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

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 

机构地区：[1]Department of Family and Community Medicine,Virginia Tech Carilion School of Medicine,Roanoke,Virginia,USA [2]Department of Family and Community Medicine,Carilion Clinic,Roanoke,Virginia,USA [3]Virginia Tech Carilion School of Medicine,Roanoke,Virginia,USA [4]Department of Health Systems and Implementation Science,Virginia Tech Carilion School of Medicine,Roanoke,Virginia,USA [5]Graduate Program in Translational Biology,Medicine,and Health,Virginia Tech,Roanoke,Virginia,USA [6]Health Analytics Research Team,Carilion Clinic,Roanoke,Virginia,USA [7]Division of Gastroenterology,Department of Internal Medicine,Carilion Clinic,Roanoke,Virginia,USA [8]Department of Family Medicine,University of Virginia School of Medicine,Charlottesville,Virginia,USA [9]Center for Health Behaviors Research,Fralin Biomedical Research Institute at VTC,Roanoke,Virginia,USA

出　　处：《Family Medicine and Community Health》2024年第S02期8-17,共10页家庭医学与社区卫生（英文）

基　　金：supported in part by the National Center for Advancing Translational Sciences of the National Institutes of Health(award number UL1TR003015).

摘　　要：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 sludge.Design We employed an exploratory sequential mixed methods study design that comprised patient interviews and a patient survey.The interviews informed final survey revisions and captured contextual data about patients’experiences with sludge.Interview transcripts were inductively and deductively analysed to identify overarching themes.The 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 distrust.Results were integrated for interpretation.Setting Southeastern United States.Participants 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 months.Results 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<0.001).Qualitative findings add d

关 键 词：SLUDGE SCREENING BURDEN 

分 类 号：R73-31[医药卫生—肿瘤]