A health systems approach to identifying barriers to breast cancer screening programmes. Methodology and application in six European countries. Issue 11 (November 2018)

• Record Type: Journal Article
• Authors: Turnbull, Eleanor; Priaulx, Jennifer; van Ravesteyn, Nicolien T.; Heinävaara, Sirpa; Siljander, Ilona; Senore, Carlo; Segnan, Nereo; Vokó, Zoltán; Hagymásy, Judit; Jarm, Katja; Veerus, Piret; de Koning, Harry J.; McKee, Martin
• Is Part Of: Health policy. Volume 122:Issue 11(2018)
• Page Start: 1198
• Page End: 1205
• Publication Date: 2018-11
• Subjects: Cancer screening -- Health systems -- Breast cancer; Medical education -- Periodicals; Medical policy -- Periodicals; Delivery of Health Care -- Periodicals; Education, Medical -- Periodicals; Health Education -- Periodicals; Health Planning -- Periodicals; Public Policy -- Periodicals; Enseignement médical -- Périodiques; Politique sanitaire -- Périodiques; Medical education; Medical policy; Periodicals; Electronic journals; Electronic journals; 362.1
• DOI: 10.1016/j.healthpol.2018.08.003
• Languages: English
• ISSNs: 0168-8510

Abstract

Highlights: Performance of cancer screening programmes typically looks only at uptake and accuracy. We place cancer screening within a whole health system framework. The Barriers to Effective Screening Tool offers a comprehensive analysis of obstacles to effective breast cancer screening. Using breast cancer screening, we show effective programmes are feasible, producing policy-relevant findings. Abstract: The benefits of population-based screening for breast cancer are now accepted although, in practice, programmes often fail to achieve their full potential. In this paper, we propose a conceptual model that situates screening programmes within the broader health system to understand the factors that influence their outcomes. We view the overall screening system as having multiple sub-systems to identify the population at risk, generate knowledge of effectiveness, maximise uptake, operate the programme, and optimise follow-up and assurance of subsequent treatment. Based on this model we have developed the Barriers to Effective Screening Tool (BEST) for analysing government-led, population-based screening programmes from a health systems perspective. Conceived as a self-assessment tool, we piloted the tool with key informants in six European countries (Estonia, Finland, Hungary, Italy, The Netherlands and Slovenia) to identify barriers to the optimal operation of population-based breast cancer screening programmes. The pilot provided valuable feedback on the barriers affecting breast cancer screening programmes and stimulated a greater recognition among those operating them of the need to take a health systems perspective. In addition, the pilot led to further development of the tool and provided a foundation for further research into how to overcome the identified barriers.