Priority Areas for Applied Cancer Screening Research: Executive Summary

The Applied Cancer Screening Research Branch (ACSRB) advances the field of cancer screening through innovative applied research and creative leadership. This includes effectiveness trials and related social and behavioral research to promote the use of effective cancer screening tests, as well as strategies for informed decision making regarding all cancer screening technologies in both community and clinical practice.

In 2001, the ACSRB invited leading experts and academics from the public and private sectors to provide input for developing a plan of action to guide future cancer screening intervention research. The plan is intended to serve as a roadmap for developing and evaluating ACSRB-supported research activities for the next three to five years.

In order to enable scientific input from a large number of cancer screening researchers, ACSRB used a novel web-based approach to elicit ideas and to obtain participant contributions (Trochim, 1989). Only the final phase of the planning process (interpretation of the data) involved a face-to face meeting with a subgroup of participants.

The process resulted in the identification of four thematic areas, representing the "big picture" and a set of 10 complementary priority areas. Each of the 10 priority areas suggests a unique pathway to advance knowledge and understanding of cancer screening. While priority areas are distinct, there is some overlap with more than one thematic area (listed below). Priority areas and themes provide empirical support for a plan of action to guide cancer screening intervention research.

Risk Communication       Communication       Decision Making       Genetic Risk	Unscreened Populations       Communication       Determinants       Disparities
Health Services Research       Cost Effectiveness       Decision Making       Health Services       Policy	Theory and Methods       Methodology       Theory

Following is a schematic of the six-phased strategic planning process. Clicking on a specific phase provides a detailed description of that phase of the process. Alternatively, an overview can be found by clicking on Strategic Planning Process.

Preparation (Table 1) Invitation to cancer screening experts Core planning committee established

Generate Statements (Table 2) Anonymous web-based brainstorming process to generate statements on cancer screening research priorities (Brainstorming)

Structure Statements (Table 3) Sort statements into related groups (themes) (Sorting) Rank statements in order of importance and feasibility (Ranking)

Map Development and Interpretation of Priorities (Interpreting Results) Point-cluster map (Figures 1-3) Cluster-point map (Figures 1-3)

4 Thematic Areas Include the 10 Priority Areas (Interpreting Results) Importance maps (Figure 4) Feasibility map (Figure 5) Pattern match of 10 priority areas (Figure 6,7-16)

Risk Communication includes the primary area of Genetic Risk, as well as part of the Communication and Decision Making areas. Areas of interest for each of the three priority areas are described below:

Communication areas of interest are:

1. Identify similarities and differences of effective cancer risk messages among subgroups (e.g., ethnic, gender and income), and support development of effective and appropriate messages related to cancer screening.
2. Support research on the potential of mixed media and new communication channels (including the Internet).
3. Support development of effective strategies for improving patient/provider communications and decision making regarding cancer screening.

Decision Making areas of interest are:

1. Encourage research on provider decision making, patient decision making, and shared decision making as well as preferences for different tests with specific population groups.
2. Encourage research on decision making when screening, follow-up and/or treatment recommendations are uncertain or unproven (e.g., PSAs, spiral CT, genetic testing).
3. Encourage research on how persons and providers deal with changes in screening technology.

Genetic Risk areas of interest are:

1. Identify screening issues associated with first-degree relatives and cancer survivors.
2. Expand applied cancer screening research to incorporate risk assessment, genetic susceptibility, genetic risk information, and biological risk. Determine how risk assessment should be incorporated into screening programs.

Health Services Research includes the primary area of cost effectiveness, as well as part of the Decision Making, Health Services, and Policy areas.

Cost Effectiveness areas of interest are:

1. Determine cost effectiveness of strategies that promote use of cancer screening.
2. Determine cost effectiveness of strategies that package cancer screening for multiple cancer sites, or with other preventive health services.

Decision Making is described under Risk Communication.

Health Services areas of interest are:

1. Develop health system strategies to improve cancer screening prevalence.
2. Access the potential for increasing cancer screening using strategies such as, packaged screening with other preventive services, and encourage opportunistic screening.

Policy areas of interest are:

1. Understand the impact of policy (e.g., insurance coverage, co-payments and deductibles) on cancer screening behavior.

Unscreened Populations comprises two primary areas, Determinants and Disparities, together with part of the Communication area.

Communication is described under Risk Communication

Determinants areas of interest are:

1. Ascertain which determinants are the same across screening modalities and populations, which ones differ, and why.
2. Understanding determinants of post-screening behavior impact of false positives on future screening; completing timely follow-up of abnormal results, and returning for annual screening.
3. Understand the ecological, community-level and contextual influences on screening behavior.

Disparities areas of interest are:

1. Identify characteristics of individuals and populations who are never or rarely screened, and develop strategies that target these individuals and populations.
2. Explore the potential of new media technologies for reducing disparities in screening and follow-up.
3. Investigate population disparities and loss to follow-up after receipt of abnormal screening results.

Theory and Methods comprises two areas, Methodology and Theory.

Methodology areas of interest are:

1. Improve and standardize methods, measures and data collection protocols used in applied cancer screening research.
2. Encourage qualitative and developmental research at multiple levels of interventions (e.g., individual, organizational and community).

Theory areas of interest are:

1. Encourage development of theory-testing interventions.
2. Encourage development and testing of theories that have not been generally applied in cancer screening research, including macro-level theories that address community, ecological and economic factors that influence screening behavior.
3. Examine the cultural relevance of existing theoretical constructs.