Canadians' willingness to receive care from physician assistants

OBJECTIVE

To determine the willingness of Canadians to accept treatment from physician assistants (PAs).

DESIGN

Respondents were asked to be surrogate patients or parents under 1 of 3 conditions selected at random. Two scenarios involved injury to themselves, with the third involving injury to their children. The wait time for a physician was assumed to be 4 hours, whereas to explore the sensitivity of patients' preferences for a range of times, PA wait times were 30 minutes, 1 hour, and 2 hours.

SETTING

Vancouver, BC.

PARTICIPANTS

Two hundred twenty-nine mothers attending a hospital with their children.

MAIN OUTCOME MEASURES

The main outcome measure was the proportion of individuals in each scenario who were willing to be treated by PAs for at least one of the time trade-off options offered. A secondary outcome was the proportion of individuals who changed their answers when the waiting time to see the PA varied.

RESULTS

Regardless of the scenarios, 99% of participants opted for PAs under the personal circumstances; 96% opted for PAs when the issue involved their children. The choice favouring the PA persisted, albeit at slightly lower proportions, as the difference in wait time between PAs and physicians decreased (85% and 67% for a difference in PA and physician wait time of 3 and 2 hours, respectively).

CONCLUSION

These findings suggest that British Columbians are willing to be treated by PAs under most circumstances, whether this includes themselves or their children. The high level of willingness to be treated by PAs demonstrates public confidence in PA care, and suggests that the use of PAs in Canadian emergency departments or clinics is a viable policy response to decreasing primary care capacity.

Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department

BACKGROUND

Pediatric acute respiratory infections (ARIs) represent a significant burden on pediatric Emergency Departments (EDs) and families. Most of these illnesses are due to viruses. However, investigations (radiography, blood, and urine testing) to rule out bacterial infections and antibiotics are often ordered because of diagnostic uncertainties. This results in prolonged ED visits and unnecessary antibiotic use. The risk of concurrent bacterial infection has been reported to be negligible in children over three months of age with a confirmed viral infection. Rapid viral testing in the ED may alleviate the need for precautionary testing and antibiotic use.

OBJECTIVES

To determine the effect of rapid viral testing in the ED on the rate of precautionary testing, antibiotic use, and length of ED visit.

SEARCH METHODS

We searched the Cochrane Central register of Controlled Trials (CENTRAL) (The Cochrane Library 2011, Issue 4); EMBASE (1988 to December 2011); MEDLINE Ovid (1950 to November week 4, 2011); MEDLINE In-Process & Other Non-Indexed Citations (8 December 2011); HealthStar (1966 to 2009); BIOSIS Previews (1969 to December 2011); CAB Abstracts (1973 to December 2011); CBCA Reference (1970 to 2007); and Proquest Dissertations and Theses (1861 to 2009).

SELECTION CRITERIA

Randomized controlled trials (RCTs) of rapid viral testing for children with ARIs in the ED.

DATA COLLECTION AND ANALYSIS

Two review authors used the inclusion criteria to select trials, evaluate their quality and extract data. We obtained missing data from trial authors. We expressed differences in rate of investigations and antibiotic use as risk ratios (RRs), and expressed difference in ED length of visits as mean differences (MDs), with 95% confidence intervals (CIs).

MAIN RESULTS

We included four trials (three RCTs and one quazi-RCT), with 759 children in the rapid viral testing group and 829 in the control group. Three out of the four studies were comparable in terms of young age of participants, with one study increasing the age of inclusion up to five years of age. All studies included either fever or respiratory symptoms as inclusion criteria (two required both, one required fever or respiratory symptoms, and one required only fever). All studies were comparable in terms of exclusion criteria, intervention, and outcome data. In terms of risk of bias, one study failed to utilize a random sequence generator, one study did not comment on completeness of outcome data, and only one of four studies included allocation concealment as part of the study design. None of the studies definitively blinded participants.Rapid viral testing did not reduce antibiotic use in the ED significantly, neither clinically nor statistically. We found lower rates of chest radiography (RR 0.77, 95% CI 0.65 to 0.91) in the rapid viral testing group, but no effect on length of ED visits, or blood or urine testing in the ED. No study made mention of any adverse effects related to viral testing.

AUTHORS' CONCLUSIONS

Current evidence is insufficient to support routine rapid viral testing as a means to reduce antibiotic use in pediatric EDs. Results suggest that rapid viral testing may be beneficial in terms of reducing rates of antibiotic usage, urine investigations and blood investigations, but are not statistically significant due to lack of power. Rapid viral testing does reduce the rate of chest X-rays in the ED. A large trial addressing the effect on antibiotic usage is needed.

