Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation
Abstract Background Internationally, systematic screening for sight-threatening diabetic retinopathy (STDR) usually includes annual recall. Researchers and policy-makers support extending screening intervals, citing evidence from observational studies with low incidence rates. However, there is litt...
Main Authors: | , , , , , , |
---|---|
Format: | Article |
Language: | English |
Published: |
BMC
2020-06-01
|
Series: | BMC Public Health |
Subjects: | |
Online Access: | http://link.springer.com/article/10.1186/s12889-020-08974-1 |
id |
doaj-ad237cc00bd84beaaec82d6e8936fe64 |
---|---|
record_format |
Article |
spelling |
doaj-ad237cc00bd84beaaec82d6e8936fe642020-11-25T02:17:21ZengBMCBMC Public Health1471-24582020-06-0120111210.1186/s12889-020-08974-1Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementationP. Byrne0C. Thetford1M. Gabbay2P. Clarke3E. Doncaster4S. P. Harding5for the ISDR Study GroupInstitute of Population Health, University of LiverpoolFaculty of Health and Wellbeing, University of Central LancashireInstitute of Population Health, University of LiverpoolInstitute of Population Health, University of LiverpoolISDR Public Involvement Group, University of LiverpoolEye and Vision Science, University of Liverpool and St. Paul’s Eye Unit, Royal Liverpool University HospitalAbstract Background Internationally, systematic screening for sight-threatening diabetic retinopathy (STDR) usually includes annual recall. Researchers and policy-makers support extending screening intervals, citing evidence from observational studies with low incidence rates. However, there is little research around the acceptability to people with diabetes (PWD) and health care professionals (HCP) about changing eye screening intervals. Methods We conducted a qualitative study to explore issues surrounding acceptability and the barriers and enablers for changing from annual screening, using in-depth, semistructured interviews analysed using the constant comparative method. PWD were recruited from general practices and HCP from eye screening networks and related specialties in North West England using purposive sampling. Interviews were conducted prior to the commencement of and during a randomised controlled trial (RCT) comparing fixed annual with variable (6, 12 or 24 month) interval risk-based screening. Results Thirty PWD and 21 HCP participants were interviewed prior to and 30 PWD during the parallel RCT. The data suggests that a move to variable screening intervals was generally acceptable in principle, though highlighted significant concerns and challenges to successful implementation. The current annual interval was recognised as unsustainable against a backdrop of increasing diabetes prevalence. There were important caveats attached to acceptability and a need for clear safeguards around: the safety and reliability of calculating screening intervals, capturing all PWD, referral into screening of PWD with diabetic changes regardless of planned interval. For PWD the 6-month interval was perceived positively as medical reassurance, and the 12-month seen as usual treatment. Concerns were expressed by many HCP and PWD that a 2-year interval was too lengthy and was risky for detecting STDR. There were also concerns about a negative effect upon PWD care and increasing non-attendance rates. Amongst PWD, there was considerable conflation and misunderstanding about different eye-related appointments within the health care system. Conclusions Implementing variable-interval screening into clinical practice is generally acceptable to PWD and HCP with important caveats, and misconceptions must be addressed. Clear safeguards against increasing non-attendance, loss of diabetes control and alternative referral pathways are required. For risk calculation systems to be safe, reliable monitoring and clear communication is required.http://link.springer.com/article/10.1186/s12889-020-08974-1Qualitativediabetic retinopathy screeningacceptability |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
P. Byrne C. Thetford M. Gabbay P. Clarke E. Doncaster S. P. Harding for the ISDR Study Group |
spellingShingle |
P. Byrne C. Thetford M. Gabbay P. Clarke E. Doncaster S. P. Harding for the ISDR Study Group Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation BMC Public Health Qualitative diabetic retinopathy screening acceptability |
author_facet |
P. Byrne C. Thetford M. Gabbay P. Clarke E. Doncaster S. P. Harding for the ISDR Study Group |
author_sort |
P. Byrne |
title |
Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation |
title_short |
Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation |
title_full |
Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation |
title_fullStr |
Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation |
title_full_unstemmed |
Personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation |
title_sort |
personalising screening of sight-threatening diabetic retinopathy - qualitative evidence to inform effective implementation |
publisher |
BMC |
series |
BMC Public Health |
issn |
1471-2458 |
publishDate |
2020-06-01 |
description |
Abstract Background Internationally, systematic screening for sight-threatening diabetic retinopathy (STDR) usually includes annual recall. Researchers and policy-makers support extending screening intervals, citing evidence from observational studies with low incidence rates. However, there is little research around the acceptability to people with diabetes (PWD) and health care professionals (HCP) about changing eye screening intervals. Methods We conducted a qualitative study to explore issues surrounding acceptability and the barriers and enablers for changing from annual screening, using in-depth, semistructured interviews analysed using the constant comparative method. PWD were recruited from general practices and HCP from eye screening networks and related specialties in North West England using purposive sampling. Interviews were conducted prior to the commencement of and during a randomised controlled trial (RCT) comparing fixed annual with variable (6, 12 or 24 month) interval risk-based screening. Results Thirty PWD and 21 HCP participants were interviewed prior to and 30 PWD during the parallel RCT. The data suggests that a move to variable screening intervals was generally acceptable in principle, though highlighted significant concerns and challenges to successful implementation. The current annual interval was recognised as unsustainable against a backdrop of increasing diabetes prevalence. There were important caveats attached to acceptability and a need for clear safeguards around: the safety and reliability of calculating screening intervals, capturing all PWD, referral into screening of PWD with diabetic changes regardless of planned interval. For PWD the 6-month interval was perceived positively as medical reassurance, and the 12-month seen as usual treatment. Concerns were expressed by many HCP and PWD that a 2-year interval was too lengthy and was risky for detecting STDR. There were also concerns about a negative effect upon PWD care and increasing non-attendance rates. Amongst PWD, there was considerable conflation and misunderstanding about different eye-related appointments within the health care system. Conclusions Implementing variable-interval screening into clinical practice is generally acceptable to PWD and HCP with important caveats, and misconceptions must be addressed. Clear safeguards against increasing non-attendance, loss of diabetes control and alternative referral pathways are required. For risk calculation systems to be safe, reliable monitoring and clear communication is required. |
topic |
Qualitative diabetic retinopathy screening acceptability |
url |
http://link.springer.com/article/10.1186/s12889-020-08974-1 |
work_keys_str_mv |
AT pbyrne personalisingscreeningofsightthreateningdiabeticretinopathyqualitativeevidencetoinformeffectiveimplementation AT cthetford personalisingscreeningofsightthreateningdiabeticretinopathyqualitativeevidencetoinformeffectiveimplementation AT mgabbay personalisingscreeningofsightthreateningdiabeticretinopathyqualitativeevidencetoinformeffectiveimplementation AT pclarke personalisingscreeningofsightthreateningdiabeticretinopathyqualitativeevidencetoinformeffectiveimplementation AT edoncaster personalisingscreeningofsightthreateningdiabeticretinopathyqualitativeevidencetoinformeffectiveimplementation AT spharding personalisingscreeningofsightthreateningdiabeticretinopathyqualitativeevidencetoinformeffectiveimplementation AT fortheisdrstudygroup personalisingscreeningofsightthreateningdiabeticretinopathyqualitativeevidencetoinformeffectiveimplementation |
_version_ |
1724886835187941376 |