Individualized Prostate Cancer Testing : men's views on participation

Prostate cancer (PCa) is the second most common cancer in men in the world and the fourth most common occurring cancer overall. However, because the harms from testing with prostate-specific antigen (PSA) are considered to outweigh the benefits, no governmental body has yet adopted a PSA-based screening program. Risk-based screening could potentially help reduce the proportion of men undergoing biopsy by identifying individuals at the highest risk of developing PCa, and thus reduce the harms of overdiagnosis and overtreatment. However, little is known about the psycho-social aspects surrounding risk-stratified PCa testing. This thesis, and the papers encompassed, aims to increase knowledge regarding men’s views on participation to individualized prostate cancer testing (PCT). Their interest in partaking in a risk-based PCT as well as its effect on their psycho-social health were investigated. A better understanding of their views, as well as predictors of participation and aspects of invitation would help inform development of population-based PCa screening programs to optimize attendance. By using a cross-sectional survey in Paper I, the objective was to explore the general population’s interest in, and acceptability of, the prospect of risk-stratified cancer screening programs. A representative sample of 10.000 individuals (20-74 years of age) were invited to respond to a web-survey with questions developed by a panel of experts. Men were asked about PCa screening and women were asked about breast cancer screening. Out of our 2822 respondents (28%), a vast majority (94%) showed interest in wanting to know their cancer risk, with men presenting more certainty than women. A total of 87% agreed to the concept that if identified with a high risk, they would get screened more often. Only 27%, however, would agree to get screened less often if identified as having a low risk. Paper II, Paper III and Paper IV studied actual participation in risk-based PCT. The PCa test was conducted within the frame of the STHLM3 trial, a large study for men 50-69 years of age in the region of Stockholm (Sweden). STHLM3 aimed at validating a risk-based PCT model in order to identify high-risk PCa. By participating in STHLM3, men were communicated their PCa risk (low, intermediate or high). The study sample in Paper II represented a sub-sample of 28.134 men invited to the pilot study of STHLM3. They were randomly allocated to different survey design factors in order to investigate optimization of participation rates. The study sample for Paper III and IV was also nested in STHLM3 and consisted of 10.000 men. They were invited to respond to a web- survey concerning worry, knowledge, health behavior and attitudes, as well as health related quality of life, three months before STHLM3, at invitation to STHLM3, and five months after participation in STHLM3. Paper II and Paper III investigated predictors of participation to the risk-based PCa screening program. Paper II investigated survey and invitation design predictors (the use of a pre-notification, the length of the invitation letter, the length of the questionnaire and the use of a reminder or not). Paper III examined psycho-social predictors (worry, knowledge, health behavior and attitudes, and health-related quality of life) for participation in PCT. The participation rate in Paper II was 34%. The use of a pre-notification and a reminder increased participation to STHLM3. In Paper III, 1915 men responded to the questionnaire three months before invitation to STHLM3. When comparing decliners of STHLM3 (30%) with participants to STHLM3 (70%), participants presented more worry and an increased level of vulnerability, as well as a better general health than decliners. Finally, almost 1000 men responded to the psycho-social questionnaire three months before STHLM3 as well as five months after STHLM3, enabling examination of the impact over time of participating to the risk-based PCT in STHLM3. Men assigned to a low or intermediate risk level reported that the levels of worry decreased over time, whereas men assigned to a high-risk level reported no increased level of worry. A low level of PCa knowledge was observed throughout Paper III and IV, calling for improved effort on that front before introducing PCa screening. Although participation rates could still be optimized, if implemented risk-stratified screening has the possibility to be accepted by the general public. Moreover, the study revealed no negative impact on the well-being of men participating in risk-based PCa testing

Efektifitas metode bervariasi terhadap hasil belajar siswa pada bidang studi PAI Di SMP Zainuddin Waru Sidoarjo

Dalam skripsi ini penulis membahas tentang Efektifitas penggunaan Metode Bervariasi Terhadap Hasil Belajar Siswa Pada Bidang Studi PAI Di SMP Zainuddin Waru Sidoarjo dengan tiga rumusan masalah sebagai berikut : 1. Bagaimana penggunaan metode bervariasi di SMP Zainuddin Waru Sidoarjo ? 2. Bagaimana hasil belajar siswa SMP Zainuddin Waru Sidoarjo ? 3. Sejauh mana efektifitas penggunaan metode bervariasi terhadap basil belajar siswa pada bidang studi PAI di SMP Zainuddin Waru Sidoarjo ? Penelitian ini merupakan penelitian kuantitatif dengan populasi berjumlah 108 siswa, yaitu siswa kelas VIII. Dalam hal ini penulis mengambil sampel 30% dari seluruh populasi yang berjumlah 108 siswa sehingga menjadi 30 siswa. Dalam menjawab permasalahan di atas, penulis menggunakan metode pengumpulan data berupa metode observasi, dokumentasi, wawancara atau interview, dan metode angket atau quesioner. Sedangkan untuk analisa data penulis menggunakan analisa data statistik product moment. Berdasarkan hasil penelitian kemudian dapat disimpulkan bahwa penggunaan metode bervariasi di SMP Zainuddin Waru Sidoarjo terbilang baik. Dan hasil belajar siswa pada bidang studi Pendidikan Agama Islam di SMP Zainuddin Waru Sidoarjo terbilang sangat baik. Kemudian dari hasil akhir statistik menunjukkan bahwa ada pengaruh yang terbilang kuat atau tinggi antara efektifitas metode bervariasi terhadaP. basil belajar siswa pada bidang studi Pendidikan Agama Islam di SMP Zainuddin Waru Sidoarjo dengan hasil 0,836

