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Shokar NK, Calderón-Mora J, Salaiz R, Casner N, Zuckerman MJ, Byrd TL, Shokar GS, Dwivedi A. Implementation and Evaluation of a Large Community-Based Colorectal Cancer Screening Program. JOURNAL OF PUBLIC HEALTH MANAGEMENT AND PRACTICE 2024; 30:E143-E153. [PMID: 38603761 DOI: 10.1097/phh.0000000000001864] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/13/2024]
Abstract
CONTEXT Colorectal cancer (CRC) screening can significantly reduce incidence and mortality; however, screening rates are suboptimal. The lowest rates are among those with no usual source of care and the uninsured. OBJECTIVE We describe the implementation and evaluation of a community-based CRC screening program from 2012 to 2015 designed to increase screening within a predominantly Hispanic US-Mexico border population. METHODS The multicomponent, evidence-based program provided in-person, bilingual, culturally tailored health education facilitated by community health workers, no-cost primarily stool-based testing and diagnostic colonoscopy, and navigation. We recruited uninsured individuals due for CRC screening from clinics and community sites. An extensive qualitative and quantitative program process and outcome evaluation was conducted. RESULTS In total, 20 118 individuals were approached, 8361 were eligible for screening; 74.8% completed screening and 74.6% completed diagnostic testing; 14 cancers were diagnosed. The mean age of participants was 56.8 years, and the majority were Hispanic, female, and of low socioeconomic status. The process evaluation gathered information that enabled effective program implementation and demonstrated effective staff training, compliance with processes, and high patient satisfaction. CONCLUSIONS This program used a population-based approach focusing on uninsured individuals and proved successful at achieving high fecal immunochemical test kit return rates and colonoscopy completion rates. Key factors related to its success included tailoring the intervention to our priority population, strong partnerships with community-based sites and clinics, expertise in clinical CRC screening, and an active community advisory board. This program can serve as a model for similar populations along the border to increase CRC screening rates among the underserved.
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Affiliation(s)
- Navkiran K Shokar
- Author Affiliations: Departments of Population Health (Drs N. K. Shokar and Calderón-Mora) and Medical Education (Dr G. S. Shokar), Dell Medical School, University of Texas at Austin, Austin, Texas; Department of Family and Community Medicine (Ms Salaiz), Division of Gastroenterology (Dr Zuckerman), Department of Internal Medicine (Ms Casner), and Department of Molecular and Translational Medicine (Dr Dwivedi), Paul L. Foster School of Medicine, Texas Tech University Health Sciences Center El Paso, El Paso, Texas; and School of Health Professions, University of Texas at Tyler, Tyler, Texas (Dr Byrd)
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Vachon EA, Katz ML, Rawl SM, Stump TE, Emerson B, Baltic RD, Biederman EB, Monahan PO, Kettler CD, Paskett ED, Champion VL. Comparative effectiveness of two interventions to increase colorectal cancer screening among females living in the rural Midwest. J Rural Health 2024. [PMID: 38391093 DOI: 10.1111/jrh.12828] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2023] [Revised: 01/17/2024] [Accepted: 02/05/2024] [Indexed: 02/24/2024]
Abstract
PURPOSE To assess the comparative effectiveness of a tailored, interactive digital video disc (DVD) intervention versus DVD plus patient navigation (PN) intervention versus usual care (UC) on the uptake of colorectal cancer (CRC) screening among females living in Midwest rural areas. METHODS As part of a larger study, 663 females (ages 50-74) living in rural Indiana and Ohio and not up-to-date (UTD) with CRC screening at baseline were randomized to one of three study groups. Demographics , health status/history, and beliefs and attitudes about CRC screening were measured at baseline. CRC screening was assessed at baseline and 12 months from medical records and self-report. Multivariable logistic regression was used to determine whether females in each group were UTD for screening and which test they completed. RESULTS Adjusted for covariates, females in the DVD plus PN group were 3.5× more likely to complete CRC screening than those in the UC group (odds ratio [OR] 3.62; 95% confidence interval [CI]: 2.09, 6.47) and baseline intention to receive CRC screening (OR 3.45, CI: 2.21,5.42) at baseline. Adjusting for covariates, there was no difference by study arm whether females who became UTD for CRC screening chose to complete a colonoscopy or fecal occult blood test/fecal immunochemical test. CONCLUSIONS Many females living in the rural Midwest are not UTD for CRC screening. A tailored intervention that included an educational DVD and PN improved knowledge, addressed screening barriers, provided information about screening test options, and provided support was more effective than UC and DVD-only to increase adherence to recommended CRC screening.
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Affiliation(s)
- Eric A Vachon
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana, USA
| | - Mira L Katz
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, USA
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Susan M Rawl
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
| | - Timothy E Stump
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Brent Emerson
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus, Ohio, USA
| | - Ryan D Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Erika B Biederman
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
| | - Patrick O Monahan
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Carla D Kettler
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Electra D Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio, USA
- Department of Medicine, Division of Cancer Prevention and Control, College of Medicine, The Ohio State University, Columbus, Ohio, USA
| | - Victoria L Champion
- School of Nursing, Indiana University, Indianapolis, Indiana, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, Indiana, USA
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Wangen M, Escoffery C, Fernandez ME, Friedman DB, Hannon P, Ko LK, Maxwell AE, Petagna C, Risendal B, Rohweder C, Leeman J. Twenty years of capacity building across the cancer prevention and control research network. Cancer Causes Control 2023; 34:45-56. [PMID: 37067700 PMCID: PMC10106885 DOI: 10.1007/s10552-023-01690-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2022] [Accepted: 03/29/2023] [Indexed: 04/18/2023]
Abstract
PURPOSE To improve population health, community members need capacity (i.e., knowledge, skills, and tools) to select and implement evidence-based interventions (EBIs) to fit the needs of their local settings. Since 2002, the Centers for Disease Control and Prevention has funded the national Cancer Prevention and Control Research Network (CPCRN) to accelerate the implementation of cancer prevention and control EBIs in communities. The CPCRN has developed multiple strategies to build community members' capacity to implement EBIs. This paper describes the history of CPCRN's experience developing and lessons learned through the use of five capacity-building strategies: (1) mini-grant programs, (2) training, (3) online tools, (4) evidence academies, and (5) evaluation support for partners' capacity-building initiatives. METHODS We conducted a narrative review of peer-reviewed publications and grey literature reports on CPCRN capacity-building activities. Guided by the Interactive Systems Framework, we developed histories, case studies, and lessons learned for each strategy. Lessons were organized into themes. RESULTS Three themes emerged: the importance of (1) community-engagement prior to and during implementation of capacity-building strategies, (2) establishing and sustaining partnerships, and (3) co-learning at the levels of centers, networks, and beyond. CONCLUSION CPCRN activities have increased the ability of community organizations to compete for external funds to support implementation, increased the use of evidence in real-world settings, and promoted the broad-scale implementation of cancer control interventions across more than eight states. Lessons from this narrative review highlight the value of long-term thematic networks and provide useful guidance to other research networks and future capacity-building efforts.
