# A Descriptive Thematic Review of Barriers, Facilitators, and Recommendations for Cancer Screening Uptake Among Community Dwelling Adults with Mental Ill-Health

## TL;DR

This paper reviews barriers and solutions for cancer screening among adults with mental health issues, highlighting the need for better access and support.

## Contribution

The study provides a thematic review of barriers, facilitators, and recommendations for improving cancer screening uptake among adults with mental ill-health.

## Key findings

- Social determinants of health, comorbidities, and health system factors are key barriers to cancer screening for people with mental ill-health.
- Trust, support, and health system interventions are facilitators that can improve screening rates.
- Under-screening contributes to a 20-year life expectancy gap for this population.

## Abstract

Public health relevance—How does this work relate to a public health issue?
Cancers and mental health conditions are each among the greatest contributors to the global burden of disease; as comorbid conditions, they pose even greater burdens on individuals, families, healthcare resources, and communities.Complexity across the trajectory of cancer screening and treatment for people with comorbid mental ill-health is a significant and multi-faceted public health issue, underpinned by multiple inequalities in the social determinants of health.

Cancers and mental health conditions are each among the greatest contributors to the global burden of disease; as comorbid conditions, they pose even greater burdens on individuals, families, healthcare resources, and communities.

Complexity across the trajectory of cancer screening and treatment for people with comorbid mental ill-health is a significant and multi-faceted public health issue, underpinned by multiple inequalities in the social determinants of health.

Public health significance—Why is this work of significance to public health?
Cancer screening is a pivotal step in addressing cancer burden incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years.Inequity of access to early cancer screening and treatment is understood as a significant contributor to the up to 20-year gap in life expectancy for people with mental ill-health.

Cancer screening is a pivotal step in addressing cancer burden incidence, mortality, years of life lost, years lived with disability, and disability-adjusted life-years.

Inequity of access to early cancer screening and treatment is understood as a significant contributor to the up to 20-year gap in life expectancy for people with mental ill-health.

Public health implications—What are the key implications or messages for practitioners, policy makers and/or researchers in public health?
Access to early and regular screening for cancers is vital to address disparities in health status for people with mental health conditions.Multiple barriers to cancer screening and treatment at individual, community, health workforce, health service and system levels must be understood and addressed.

Access to early and regular screening for cancers is vital to address disparities in health status for people with mental health conditions.

Multiple barriers to cancer screening and treatment at individual, community, health workforce, health service and system levels must be understood and addressed.

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.