title: Effective interventions to facilitate the uptake of breast, cervical and colorectal cancer screening: an implementation guideline.
abstract: BACKGROUND
  Appropriate screening may reduce the mortality and morbidity of colorectal, breast, and cervical cancers. Several high-quality systematic reviews and practice guidelines exist to inform the most effective screening options. However, effective implementation strategies are warranted if the full benefits of screening are to be realized. We developed an implementation guideline to answer the question: What interventions have been shown to increase the uptake of cancer screening by individuals, specifically for breast, cervical, and colorectal cancers?
  
  
  METHODS
  A guideline panel was established as part of Cancer Care Ontario's Program in Evidence-based Care, and a systematic review of the published literature was conducted. It yielded three foundational systematic reviews and an existing guidance document. We conducted updates of these reviews and searched the literature published between 2004 and 2010. A draft guideline was written that went through two rounds of review. Revisions were made resulting in a final set of guideline recommendations.
  
  
  RESULTS
  Sixty-six new studies reflecting 74 comparisons met eligibility criteria. They were generally of poor to moderate quality. Using these and the foundational documents, the panel developed a draft guideline. The draft report was well received in the two rounds of review with mean quality scores above four (on a five-point scale) for each of the items. For most of the interventions considered, there was insufficient evidence to support or refute their effectiveness. However, client reminders, reduction of structural barriers, and provision of provider assessment and feedback were recommended interventions to increase screening for at least two of three cancer sites studied. The final guidelines also provide advice on how the recommendations can be used and future areas for research.
  
  
  CONCLUSIONS
  Using established guideline development methodologies and the AGREE II as our methodological frameworks, we developed an implementation guideline to advise on interventions to increase the rate of breast, cervical and colorectal cancer screening. While advancements have been made in these areas of implementation science, more investigations are warranted.
authors.affiliation: Program in Evidence-based Care, Cancer Care Ontario, Hamilton, Ont., 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: D001943:Breast Neoplasms / Q000175:diagnosis*; D015179:Colorectal Neoplasms / Q000175:diagnosis*; D055088:Early Detection of Cancer / Q000379:methods*; D019317:Evidence-Based Medicine; D005104:Expert Testimony; D005260:Female; D019983:Guideline Adherence; D006801:Humans; D038622:Internationality; D008297:Male; D009864:Ontario; D017060:Patient Satisfaction; D017410:Practice Guidelines as Topic; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*