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Affiliation(s)
- Mary Wangen
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA.
| | - Cam Escoffery
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Maria E Fernandez
- School of Public Health, The University of Texas Health Science Center at Houston, Health Promotion and Behavioral Sciences, Houston, TX, USA
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Arnold School of Public Health, Columbia, SC, USA
| | - Peggy Hannon
- School of Public Health, Health Promotion Research Center, The University of Washington, Seattle, WA, USA
| | - Linda K Ko
- School of Public Health, Health Promotion Research Center, The University of Washington, Seattle, WA, USA
| | - Annette E Maxwell
- Los Angeles, Fielding School of Public Health and Jonsson, Comprehensive Cancer Center, Health Policy and Management, The University of California, Los Angeles, CA, USA
| | - Courtney Petagna
- Rollins School of Public Health, Department of Behavioral Sciences and Health Education, Emory University, Atlanta, GA, USA
| | - Betsy Risendal
- Colorado School of Public Health, Department of Community & Behavioral Health, The University of Colorado Denver Anschutz Medical Campus, Aurora, CO, USA
| | - Catherine Rohweder
- Center for Health Promotion and Disease Prevention, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
| | - Jennifer Leeman
- School of Nursing, The University of North Carolina at Chapel Hill, Chapel Hill, NC, USA
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Das TS, Rauch J, Shaukat A. Colorectal cancer screening-what does the recent NordICC trial mean for the U.S. population? Transl Gastroenterol Hepatol 2023; 8:40. [PMID: 38021363 PMCID: PMC10643301 DOI: 10.21037/tgh-23-20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/02/2023] [Accepted: 08/10/2023] [Indexed: 12/01/2023] Open
Abstract
The incidence of colorectal cancer (CRC) has declined over time, though it remains a significant cause of morbidity and mortality in the U.S. It has the third highest incidence in incidence among all cancers and is the second leading cause of cancer death in both men and women. Screening reduces the incidence and mortality from CRC. There are several modalities for CRC screening, but the most common ones are a choice between a non-invasive stool-based test, such as fecal immunochemical testing (FIT) or an invasive endoscopic modality, such as colonoscopy. In the U.S. colonoscopy is the predominant CRC screening modality, with observational studies reporting large reductions in CRC incidence and mortality. Recently, a large randomized controlled trial (RCT) on effectiveness of colonoscopy reported smaller than expected reduction in CRC incidence and no reduction in CRC mortality with colonoscopy screening. Explanations of the lower than expected benefit include low uptake of colonoscopy, short follow-up for mortality endpoints and quality indicators (QIs) for some of the endoscopists participating in the screening colonoscopies. The findings of the study need to be taken in context with other literature on effectiveness of colonoscopy, with the overall message of reassuring patients of the benefits of screening, and colonoscopy. Here, we discuss the latest evidence on colonoscopy screening and it in the context of other screening modalities and the landscape.
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Affiliation(s)
- Taranika Sarkar Das
- Division of Gastroenterology, NYU Grossman School of Medicine, New York, NY, USA
| | - Jessica Rauch
- Division of Gastroenterology, NYU Grossman School of Medicine, New York, NY, USA
| | - Aasma Shaukat
- Division of Gastroenterology, NYU Grossman School of Medicine, New York, NY, USA
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Tangka FKL, Subramanian S, Hoover S, Cariou C, Creighton B, Hobbs L, Marzano A, Marcotte A, Norton DD, Kelly-Flis P, Leypoldt M, Larkins T, Poole M, Boehm J. Improving the efficiency of integrated cancer screening delivery across multiple cancers: case studies from Idaho, Rhode Island, and Nebraska. Implement Sci Commun 2022; 3:133. [PMID: 36527147 PMCID: PMC9756516 DOI: 10.1186/s43058-022-00381-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/24/2022] [Accepted: 11/30/2022] [Indexed: 12/23/2022] Open
Abstract
BACKGROUND Three current and former awardees of the Centers for Disease Control and Prevention's Colorectal Cancer Control Program launched integrated cancer screening strategies to better coordinate multiple cancer screenings (e.g., breast, cervical, colorectal). By integrating the strategies, efficiencies of administration and provision of screenings can be increased and costs can be reduced. This paper shares findings from these strategies and describes their effects. METHODS The Idaho Department of Health and Welfare developed a Baseline Assessment Checklist for six health systems to assess the current state of policies regarding cancer screening. We analyzed the checklist and reported the percentage of checklist components completed. In Rhode Island, we collaborated with a nurse-patient navigator, who promoted cancer screening, to collect details on patient navigation activities and program costs. We then described the program and reported total costs and cost per activity. In Nebraska, we described the experience of the state in administering an integrated contracts payment model across colorectal, breast, and cervical cancer screening and reported cost per person screened. Across all awardees, we interviewed key stakeholders. RESULTS In Idaho, results from the checklist offered guidance on areas for enhancement before integrated cancer screening strategies, but identified challenges, including lack of capacity, limited staff availability, and staff turnover. In Rhode Island, 76.1% of 1023 patient navigation activities were for colorectal cancer screening only, with a much smaller proportion devoted to breast and cervical cancer screening. Although the patient navigator found the discussions around multiple cancer screening efficient, patients were not always willing to discuss all cancer screenings. Nebraska changed its payment system from fee-for-service to fixed cost subawards with its local health departments, which integrated cancer screening funding. Screening uptake improved for breast and cervical cancer but was mixed for colorectal cancer screening. CONCLUSIONS The results from the case studies show that there are barriers and facilitators to integrating approaches to increasing cancer screening among primary care facilities. However, more research could further elucidate the viability and practicality of integrated cancer screening programs.