The impact of an oral rehydration clinical pathway in a paediatric emergency department

OBJECTIVE

To measure the impact of implementing an oral rehydration clinical pathway for children with mild to moderate dehydration from gastroenteritis in the paediatric emergency department (ED) on the indicators of health care utilization.

METHODS

ED charts of children, six months to 17 years of age, meeting the criteria for the oral rehydration clinical pathway were reviewed. There were three 12-month periods of data collection: pre-implementation, transition and postimplementation. The clinical pathway consisted of a standard nursing assessment form and instructions on oral rehydration to be initiated and maintained by caregivers while waiting to see a physician. The primary outcome measure was ED length of visit (LOV) for children treated using the clinical pathway. This was compared with LOV for all other ED visits during the study periods to highlight the effect of the clinical pathway implementation. Secondary outcome measures included rate of intravenous rehydration, unscheduled return visits to the ED and hospital admission.

RESULTS

During the three data collection periods, 11,816 children met the eligibility criteria. A decrease in the mean LOV of 24 min (95% CI 17 to 31) was observed, as well as a trivial decrease in the rate of intravenous rehydration therapy (14.6% to 12%) with implementation of the clinical pathway.

CONCLUSION

The implementation of an oral rehydration clinical pathway in the ED led to a modest reduction in the ED LOV.

Body mass index and the risk of acute injury in adolescents

OBJECTIVE

To evaluate the relationship between body mass index (BMI) and acute injury in adolescents.

METHODS

An analysis of cross-sectional data from the Canadian Community Health Survey (CCHS) Cycle 3.1 collected by Statistics Canada in 2005 was conducted. The CCHS is a population-based survey that collects information pertaining to the Canadian population health status, health care use and health determinants. The CCHS Cycle 3.1 included 132,221 respondents, of whom 12,317 were 12 to 17 years of age. Multivariate logistic regression was used to estimate the odds of injury occurrence by BMI categories (obese, overweight and neither).

RESULTS

The association between overweight and obese BMI levels and injury occurrence in the bivariate model was not significant after adjusting for sex, health status, activity levels and socioeconomic status (OR=1.10 [95% CI 0.97 to 1.24] for overweight and OR=1.12 [95% CI 0.92 to 1.37] for obesity). A subanalysis of those with an injury in the past 12 months found an elevated odds of experiencing multiple injuries in the overweight group, after adjusting for age, health status and physical activity level (OR=1.43 [95% CI 1.16 to 1.77]).

CONCLUSION

An increased risk of acute injury in obese and overweight adolescents was not observed. However, the subgroup analysis suggested that multiple injuries are relatively frequent in the overweight BMI group.

Cost-effectiveness of metered-dose inhalers for asthma exacerbations in the pediatric emergency department

OBJECTIVE

To compare the incremental cost and effects (averted admission) of using a metered-dose inhaler (MDI) against wet nebulization to deliver bronchodilators for the treatment of mild to moderately severe asthma in pediatric emergency departments (EDs).

METHODS

We measured the incremental cost-effectiveness from the perspective of the hospital, by creating a model using outcome characteristics from a Cochrane systematic review comparing the efficacy of using MDIs versus nebulizers for the delivery of albuterol to children presenting to the ED with asthma. Cost data were obtained from hospitals and regional authorities. We determined the incremental cost-effectiveness ratio and performed probabilistic sensitivity analyses using Monte Carlo simulations.

RESULTS

Using MDIs in the ED instead of wet nebulization may result in net savings of Can$154.95 per patient. Our model revealed that using MDIs in the ED is a dominant strategy, one that is more effective and less costly than wet nebulization. Probabilistic sensitivity analyses revealed that 98% of the 10 000 iterations resulted in a negative incremental cost-effectiveness ratio. Sensitivity analyses around the costs revealed that MDI would remain a dominant strategy (90% of 10 000 iterations) even if the net cost of delivering bronchodilators by MDI was Can$70 more expensive than that of nebulized bronchodilators.

CONCLUSIONS

Use of MDIs with spacers in place of wet nebulizers to deliver albuterol to treat children with mild-to-moderate asthma exacerbations in the ED could yield significant cost savings for hospitals and, by extension, to both the health care system and families of children with asthma.

