Determinants of Overuse of Cancer Screening: A Systematic Review
Jean Pannikottu
Northeast Ohio Medical University
Jean Pannikottu is an M.D. candidate in the Class of 2019 at Northeast Ohio Medical University (NEOMED) and holds a B.S. degree in Natural Sciences from The University of Akron. This summer, she was part of the MSTAR (Medical Student Training in Aging Research) program administered by American Federation for Aging Research (AFAR) and National Institute on Aging (NIA). Under the guidance of Dr. Jodi Segal at Johns Hopkins University, she explored determinants of cancer screening overuse. She has previously conducted clinical research in various departments at the Cleveland Clinic and Western Reserve Hospital. In her medical school, she founded the American Sign Language club, which has been nominated for the diversity club of the year. She is also president of the medical school book club and has held leadership roles in the NEOMED American Medical Student Association (AMSA) chapter.
Abstract
Introduction: There is growing awareness of overuse of services in the U.S. health care system. This study systematically examines the determinants of overuse of cancer screening and surveillance.Methods: Using MEDLINE and... [ view full abstract ]
Introduction: There is growing awareness of overuse of services in the U.S. health care system. This study systematically examines the determinants of overuse of cancer screening and surveillance.
Methods: Using MEDLINE and Embase, relevant articles were systematically searched and analyzed from January 1998 to July 2016. A specific search for articles addressing cancer screening through September 2016 and a handsearch using the reference lists of included articles were also conducted. Studies were included if they were written in English, contained original data, pertained to a U.S. population, and identified determinants associated with overuse. A single reviewer abstracted data, and a second reviewer confirmed data accuracy. Risk of bias was assessed by two independent reviewers.
Results: Thirty-six articles were included. The studies described determinants of overuse of cancer screening and surveillance for breast cancer in 7 articles, cervical cancer in 9 articles, colon cancer in 14 articles, and other types of cancer in 8 articles. Across all the types of cancer screening, the “younger” older patient was significantly at risk for overuse; clinician recommendation for screening was also consistently a determinant of unnecessary screening. Abundant access to primary care was associated with overuse of breast cancer screening and surveillance. Cervical cancer screening overuse was associated with gynecologist involvement in care, decreased physician awareness and agreement of guidelines, and generous insurance coverage (among patients with former hysterectomies). Surgeon involvement in care and care at a high-volume site were determinants of overuse of colon cancer screening and surveillance. Overuse of breast cancer and colon cancer screening and surveillance varied regionally.
Discussion: The literature supports that liberal access to care and clinicians’ recommendations to screen increase the likelihood of unnecessary cancer screening and surveillance. This points to education of clinicians (and patients) about appropriate screening as an enduring need for high value care delivery.
Authors
-
Jean Pannikottu
(Northeast Ohio Medical University)
-
Monica Tung
(Johns Hopkins University)
-
Stephanie Nothelle
(Johns Hopkins University)
-
Ritu Sharma
(Johns Hopkins University)
-
Jodi Segal
(Johns Hopkins University)
Topic Areas
Prevalence and drivers of overuse , Overuse in the care of the elderly and at end of life , Organizational factors (such as structure and culture) that drive overuse
Session
OS-1 » Oral Presentations: Drivers of Overuse (09:30 - Friday, 5th May, Salons 4 & 5)
Presentation Files
The presenter has not uploaded any presentation files.