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Affiliation(s)
- Florence K. L. Tangka
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop S107-4, Atlanta, GA 30341-3717 USA
| | - Sujha Subramanian
- grid.62562.350000000100301493RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413 USA
| | - Sonja Hoover
- grid.62562.350000000100301493RTI International, 307 Waverley Oaks Road, Suite 101, Waltham, MA 02452-8413 USA
| | - Charlene Cariou
- Southwest District Health, 13307 Miami Lane, Caldwell, ID 83607 USA
| | - Becky Creighton
- grid.280384.50000 0004 0394 4525Idaho Comprehensive Cancer Control Program, Division of Public Health, Idaho Department of Health and Welfare, 450 W State Street, Boise, ID 83702 USA
| | - Libby Hobbs
- grid.280384.50000 0004 0394 4525Bureau of Community and Environmental Health, Division of Public Health, Idaho Department of Health and Welfare, 450 W State Street, Boise, ID 83702 USA
| | - Amanda Marzano
- WellOne Primary Medical and Dental Care, 35 Village Plaza Way, North Scituate, RI 02857 USA
| | - Andrea Marcotte
- WellOne Primary Medical and Dental Care, 35 Village Plaza Way, North Scituate, RI 02857 USA
| | - Deirdre Denning Norton
- WellOne Primary Medical and Dental Care, 35 Village Plaza Way, North Scituate, RI 02857 USA
| | - Patricia Kelly-Flis
- WellOne Primary Medical and Dental Care, 35 Village Plaza Way, North Scituate, RI 02857 USA
| | - Melissa Leypoldt
- grid.280417.80000 0004 0420 6102Women’s and Men’s Health Programs, Lifespan Health Unit, Public Health, Nebraska Department of Health and Human Services, 301 Centennial Mall S, Lincoln, NE 68508 USA
| | - Teri Larkins
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop S107-4, Atlanta, GA 30341-3717 USA
| | - Michelle Poole
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop S107-4, Atlanta, GA 30341-3717 USA
| | - Jennifer Boehm
- grid.416738.f0000 0001 2163 0069Centers for Disease Control and Prevention, 4770 Buford Highway, NE, Mailstop S107-4, Atlanta, GA 30341-3717 USA
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Islami F, Guerra CE, Minihan A, Yabroff KR, Fedewa SA, Sloan K, Wiedt TL, Thomson B, Siegel RL, Nargis N, Winn RA, Lacasse L, Makaroff L, Daniels EC, Patel AV, Cance WG, Jemal A. American Cancer Society's report on the status of cancer disparities in the United States, 2021. CA Cancer J Clin 2022; 72:112-143. [PMID: 34878180 DOI: 10.3322/caac.21703] [Citation(s) in RCA: 86] [Impact Index Per Article: 43.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/07/2021] [Accepted: 09/07/2021] [Indexed: 02/06/2023] Open
Abstract
In this report, the authors provide comprehensive and up-to-date US data on disparities in cancer occurrence, major risk factors, and access to and utilization of preventive measures and screening by sociodemographic characteristics. They also review programs and resources that have reduced cancer disparities and provide policy recommendations to further mitigate these inequalities. The overall cancer death rate is 19% higher among Black males than among White males. Black females also have a 12% higher overall cancer death rate than their White counterparts despite having an 8% lower incidence rate. There are also substantial variations in death rates for specific cancer types and in stage at diagnosis, survival, exposure to risk factors, and receipt of preventive measures and screening by race/ethnicity, socioeconomic status, and geographic location. For example, kidney cancer death rates by sex among American Indian/Alaska Native people are ≥64% higher than the corresponding rates in each of the other racial/ethnic groups, and the 5-year relative survival for all cancers combined is 14% lower among residents of poorer counties than among residents of more affluent counties. Broad and equitable implementation of evidence-based interventions, such as increasing health insurance coverage through Medicaid expansion or other initiatives, could substantially reduce cancer disparities. However, progress will require not only equitable local, state, and federal policies but also broad interdisciplinary engagement to elevate and address fundamental social inequities and longstanding systemic racism.
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Affiliation(s)
- Farhad Islami
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Carmen E Guerra
- Department of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania
| | - Adair Minihan
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - K Robin Yabroff
- Health Services Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Stacey A Fedewa
- Screening and Risk Factors Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Kirsten Sloan
- Public Policy, American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Tracy L Wiedt
- Health Equity, Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Blake Thomson
- Cancer Disparity Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Rebecca L Siegel
- Surveillance Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Nigar Nargis
- Tobacco Control Research, Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
| | - Robert A Winn
- Massey Cancer Center, Virginia Commonwealth University, Richmond, Virginia
| | - Lisa Lacasse
- American Cancer Society Cancer Action Network, Washington, District of Columbia
| | - Laura Makaroff
- Prevention and Early Detection, American Cancer Society, Atlanta, Georgia
| | - Elvan C Daniels
- Extramural Discovery Science, American Cancer Society, Atlanta, Georgia
| | - Alpa V Patel
- Department of Population Science, American Cancer Society, Atlanta, Georgia
| | - William G Cance
- Office of the Chief Medical and Scientific Officer, American Cancer Society, Atlanta, Georgia
| | - Ahmedin Jemal
- Department of Surveillance and Health Equity Science, American Cancer Society, Atlanta, Georgia
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Luque JS, Matthew OO, Jackson DR, Vargas MA, Austin T, Ali A, Kiros GE, Harris CM, Tawk R, Gwede CK, Wallace K, Jean-Pierre P. Assessing the effectiveness of a community health advisor plus screen to save educational intervention on stool-based testing adherence in an African American safety net clinic population: study protocol for a randomized pragmatic trial. Trials 2022; 23:151. [PMID: 35168640 PMCID: PMC8845372 DOI: 10.1186/s13063-022-06076-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2021] [Accepted: 02/02/2022] [Indexed: 11/10/2022] Open
Abstract
Background Colorectal cancer (CRC) is the second most deadly cancer affecting US adults and is also one of the most treatable cancers when detected at an earlier clinical stage of disease through screening. CRC health disparities experienced by African Americans are due in part to the later stage of diagnosis, suggesting the importance of improving African Americans’ CRC screening participation. The national Screen to Save (S2S) initiative employs a community health educator to deliver CRC screening education which can be tailored for specific populations, and such approaches have increased CRC screening rates in disadvantaged and racial/ethnic minority populations. Methods/design In this trial emphasizing stool-based CRC screening, focus groups informed the development of an adapted S2S video and brochure tailored for African Americans and identified preferred motivational text messages for a multicomponent community health advisor (CHA) intervention. A CHA hired from the community was trained to deliver a 6-week CRC educational intervention consisting of an initial face-to-face meeting followed by 5 weeks of calls and texts. Interested eligible persons are enrolled primarily through recruitment by two partnering community health centers (CHCs) and secondarily through various outreach channels and, after consenting and completing a baseline survey, are randomly assigned to one of two study arms. The CHCs are blinded to study arm assignment. Intervention arm participants receive the brochure and CHA intervention while participants assigned to the control group receive only the brochure. All participants receive a stool-based CRC screening test from their health center, and the primary outcome is the completion of the screening test at 12 months. Secondary objectives are to estimate the effect of the intervention on mediating factors, explore the effect of moderating factors, and perform a cost-effectiveness analysis of the CHA intervention. Discussion The TUNE-UP study will enhance understanding about CRC screening in African Americans obtaining primary health care through CHCs and is one of the very few studies to examine a CHA intervention in this context. A better understanding of the mechanisms by which the intervention affects patient beliefs and behaviors will help focus future research while the exploratory cost-effectiveness analysis will inform CHCs’ decision-making about implementing a CHA program to increase screening and reduce cancer health disparities. Trial registration ClinicalTrials.govNCT04304001. Registered on March 11, 2020.
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Affiliation(s)
- John S Luque
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA.