Prospective assessment of practice pattern variations in the treatment of pediatric gastroenteritis

OBJECTIVES

We aimed to determine whether significant variations in the use of intravenous rehydration existed among institutions, controlling for clinical variables, and to assess variations in the use of ancillary therapeutic and diagnostic modalities.

METHODS

We conducted a prospective cohort study of children 3 to 48 months of age who presented to 11 emergency departments with acute gastroenteritis, using surveys, medical record reviews, and telephone follow-up evaluations.

RESULTS

A total of 647 eligible children were enrolled and underwent chart review; 69% (446 of 647 children) participated in the survey, and 89% of survey participants (398 of 446 children) had complete follow-up data. Twenty-three percent (149 of 647 children) received intravenous rehydration (range: 6%-66%; P < .001) and 13% (81 of 647 children) received ondansetron (range: 0%-38%; P < .001). Children who received intravenous rehydration had lower Canadian Triage Acuity Scale scores at presentation (3.1 ± 0.5 vs 3.5 ± 0.5; P < .0001). Regression analysis revealed that the greatest predictor of intravenous rehydration was institution location (odds ratio: 3.0 [95% confidence interval: 1.8-5.0]). Children who received intravenous rehydration at the index visit were more likely to have an unscheduled follow-up health care provider visit (29% vs 19%; P = .05) and to revisit an emergency department (20% vs 9%; P = .002).

CONCLUSIONS

In this cohort, intravenous rehydration and ondansetron use varied dramatically. Use of intravenous rehydration at the index visit was significantly associated with the institution providing care and was not associated with a reduction in the need for follow-up care.

Cochrane Review: Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department

Background

Pediatric acute respiratory infections (ARIs) represent a significant burden on pediatric emergency departments (ED) and families. Most of these illnesses are due to viruses. However, investigations (radiography, blood and urine testing) to rule out bacterial infections and antibiotics are often ordered because of diagnostic uncertainties. This results in prolonged ED visits and unnecessary antibiotic use. The risk of concurrent bacterial infection has been reported to be negligible in children over three months of age with a confirmed viral infection. Rapid viral testing in the ED may alleviate the need for precautionary testing and antibiotic use.

Objectives

To determine the effect of rapid viral testing in the ED on the rate of precautionary testing, antibiotic use and ED length of visit.

Search strategy

We searched the Cochrane Central register of Controlled Trials (CENTRAL) (The Cochrane Library, 2009, issue 1) which contains the ARI Group's Specialized Register, MEDLINE (1950 to April Week 3 2009), EMBASE (1988 to Week 16, 2009), MEDLINE In‐Process & Other Non‐Indexed Citations (April 27, 2009), HealthStar (1966 to 2009), BIOSIS Previews (1969 to 2009), CAB Abstracts (1973 to 2007), CBCA Reference (1970 to 2007), and Proquest Dissertations and Theses (1861 to 2009).

Selection criteria

Randomized controlled trials (RCTs) of rapid viral testing for children with ARIs in the ED.

Data collection and analysis

Two review authors used the inclusion criteria to select trials, evaluate their quality and extract data. Missing data were obtained from trial authors. Differences in rate of investigations and antibiotics use were expressed as risk ratios (RR) and difference in ED length of visits was expressed as mean difference, with 95% confidence interval (CI).

Main results

Four trials were included, three RCTs and one quazi‐RCT, with 759 children in the rapid viral testing and 829 in the control group. Rapid viral testing did not reduce antibiotic use in the ED significantly, neither clinically nor statistically. We found lower rates of chest radiography (RR 0.77, 95% CI 0.65 to 0.91) in the rapid viral testing group but no effect on length of ED visits, blood or urine testing in the ED.

Authors' conclusions

Current evidence is insufficient, although promising, to support routine rapid viral testing as a means to reduce antibiotic use in pediatric EDs. Results suggest that rapid viral testing may be beneficial but are not statistically significant due to lack of power. A large trial addressing these outcome measures is needed.

Plain Language Summary

Does rapid viral testing in the Emergency Department affect the treatment of children with fever and respiratory problems?

