Scelte gestionali per sostenere e migliorare i programmi di screening oncologico.

Improving screening programmes in terms of increasing screening participation and providing appropriate follow-up is a major challenge requiring great planning. This contribution discusses the effect of a major intra-organizational intervention on three population-based oncological screening programs (i.e., breast, cervical, and colorectal cancers) active in a large Italian Screening Centre. A review of the literature data on the key elements for high-quality healthcare was conducted. The PRECEDE-PROCEED model was retrospectively used as a theoretical frame for the improvement strategies adopted in the Centre. Classification of interventions to increase participation was performed according by target: individual, population, health workers, tests, and health service management. To assess the impact of the reorganization on the three screening programmes, the 'participation rate in the first-level screening tests' indicator was considered; the years 2018, 2019, and 2022 were analyzed.The main factors driven by the change were optimization of resources (human and financial), a stronger leadership, a higher collaboration level, stakeholders' engagement, positive work culture, and continuous staff learning. Reminders to non-responders (mobile phone text-message and letter), delivery of publicity by media, offering the self-sampling method for HPV testing, and increasing accessibility were implemented.A significant increase in screening participation was observed for all screening programmes when comparing the participation rates in 2022 to those in 2018 and 2019. In particular, focusing on 2019 (the last standard activity year before the COVID-19 emergency), an increase in participation rate of 3% for breast, 8.5% for cervical, and 4.6% for colorectal cancer screening was observed. This increase can plausibly be an effect of the improvement strategies implemented in the Centre.Performance measurements and internal and external feedback are regularly conducted to ensure ongoing improvement.

Didactic and narrative persuasion: An experiment to promote colorectal cancer screening.

We tested whether a didactic and a narrative video (i.e. educational content and personal stories versus irrelevant information) could boost colorectal cancer (CRC) screening intention directly and through cognitive predictors of CRC screening behavior. We also tested whether exposure to a story changed participants' affective forecasting, reducing the perception of negative emotions associated with CRC screening (disgust, embarrassment, and fear). The study was conducted online with a between-participants design and recruiting a convenience sample (N = 375). We found that, compared with watching the control video, being exposed to the narrative video about CRC screening was indirectly associated with greater screening intention via vicarious experience and positive attitudes, whereas watching the didactic video was positively associated with CRC screening intention only among participants who had received an invitation letter but did not get screened, and among those yet to receive an invitation to screen. In the latter group, screening intention was boosted through positive attitudes. Our findings do not confirm that stories change affective forecasting, but narration likely fosters messages acceptance through vicarious experience. We also found support for the effectiveness of physicians' recommendations in promoting CRC screening, an intervention that might be effectively administered through a generalized, cost-effective video.

Applying the healthcare failure mode and effects analysis approach to improve the quality of an organised colorectal cancer screening programme.

OBJECTIVE: The first level of a colorectal cancer (CRC) screening process was systematically analysed using the Healthcare Failure Mode and Effects Analysis (HFMEA) approach by a multidisciplinary team aiming to improve the programme quality. SETTING: The study was conducted at the Local Health Authority of Bologna, Northern Italy. METHODS: Seven brainstorming sessions were conducted and all the activities performed were recorded on a FMEA worksheet consisting of individual records reporting the specific phases of the analysed process along with associated activities, possible failure modes, their causes and effects, the obtained risk priority numbers (RPNs) and the control measures to plan. RESULTS: Twenty-three failure modes, 14 effects and 12 possible causes were identified. Nine failure modes were prioritised according to the RPN obtained; most resulted in possible false-negative faecal immunochemical test (FIT) results (66.7%), followed by sample loss (22.2%) and not reaching the entire target population (11.1%). This leads to 66.7% of corrective/preventive actions being applied to the phase of returning the stool sample by the citizen. For this phase reorganisation, the local pharmacies were involved not only as FIT kit delivery points but also as specimen collection and sending points to the laboratory. These organisational changes allowed the introduction of complete traceability of kits and specimens flow, as well as temperature control. A re-evaluation of the prioritised failure modes 6 months after launching the implemented screening process showed that HFMEA application decreased the risk of potential errors by 75.9%. CONCLUSION: HFMEA application in CRC screening programme is a useful tool to reduce potential errors.

The Positive Effect of an Online Appointment Portal on a Breast Cancer Screening Program.