| | - Olayemi O Matthew
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Deloria R Jackson
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Matthew A Vargas
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Tifini Austin
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Askal Ali
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Gebre E Kiros
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Cynthia M Harris
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Rima Tawk
- College of Pharmacy & Pharmaceutical Sciences, Institute of Public Health, Florida A&M University, 1515 South Martin Luther King Jr. Blvd., Tallahassee, FL, 32307, USA
| | - Clement K Gwede
- Division of Population Sciences, Department of Health Outcomes and Behavior, Moffitt Cancer Center, Tampa, FL, 33612, USA
| | - Kristin Wallace
- Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, 68 President Street, Charleston, SC, 29425, USA.,Hollings Cancer Center, Medical University of South Carolina, 86 Jonathan Lucas Street, Charleston, SC, 29425, USA
| | - Pascal Jean-Pierre
- Department of Behavioral Sciences and Social Medicine, College of Medicine, Florida State University, 1115 West Call Street, Tallahassee, FL, 32306, USA
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Solonowicz O, Stier M, Kim K, Kupfer S, Tapper E, Sengupta N. Digital Navigation Improves No-Show Rates and Bowel Preparation Quality for Patients Undergoing Colonoscopy: A Randomized Controlled Quality Improvement Study. J Clin Gastroenterol 2022; 56:166-172. [PMID: 33471486 PMCID: PMC10065085 DOI: 10.1097/mcg.0000000000001497] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Accepted: 12/13/2020] [Indexed: 01/22/2023]
Abstract
OBJECTIVES Because of high historical no-show rates and poor bowel preparation quality in our unit, we sought to evaluate whether text message navigation for patients scheduled for colonoscopy would reduce no-show rates and improve bowel preparation quality compared with usual care. METHODS We performed a randomized controlled quality improvement study from April to August 2019 in an urban academic endoscopy unit. All patients scheduled for colonoscopy were randomly assigned to a control group that received usual care (paper instructions/nursing precalls) or to the intervention group that received usual care plus the text message program [short message service (SMS)]. The program provided timed-release instructions on dietary modifications and bowel preparation before colonoscopy. The primary outcome was no-shows. Secondary outcomes were no-show/same-day cancellations, no-show/cancellations within 7 days of the procedure, and bowel preparation quality. RESULTS A total of 1625 patients were randomized (SMS=833, control=792). No-show rates were significantly lower in the SMS group compared with the control group (8% vs. 14%; P<0.0001). Similar results were found for no-show/same-day cancellations (10% vs. 16%; P=0.0003), and no-show/cancellations within 7 days (18% vs. 26%; P=0.0008). There was no difference in adequate bowel preparation for all colonoscopies between the groups (89% vs. 87%; P=0.47). However, rates of adequate bowel preparation for screening/surveillance colonoscopies were significantly higher in SMS versus control groups (93% vs. 88%; P=0.04). CONCLUSIONS Text message navigation for patients scheduled for colonoscopy improved the quality of colorectal cancer screening by decreasing no-show rates and increasing adequate bowel preparation rates in patients undergoing screening colonoscopy compared with usual care.
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Affiliation(s)
- Olga Solonowicz
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Matt Stier
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Karen Kim
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Sonia Kupfer
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
| | - Elliot Tapper
- Section of Gastroenterology, Department of Medicine, University of Michigan Medicine, Ann Arbor, MI 48109
| | - Neil Sengupta
- Section of Gastroenterology, Hepatology and Nutrition, Department of Medicine, University of Chicago Medicine, Chicago IL, 60637
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9
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Malo TL, Correa SY, Moore AA, Ferrari RM, Leeman J, Brenner AT, Wheeler SB, Tan X, Reuland DS. Centralized colorectal cancer screening outreach and patient navigation for vulnerable populations in North Carolina: study protocol for the SCORE randomized controlled trial. Implement Sci Commun 2021; 2:113. [PMID: 34620250 PMCID: PMC8499575 DOI: 10.1186/s43058-021-00194-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/15/2021] [Accepted: 07/31/2021] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND Although colorectal cancer (CRC) screening is effective in reducing CRC mortality, screening rates in vulnerable populations served by community health centers (CHCs) remain below national targets. CHCs in North Carolina are challenged to reach CRC screening targets as they tend to be under-resourced, have limited capacity to implement and sustain population health interventions, and typically operate independently from one another and from regional colonoscopy providers. The Scaling Colorectal Cancer Screening Through Outreach, Referral, and Engagement (SCORE) project is designed to address barriers to CRC screening in partnership with CHCs by implementing a multilevel intervention that includes centralized support infrastructure for mailed fecal immunochemical test (FIT) outreach and patient navigation to follow-up colonoscopy. This paper describes protocols for the SCORE implementation trial. METHODS We will conduct a type 2 hybrid effectiveness-implementation trial that will assess effectiveness at increasing CRC screening and follow-up rates while also assessing implementation outcomes. The planned trial sample will include 4000 CHC patients who are at average CRC risk and due for screening. Participants will be randomized 1:1 to receive either usual care or a multilevel intervention that includes mailed FIT outreach and patient navigation support to follow-up colonoscopy for those with abnormal FIT. The primary effectiveness outcome is completion of any CRC screening test at six months after randomization. We will also conduct a multilevel assessment of implementation outcomes and determinants. DISCUSSION This hybrid effectiveness-implementation trial will evaluate the effectiveness and implementation of an intervention that provides centralized infrastructure for mailed FIT screening and patient navigation for CHCs that operate independently of other healthcare facilities. Findings from this research will enhance understanding of the effectiveness of a centralized approach and factors that determine successful implementation in vulnerable patient populations. TRIAL REGISTRATION The trial was registered on May 28, 2020, at ClinicalTrials.gov (identifier NCT04406714).
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Affiliation(s)
- Teri L. Malo
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
| | - Sara Y. Correa
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
| | - Alexis A. Moore
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
| | - Renée M. Ferrari
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
| | - Jennifer Leeman
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
- School of Nursing, University of North Carolina at Chapel Hill, 120 North Medical Drive, Chapel Hill, NC 27599 USA
| | - Alison T. Brenner
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC 27599 USA
| | - Stephanie B. Wheeler
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
- Gillings School of Global Public Health, University of North Carolina at Chapel Hill, 135 Dauer Drive, Chapel Hill, NC 27599 USA
| | - Xianming Tan
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
| | - Daniel S. Reuland
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 450 West Drive, Chapel Hill, NC 27599 USA
- School of Medicine, University of North Carolina at Chapel Hill, 5034 Old Clinic Building, Chapel Hill, NC 27599 USA
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10
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Ramli NS, Manaf MRA, Hassan MR, Ismail MI, Nawi AM. Effectiveness of Colorectal Cancer Screening Promotion Using E-Media Decision Aids: A Systematic Review and Meta-Analysis. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18158190. [PMID: 34360481 PMCID: PMC8345994 DOI: 10.3390/ijerph18158190] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/24/2021] [Revised: 07/30/2021] [Accepted: 07/30/2021] [Indexed: 12/09/2022]
Abstract
Colorectal cancer (CRC)-screening reduces mortality, yet remains underutilized. The use of electronic media (e-media) decision aids improves saliency and fosters informed decision-making. This systematic review aimed to determine the effectiveness of CRC-screening promotion, using e-media decision aids in primary healthcare (PHC) settings. Three databases (MEDLINE, Web of Science, and the Cochrane Library) were searched for eligible studies. Studies that evaluated e-media decision aids compared to usual care or other conditions were selected. Quality was assessed by using Cochrane tools. Their effectiveness was measured by CRC-screening completion rates, and meta-analysis was conducted to calculate the pooled estimates. Ten studies involving 9393 patients were included in this review. Follow-up durations spanned 3–24 months. The two types of decision-aid interventions used were videos and interactive multimedia programs, with durations of 6–15 min. Data from nine feasible studies with low or some risk of bias were synthesized for meta-analysis. A random-effects model revealed that CRC-screening promotion using e-media decision aids were almost twice as likely to have screening completion than their comparisons (OR 1.62, 95% CI: 1.03–2.62, p < 0.05). CRC-screening promotion through e-media has great potential for increasing screening participation in PHC settings. Thus, its development should be prioritized, and it should be integrated into existing programs.
