A Descriptive Thematic Review of Barriers, Facilitators, and Recommendations for Cancer Screening Uptake Among Community Dwelling Adults with Mental Ill-Health.
The much higher rate of premature mortality from cancer among people with mental ill-health is a major contributor to 20-year reduction in life expectancy for this population, relative to the broader population. Under-screening and delays in screening for cancers are recognized as significant issues contributing to this health inequality. This thematic review explored the common barriers to delayed cancer screening, facilitators to overcome those barriers, and the associated recommendations to improve screening rates for people with mental ill-health. Inclusion criteria were peer-reviewed quantitative, qualitative or mixed methods studies and reviews, available in English, involving adults with mental ill-health (experiencing mental distress or with diagnosed mental disorder), living in the community and in contact with primary, secondary or tertiary mental health services, exploring their screening experiences for any type of cancer. The reviewed literature from 37 studies that met the inclusion criteria highlighted key themes contributing to the health disparity experienced by this population, including social determinants of health, comorbidities, and health system factors. Facilitators such as trust, support, self-care, and interventions at a health system level were also highlighted. Study quality was appraised using the MMAT v.18 and CASP tools. All studies that met the inclusion criteria, regardless of quality, were included in the review to provide a comprehensive analysis of the existing literature on this topic. Building upon this literature, further recommendations are presented on how to reduce the cancer screening inequality experienced by people with mental ill-health.