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Hanna Skrobanski


PhD Student
+44 (0)1483 684679

Academic and research departments

Faculty of Health and Medical Sciences.

My publications

Publications

Flanagan J.M., Skrobanski H., Shi X., Hirst Y. (2019) Self-care behaviors of ovarian cancer patients before their diagnosis: Proof-of-concept study,Journal of Medical Internet Research 5 (1) e10447 Journal of Medical Internet Research
Background: Longer patient intervals can lead to more late-stage cancer diagnoses and higher mortality rates. Individuals may delay presenting to primary care with red flag symptoms and instead turn to the internet to seek information, purchase over-the-counter medication, and change their diet or exercise habits. With advancements in machine learning, there is the potential to explore this complex relationship between a patient?s symptom appraisal and their first consultation at primary care through linkage of existing datasets (eg, health, commercial, and online).

Objective: Here, we aimed to explore feasibility and acceptability of symptom appraisal using commercial- and health-data linkages for cancer symptom surveillance.

Methods: A proof-of-concept study was developed to assess the general public?s acceptability of commercial- and health-data linkages for cancer symptom surveillance using a qualitative focus group study. We also investigated self-care behaviors of ovarian cancer patients using high-street retailer data, pre- and postdiagnosis.

Results: Using a high-street retailer?s data, 1118 purchases?from April 2013 to July 2017?by 11 ovarian cancer patients and one healthy individual were analyzed. There was a unique presence of purchases for pain and indigestion medication prior to cancer diagnosis, which could signal disease in a larger sample. Qualitative findings suggest that the public are willing to consent to commercial- and health-data linkages as long as their data are safeguarded and users of this data are transparent about their purposes.

Conclusions: Cancer symptom surveillance using commercial data is feasible and was found to be acceptable. To test efficacy of cancer surveillance using commercial data, larger studies are needed with links to individual electronic health records.

Skrobanski Hanna, Ream Emma, Poole Karen, Whitaker Katriina (2019) Understanding primary care nurses? contribution to cancer early diagnosis: A systematic review,European Journal of Oncology Nursing 41 pp. 149-164 Elsevier

Purpose: Primary care nurses can contribute to cancer early diagnosis. The objective of this systematic review was to identify, appraise and synthesise evidence on primary care nurses? contribution towards cancer early diagnosis in developed countries.

Method: The following databases were searched in September 2017: MEDLINE, PsychINFO, CINAHL, SCOPUS, and EMBASE. Data were extracted on nurses?: knowledge of cancer; frequency of 'cancer early diagnosis-related discussions' with patients; and perceived factors influencing these discussions. Studies were appraised using the Mixed Methods Appraisal Tool.

Results: Twenty-one studies were included from: United States, United Kingdom, Ireland, Spain, Turkey, Australia, Brazil and Middle East. Studies were mostly of low quality (one did not meet any appraisal criteria, 15 met one, four met two, and one met three). Nurses? knowledge of cancer, and their frequency of ?cancer early diagnosis-related discussions?, varied across countries. This may be due to measurement bias or nurses? divergent roles across healthcare systems. Commonly perceived barriers to having screening discussions included: lack of time, insufficient knowledge and communication skills, and believing that patients react negatively to this topic being raised

Conclusions: Findings suggest a need for nurses to be adequately informed about, and have the confidence and skills to discuss, the topic of cancer early diagnosis. Further high-quality research is required to understand international variation in primary care nurses? contribution to this field, and to develop and evaluate optimal methods for preparing them for, and supporting them in, this.

McGregor Lesley M., Skrobanski Hanna, Ritchie Mary, Berkman Lindy, Miller Hayley, Freeman Madeleine, Patel Nishma, Morris Stephen, Rees Colin, Von Wagner Christian (2019) Using specialist screening practitioners (SSPs) to increase uptake of bowel scope (flexible sigmoidoscopy) screening: Results of a feasibility single-stage phase II randomised trial,BMJ Open 9 (2) BMJ Publishing Group

Objective: To determine the feasibility of specialist screening practitioners (SSPs) offering patient navigation (PN) to facilitate uptake of bowel scope screening (BSS) among patients who do not confirm or attend their appointment.