Children admitted to Emergency Departments (ED) with fever and respiratory symptoms represent a major burden to the health care system, as well as significant anxiety and expense to parents and caregivers.  Physicians often order diagnostic tests and may prescribe antibiotics when they are unsure of the cause of the illness and are concerned about the possibility of serious bacterial infection. However, in most cases, fever and respiratory symptoms are caused by viruses. In addition, in children in whom a virus is found to be the cause of their illness, the risk of serious bacterial infection is very low. This review was conducted to assess whether a rapid viral test done in the ED changes what physicians do when treating these children. We found that in previously healthy children coming to the ED with fever and respiratory symptoms, a rapid viral test reduces the use of chest X‐rays and that there is a trend toward less antibiotic usage, and blood and urine investigations. The true impact of this intervention on the latter three outcomes requires trials with larger enrollment numbers.

Rapid viral diagnosis for acute febrile respiratory illness in children in the Emergency Department

BACKGROUND

Pediatric acute respiratory infections (ARIs) represent a significant burden on pediatric emergency departments (ED) and families. Most of these illnesses are due to viruses. However, investigations (radiography, blood and urine testing) to rule out bacterial infections and antibiotics are often ordered because of diagnostic uncertainties. This results in prolonged ED visits and unnecessary antibiotic use. The risk of concurrent bacterial infection has been reported to be negligible in children over three months of age with a confirmed viral infection. Rapid viral testing in the ED may alleviate the need for precautionary testing and antibiotic use.

OBJECTIVES

To determine the effect of rapid viral testing in the ED on the rate of precautionary testing, antibiotic use and ED length of visit.

SEARCH STRATEGY

We searched the Cochrane Central register of Controlled Trials (CENTRAL) (The Cochrane Library, 2009, issue 1) which contains the ARI Group's Specialized Register, MEDLINE (1950 to April Week 3 2009), EMBASE (1988 to Week 16, 2009), MEDLINE In-Process & Other Non-Indexed Citations (April 27, 2009), HealthStar (1966 to 2009), BIOSIS Previews (1969 to 2009), CAB Abstracts (1973 to 2007), CBCA Reference (1970 to 2007), and Proquest Dissertations and Theses (1861 to 2009).

SELECTION CRITERIA

Randomized controlled trials (RCTs) of rapid viral testing for children with ARIs in the ED.

DATA COLLECTION AND ANALYSIS

Two review authors used the inclusion criteria to select trials, evaluate their quality and extract data. Missing data were obtained from trial authors. Differences in rate of investigations and antibiotics use were expressed as risk ratios (RR) and difference in ED length of visits was expressed as mean difference, with 95% confidence interval (CI).

MAIN RESULTS

Four trials were included, three RCTs and one quazi-RCT, with 759 children in the rapid viral testing and 829 in the control group. Rapid viral testing did not reduce antibiotic use in the ED significantly, neither clinically nor statistically. We found lower rates of chest radiography (RR 0.77, 95% CI 0.65 to 0.91) in the rapid viral testing group but no effect on length of ED visits, blood or urine testing in the ED.

AUTHORS' CONCLUSIONS

Current evidence is insufficient, although promising, to support routine rapid viral testing as a means to reduce antibiotic use in pediatric EDs. Results suggest that rapid viral testing may be beneficial but are not statistically significant due to lack of power. A large trial addressing these outcome measures is needed.

[Comparative study of thoracoscopy versus thoracotomy in esophageal atresia]

INTRODUCTION

Thoracoscopic treatment of esophageal atresia type 3 has been previously reported to be feasible but no study clearly showed the benefits of thoracoscopy compared to open procedure. The aim of this study was to compare the outcome of esophageal atresia type III treated by thoracoscopic or open procedure.

MATERIAL AND METHOD

From january 2000 to december 2006, 31 children were operated, 17 by thoracotomy (weight range from 1750 to 4020 g) and 14 by thoracoscopy (weight range from 2110 to 4160 g). Neonatal deaths from an independent condition (3 cases in thoracotomy group) were excluded from the study and we analyzed 14 children in each group. Analyzed data included length of surgery, length of post operative assisted ventilation, length of pleural drainage, length of stay in ICU, delay before oral feeding, length of morphine analgesia, length of hospitalization and rate of complication.

RESULTS

Length of morphine analgesia was higher in thoracotomy group than in thoracoscopic group (mean 6.6 days versus 5.3 days, p = 0.16). Length of hospitalization was also higher in thoracotomy group (mean 22.6 days versus 19.1 days, p = 0.3). The rate of complication with thoracoscopy was not higher need of oesophageal dilatation (21% in thoracoscopic group versus 14% in thoracotomy group), need of Nissen fundoplication (21% in thoracoscopic group versus 28% in thoracotomy group).

