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      Development of a measurement tool to assess public awareness of cancer

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          Abstract

          Objective:

          We aimed to develop and validate a measurement tool to assess cancer awareness in the general population: the cancer awareness measure (CAM).

          Methods:

          Items assessing awareness of cancer warning signs, risk factors, incidence, screening programmes and attitudes towards help seeking were extracted from the literature or generated by expert groups. To determine reliability, the CAM was administered to a university participant panel ( n=148), with a sub-sample ( n=94) completing it again 2 weeks later. To establish construct validity, CAM scores of cancer experts ( n=12) were compared with those of non-medical academics ( n=21). Finally, university students ( n=49) were randomly assigned to read either a cancer information leaflet or a leaflet with control information before completing the measure, to ensure the CAM was sensitive to change.

          Results:

          Cognitive interviewing indicated that the CAM was being interpreted as intended. Internal reliability (Cronbach's α=0.77) and test–retest reliability ( r=0.81) were high. Scores for cancer experts were significantly higher than those for non-medical academics ( t(31)=6.8, P<0.001). CAM scores were higher among students who received an intervention leaflet than the control leaflet ( t(47)=4.8, P<0.001).

          Conclusions:

          These studies show the psychometric properties of the CAM and support its validity as a measure of cancer awareness in the general population.

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          Most cited references23

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          Influence of delay on survival in patients with breast cancer: a systematic review.

          Most patients with breast cancer are detected after symptoms occur rather than through screening. The impact on survival of delays between the onset of symptoms and the start of treatment is controversial and cannot be studied in randomised controlled trials. We did a systematic review of observational studies (worldwide) of duration of symptoms and survival. We identified 87 studies (101,954 patients) with direct data linking delay (including delay by patients) and survival. We classified studies for analysis by type of data in the original reports: category I studies had actual 5-year survival data (38 studies, 53,912 patients); category II used actuarial or multivariate analyses (21 studies, 25,102 patients); and category III was all other types of data (28 studies, 22,940 patients). We tested the main hypothesis that longer delays would be associated with lower survival, and a secondary hypothesis that longer delays were associated with more advanced stage, which would account for lower survival. In category I studies, patients with delays of 3 months or more had 12% lower 5-year survival than those with shorter delays (odds ratio for death 1.47 [95% CI 1.42-1.53]) and those with delays of 3-6 months had 7% lower survival than those with shorter delays (1.24 [1.17-1.30]). In category II, 13 of 14 studies with unrestricted samples showed a significant adverse relation between longer delays and survival, whereas four of five studies of only patients with operable disease showed no significant relation. In category III, all three studies with unrestricted samples supported the primary hypothesis. The 13 informative studies showed that longer delays were associated with more advanced stage. In studies that controlled for stage, longer delay was not associated with shorter survival when the effect of stage on survival was taken into account. Delays of 3-6 months are associated with lower survival. These effects cannot be accounted for by lead-time bias. Efforts should be made to keep delays by patients and providers to a minimum.
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            Factors predicting delayed presentation of symptomatic breast cancer: a systematic review.

            Delayed presentation of symptomatic breast cancer is associated with lower survival. Understanding of the factors that influence delay is important for the development of strategies to shorten delays. We did a systematic review to assess the quality and strength of evidence on risk factors for delays by patients and providers. We generated hypotheses about the relation between each putative risk factor and delay, against which we tested studies. We did searches to identify papers containing original data related to risk factors for delays by patients (n=86) and providers (n=28). We critically appraised the papers for inclusion in the review according to predefined criteria. The small number of studies of adequate quality did not allow formal meta-analysis. We therefore assigned strength of evidence according to a combination of the number and size of studies supporting, not supporting, or refuting the hypotheses. Most studies were deemed to be of poor quality and were excluded. Among 23 studies of adequate quality, however, there was strong evidence for an association between older age and delay by patients, and strong evidence that marital status was unrelated to delays by patients. Younger age and presentation with a breast symptom other than a lump were strong risk factors for delays by providers. Moderate evidence was shown for several other factors. The strength of the current evidence is inadequate to inform the development of specific strategies to shorten delays by patients or providers. Clarification of the findings of this review through a major programme of primary research is urgently required.
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              The Handbook of Psychological Testing

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                Author and article information

                Journal
                Br J Cancer
                British Journal of Cancer
                Nature Publishing Group
                0007-0920
                1532-1827
                03 December 2009
                03 December 2009
                03 December 2009
                : 101
                : S2
                : S13-S17
                Affiliations
                [1 ]Cancer Research UK Health Behaviour Research Centre, Department of Epidemiology and Public Health, UCL Gower Street, London WC1E 6BT, UK
                [2 ]Cancer Research UK Promoting Early Presentation Group, Institute of Psychiatry, King's College London, St Thomas' Hospital London, UK
                [3 ]Cancer Research UK Primary Care Education Research Group, Cancer Epidemiology Unit, University of Oxford Richard Doll Building, Roosevelt Drive, Oxford, UK
                [4 ]General Practice and Primary Care, Division of Community Based Sciences, Faculty of Medicine, University of Glasgow 1 Horselethill Road, Glasgow, UK
                [5 ]Health Information Department, Cancer Research UK, 61 Lincoln's Inn Fields London, UK
                Author notes
                [* ]Author for correspondence: j.wardle@ 123456ucl.ac.uk
                Article
                6605385
                10.1038/sj.bjc.6605385
                2790699
                19956157
                ed7df7b1-e3bd-4a1c-b066-50e26f127a62
                Copyright 2009, Cancer Research UK
                History
                Categories
                Papers

                Oncology & Radiotherapy
                cancer awareness,psychometrics,measurement
                Oncology & Radiotherapy
                cancer awareness, psychometrics, measurement

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