Design: A single-stage phase II trial.

Setting: South Tyneside District Hospital, Tyne and Wear, England, UK.

Participants: Individuals invited for BSS at South Tyneside District Hospital during the 6-month recruitment period were invited to participate in the study.

Intervention: Consenting individuals were randomly assigned to either the PN intervention or usual care group in a 4:1 ratio. The intervention involved BSS non-attenders receiving a phone call from an SSP to elicit their reasons for non-attendance and offer educational, practical and emotional support as required. If requested by the patient, another BSS appointment was then scheduled.

Primary outcome measure: The number of non-attenders in the intervention group who were navigated and then rebooked and attended their new BSS appointment.

Secondary outcome measures: Barriers to BSS attendance, patient-reported outcomes including informed choice and satisfaction with BSS and the PN intervention, reasons for study non-participation, SSPs' evaluation of the PN process and a cost analysis.

Results: Of those invited to take part (n=1050), 152 (14.5%) were randomised into the study: PN intervention=109; usual care=43. Most participants attended their BSS appointment (PN: 79.8%; control: 79.1%) leaving 22 eligible for PN: only two were successfully contacted. SSPs were confident in delivering PN, but were concerned that low BSS awareness and information overload may have deterred patients from taking part in the study. Difficulty contacting patients was reported as a burden to their workload.

Conclusions: PN, as implemented, was not a feasible intervention to increase BSS uptake in South Tyneside. Interventions to increase BSS awareness may be better suited to this population.

Von Wagner Christian, Bonello Bernadette, Stoffel Sandro, Skrobanski Hanna, Freeman Madeleine, Kerrison Robert S., McGregor Lesley M. (2018) Barriers to bowel scope (flexible sigmoidoscopy) screening: A comparison of non-responders, active decliners and non-attenders 11 Medical and Health Sciences 1117 Public Health and Health Services,BMC Public Health 18 (1) Biomed Central
Background

Participation in bowel scope screening (BSS) is low (43%), limiting its potential to reduce colorectal cancer (CRC) incidence and mortality. This study aimed to quantify the prevalence of barriers to BSS and examine the extent to which these barriers differed according to non-participant profiles: non-responders to the BSS invitation, active decliners of the invitation, and non-attenders of confirmed appointments.

Methods

Individuals invited for BSS between March 2013 and December 2015, across 28 General Practices in England, were sent a questionnaire. Questions measured initial interest in BSS, engagement with the information booklet, BSS participation, and, where applicable, reasons for BSS non-attendance. Chi-square tests of independence were performed to examine the relationship between barriers, non-participant groups and socio-demographic variables.

Results

1478 (45.8%) questionnaires were returned for analysis: 1230 (83.2%) attended screening, 114 (7.7%) were non-responders to the BSS invitation, 100 (6.8%) were active decliners, and 34 (2.3%) were non-attenders. Non-responders were less likely to have read the whole information booklet than active decliners (x2 (2, N = 157) = 7.00, p = 0.008) and non-attenders (x2 (2, N = 101) = 8.07, p = 0.005). Non-responders also had lower initial interest in having BSS than either active decliners (x2 (2, N = 213) = 6.07, p = 0.014) or non-attenders (x2 (2, N = 146) = 32.93, p

Conclusions

Interventions to improve BSS uptake should be more nuanced and use targeted strategies to address the specific needs of each group.