BACKGROUND: The adoption of web-based appointment methods by health care systems is increasing. OBJECTIVES: This study primarily aimed to evaluate in the setting of an organized breast cancer screening program the actual usage of an online appointment portal by the target population, i.e., how the online tool was used (type and timing of the actions performed) and by whom (users' characteristics); the effect of coronavirus disease 2019 (COVID-19) on its usage was also investigated. The effect of adopting this tool on the attendance to breast cancer screening was contextually investigated. METHODS: Electronic data records of 75,903 women (45-74 years old, residing in the territory of Bologna Local Health Authority) were retrospectively reviewed. RESULTS: In total, 12.4% of women logged into the online portal at least once. Most of them (79.9%) rescheduled, 15.7% viewed, and 4.4% cancelled their own appointment. In addition, 40.6% of all rescheduling actions were performed by the online portal; the remaining was performed by the toll-free number/dedicated email address. The highest peak (13.8%) of web accesses was registered at 10 a.m. Monday to Friday, when the toll-free number service is available. Percentages of portal usage were higher: (1) among the younger women, of Italian nationality, and for the first time invited to mammographic screening (p < 0.0001), and (2) in the pandemic period versus the prepandemic period (12.5 vs. 8.6%, respectively; p < 0.001). Finally, when compared to not using, the online portal usage led to an overall reduction in the no-show rate of almost 20% (p < 0.0001). CONCLUSION: The action mainly performed by using the online appointment portal was the appointment rescheduling. The usage of this tool had a positive effect on the no-show rate and it can be speculated that has led to a reduction of the request load to be handled by the center's screening staff. Finally, this study confirmed that the COVID-19 pandemic boosted the use of digital technologies.

Psychosocial Predictors of Colorectal Cancer Screening Intention: An Experiment on the Invitation Letter.

BACKGROUND: In Italy, attendance rates for colorectal cancer (CRC) screening are suboptimal. The present work analysed cognitive and emotional predictors of CRC screening intention and tested an intervention on a real invitation letter to improve CRC screening intention, both directly and in interaction with the predictors of our model. METHODS: Our model included variables from the theory of planned behaviour and the emotional barriers to bowel screening scale. We applied six changes to an invitation letter used in Italy to avoid the repetition of words like 'faeces', 'blood', or 'occult' and reduce the prompting of disgust. The 228 participants were randomly assigned to a between-participants design (original letter vs. manipulated letter). RESULTS: Disgust hindered CRC screening intention, while embarrassment, fear, and subjective norms (i.e., perception of the social pressures to attend CRC screening) were not associated with intention to screen. More positive attitudes towards CRC screening were associated with a higher intention to screen. The positive association between perceived behavioural control and CRC screening intention was stronger for participants who read the letter with fewer (vs. more) references to bodily waste. Letter manipulation did not affect intention to screen. CONCLUSIONS: The disgust associated with faecal matter is a critical factor in determining CRC screening attendance, and it should be acknowledged as such in public policies. Until new screening tests avoiding the activation of this emotional reaction are concretely available, public campaigns should improve CRC screening participation by boosting both positive attitudes towards screening and patients' perceived behavioural control.

Subsequent attendance in a breast cancer screening program after a false-positive result in the Local Health Authority of Bologna (Italy).

We conducted a cross-sectional study to assess the likelihood of returning for routine breast cancer screening among women who have experienced a false-positive result (FPR) and to describe the possible individual and organizational factors that could influence subsequent attendance to the screening program. Several information were collected on demographic and clinical characteristics data. Electronic data from 2014 to 2016 related to breast screening program of the Local Health Authority (LHA) of Bologna (Italy) of women between 45 and 74 years old were reviewed. A total of 4847 women experienced an FPR during mammographic screening and were recalled to subsequent round; 80.2% adhered to the screening. Mean age was 54.2 ± 8.4 years old. Women resulted to be less likely to adhere to screening if they were not-Italian (p = 0.001), if they lived in the Bologna district (p < 0.001), if they had to wait more than 5 days from II level test to end of diagnostic procedures (p = 0.001), if the diagnostic tests were performed in a hospital with the less volume of activity and higher recall rate (RR) (p < 0.001) and if they had no previous participation to screening tests (p < 0.001). Our results are consistent with previous studies, and encourages the implementation and innovation of the organizational characteristics for breast cancer screening. The success of screening programs requires an efficient indicators monitoring strategy to develop and evaluate continuous improvement processes.

Obtenção e avaliação da atividade antioxidante de farinha de cascas de uvas Niágara / Collection and evaluation of antioxidant activity of flours from the Niagara grape

Neste trabalho determinou-se a atividade antioxidante dos extratos preparados a partir das farinhas de cascas de uva Niágara (Vitis Labrusca L.), da família Vitaceae, através da redução do 1,1 – difenil – 2 – picrilhidrazil – DPPH. Para o preparo das farinhas, a secagem das cascas foi feita em estufa convencional, em estufa com circulação forçada de ar, em balança de infravermelho e em forno de microondas. Para a obtenção das farinhas de cascas de uva foram usadas diferentes temperaturas/potências, com posteiror moagem. Paralelamente determinou-se o poder antioxidante de uma série de soluções de ácido ascórbico padrão referencial. Observou-se que, dependendo das condições de secagem, o poder antioxidante da farinha obtida foi equivalente ao de uma quantidade diferente de ácido ascórbico, os valores encontrados foram: zero (para 60ºC em estufa normal ou em estufa com circulação forçada); 6,02. 10 – 6M (estufa normal a 90 ºC); 3,261.10 – 5 M (para estufa com circulação forçada a 40ºC); 6,354.10 – 5 M (estufa com circulação forçada a 90ºC); 5,350.10 - 5 M (balança de infravermelho); 8,383.10 – 5 M (forno microondas, potência alta) e 9,455.10 – 5 M de ácido ascórbico (forno microondas, potência média-baixa).