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Abstract
Background
It is crucial to determine feasibility of risk-stratified screening to facilitate successful implementation. We introduced risk-stratification (BC-Predict) into the NHS Breast Screening Programme (NHSBSP) at three screening sites in north-west England from 2019 to 2021. The present study investigated the views of healthcare professionals (HCPs) on acceptability, barriers, and facilitators of the BC-Predict intervention and on the wider implementation of risk-based screening after BC-Predict was implemented in their screening site.
Methods
Fourteen semi-structured interviews were conducted with HCPs working across the breast screening pathway at three NHSBSP sites that implemented BC-Predict. Thematic analysis interpreted the data.
Results
Three pre-decided themes were produced. (1) Acceptability of risk-based screening: risk-stratification was perceived as a beneficial step for both services and women. HCPs across the pathway reported low burden of running the BC-Predict trial on routine tasks, but with some residual concerns; (2) Barriers to implementation: comprised capacity constraints of services including the inadequacy of current IT systems to manage women with different risk profiles and, (3) Facilitators to implementation: included the continuation of stakeholder consultation across the pathway to inform implementation and need for dedicated risk screening admin staff, a push for mammography staff recruitment and guidance for screening services. Telephone helplines, integrating primary care, and supporting access for all language needs was emphasised.
Conclusion
Risk-stratified breast screening was viewed as a progressive step providing it does not worsen inequalities for women. Implementation of risk-stratified breast screening requires staff to be reassured that there will be systems in place to support implementation and that it will not further burden their workload. Next steps require a comprehensive assessment of the resource needed for risk-stratification versus current resource availability, upgrades to screening IT and building screening infrastructure. The role of primary care needs to be determined. Simplification and clarification of risk-based screening pathways is needed to support HCPs agency and facilitate implementation. Forthcoming evidence from ongoing randomised controlled trials assessing effectiveness of breast cancer risk-stratification will also determine implementation.
It is crucial to determine feasibility of risk-stratified screening to facilitate successful implementation. We introduced risk-stratification (BC-Predict) into the NHS Breast Screening Programme (NHSBSP) at three screening sites in north-west England from 2019 to 2021. The present study investigated the views of healthcare professionals (HCPs) on acceptability, barriers, and facilitators of the BC-Predict intervention and on the wider implementation of risk-based screening after BC-Predict was implemented in their screening site.
Methods
Fourteen semi-structured interviews were conducted with HCPs working across the breast screening pathway at three NHSBSP sites that implemented BC-Predict. Thematic analysis interpreted the data.
Results
Three pre-decided themes were produced. (1) Acceptability of risk-based screening: risk-stratification was perceived as a beneficial step for both services and women. HCPs across the pathway reported low burden of running the BC-Predict trial on routine tasks, but with some residual concerns; (2) Barriers to implementation: comprised capacity constraints of services including the inadequacy of current IT systems to manage women with different risk profiles and, (3) Facilitators to implementation: included the continuation of stakeholder consultation across the pathway to inform implementation and need for dedicated risk screening admin staff, a push for mammography staff recruitment and guidance for screening services. Telephone helplines, integrating primary care, and supporting access for all language needs was emphasised.
Conclusion
Risk-stratified breast screening was viewed as a progressive step providing it does not worsen inequalities for women. Implementation of risk-stratified breast screening requires staff to be reassured that there will be systems in place to support implementation and that it will not further burden their workload. Next steps require a comprehensive assessment of the resource needed for risk-stratification versus current resource availability, upgrades to screening IT and building screening infrastructure. The role of primary care needs to be determined. Simplification and clarification of risk-based screening pathways is needed to support HCPs agency and facilitate implementation. Forthcoming evidence from ongoing randomised controlled trials assessing effectiveness of breast cancer risk-stratification will also determine implementation.
| Original language | English |
|---|---|
| Article number | 1058 |
| Journal | BMC Cancer |
| Volume | 22 |
| DOIs | |
| Publication status | Published - 12 Oct 2022 |
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(MCHP) : Manchester Centre for Health Psychology
Peters, S. (PI), Ulph, F. (PI), Arden Armitage, C. (Researcher), Borrelli, B. (Researcher), Bowen, A. (Researcher), Byrne-Davis, L. (Researcher), Edge, D. (Researcher), French, D. (Researcher), Hart, J. (Researcher), Todd, C. (Researcher), Skevington, S. (Researcher), Wearden, A. (Researcher), Cotterill, S. (Researcher), Brooks, J. (Researcher), Brown, L. (Researcher), Bull, E. (Researcher), Cordingley, L. (Researcher), Epton, T. (Researcher), Smith, D. (Researcher), Speer, S. (Researcher), Powell, R. (Researcher), Bartlett, K. (Researcher), Coupe, N. (Researcher), Shepherd, S. (Researcher), Dienes, K. (Researcher), Ghio, D. (Researcher), Hood, A. (Researcher), Lavallee, J. (Researcher), Rowland, C. (Researcher), Benton, J. (Researcher), Goldthorpe, J. (Researcher), McWilliams, L. (Researcher), Keyworth, C. (Researcher), Goulding, R. (Researcher), Loughran, M. (Researcher), Hawkes, R. (Researcher), Kapadi, A. (Researcher), Hurley, R. (Researcher), Leather, J. (Researcher), Musa, C. (Researcher), Angelakis, I. (Researcher), Reid, C. (Researcher), Reid, H. (PGR student), Hulme, L. (PGR student), Hindmarch, S. (PGR student), Plant, S. (Researcher), Peterson, J. (Researcher), Woof, V. (PGR student), Devereux-Fitzgerald, A. (Researcher), Sawyer, C. (Researcher), Wilkes, J. (Researcher), Birtwell, K. (Researcher), Stringer, G. (Researcher), Tang, M. Y. (Researcher), Coupe, N. (Researcher), Hamnett, C. (Support team), Lyons, S. (Researcher), Hulme, L. (PGR student) & Lee, R. (Researcher)
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Project: Research