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Patients’experiences with‘sludge’(administrative burden)in the cancer screening process and its relationship with screening completion,experience and health system distrust

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Family Medicine and Community Health 2024年第S2期12卷 8-17页

作者： Michelle S Rockwell Brianna Chang Vivian Zagarese Jamie K Turner Ally Southworth YingXing wu Paul Yeaton Li Li Jeffrey S Stein Sarah H Parker john w epling Department of Family and Community Medicine Virginia Tech Carilion School of MedicineRoanokeVirginiaUSA Department of Family and Community Medicine Carilion ClinicRoanokeVirginiaUSA Virginia Tech Carilion School of Medicine RoanokeVirginiaUSA Department of Health Systems and Implementation Science Virginia Tech Carilion School of MedicineRoanokeVirginiaUSA Graduate Program in Translational Biology Medicineand HealthVirginia TechRoanokeVirginiaUSA Health Analytics Research Team Carilion ClinicRoanokeVirginiaUSA Division of Gastroenterology Department of Internal MedicineCarilion ClinicRoanokeVirginiaUSA Department of Family Medicine University of Virginia School of MedicineCharlottesvilleVirginiaUSA Center for Health Behaviors Research Fralin Biomedical Research Institute at VTCRoanokeVirginiaUSA

Objective‘Sludge’refers to administrative burdens or frictions that preclude people from getting what they want or need(eg,duplicative forms,complicated instructions,long waiting times).This mixed methods study evaluated patients’perceptions of sludge in the colorectal cancer(CRC)screening process and some impacts of this *** we employed an exploratory sequential mixed methods study design that comprised patient interviews and a patient *** interviews informed final survey revisions and captured contextual data about patients’experiences with *** transcripts were inductively and deductively analysed to identify overarching *** survey quantified sludge,delayed or forgone screenings,screening experience(Net Promoter Score)and health system distrust(Health System Distrust Scale).we usedχ2 or t-tests for univariable comparisons and logistic or linear regressions to evaluate the association between cumulative sludge score and delayed or forgone screenings,screening experience and health system *** were integrated for *** Southeastern United *** Patients who were 45–75 years of age,at average risk for CRC and had either completed or been referred for CRC screening(colonoscopy or stool-based test)within the previous 12 *** 22 interview participants and 255 survey participants completed the study.38(15%)survey participants rated their screening experience as poor(Net Promoter Score=0–7 out of 10).The mean(SD)Health System Distrust Scale score was 22.4(6.3)out of 45 possible points(higher score=greater distrust).Perceptions of sludge in the CRC screening process varied,with long waiting times and burdensome communication being the most common sources(58%and 35%of participants,respectively).Sludge was positively associated with delayed or forgone screenings(OR=1.42,95%CI 1.28,1.57,p<0.001),poor screening experience(OR=1.15,95%CI 1.04,1.28,p=0.009)and health system distrust(β=0.47,p

关键词： sludge screening burden

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