CONCLUSION

Thoracoscopic treatment of esophageal atresia type III reduces the need of morphine analgesia and the length of stay without increasing the risk of postoperative complications.

Total societal costs attributable to the prevention of recurrent HER2+ breast cancer

Abstract #6101

Introduction: Adjuvant therapies are available to prevent breast cancer recurrence that may reduce morbidity and mortality. However, the associated savings to society have not been quantified, particularly for HER2+ patients. Methods: We reviewed the literature (PubMed) to estimate the costs attributable to breast cancer recurrence including direct (medical and non-medical) and indirect (loss income, productivity, informal care) costs. The following sources were used to estimate the recurrence cost. The 10-year average direct medical costs of recurrence were obtained from an analysis of SEER-Medicare data (Stokes 2008). This study compared women with recurrence to similar women without recurrence and accounts for differential costs associated with survival (ie, it did not estimate only the cost of treating recurrent cancer). In the initial year after cancer diagnosis, women required an additional 66 hours of personal time to obtain medical services (Yabroff 2007). After recurrence, an excess of 9% of patients would leave the work force if they were aged 50-64 (Lidgren 2007). Women were found to take an additional 8.5 months away from work during the 3 years following a recurrence compared with those without recurrence (Drolet 2005). The intensity of informal care was similar (0.8 hour/week) in the first year after recurrence as it was for women without recurrence (Lidgren 2007). The valuation of utilization was conducted from a societal perspective and costs reported as 2008 US dollars. Because certain costs were relevant to specific ages, we estimated costs in 3 age cohorts (30-49, 50-69, and ≥70). Lost income from early retirement was calculated as the number of years retired from work before the age 65 times the annual average income derived using the national average wage and benefit data. Patient time required for receiving care, time absent from work, and caregiver time were also valued in the same way. We combined this information into a simulation used to estimate the number of HER2+ women diagnosed in one calendar year in the United States, and whose recurrence could be prevented with trastuzumab. The model accounted for variability of clinical and economic inputs by sampling from distributions using 5,000 replications. The mean costs per person and the middle 95% of the distribution were reported. Results: For ages 50-69, early retirement costs were $39,600. Costs due to work absences were $41,600 (age 30-49) and were $31,200 (age 50-69). The total societal costs attributable to a single recurrence were $60,400 ($32,000 to $129,000) for ages 30-49, $89,600 ($45,000 to $203,000) for ages 50-69, and $18,900 ($13,000 to $25,000) for ages ≥70. Overall, the savings from preventing recurrence with trastuzumab were estimated at over $167 million ($70 million to $385 million) per year of diagnosed cases of HER2+ tumors. Conclusion: Therapies that can prevent breast cancer recurrence can lead to substantial savings to society and represent a considerable opportunity cost.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 6101.

Estimating recurrences prevented from using trastuzumab in adjuvant breast cancer in the United States

Abstract #2107

Introduction: Trastuzumab was recently approved for adjuvant use in HER2+ breast cancer. Adjuvant treatment should result in a reduction in recurrences, but this has not been estimated from a US population perspective. Methods: We estimated the number of HER2+ breast cancers in the US in 2005 using SEER data. Because HER2 status is not available in SEER, the number of HER2+ patients was estimated using the known relationship between HER2 status and both estrogen receptor (ER) and progesterone receptor (PR) status. Patients with no ER or PR results were assumed to have no HER2 testing. HER2+ proportions for remaining ER+/PR+, ER+/PR-, ER-/PR+ and ER-/PR- patients were estimated from published data and applied to patients diagnosed in the 17 SEER registries. The resulting rates were applied to the 2005 US female population counts. Estimated HER2+ patient counts were stratified by nodal status (+/-), and age (30-50, 50-70, and &gt;70 years). Patients with significant underlying cardiovascular (CV) disease were assumed not to use trastuzumab. Underlying recurrence rates were pooled across studies that compared doxorubicin and cyclophosphamide followed by a taxane (AC-T) versus the same regimen plus 52 weeks of trastuzumab (AC-TH). Rates were stratified by nodal status. The relative risk of recurrence with trastuzumab (0.53) was assumed to be constant across subgroups based on published data, and assumed to persist for 5 years. One study (NSABP B-31) estimated the proportion experiencing a CV event (primarily defined as ejection fraction decline below threshold or dyspnea with normal activity) based on 5-year follow-up. Probabilistic model inputs were used to reflect the likelihood of possible values where possible. The results were run using 5,000 replications and reported as the mean and middle 95% of the distribution using @Risk (Palisade Corp., Ithaca, NY). Results: The model estimated that there are approximately 28,500 (95% interval 26,400 to 31,500) patients who could be diagnosed with HER2+ breast cancer in one year in the US, 6,128 (95% interval 4,292 to 8,600) of whom will have a recurrence within 5 years, and up to 2,619 of whom (95% interval 1,506 to 3,701) who could be prevented from disease recurrence with trastuzumab use. The number of patients who might experience a CV event is approximately 941 (95% interval 510 to 1,395) giving a ratio of 2.7 recurrences prevented for every CV event (95% interval 1.4 to 5.6). Conclusion: Trastuzumab is capable of preventing at least 2,600 recurrences within 5 years after its initial year of use. Its most clinically important side effect, a CV event, is likely to appear once for every 2.7 recurrences that are prevented, although many cases are asymptomatic and reversible. Extrapolated over 20 years, targeting HER2+ tumors in the adjuvant setting could prevent as many as 50,000 HER2+ patients from recurrence with important clinical, humanistic and economic consequences for patients, physicians and payors.