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Affiliation(s)
- Nur Suhada Ramli
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (N.S.R.); (M.R.A.M.); (M.R.H.)
- Ministry of Health, Malaysia, Federal Government Administrative Centre, Putrajaya 62514, Malaysia
| | - Mohd Rizal Abdul Manaf
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (N.S.R.); (M.R.A.M.); (M.R.H.)
| | - Mohd Rohaizat Hassan
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (N.S.R.); (M.R.A.M.); (M.R.H.)
| | - Muhamad Izwan Ismail
- Department of Surgery, Hospital Sultanah Aminah, Jalan Persiaran Abu Bakar Sultan, Johor Bahru 80100, Malaysia;
| | - Azmawati Mohammed Nawi
- Department of Community Health, Faculty of Medicine, Universiti Kebangsaan Malaysia, Jalan Yaakob Latif, Cheras, Kuala Lumpur 56000, Malaysia; (N.S.R.); (M.R.A.M.); (M.R.H.)
- Correspondence:
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11
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Farr DE, Haynes VE, Armstead CA, Brandt HM. Stakeholder Perspectives on Colonoscopy Navigation and Colorectal Cancer Screening Inequities. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2021; 36:670-676. [PMID: 31970699 DOI: 10.1007/s13187-019-01684-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/29/2023]
Abstract
Black adults complete colonoscopies at lower rates than other groups despite increased colorectal cancer risk. Patient navigation represents a strategy to address the varied factors that influence colonoscopy completion, but few reports describe how navigation reduces racial disparities in colorectal cancer screening rates. The purpose of this study was to understand how a statewide colonoscopy navigation program addressed the challenges faced by low-income Black adults attempting to complete screening colonoscopy. A qualitative case study analysis was conducted at a participating clinical site of a statewide colonoscopy navigation program. Clinical observations, document reviews, and semi-structured interviews were conducted with patients, patient navigators, and clinical staff. Patient participants were recruited to ensure maximum variation related to gender and colonoscopy completion. Thematic coding allowed researchers to examine experiences, perceptions, and emotions related to patient navigation. In total, 31 interviews were completed between October 2014 and February 2015. Patients and patient navigators reported logistical, psychosocial, and knowledge-related barriers to colonoscopy completion. Clinical staff reports focused mostly on logistical barriers. Benefits of patient navigation also varied by participant type with clinical staff revealing positive effects on the clinic's relationships with referring specialty practices. Patient navigators address barriers that are important to patients, but often unseen by clinical staff/providers. New information about the benefits different stakeholders derive from this strategy was revealed. Together these findings provide insight into the processes associated with this strategy and novel information about the appeal of patient navigation to various stakeholders.
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Affiliation(s)
- Deeonna E Farr
- Department of Health Education and Promotion, College of Health and Human Performance, East Carolina University, 2307 Carol G. Belk Building, Mail Stop 529, Greenville, NC, 27858, USA.
| | - Venice E Haynes
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
| | - Cheryl A Armstead
- Department of Psychology, University of South Carolina Health Equity Laboratory, Barnwell College, Rm. 429, University of South Carolina, Columbia, SC, 29208, USA
| | - Heather M Brandt
- Department of Health Promotion, Education, and Behavior, Arnold School of Public Health, University of South Carolina, 915 Greene Street, Columbia, SC, 29208, USA
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12
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Hyams T, Mueller N, Curbow B, King-Marshall E, Sultan S. Screening for colorectal cancer in people ages 45-49: research gaps, challenges and future directions for research and practice. Transl Behav Med 2021; 12:198-202. [PMID: 34184736 DOI: 10.1093/tbm/ibab079] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Travis Hyams
- National Cancer Institute, Division of Cancer Control and Population Sciences, Office of the Director, Rockville, MD, USA.,Department of Behavioral and Community Health, University of Maryland, College Park, School of Public Health, College Park, MD USA
| | - Nora Mueller
- Department of Social and Behavioral Sciences, Harvard T.H. Chan School of Public Health, Boston, MA, USA
| | - Barbara Curbow
- Department of Behavioral and Community Health, University of Maryland, College Park, School of Public Health, College Park, MD USA
| | - Evelyn King-Marshall
- Department of Behavioral and Community Health, University of Maryland, College Park, School of Public Health, College Park, MD USA
| | - Shahnaz Sultan
- Department of Medicine, Division of Gastroenterology, Hepatology, and Nutrition, University of Minnesota, Minneapolis, MN, USA
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13
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Petrik AF, Keast E, Johnson ES, Smith DH, Coronado GD. Development of a multivariable prediction model to identify patients unlikely to complete a colonoscopy following an abnormal FIT test in community clinics. BMC Health Serv Res 2020; 20:1028. [PMID: 33172444 PMCID: PMC7654150 DOI: 10.1186/s12913-020-05883-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/19/2019] [Accepted: 10/31/2020] [Indexed: 12/23/2022] Open
Abstract
Background Colorectal cancer (CRC) is the 3rd leading cancer killer among men and women in the US. The Strategies and Opportunities to STOP Colon Cancer in Priority Populations (STOP CRC) project aimed to increase CRC screening among patients in Federally Qualified Health Centers (FQHCs) through a mailed fecal immunochemical test (FIT) outreach program. However, rates of completion of the follow-up colonoscopy following an abnormal FIT remain low. We developed a multivariable prediction model using data available in the electronic health record to assess the probability of patients obtaining a colonoscopy following an abnormal FIT test. Methods To assess the probability of obtaining a colonoscopy, we used Cox regression to develop a risk prediction model among a retrospective cohort of patients with an abnormal FIT result. Results Of 1596 patients with an abnormal FIT result, 556 (34.8%) had a recorded colonoscopy within 6 months. The model shows an adequate separation of patients across risk levels for non-adherence to follow-up colonoscopy (bootstrap-corrected C-statistic > 0.63). The refined model included 8 variables: age, race, insurance, GINI income inequality, long-term anticoagulant use, receipt of a flu vaccine in the past year, frequency of missed clinic appointments, and clinic site. The probability of obtaining a follow-up colonoscopy within 6 months varied across quintiles; patients in the lowest quintile had an estimated 18% chance, whereas patients in the top quintile had a greater than 55% chance of obtaining a follow-up colonoscopy. Conclusions Knowing who is unlikely to follow-up on an abnormal FIT test could help identify patients who need an early intervention aimed at completing a follow-up colonoscopy. Trial registration This trial was registered at ClinicalTrials.gov (NCT01742065) on December 5, 2012. The protocol is available. Supplementary Information The online version contains supplementary material available at 10.1186/s12913-020-05883-2.
