title: What implementation interventions increase cancer screening rates? a systematic review.
abstract: BACKGROUND
  Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. As part of a larger agenda to create an implementation guideline, we conducted a systematic review to evaluate interventions designed to increase the rate of breast, cervical, and colorectal cancer (CRC) screening. The interventions considered were: client reminders, client incentives, mass media, small media, group education, one-on-one education, reduction in structural barriers, reduction in out-of-pocket costs, provider assessment and feedback interventions, and provider incentives. Our primary outcome, screening completion, was calculated as the overall median post-intervention absolute percentage point (PP) change in completed screening tests.
  
  
  METHODS
  Our first step was to conduct an iterative scoping review in the research area. This yielded three relevant high-quality systematic reviews. Serving as our evidentiary foundation, we conducted a formal update. Randomized controlled trials and cluster randomized controlled trials, published between 2004 and 2010, were searched in MEDLINE, EMBASE and PSYCHinfo.
  
  
  RESULTS
  The update yielded 66 studies new eligible studies with 74 comparisons. The new studies ranged considerably in quality. Client reminders, small media, and provider audit and feedback appear to be effective interventions to increase the uptake of screening for three cancers. One-on-one education and reduction of structural barriers also appears effective, but their roles with CRC and cervical screening, respectively, are less established. More study is required to assess client incentives, mass media, group education, reduction of out-of-pocket costs, and provider incentive interventions.
  
  
  CONCLUSIONS
  The new evidence generally aligns with the evidence and conclusions from the original systematic reviews. This review served as the evidentiary foundation for an implementation guideline. Poor reporting, lack of precision and consistency in defining operational elements, and insufficient consideration of context and differences among populations are areas for additional research.
authors.affiliation: Program in Evidence-based Care, Cancer Care Ontario, Hamilton, Ontario, Canada. mbrouwer@mcmaster.ca
authors.forename: Melissa C
authors.initials: MC
authors.lastname: Brouwers
authors.forename: Carol
authors.initials: C
authors.lastname: De Vito
authors.forename: Lavannya
authors.initials: L
authors.lastname: Bahirathan
authors.forename: Angela
authors.initials: A
authors.lastname: Carol
authors.forename: June C
authors.initials: JC
authors.lastname: Carroll
authors.forename: Michelle
authors.initials: M
authors.lastname: Cotterchio
authors.forename: Maureen
authors.initials: M
authors.lastname: Dobbins
authors.forename: Barbara
authors.initials: B
authors.lastname: Lent
authors.forename: Cheryl
authors.initials: C
authors.lastname: Levitt
authors.forename: Nancy
authors.initials: N
authors.lastname: Lewis
authors.forename: S Elizabeth
authors.initials: SE
authors.lastname: McGregor
authors.forename: Lawrence
authors.initials: L
authors.lastname: Paszat
authors.forename: Carol
authors.initials: C
authors.lastname: Rand
authors.forename: Nadine
authors.initials: N
authors.lastname: Wathen
mesh_terms: D003113:Colonoscopy / Q000706:statistics & numerical data; D055088:Early Detection of Cancer / Q000706:statistics & numerical data*; D006293:Health Promotion / Q000379:methods*; D006801:Humans; D008327:Mammography / Q000706:statistics & numerical data; D008402:Mass Media; D009780:Occult Blood; D010353:Patient Education as Topic / Q000379:methods; D017010:Reminder Systems; D012812:Sigmoidoscopy / Q000706:statistics & numerical data; D014626:Vaginal Smears / Q000706:statistics & numerical data