Citation Information: Cancer Res 2009;69(2 Suppl):Abstract nr 2107.

Effects of caffeine on sensorimotor gating of the startle reflex in normal control subjects: impact of caffeine intake and withdrawal

RATIONALE

Prepulse inhibition (PPI), a cross-species measure of sensorimotor gating, is impaired in certain neuropsychiatric disorders. This study was designed to assess caffeine effects on PPI in normal humans, as part of an effort to understand cross-species differences and similarities in the neurochemical regulation of PPI.

METHODS

Startle was measured during a screening session; 7 days later, subjects were retested after placebo or caffeine (200 mg; double-blind design). Subjects were characterized as low versus high caffeine drinkers based on established scales (range 11-628 mg/day), and either maintained ad libitum caffeine intake (Ad lib study; n=18) or refrained from caffeine consumption for > or =15 h prior to testing (Withdrawal study; n=12). Autonomic and self-rating measures, acoustic and tactile startle, and unimodal and cross-modal PPI, were measured in divided sessions for 3 h post-treatment.

RESULTS

There were significant effects of caffeine and/or caffeine withdrawal on several self-rating and autonomic measures, and on startle reflex habituation, but not on acoustic or tactile startle magnitude or PPI. Difference scores of startle data from screening versus test days revealed no group effects on startle magnitude, but PPI difference scores revealed that caffeine had opposite effects on low versus high caffeine drinkers (means=57 versus 258 mg/day) in the two withdrawal states. In the absence of withdrawal, caffeine reduced PPI in heavy caffeine drinkers; during withdrawal, caffeine increased PPI in heavy caffeine drinkers. The opposite pattern was evident in low caffeine drinkers.

CONCLUSIONS

While a physiologically active dose of caffeine has no simple effects on PPI in normal humans, both withdrawal states and normal levels of caffeine consumption may be important factors in understanding this drug's effects on sensorimotor gating.

Strategies for reaching Asian Americans with health information

INTRODUCTION

Cultural, linguistic, and economic barriers place many Asian Americans in jeopardy of missing opportunities for disease prevention, early diagnosis, prompt treatment, and participation in clinical trials. One way to learn how to address these barriers is through the development of a demonstration health education and prevention program focused on an indicator disease such as cancer.

METHODS

In 1994, the University of California, San Diego (UCSD) Cancer Center began a highly focused cancer education program. Staffing was done with a variety of bicultural and bilingual undergraduates recruited from local colleges and trained to work as community health educators. Asian grocery stores were selected as optimal educational sites. Adaptation of sheltered English teaching techniques and hands-on teaching aids helped to overcome language and educational barriers. The educational intervention was evaluated using unobtrusive measures.

RESULTS

With the volunteers' help, culturally sensitive means to disseminate information on cancer were evaluated. A variety of approaches evolved that effectively bridged many communication barriers. Fear of cancer itself, belief that thinking about cancer could provoke the onset of the disease, and financial barriers to care proved to be just as formidable barriers to cancer education in this ethnic group as they are in others. Using student volunteers and donated store space, this educational program was conducted with minimal expense.

CONCLUSION

Reaching this population with the help of ethnically and linguistically compatible students was effective, but the barriers they faced when trying to connect with their potential audience were still considerable. Rigorous evaluation of the strategies used in this intervention is warranted.