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Three ways to improve patient care by increasing patient screening uptake

31 March, 2022
Female patients sit in doctor's waiting room

Patient screening is vital to improving the quality of patient care and outcomes. Yet the challenges in promoting patient screening attendance are not yet fully understood by researchers or practitioners. 

Read on to discover how three HRB-funded research groups propose how to improve uptake of patient screening across three different areas of healthcare.

Let’s start by looking at three separate HRB-funded studies, which each take a different approach to patient screening. 

Improving cancer pain treatments in Ireland   

Cancer is a significant health concern in Ireland, with one in two diagnosed with cancer in their lifetime and pain affecting up to 40% of cancer survivors. However, despite being a common symptom, Laserina O’Connor et al. found that pain was not typically recorded in cancer patient medical records. As a result, they advocate for routine cancer pain screening to improve the quality of cancer pain treatment in Ireland. 

Reducing sight loss among Ireland’s diabetic population   

Diabetic retinopathy (DR) affects approximately 25% of the Irish population diagnosed with diabetes, and is a leading cause of blindness among working-age adults. Regular screening for this condition can reduce the risk of vision loss. Yet, in a 2019 study, Fiona Riordan et al. calculated that over a third of eligible participants had not consented to screening. This prompted the team to learn more about the behaviors of patients that did attend diabetic retinopathy screening (DRS). 

Minimizing cervical cancer incidence and mortality globally  

Cancer screening uptake is declining in several countries, including England, Ireland, Sweden, and Australia, even though screenings have reduced cervical cancer incidence and mortality.  

In the third HRB-funded research project we’re looking at, Mairead O’Connor et al. highlighted several key clinical behaviors that could influence patients’ attitudes and actions around screening. Ultimately, their results could inform future initiatives encouraging women to have smear tests. 

So, what shared findings did these separate research projects have? Here are three key lessons from these studies on how to increase uptake of patient screening…  

#1 Improve awareness and attitudes to patient screening   

One finding highlighted prominently in all three studies is the need to raise awareness of the importance of screenings through patient education.  

For patients to make an informed decision, they must understand why screening is being offered, what happens during the test, the benefits and risks of screening, the potential outcomes (including further tests), and what happens to their screening records.  

Indeed, lack of understanding contributed to diabetic retinopathy screening non-attendance. Riordan et al. found those at risk of developing diabetic retinopathy have limited awareness of the benefits of screening or the risks the condition carries. So increased patient education, particularly in these areas, could prove effective at increasing routine attendance.  

Likewise, Mairead O’Connor has made a strong case for testing advertising campaigns featuring high-profile women demonstrating positive screening behaviors. Her research found that marketing activities like these using other women as role models could resonate strongly with this audience, countering women’s negative beliefs about screening, and increasing smear test attendance.  

Moreover, ensuring all patients have the necessary information to make an informed decision leads to empowering patients to be proactively involved in their health. Therefore, this approach could work particularly well for those that do not typically attend screenings due to negative emotions (fear or worry), perceived risk, poor health literacy, or negative attitudes and beliefs associated with screening. 

#2 Train healthcare professionals to empower patients   

Screening work is delivered mainly in primary care, whether in general practice or community services. As a result, primary care practitioners featured heavily in all three studies conducted. Each research group suggested additional practitioner training as an effective way to improve screening uptake.  

A common theme throughout the research was the reluctance, lack of understanding, or lack of confidence felt by practitioners when discussing screening with patients. Therefore, training on how to have “difficult conversations” could prove effective at increasing uptake by increasing confidence and comfort among healthcare professionals.  

This is best highlighted by Mairead O’Connor et al., who found healthcare professionals were missing out on valuable opportunities to register patients for screening or improve awareness of the benefits associated with screening. Indeed, they discovered practitioners considered HPV (Human Papillomavirus) a complex and challenging topic to discuss with patients for wide-ranging reasons, including their lack of comfort in discussing patients’ sexual behaviors relative to HPV screening. 

Similarly, Laserina O’Connor et al. listed pain management and assessment training for all healthcare professionals working with cancer patients as essential to improving cancer patient care. Firstly, they argue with further training, oncology practitioners would be more inclined to discuss pain with patients. Secondly, they discovered pain education could encourage a more holistic approach to patient treatment, stating that “optimal pain management does not stem from a medical model approach to pain education but from an interprofessional approach.” 

For these reasons, it is clear that primary care practitioners have both the opportunity and ability to boost patient engagement with screening, but further support and training is needed to maximise their impact here. 

#3 Use the right tools at the right time 

Last but not least, all three studies note the potential for tools and systems to help widen access, streamline processes, and ensure critical screening conversations occur.  

A common barrier for patients is a lack of time to discuss, register, or attend a screening due to limited availability of appointments, limited time with their healthcare practitioner, or work and family commitments. Tools and systems such as screening invitation reminders by post, telephone, or text message could lift attendance. Likewise, this would also allow practices to develop tailored messaging for specific patient groups to help boost patient motivation and engagement. 

Significantly, Laserina O’Connor et al. discovered cancer pain patients were reluctant to self-report pain during their medical oncology outpatient review due to time constraints and the belief that reporting would distract from their current or future anti-cancer treatment plans. Adopting a tool here could ensure their pain was discussed seriously, resulting in a more holistic approach to treatment. 

An added challenge is the limited time GPs have to speak with patients during fixed appointments. One solution Mairead O’Connor suggests is the use of on-screen prompts to notify GPs to ask patients about screening. This could be an effective strategy in driving uptake, since primary care endorsements can go a long way to motivating patients to attend screening. 

A multifaceted approach to increasing patient screening uptake 

As you can see, healthcare practitioners across different specialties share common challenges when trying to increase screening attendance. With all three papers underlining the need for more patient education, practitioner training, and practical tools, it’s clear that there is no silver bullet to driving uptake of patient screening: this is a problem that requires a holistic solution.  

Further research is needed to build a fuller picture of the barriers to screening uptake in other areas of medicine – but these lessons from oncology and diabetic retinopathy offer an encouraging starting point for future studies. 

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