’ preference to discuss screening with their general practitioner.Conclusion Individuals not only expressed high willingness to be screened but also voiced the concern that a new screening programme may pressure limited healthcare resources. If implemented, it is crucial to develop educational materials that meet the public’s information needs and explain the test procedures and eligibility criteria while avoiding stigmatising language

Professionals’ views on the justification for esophageal adenocarcinoma screening: A systematic literature search and qualitative analysis

Screening for early esophageal adenocarcinoma (EAC), including screening for its precursor Barrett's esophagus (BE), has the potential to reduce EAC-related mortality and morbidity. This literature review aimed to explore professionals’ views on the justification for EAC screening. A systematic search of Ovid Medline, EMBASE, and PsycInfo, from January 1, 2000 to September 22, 2022, identified 5 original studies and 63 expert opinion articles reporting professionals’ perspectives on EAC screening. Included articles were qualitatively analyzed using the framework method, which was deductively led by modernized screening principles. The analyses showed that many professionals are optimistic about technological advancements in BE detection and treatment. However, views on whether the societal burden of EAC merits screening were contradictory. In addition, knowledge of the long-term benefits and risks of EAC screening is still considered insufficient. There is no consensus on who to screen, how often to screen, which screening test to use, and how to manage non-dysplastic BE. Professionals further point out the need to develop technology that facilitates automated test sample processing and public education strategies that avoid causing disproportionately high cancer worry and social stigma. In conclusion, modernized screening principles are currently insufficiently fulfilled to justify widespread screening for EAC. Results from future clinical screening trials and risk prediction modeling studies may shift professionals’ thoughts regarding justification for EAC screening

Dutch, UK and US professionals perceptions of screening for Barretts esophagus and esophageal adenocarcinoma: a concept mapping study.

BACKGROUND: Novel, less-invasive technologies to screen for Barretts esophagus (BE) may enable a paradigm shift in early detection strategies for esophageal adenocarcinoma (EAC). Understanding professionals perspectives on screening is important to determine how to proceed. We aimed to explore and compare professionals perceptions of screening for BE and EAC screening in three countries. METHODS: In this study, 29 Dutch, 20 British and 18 American health care professionals (clinicians, researchers and policy makers) participated in concept mapping: a mixed-methods consensus building methodology. Statements on perceived barriers, facilitators, advantages, disadvantages, implications or worries associated with screening for BE and EAC were collected in asynchronous digital brainstorm sessions. Subsequently, participants sorted the statements into groups according to thematic similarity and assessed the relevance of each statement in evaluating the acceptability of BE and EAC screening. Multidimensional scaling and cluster analysis were used to map the associations between generated statements. RESULTS: Professionals across three countries identified eight consistent themes that relate to their perceptions of screening for BE and EAC: (1) Benefits, (2) Harms, (3) Clinical effectiveness concerns, (4) Screening population, (5) Screening modality, (6) Resources, (7) Ownership, and (8) Public communication. Dutch and American professionals prioritized the potential health benefits of screening but also questioned clinical impact. In contrast, British participants prioritized identification of the screening population and suitable test. CONCLUSIONS: Most professionals see potential in less-invasive screening tests for BE and EAC but underline the need to define the target screening population and determine benefits and harms before widely employing them. Successful implementation will require thoughtful consideration of the involvement of general practitioners, readiness of endoscopy and pathology services, balanced public communication, and country-specific regulations

Dutch, UK and US professionals' perceptions of screening for Barrett's esophagus and esophageal adenocarcinoma: a concept mapping study.