Effects of pre-notification, invitation length, questionnaire length and reminder on participation rate: a quasi-randomised controlled trial

Abstract Background Improving participation rates in epidemiologic studies using questionnaires and biological sampling is important for the generalizability of the outcome. The aim of this study was to examine the effects of pre-notification, invitation length, questionnaire length, and reminder on participation rate and to investigate whether some factors contributed to participants doing both the questionnaire and blood sampling as oppose to only one part. Methods Our study was embedded within the pilot testing of a large population-based study about prostate cancer screening. Our study sample consisted of 28.134 men between 50 and 69 years of age and living in the region of Stockholm (Sweden) invited to respond to a web-based questionnaire and to provide blood for prostate cancer testing. The men were randomly allocated according to birth of date to receive either: (a) a pre-notification postcard or not; (b) a shorter or a longer invitation letter; (c) a shorter or a longer web-based questionnaire, and (d) a reminder or not. The effects of the survey design factors were tested using chi-square. Results The use of a pre-notification (p < 0.0001), a longer questionnaire (p = 0.004) and the use of a reminder (p = 0.02) were associated with an increase in overall participation, i.e. responding to the questionnaire or providing blood for PCT or performing both components. Conclusions The results of this pilot study justified the use of a pre-notification and a reminder in the following large population based study since the benefits of increased participation traded off against the greater costs incurred. Furthermore, we were able to use the longer version of the questionnaire, which allowed us to collect more information without risking a lower response rate

The STHLM3-model, Risk-based Prostate Cancer Testing Identifies Men at High Risk Without Inducing Negative Psychosocial Effects

Background: The new STHLM3 test, combining protein markers, genetic markers, and clinical data to assess a man's prostate cancer (PCa) risk, has been investigated in Sweden within the frame of the STHLM3 trial. Objective: To assess whether the STHLM3 test influences men's worry level, PCa knowledge, attitude, and health-related quality of life (HRQoL). Design, setting, and participants: Invitations with login to the web survey were mailed to 10 000 men, 50–69 yr of age, who were eligible for the STHLM3 trial. The survey was sent 3 mo before invitation to the STHLM3 trial (baseline) and 5 mo after STHLM3 (follow-up). At baseline, the men were unaware of the upcoming invitation to STHLM3. The survey covered the following: PCa-specific worry and perceived vulnerability, knowledge about PCa, attitude toward PCa testing and health behavior, and HRQoL Outcome measurements and statistical analysis: Survey scores were compared between baseline and follow-up by using the nonparametric Wilcoxon-signed rank tests for paired samples. Analysis of covariance was performed for PCa risk group comparisons. Results and limitations: A total of 994 men (10%) responded to our survey at baseline and follow-up, and were assessed as follows: low risk: 421 men; intermediate risk: 421 men; and high risk:152, of whom 59 were diagnosed with PCa after further investigation. In men assessed as having low and intermediate risk, level of worrying decreased at follow-up (p < 0.001), whereas no changes were observed in men at high risk. Moreover, no HRQoL changes were observed over time. The low response rate is the main limitation. Conclusions: We found that the STHLM3 model, a risk-based PCa test, showed no negative impact on the well-being of men. Patient summary: Since our results suggest that the risk-based screening as used in STHLM3 did not induce negative psychological effects on the participants, we can recommend this risk-based approach for population-based prostate cancer screening

Public interest in and acceptability of the prospect of risk-stratified screening for breast and prostate cancer

For risk-stratified screening to be implemented as a screening program for breast and prostate cancer it has to be accepted among the general population. Investigating public interest in stratified screening and its acceptability to the public is therefore essential since as yet little is known. Cross-sectional web survey sent to a sample of 10 000 individuals (20-74 years of age) representative of the Swedish population as registered in 2009. Among the responders (28%), a vast majority (94%) expressed an interest in knowing their breast or prostate cancer risk and stated wanting to know to 'avoid worrying'. Men and women were equally interested in knowing their prostate and breast cancer risk, respectively. However, men showed more certainty. Trusting the healthcare workers with personal information (63%) as well as genetic information (70%), in order to calculate the risk, did not seem to be a major issue. Furthermore, 87% would agree to get screened more often if identified with a high risk, whereas, if identified with a low risk, only 27% would agree to get screened less often. Finally, although a consultation with a physician seemed to be the preferred way to communicate the risk, a majority would agree to receive it via a letter or a phone call. Risk-stratified screening has the possibility to be accepted by the general public. Knowledge about interest and acceptability of the prospect of risk-stratified screening for breast and prostate cancer will help when implementing new screening strategie

Additional file 1: of Effects of pre-notification, invitation length, questionnaire length and reminder on participation rate: a quasi-randomised controlled trial

English translation of the invitation letters as well as the checklist. A. Long version of the invitation letter. B. Short version of the invitation letter. (PDF 184 kb

Prostate cancer (PC) knowledge by participation to risk-based PC screening, three months before invitation to screening.

<p>Prostate cancer (PC) knowledge by participation to risk-based PC screening, three months before invitation to screening.</p

Men’s worry and perceived vulnerability to prostate cancer (PC) by participation to risk-based PC screening, three months before invitation to screening.

<p>Men’s worry and perceived vulnerability to prostate cancer (PC) by participation to risk-based PC screening, three months before invitation to screening.</p

Health behaviour scale scores by participation to risk-based PC screening, three months before invitation to screening.

<p>Health behaviour scale scores by participation to risk-based PC screening, three months before invitation to screening.</p