Everybody can experience issues which can prevent them from attending a screening appointment, however small improvements to the services on offer can help to reduce these barriers and can help make the process much more accessible.

By nature of the fact that cancer services can be universal, all the national screening programmes can be perceived to have barriers to accessing them, below are a list of barriers that have been identified by community members and service providers.

Barriers to all screening programmes

Barrier

Lack of awareness of the screening process and the importance of early diagnosis

Solution

Discuss screening openly to normalise the conversation.

Barrier

Fear or past trauma could prevent people from attending screening appointments due to the invasive nature also circulation of horror stories from peers or family members can cause anxiety.

Solution

1.            Understand the individual and what their prior experiences may be.  This is not always possible in a short conversation but some form of pre – contact may make this easier by building trust and making the service person-centred.
2.       Reinforce screening is not a test for cancer but to identify potential problems so solutions can be put in place to deal with issues before they become cancer.
3.       Link people with peers who have undergone screening and had a positive experience so to help alleviate some of the anxiety.

Barrier

Difficulty understanding the information provided on the screening letter. This could be due to language or literacy issues.

Solution

Provide all screening letters in an easy read format and where available take advantage of translated materials from a reputable source.

Barrier

Fear of talking about cancer, some community members refuse to talk about cancer or even say the word cancer because of the negative outcomes that people associate with a cancer diagnosis.

Solution

Normalise talking about cancer, use different media to share messages.  Talk about the positive outcomes, reassure people that getting seen and diagnosed early will mean their chance of a getting the ‘All Clear’ are much higher and the treatment they will need will be less severe.

Barriers to cervical screening

Barrier

Booking a cervical screening appointment – calling a GP surgery can sometimes be difficult due to high demand for appointments so callers can be left in a queue. Additionally, due to work commitments it can sometimes be difficult to get an appointment that fits the work schedule due to practice opening hours.

Solution

1.       Offer an alternative option of a different GP phone number to book a screening appointment so patients don’t need to wait in the regular appointment booking queue
2.       Provide the ability to book screening appointments online
3.       Provide evening and weekend screening appointments
4.       Provide drop in style cervical screening sessions.

Barrier

Lack of understanding of the importance of cervical screening due to receiving the HPV vaccine or due to not being sexually active.

Solution

1.       Reinforce the message that screening saves lives and even if you have been vaccinated you should still attend screening appointments when invited.
2.       Raise awareness that HPV can be spread in several ways not just sexual activity so people who are not sexually active are still at risk so should be screened when invited.

Barriers to bowel screening

Barrier

The yuck factor – People can be put off the screening because they must touch their poo.

Solution

Talk through different ways someone can collect their sample and explain how they don’t have to touch it, so they don’t need to be concerned about the hygiene of collecting the sample.

Barrier

Difficultly understanding the screening instructions.

Solution

Talk through the process in an easy step by step approach using pictures and models where appropriate.

Barrier

Support required to take the sample

Solution

Carers and health care professionals should be trained in how to take the sample so they can assist with the collection.  LHA has pictorial ‘How To’ guides to use.

Barriers to breast screening

Barrier

Access – not all screening locations are easily accessible such as mobile units are not always wheelchair accessible.

Solution

Encourage people with accessibility needs to make the service aware of their needs before their appointment so accessibility can be reviewed and necessary adjustments can be made prior to the appointment.

Barrier

Embarrassment / uncomfortable with the screening process – stripping off to the waist down in front of a stranger can be a daunting task for anyone.

Solution

Explain how important screening is and how it can save your life. Also reassure people that the mammographers carry out hundreds of scans a month so there isn’t anything they haven’t seen before, and they are only interested in what’s going on inside your breasts not what they look like on the outside.