Acknowledgements: The authors thank Henk Schers, Breg Braak, Irene Debiram, and Nicola Grehan for their assistance with the data collection process. The authors also thank Izhar Bagwan, Corinne Bakker, Bertine Bast, Ian Beales, Dorien van der Biessen-van Beek, Duncan Blake, Truuske de Bock, Jan Bornschein, Geert Bulte, David Chan, Parakrama Chandrasoma, Marion Claes, Helen Coleman, Scott Corbett, Tom Crosby, Katherine Dickerman, Jason Dunn, Gary Falk, Kieran Foley, Vicky Goh, James Gossage, John Haydek, Yasmijn van Herwaarden, Remco Huiszoon, Madhu Iyengar, Marnix Jansen, Blake Jones, Jeffrey Kaplan, David Katzka, Sunnie Kim, Bastiaan Klarenbeek, Iris Lansdorp-Vogelaar, Alexis Leal, Christopher Lieu, Arjan Lock, Mirjam van Loon, Martin McCarter, Elizabeth Montgomery, Iris Nagtegaal, Grard Nieuwenhuizen, Gert Olthuis, Ariadne Ooms, Frank Oort, Claire Palles, Christopher Peters, Frans Peters, Massimiliano Di Pietro, Chella van der Post, Leo van Rossum, Heidi Rutten, Maartje Schermers, Erik Schoon, Pim Schout, Ruud Schrauwen, Iris Seriese, Siddharth Singh, Jo Skinner, Richard Skipworth, Marije van Slingerland, Manon Spaander, Adriaan Tan, Danielle Timmermans, Jamie Weaver, David Weinberg, Ravy Vajravelu, Rena Yadlapati, Yeng Ang, and anonymous participants for their thoughtful and diligent participation throughout the study period. All respondents participated independently from their affiliation.BACKGROUND: Novel, less-invasive technologies to screen for Barrett's esophagus (BE) may enable a paradigm shift in early detection strategies for esophageal adenocarcinoma (EAC). Understanding professionals' perspectives on screening is important to determine how to proceed. We aimed to explore and compare professionals' perceptions of screening for BE and EAC screening in three countries. METHODS: In this study, 29 Dutch, 20 British and 18 American health care professionals (clinicians, researchers and policy makers) participated in concept mapping: a mixed-methods consensus building methodology. Statements on perceived barriers, facilitators, advantages, disadvantages, implications or worries associated with screening for BE and EAC were collected in asynchronous digital brainstorm sessions. Subsequently, participants sorted the statements into groups according to thematic similarity and assessed the relevance of each statement in evaluating the acceptability of BE and EAC screening. Multidimensional scaling and cluster analysis were used to map the associations between generated statements. RESULTS: Professionals across three countries identified eight consistent themes that relate to their perceptions of screening for BE and EAC: (1) Benefits, (2) Harms, (3) Clinical effectiveness concerns, (4) Screening population, (5) Screening modality, (6) Resources, (7) Ownership, and (8) Public communication. Dutch and American professionals prioritized the potential health benefits of screening but also questioned clinical impact. In contrast, British participants prioritized identification of the screening population and suitable test. CONCLUSIONS: Most professionals see potential in less-invasive screening tests for BE and EAC but underline the need to define the target screening population and determine benefits and harms before widely employing them. Successful implementation will require thoughtful consideration of the involvement of general practitioners, readiness of endoscopy and pathology services, balanced public communication, and country-specific regulations

Acceptability of risk-based triage in cervical cancer screening: A focus group study

Background Compared to the previous cytology-based program, the introduction of primary high-risk human papillomavirus (hrHPV) based screening in 2017 has led to an increased number of referrals. To counter this, triage of hrHPV-positive women in cervical cancer screening can potentially be optimized by taking sociodemographic and lifestyle risk factors for cervical abnormalities into account. Therefore, it is essential to gain knowledge of the views of women (30–60 years) eligible for cervical cancer screening. Objective The main goal of this qualitative study was to gain insight in the aspects that influence acceptability of risk-based triage in cervical cancer screening. Design A focus group study in which participants were recruited via four general medical practices, and purposive sampling was used to maximize heterogeneity with regards to age, education level, and cervical cancer screening experiences. Approach The focus group discussions were transcribed verbatim and analyzed using reflexive thematic analysis. Participants A total of 28 women (average age: 45.2 years) eligible for cervical cancer screening in The Netherlands participated in seven online focus group discussions. Half of the participants was higher educated, and the participants differed in previous cervical cancer screening participation and screening result. Key results In total, 5 main themes and 17 subthemes were identified that determine the acceptability of risk-stratified triage. The main themes are: 1) adequacy of the screening program: an evidence-based program that is able to minimize cancer incidence and reduce unnecessary referrals; 2) personal information (e.g., sensitive topics and stigma); 3) emotional impact: fear and reassurance; 4) communication (e.g., transparency); and 5) autonomy (e.g., prevention). Conclusion The current study highlights several challenges regarding the development and implementation of risk-based triage that need attention in order to be accepted by the target group. These challenges include dealing with sensitive topics and a transparent communication strategy