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Affiliation(s)
- Amanda F Petrik
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR, 97381, USA.
| | - Erin Keast
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR, 97381, USA
| | - Eric S Johnson
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR, 97381, USA
| | - David H Smith
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR, 97381, USA
| | - Gloria D Coronado
- The Center for Health Research, Kaiser Permanente Northwest, 3800 N. Interstate Avenue, Portland, OR, 97381, USA
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14
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Safizadeh H, Mangolian Shahrbabaki P, Hafezpour S. Organizational Transformation to Improve Breast Cancer Screening Behaviors in Iranian Women: A Qualitative Study. INTERNATIONAL QUARTERLY OF COMMUNITY HEALTH EDUCATION 2020; 42:21-27. [PMID: 33167793 DOI: 10.1177/0272684x20972647] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
Abstract
Breast cancer is the most common cause of premature mortality among women, and screening is one of the most important means of early diagnosis of breast cancer. This qualitative study was conducted to explore strategies for promoting breast cancer screening behaviors from the perspective of health volunteers in south-east Iran. Data collection was performed through focus groups. Using the purposive sampling method, 35 participants were selected and data were analyzed using a specific qualitative content analysis framework. By analyzing the data to provide strategies for promoting breast cancer screening behaviors, the main theme of "organizational transformation" with five subthemes including the promotion of health-centered beliefs in society, the development of culture-based training, the media revolution, financial support, and the provision of efficient health-care providers were extracted. According to the results of the study, the development of organizational transformation plays an important role in planning for the promotion of breast cancer screening.
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Affiliation(s)
- Hossein Safizadeh
- Department of Community Medicine, School of Medicine, Research Center for Social Determinants of Health, Institute for Futures Studies in Health, Kerman University of Medical Sciences, Kerman, Iran
| | - Parvin Mangolian Shahrbabaki
- Nursing Research Center, Department of Critical Care Nursing, Razi Faculty of Nursing and Midwifery, Kerman University of Medical Sciences, Kerman, Iran
| | - Sara Hafezpour
- Community Health Practitioner, Shiraz University of Medical Sciences, Shiraz, Iran
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15
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Abstract
Colorectal cancer screening is essential to detect and remove premalignant lesions to prevent the development of colorectal cancer. Multiple screening modalities are available, including colonoscopy and stool-based testing. Colonoscopy remains the gold standard for detection and removal of premalignant colorectal lesions. Screening guidelines by the American Cancer Society now recommend initiating screening for all average-risk adults at 45 years old. Family history of colorectal cancer, other cancers, and advanced colon polyps are strong risk factors that must be considered in order to implement earlier testing. Epidemiologic studies continue to show disparities in colorectal cancer incidence and mortality and wide variability in screening rates.
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Affiliation(s)
- Eric M Montminy
- Division of Gastroenterology, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Albert Jang
- Department of Internal Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Michael Conner
- Department of Internal Medicine, Tulane University School of Medicine, 1430 Tulane Avenue, New Orleans, LA 70112, USA
| | - Jordan J Karlitz
- Southeast Louisiana Veterans Health Care System, Gastroenterology Section, 2400 Canal St, Medicine Service, Ste 3H, New Orleans, LA 70119, USA; Division of Gastroenterology, Tulane University School of Medicine, New Orleans, LA 70112, USA.
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16
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Breast Cancer Screening Shared Decision-Making in Older African-American Women. J Natl Med Assoc 2020; 112:556-560. [PMID: 32624238 DOI: 10.1016/j.jnma.2020.05.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2018] [Accepted: 05/19/2020] [Indexed: 11/23/2022]
Abstract
BACKGROUND Discussions about whether to continue breast cancer screening in older women are complex, particularly for African American women. Decision aids may be helpful in guiding these conversations; however, little is known about the feasibility and acceptability of using breast cancer decision aids in older African American women. This study explored African American women's knowledge of breast cancer screening guidelines in older adults, prior conversations with providers regarding continuation of screening, and their understanding/willingness to engage in discussions about individualized breast cancer screening decision-making using two versions of tested decision aids. METHODS Twenty-four African American women; (age m = 83) in urban geriatric practice. Interviews with African American women age 75+. Both DAs include age, health/functional status, and comorbidities questions to determine a BCS harms/benefit score. RESULTS Most participants (75%) reported familiarity with current breast cancer screening guidelines. Twenty-nine percent reported prior discussions with providers about continuing breast cancer screenings. Sixty percent did not need assistance completing DAs while 40% did. 66.7% found the decision aids "very helpful" in reflecting their breast cancer screening thoughts; 58.3% had no preference regarding either decision aid version. 75% of participants were willing to complete the decision aid before a provider visit. Participants equally preferred a health educator or provider facilitating discussion of breast cancer screening harms and benefits and potential cessation. CONCLUSIONS Older African American women are willing to engage in discussions about whether or not to continue breast cancer screening and found decision aids helpful.
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Abstract
Most screening in the United States occurs in an opportunistic fashion, although organized screening occurs in some integrated health care systems. Organized colorectal cancer (CRC) screening consists of an explicit screening policy, defined target population, implementation team, health care team for clinical care delivery, quality assurance infrastructure, and method for identifying cancer outcomes. Implementation of an organized screening program offers opportunities to systematically assess the success of the program and develop interventions to address identified gaps in an effort to optimize CRC outcomes. There is evidence of that organized screening is associated with improvements in screening participation and CRC mortality.
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Affiliation(s)
- Jason A Dominitz
- Veterans Health Administration, University of Washington School of Medicine, Seattle, WA, USA.
| | - Theodore R Levin
- Gastroenterology Department, Kaiser Permanente Medical Center, The Permanente Medical Group, 1425 South Main Street, Walnut Creek, CA 94596, USA; The Kaiser Permanente Division of Research, Oakland, CA 94612, USA
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18
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Shah SC, Nunez H, Chiu S, Hazan A, Chen S, Wang S, Itzkowitz S, Jandorf L. Low baseline awareness of gastric cancer risk factors amongst at-risk multiracial/ethnic populations in New York City: results of a targeted, culturally sensitive pilot gastric cancer community outreach program. ETHNICITY & HEALTH 2020; 25:189-205. [PMID: 29115149 DOI: 10.1080/13557858.2017.1398317] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/20/2017] [Accepted: 10/16/2017] [Indexed: 06/07/2023]
Abstract
Background and Aims: There are limited efforts to address modifiable risk factors for gastric cancer (GC) among racial/ethnic groups at higher GC risk, which may reflect decreased public awareness of risk factors. Our primary aim was to assess baseline awareness of GC risk factors and attitudes/potential barriers for uptake of a GC screening program among high-risk individuals.Methods: Participants attended a linguistically and culturally targeted GC educational program in East Harlem (EH)/Bronx and Chinatown communities in New York City. Demographic information and relevant behavioral/lifestyle habits were collected. Participants' ability to identify GC risk factors and attitudes/barriers surrounding GC screening were assessed before and after the program.Results: Of the 168 included participants, most were female with 77% above age 70. Nearly half of participants in the EH/Bronx programs identified themselves as black and 63% as Hispanic/Latino; 93% of the Chinatown participants identified as Chinese. Among EH/Bronx participants, the majority correctly identified older age, smoking, alcohol, H. pylori, family history, race/ethnicity, excess salt, and preserved foods as risk factors. Among Chinatown participants, the majority correctly identified smoking, alcohol, race/ethnicity, and excess salt, although only 53% and 57.8% correctly identified H. pylori and preserved foods, respectively; the majority incorrectly answered that older age was not a major risk factor. The majority in both groups failed to identify male gender as higher risk and incorrectly identified stress and obesity as major risk factors. Participants were more concerned about the potential findings on GC screening tests than the risks and costs or having to take time off work.Conclusion: Among multiracial/ethnic groups of individuals presumably at higher risk for GC, we identified several gaps in baseline knowledge of both modifiable and non-modifiable GC risk factors. Culturally and linguistically appropriate educational interventions may be a worthwhile adjunctive intervention within the context of a targeted GC screening program.