Hirst Yasmin, Skrobanski Hanna, Kerrison Robert S., Kobayashi Lindsay C., Counsell Nicholas, Djedovic Natasha, Ruwende Josphine, Stewart Mark, Von Wagner Christian (2017) Text-message Reminders in Colorectal Cancer Screening (TRICCS): A randomised controlled trial,BRITISH JOURNAL OF CANCER 116 (11) pp. 1408-1414 NATURE PUBLISHING GROUP

Background:

We investigated the effectiveness of a text-message reminder to improve uptake of the English Bowel Cancer Screening programme in London.

Methods:

We performed a randomised controlled trial across 141 general practices in London. Eight thousand two hundred sixty-nine screening-eligible adults (aged 60?74 years) were randomised in a 1 : 1 ratio to receive either a text-message reminder (n=4134) or no text-message reminder (n=4135) if they had not returned their faecal occult blood test kit within 8 weeks of initial invitation. The primary outcome was the proportion of adults returning a test kit at the end of an 18-week screening episode (intention-to-treat analysis). A subgroup analysis was conducted for individuals receiving an invitation for the first time.

Results:

Uptake was 39.9% in the control group and 40.5% in the intervention group. Uptake did not differ significantly between groups for the whole study population of older adults (adjusted odds ratio (OR) 1.03, 95% confidence interval (CI) 0.94?1.12; P=0.56) but did vary between the groups for first-time invitees (uptake was 34.9% in the control and 40.5% in the intervention; adjusted OR 1.29, 95% CI 1.04?1.58; P=0.02).

Conclusions:

Although text-message reminders did not significantly increase uptake of the overall population, the improvement among first-time invitees is encouraging.

Atkin W., Cross A.J., Kralj-Hans I., Macrae E., Piggott C., Pearson S., Wooldrage K., Brown J., Lucas F., Prendergast A., Marchevsky N., Patel B., Pack K., Howe R., Skrobanski H., Kerrison R., Swart N., Snowball J., Duffy S.W., Morris S., von Wagner C., Halloran S. (2019) Faecal immunochemical tests versus colonoscopy for post-poly pectomy surveillance: An accuracy, acceptability and economic study,HEALTH TECHNOLOGY ASSESSMENT 23 (1) pp. I-84 NIHR JOURNALS LIBRARY
Background

In the UK, patients with one or two adenomas, of which at least one is e 10 mm in size, or three or four small adenomas, are deemed to be at intermediate risk of colorectal cancer (CRC) and referred for surveillance colonoscopy 3 years post polypectomy. However, colonoscopy is costly, can cause discomfort and carries a small risk of complications.

Objectives

To determine whether or not annual faecal immunochemical tests (FITs) are effective, acceptable and cost saving compared with colonoscopy surveillance for detecting CRC and advanced adenomas (AAs).

Design

Diagnostic accuracy study with health psychology assessment and economic evaluation.

Setting

Participants were recruited from 30 January 2012 to 30 December 2013 within the Bowel Cancer Screening Programme in England.

Participants

Men and women, aged 60?72 years, deemed to be at intermediate risk of CRC following adenoma removal after a positive guaiac faecal occult blood test were invited to participate. Invitees who consented and returned an analysable FIT were included.

Intervention

We offered participants quantitative FITs at 1, 2 and 3 years post polypectomy. Participants testing positive with any FIT were referred for colonoscopy and not offered further FITs. Participants testing negative were offered colonoscopy at 3 years post polypectomy. Acceptibility of FIT was assessed using discussion groups, questionnaires and interviews.

Main outcome measures

The primary outcome was 3-year sensitivity of an annual FIT versus colonoscopy at 3 years for detecting advanced colorectal neoplasia (ACN) (CRC and/or AA). Secondary outcomes included participants? surveillance preferences, and the incremental costs and cost-effectiveness of FIT versus colonoscopy surveillance.