Acceptability of risk-based triage in cervical cancer screening:A focus group study

BACKGROUND: Compared to the previous cytology-based program, the introduction of primary high-risk human papillomavirus (hrHPV) based screening in 2017 has led to an increased number of referrals. To counter this, triage of hrHPV-positive women in cervical cancer screening can potentially be optimized by taking sociodemographic and lifestyle risk factors for cervical abnormalities into account. Therefore, it is essential to gain knowledge of the views of women (30-60 years) eligible for cervical cancer screening. OBJECTIVE: The main goal of this qualitative study was to gain insight in the aspects that influence acceptability of risk-based triage in cervical cancer screening. DESIGN: A focus group study in which participants were recruited via four general medical practices, and purposive sampling was used to maximize heterogeneity with regards to age, education level, and cervical cancer screening experiences. APPROACH: The focus group discussions were transcribed verbatim and analyzed using reflexive thematic analysis. PARTICIPANTS: A total of 28 women (average age: 45.2 years) eligible for cervical cancer screening in The Netherlands participated in seven online focus group discussions. Half of the participants was higher educated, and the participants differed in previous cervical cancer screening participation and screening result. KEY RESULTS: In total, 5 main themes and 17 subthemes were identified that determine the acceptability of risk-stratified triage. The main themes are: 1) adequacy of the screening program: an evidence-based program that is able to minimize cancer incidence and reduce unnecessary referrals; 2) personal information (e.g., sensitive topics and stigma); 3) emotional impact: fear and reassurance; 4) communication (e.g., transparency); and 5) autonomy (e.g., prevention). CONCLUSION: The current study highlights several challenges regarding the development and implementation of risk-based triage that need attention in order to be accepted by the target group. These challenges include dealing with sensitive topics and a transparent communication strategy.</p

Risk factors and clinical outcomes of endoscopic dilation in benign esophageal strictures: a long-term follow-up study

Background and Aims: Endoscopic dilation (ED) is still the mainstay of therapeutic management of benign esophageal strictures (BESs). This study aimed to establish risk factors for refractory BESs and assess long-term clinical outcomes of ED. Methods: We performed a retrospective study in 891 patients who underwent ED from 2003 to 2018 for BESs. We searched electronic medical records in 6 tertiary care centers in the Netherlands for data on clinical outcome of ED. Median follow-up was 39 months. The primary endpoint was risk factors for refractory BESs, defined as factors associated with an increased number of ED sessions during follow-up. Secondary endpoints were time from first to last ED session and adverse events. Results: Dilation up to 13 to 15 mm was associated with a higher number of ED sessions than dilation up to 16 to 18 mm (5.0 vs 4.1; hazard ratio [HR], 1.4; P = .001). Compared with peptic strictures, anastomotic (4.9 vs 3.6; HR, 2.1; P < .001), radiation (5.0 vs 3.6; HR, 3.0; P < .001), caustic (7.2 vs 3.6; HR, 2.7; P < .001), and postendotherapy (3.9 vs 3.6; HR, 1.8; P = .005) strictures were associated with a higher number of ED sessions. After 1 year of follow-up, the proportions of patients who remained free of ED was 75% in anastomotic, 71% in radiation, 70% in peptic, 83% in postendotherapy, and 62% in caustic strictures. Esophageal perforation occurred in 23 ED sessions (.4%) in 22 patients (2.4%). Conclusions: More than 60% of patients with BESs remain free of ED after 1 year of follow-up. Because dilation up to 16 to 18 mm diameter was associated with fewer ED sessions during follow-up, we suggest that clinicians should consider dilation up to at least 16 mm to reduce the number of ED sessions in these patients