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Affiliation(s)
- Shailja C Shah
- Department of Medicine, The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Helen Nunez
- Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sophia Chiu
- Asian Pacific Medical Student Association Chapter, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Ariela Hazan
- Asian Pacific Medical Student Association Chapter, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Sida Chen
- Asian Pacific Medical Student Association Chapter, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Shutao Wang
- Asian Pacific Medical Student Association Chapter, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Steven Itzkowitz
- Department of Medicine, The Dr. Henry D. Janowitz Division of Gastroenterology, Icahn School of Medicine at Mount Sinai, New York, NY, USA
- Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Lina Jandorf
- Division of Cancer Prevention and Control, Department of Oncological Sciences, Icahn School of Medicine at Mount Sinai, New York, NY, USA
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Temucin E, Nahcivan NO. The Effects of the Nurse Navigation Program in Promoting Colorectal Cancer Screening Behaviors: a Randomized Controlled Trial. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:112-124. [PMID: 30470978 DOI: 10.1007/s13187-018-1448-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Although screening programs are known and recommended for the early detection of colorectal cancer (CRC), the screening rates for the fecal occult blood test (FOBT) and colonoscopy are very low among adult individuals. Navigation programs, also known as individualized counseling, have recently begun to be used for increasing screening rates. The purpose of this study was to compare the efficacy of the Nurse Navigation Program versus usual care on CRC screening participation and movement in stage of adoption for CRC screening and to examine perceived benefits of and barriers to CRC screening. This study was designed in line with a pre- and posttest two-group methodology. A total of 110 participants (55 nurse-navigated and 55 non-navigated patients) were studied. Data were collected using the following three tools: a sociodemographic information form, the Harvard Colorectal Cancer Risk Assessment Tool, and Instruments to Measure Colorectal Cancer Screening Benefits and Barriers. Following the Nurse Navigation Program, the FOBT (82 and 84%, respectively) and colonoscopy completion rates (15 and 22%, respectively) were significantly higher in the nurse-navigated group than in the non-navigated group at 3 and 6 months follow-up. Following the program, the benefit perceptions of the nurse-navigated group about CRC screening were improved, and their barrier perceptions were reduced. The results showed that the Nurse Navigation Program had significant effects on CRC screening behavior and health-related beliefs concerning CRC screening. Further assessment of the Nurse Navigation Program in different groups should be performed to observe its effects.
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Affiliation(s)
- Elif Temucin
- Nursing Faculty, Oncology Nursing Department, University of Health Sciences, Istanbul, Turkey.
| | - Nursen O Nahcivan
- Florence Nightingale Nursing Faculty, Public Health Nursing Department, Istanbul University, Istanbul, Turkey
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20
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Barrington WE, DeGroff A, Melillo S, Vu T, Cole A, Escoffery C, Askelson N, Seegmiller L, Gonzalez SK, Hannon P. Patient navigator reported patient barriers and delivered activities in two large federally-funded cancer screening programs. Prev Med 2019; 129S:105858. [PMID: 31647956 PMCID: PMC7055651 DOI: 10.1016/j.ypmed.2019.105858] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2019] [Revised: 09/20/2019] [Accepted: 09/24/2019] [Indexed: 11/17/2022]
Abstract
Few data are available on patient navigators (PNs) across diverse roles and organizational settings that could inform optimization of patient navigation models for cancer prevention. The National Breast and Cervical Cancer Early Detection Program (NBCCEDP) and the Colorectal Cancer and Control Program (CRCCP) are two federally-funded screening programs that support clinical- and community-based PNs who serve low-income and un- or underinsured populations across the United States. An online survey assessing PN characteristics, delivered activities, and patient barriers to screening was completed by 437 of 1002 identified PNs (44%). Responding PNs were racially and ethnically diverse, had varied professional backgrounds and practice-settings, worked with diverse populations, and were located within rural and urban/suburban locations across the U.S. More PNs reported working to promote screening for breast/cervical cancers (BCC, 94%) compared to colorectal cancer (CRC, 39%). BCC and CRC PNs reported similar frequencies of individual- (e.g., knowledge, motivation, fear) and community-level patient barriers (e.g., beliefs about healthcare and screening). Despite reporting significant patient structural barriers (e.g., transportation, work and clinic hours), most BCC and CRC PNs delivered individual-level navigation activities (e.g., education, appointment reminders). PN training to identify and champion timely and patient-centered adjustments to organizational policies, practices, and norms of the NBCCEDP, CRCCP, and partner organizations may be beneficial. More research is needed to determine whether multilevel interventions that support this approach could reduce structural barriers and increase screening and diagnostic follow-up among the marginalized communities served by these two important cancer-screening programs.
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Affiliation(s)
| | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Stephanie Melillo
- Centers for Disease Control and Prevention, Atlanta, GA, United States of America
| | - Thuy Vu
- University of Washington, Seattle, WA, United States of America
| | - Allison Cole
- University of Washington, Seattle, WA, United States of America
| | - Cam Escoffery
- Emory University, Atlanta, GA, United States of America
| | | | | | | | - Peggy Hannon
- University of Washington, Seattle, WA, United States of America
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Hannon PA, Maxwell AE, Escoffery C, Vu T, Kohn MJ, Gressard L, Dillon-Sumner L, Mason C, DeGroff A. Adoption and Implementation of Evidence-Based Colorectal Cancer Screening Interventions Among Cancer Control Program Grantees, 2009-2015. Prev Chronic Dis 2019; 16:E139. [PMID: 31603404 PMCID: PMC6795067 DOI: 10.5888/pcd16.180682] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
Purpose and Objectives Colorectal cancer (CRC) is the second-leading cause of cancer death in the United States. Although effective CRC screening tests exist, CRC screening is underused. Use of evidence-based interventions (EBIs) to increase CRC screening could save many lives. The Colorectal Cancer Control Program (CRCCP) of the Centers for Disease Control and Prevention (CDC) provides a unique opportunity to study EBI adoption, implementation, and maintenance. We assessed 1) the number of grantees implementing 5 EBIs during 2011 through 2015, 2) grantees’ perceived ease of implementing each EBI, and 3) grantees’ reasons for stopping EBI implementation. Intervention Approach CDC funded 25 states and 4 tribal entities to participate in the CRCCP. Grantees used CRCCP funds to 1) provide CRC screening to individuals who were uninsured and low-income, and 2) promote CRC screening at the population level. One component of the CRC screening promotion effort was implementing 1 or more of 5 EBIs to increase CRC screening rates. Evaluation Methods We surveyed CRCCP grantees about EBI implementation with an online survey in 2011, 2012, 2013, and 2015. We conducted descriptive analyses of closed-ended items and coded open-text responses for themes related to barriers and facilitators to EBI implementation. Results Most grantees implemented small media (≥25) or client reminders (≥21) or both all program years. Although few grantees reported implementation of EBIs such as reducing structural barriers (n = 14) and provider reminders (n = 9) in 2011, implementation of these EBIs increased over time. Implementation of provider assessment and feedback increased over time, but was reported by the fewest grantees (n = 17) in 2015. Reasons for discontinuing EBIs included funding ending, competing priorities, or limited staff capacity. Implications for Public Health CRCCP grantees implemented EBIs across all years studied, yet implementation varied by EBI and did not get easier with time. Our findings can inform long-term planning for EBIs with state and tribal public health institutions and their partners.
