Implementation research on risk-stratified cancer screening in Australia

Abstract

Risk-stratified (risk-tailored) cancer screening tailors screening to individual risk rather than the mostly one-size-fits-all approach of organised population screening programs designed for the average person. There is good evidence that risk-tailored screening has the potential to increase the net benefits of screening programs and reduce related harms, if implemented well. However, the implementation of risk-tailored cancer screening in the population is challenging involving a change of practice at different health system levels i.e., individual participants, providers and system. Very little is known about stakeholder views towards risk-tailored screening for cancer types other than breast cancer. This thesis addresses gaps in research generating new evidence to inform the development of cancer control policy recommendations for the implementation of risk-tailored cancer screening in the Australian population. It provides research evidence broadly across different cancer types as well as deeper dives into melanoma and lung cancer. A scoping review and five qualitative interview studies were conducted with a range of Australian-based stakeholders i.e., the public, general practitioners (GPs), key informants i.e., policy experts, health professionals, researchers and consumers with lived experience and people at high-risk to identify the acceptability, feasibility, barriers and facilitators to implementation. Analysis was conducted using thematic and/or implementation frameworks and findings were drawn together to provide six recommendations for effective implementation. Ultimately, these findings will inform policy, practice and future research in Australia on implementation of risk-tailored screening, although the findings will be translatable to other countries with publicly funded population screening programs or similar health services.