Results

Of 8008 invitees, 5946 (74.3%) consented and returned a round 1 FIT. FIT uptake in rounds 2 and 3 was 97.2% and 96.9%, respectively. With a threshold of 40 µg of haemoglobin (Hb)/g faeces (hereafter referred to as µg/g), positivity was 5.8% in round 1, declining to 4.1% in round 3. Over three rounds, 69.2% (18/26) of participants with CRC, 34.3% (152/443) with AAs and 35.6% (165/463) with ACN tested positive at 40 µg/g. Sensitivity for CRC and AAs increased, whereas specificity decreased, with lower thresholds and multiple rounds. At 40 µg/g, sensitivity and specificity of the first FIT for CRC were 30.8% and 93.9%, respectively. The programme sensitivity and specificity of three rounds at 10 µg/g were 84.6% and 70.8%, respectively. Participants? preferred surveillance strategy was 3-yearly colonoscopy plus annual FITs (57.9%), followed by annual FITs with colonoscopy in positive cases (31.5%). FIT with colonoscopy in positive cases was cheaper than 3-yearly colonoscopy (£2,633,382), varying from £485,236 (40 µg/g) to £956,602 (10 µg/g). Over 3 years, FIT surveillance could miss 291 AAs and eight CRCs using a threshold of 40 µg/g, or 189 AAs and four CRCs using a threshold of 10 µg/g.

Conclusions

Annual low-threshold FIT with colonoscopy in positive cases achieved high sensitivity for CRC and would be cost saving compared with 3-yearly colonoscopy. However, at higher thresholds, this strategy could miss 15?30% of CRCs and 40?70% of AAs. Most participants preferred annual FITs plus 3-yearly colonoscopy. Further research is needed to define a clear role for FITs in surveillance.

Future work

Evaluate the impact of ACN missed by FITs on quality-adjusted life-years.

McGregor Lesley M., Skrobanski Hanna, Miller Hayley, Ritchie Mary, Berkman Lindy, Morris Stephen, Rees Colin, von Wagner Christian (2016) Using Specialist Screening Practitioners (SSPs) to increase uptake of the Bowel Scope (Flexible Sigmoidoscopy) Screening Programme: A study protocol for a feasibility single-stage phase II trial,Pilot and Feasibility Studies 2 (54) BioMed Central
Background: The NHS Bowel Scope Screening (BSS) programme offers men and women aged 55 years a onceonly
flexible sigmoidoscopy (FS), a test that can help reduce colorectal cancer (CRC) incidence and mortality.
However, the benefits of BSS are contingent on uptake. This National Institute for Health Research-funded singlestage
phase II trial will test the feasibility of using patient navigation (PN), an intervention that offers support to
patients to overcome barriers to healthcare, to increase BSS uptake within a socially deprived area of England.

Methods/design: All individuals invited for BSS at South Tyneside NHS Foundation Trust during the 6-month
recruitment period will be invited to take part in the study. Consenting participants will be randomised to receive
PN or usual care in a 2:1 ratio. PN involves non-attenders receiving a phone call from a Specialist Screening
Practitioner (SSP) who will elicit reasons for non-attendance and offer educational, practical, and emotional support
as needed. If requested by the patient, another appointment for BSS will then be arranged. We anticipate 30 % of
participants will be non-attenders. Using A?Hern single-stage design, with 20 % significance level and 80 % power,
at least 35 participants who receive PN need to subsequently attend for PN to be considered worthy of further
investigation in a definitive trial. The primary outcome measure will be the number of participants in the PN group
who re-book and attend their BSS appointment. A qualitative analysis of the PN transcripts, and interviews with the
SSPs, will also be conducted, alongside a quantitative analysis of completed patient-reported experience
questionnaires. An economic analysis will calculate the costs of delivering PN.

Discussion: This feasibility study will be instrumental in deciding whether to conduct the first definitive trial of PN
in BSS in England. If PN is subsequently shown to be cost-effective at increasing uptake of BSS, NHS policies could
be modified to implement PN as a standard service. The results will be disseminated in peer-reviewed journals and
at scientific conferences.

Trial registration: International Standard Randomised Controlled Trial Number, ISRCTN13314752