Please use this identifier to cite or link to this item: http://hdl.handle.net/1959.13/932034
- Title
- Colorectal cancer screening participation and medical advice seeking for symptoms in Australia
- Author/Creator
-
Courtney, Ryan James
- Institution
- University of Newcastle. Faculty of Health, School of Medicine and Public Health
- Description
- Research Doctorate - Doctor of Philosophy (PhD)
- Description
- The contents of this thesis by publication include an introduction, a critical review, five data-based manuscripts and a general discussion providing implications and conclusions. The papers examined the early detection and prevention of colorectal cancer (CRC) in the community-based setting and among first-degree relatives of CRC patients. At timing of thesis submission, three papers (two data-based and one review paper) had been accepted for publication. The remaining three are under editorial review. The burden of disease, early detection and prevention of colorectal cancer (CRC) is presented in the Introduction. It provides a general overview of CRC-related global burden of disease, its aetiology and the efficacy of screening in reducing incidence and mortality. It also examines current levels of CRC screening uptake and the populations currently experiencing inequality in CRC screening. This chapter also provides an overview of the current state of medical consultation and delay in seeking medical advice for primary symptoms of CRC (i.e. rectal bleeding and change in bowel habit). Paper One provides a critical review of methodically sound community-based approaches to increasing CRC screening levels. Paper Two is a cross-sectional study which identified the current levels of CRC screening uptake and screening in accordance with National Health and Medical Research Council (NHMRC) screening guidelines among an at-risk community cohort of persons aged 56-88 years. Paper Three is a cross-sectional cohort study using the aforementioned sampled population which assessed the socio-demographic and provider-level factors associated with ever receiving CRC testing and CRC screening in accordance with guideline recommendations. A secondary analysis was conducted to examine National Bowel Cancer Screening Program eligibility on each aforementioned outcome. Paper Four is a population-based study among first-degree relatives (FDRs) of CRC patients examining across varying levels of risk, the proportion of FDRs (i) ever receiving any CRC testing in their lifetime and (ii) screened in accordance with NHMRC screening guidelines. Socio-demographic and provider-level predictors of (i) and (ii) were also evaluated. Paper Five reports on a cross-sectional study examining, for two primary symptoms of colorectal cancer (i.e. rectal bleeding and change in bowel habit), rates of (i) non-consultation and (ii) delay in seeking medical advice for both symptoms. Additionally, the reasons for non-consultation and delay in seeking medical advice for each symptom as well as the triggers for consulting a doctor following symptom episode were investigated. Paper Six: The purpose of this study using the aforementioned Hunter Community Study cohort was to identify the socio-demographic and provider-related characteristics associated with (i) ever seeking medical advice for primary symptoms of CRC and (ii) early medical-advice-seeking behaviour for primary symptoms of CRC. Discussion and implications for future research and practice: In conclusion, this dissertation has provided insight into the current levels of CRC screening in compliance with NHMRC screening guideline recommendations at a community level and among an increased-risk population (i.e. first-degree relatives of CRC patients). Previously, little was known about community CRC screening levels across varying levels of risk. The low rates of screening in accordance with guidelines and the identified screening inequalities across individual and socio-demographic characteristics highlights the need for systematic population-based approaches to increase the rate of risk-appropriate CRC screening. This thesis also highlighted the poor receptivity of community members to prompt medical advice seeking for potential symptoms of CRC. Both high rates of delay and non-consultation for primary symptoms were evident, with little appreciable improvements indicated through a direct comparison with an earlier at-risk community data set. The current work highlights the need for systematic population-based approaches that are tested in methodically rigorous interventions, if improvements in the earlier presentation of primary symptoms and the level of risk-appropriate CRC screening are to occur. The direction of future research stemming from this dissertation and the possible pathways for future research initiatives are discussed.
- Relation
- University of Newcastle Research Higher Degree Thesis
- Date
- 2012
- Keyword(s)
-
colorectal neoplasms;
mass screening;
early detection of cancer;
prevention & control;
primary health care;
symptoms;
medical advice seeking
- Resource Type
- thesis
- Rights
- Copyright 2012 Ryan James Courtney
- Identifier
- http://hdl.handle.net/1959.13/932034
- Language
- eng
-
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