Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study

Laura J. James, Germaine Wong, Jonathan C. Craig, Angela Ju, Narelle Williams, Wai H. Lim, Nicholas C P Cross, Allison Tong

Research output: Contribution to journalArticle

4 Citations (Scopus)

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. Copyright © 2017 by the American Society of Nephrology

Original languageEnglish
Pages (from-to)568-576
Number of pages9
JournalClinical Journal of the American Society of Nephrology
Volume12
Issue number4
DOIs
Publication statusPublished - 3 Apr 2017

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Early Detection of Cancer
Colonic Neoplasms
Kidney Diseases
Interviews
Kidney
Health Priorities
Neoplasms
Insurance Benefits
Graft Survival
Patient Satisfaction
New Zealand
Dialysis
Decision Making
Patient Care
Anxiety
Transplantation
Tissue Donors
Delivery of Health Care
Health
Therapeutics

Cite this

James, Laura J. ; Wong, Germaine ; Craig, Jonathan C. ; Ju, Angela ; Williams, Narelle ; Lim, Wai H. ; Cross, Nicholas C P ; Tong, Allison. / Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD : A Semistructured Interview Study. In: Clinical Journal of the American Society of Nephrology. 2017 ; Vol. 12, No. 4. pp. 568-576.
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title = "Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD: A Semistructured Interview Study",
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. Copyright {\circledC} 2017 by the American Society of Nephrology",
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Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD : A Semistructured Interview Study. / James, Laura J.; Wong, Germaine; Craig, Jonathan C.; Ju, Angela; Williams, Narelle; Lim, Wai H.; Cross, Nicholas C P; Tong, Allison.

In: Clinical Journal of the American Society of Nephrology, Vol. 12, No. 4, 03.04.2017, p. 568-576.

Research output: Contribution to journalArticle

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T1 - Beliefs and Attitudes to Bowel Cancer Screening in Patients with CKD

T2 - 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 C P

AU - Tong, Allison

PY - 2017/4/3

Y1 - 2017/4/3

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. Copyright © 2017 by the American Society of Nephrology

AB - 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. Copyright © 2017 by the American Society of Nephrology

KW - Anxiety,Attention,Attitude,Australia,Cognition,Early Detection of Cancer,Graft Survival,Humans,Neoplasms,New Zealand,Patient Satisfaction,Renal Insufficiency, Chronic,Risk,Transplant Recipients,bowel cancer screening,chronic kidney disease,interview,kidne

U2 - 10.2215/CJN.10090916

DO - 10.2215/CJN.10090916

M3 - Article

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SP - 568

EP - 576

JO - Clinical Journal of the American Society of Nephrology

JF - Clinical Journal of the American Society of Nephrology

SN - 1555-9041

IS - 4

ER -