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Affiliation(s)
- Peggy A Hannon
- University of Washington, Seattle, Washington.,1107 NE 45th St, Ste 200, Seattle, WA 98105.
| | | | | | - Thuy Vu
- University of Washington, Seattle, Washington
| | | | | | | | | | - Amy DeGroff
- Centers for Disease Control and Prevention, Atlanta, Georgia
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Llovet D, Serenity M, Conn LG, Bravo CA, McCurdy BR, Dubé C, Baxter NN, Paszat L, Rabeneck L, Peters A, Tinmouth J. Reasons For Lack of Follow-up Colonoscopy Among Persons With A Positive Fecal Occult Blood Test Result: A Qualitative Study. Am J Gastroenterol 2018; 113:1872-1880. [PMID: 30361625 PMCID: PMC6768592 DOI: 10.1038/s41395-018-0381-4] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/14/2018] [Accepted: 08/25/2018] [Indexed: 12/11/2022]
Abstract
OBJECTIVES Follow-up colonoscopy rates among persons with positive fecal occult blood test results (FOBT + ) remain suboptimal in many jurisdictions. In Ontario, Canada, primary care providers (PCPs) are responsible for arranging follow-up colonoscopies. The objectives were to understand the reasons for a lack of follow-up colonoscopy and any action plans to address follow-up. METHODS Semi-structured interviews were conducted with 30 FOBT+ persons and 30 PCPs in Ontario. Eligible FOBT+ persons were identified through administrative databases and included those aged 50-74, with a 6-12 month old FOBT+, no follow-up colonoscopy, and no prior colorectal cancer diagnosis or colectomy. Eligible PCPs had ≥1 rostered FOBT+ person without follow-up colonoscopy. Transcripts were analyzed inductively using Nvivo 11 (QSR International Pty Ltd., 2015). RESULTS Reasons for lack of follow-up colonoscopy were: person and/or provider believed the FOBT + was a false positive; person was afraid of colonoscopy; person had other health issues; and breakdown in communication of FOBT+ results or colonoscopy appointments. PCPs who initially recommended follow-up colonoscopy did not change the minds of the persons who dismissed the FOBT+ as a false positive and/or who were afraid of the procedure. These FOBT+ persons negotiated an alternative follow-up action plan including repeating the FOBT or not following-up. CONCLUSIONS PCPs may not adequately counsel FOBT+ persons who believe the FOBT+ is a false positive and/or fear colonoscopy. PCPs may lack fail-safe systems to communicate FOBT+ results and colonoscopy appointments. Using navigators may help address these barriers and increase follow-up rates.
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Affiliation(s)
- Diego Llovet
- 1Cancer Care Ontario, Toronto, Canada.,2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada
| | | | - Lesley Gotlib Conn
- 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,3Sunnybrook Research Institute, Toronto, Canada
| | | | | | - Catherine Dubé
- 1Cancer Care Ontario, Toronto, Canada.,4Department of Medicine, University of Ottawa, Ottawa, Canada
| | - Nancy N. Baxter
- 5Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.,6Department of Surgery, St. Michael's Hospital, Toronto, Canada
| | - Lawrence Paszat
- 2Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada.,7Institute for Clinical Evaluative Sciences, Toronto, Canada
| | - Linda Rabeneck
- 1Cancer Care Ontario, Toronto, Canada.,8Department of Medicine, University of Toronto, Toronto, Canada
| | | | - Jill Tinmouth
- 1Cancer Care Ontario, Toronto, Canada.,8Department of Medicine, University of Toronto, Toronto, Canada
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23
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Subramanian S, Hoover S, Tangka FKL, DeGroff A, Soloe CS, Arena LC, Schlueter DF, Joseph DA, Wong FL. A conceptual framework and metrics for evaluating multicomponent interventions to increase colorectal cancer screening within an organized screening program. Cancer 2018; 124:4154-4162. [PMID: 30359464 DOI: 10.1002/cncr.31686] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2018] [Revised: 06/12/2018] [Accepted: 06/13/2018] [Indexed: 12/19/2022]
Abstract
BACKGROUND Multicomponent, evidence-based interventions are viewed increasingly as essential for increasing the use of colorectal cancer (CRC) screening to meet national targets. Multicomponent interventions involve complex care pathways and interactions across multiple levels, including the individual, health system, and community. METHODS The authors developed a framework and identified metrics and data elements to evaluate the implementation processes, effectiveness, and cost effectiveness of multicomponent interventions used in the Centers for Disease Control and Prevention's Colorectal Cancer Control Program. RESULTS Process measures to evaluate the implementation of interventions to increase community and patient demand for CRC screening, increase patient access, and increase provider delivery of services are presented. In addition, performance measures are identified to assess implementation processes along the continuum of care for screening, diagnosis, and treatment. Series of intermediate and long-term outcome and cost measures also are presented to evaluate the impact of the interventions. CONCLUSIONS Understanding the effectiveness of multicomponent, evidence-based interventions and identifying successful approaches that can be replicated in other settings are essential to increase screening and reduce CRC burden. The use of common framework, data elements, and evaluation methods will allow the performance of comparative assessments of the interventions implemented across CRCCP sites to identify best practices for increasing colorectal screening, particularly among underserved populations, to reduce disparities in CRC incidence and mortality.
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Affiliation(s)
| | | | - Florence K L Tangka
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Amy DeGroff
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | | | | | - Dara F Schlueter
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Djenaba A Joseph
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
| | - Faye L Wong
- Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia
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24
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McGregor LM, Kerrison RS, Green T, Macleod U, Hughes M, Gibbins M, Morris S, Rees C, von Wagner C. Using primary care-based paper and telephone interventions to increase uptake of bowel scope screening in Yorkshire: a protocol of a randomised controlled trial. BMJ Open 2018; 8:e024616. [PMID: 30056395 PMCID: PMC6067356 DOI: 10.1136/bmjopen-2018-024616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2018] [Revised: 06/12/2018] [Accepted: 06/25/2018] [Indexed: 11/10/2022] Open
Abstract
INTRODUCTION Evidence suggests bowel scope screening (BSS) can significantly reduce an individual's risk of developing colorectal cancer (CRC). BSS for 55 year olds was therefore introduced to the English Bowel Cancer Screening Programme (BCSP) in 2013. However, the benefits are only gained from test completion and uptake is low (43%). Primary care involvement has consistently shown benefits to cancer screening uptake and so this study aims to build on this knowledge and evaluate general practitioner (GP) practice led interventions designed to increase BSS attendance. METHODS AND ANALYSIS A three-arm randomised controlled trial will be conducted to evaluate three interventions: one intervention for prospective BSS invitees (primer letter with locally tailored leaflet sent by an individual's GP practice) and two interventions for those who do not attend their BSS appointment (a self-referral letter sent by an individual's GP practice and a patient navigation call made on behalf of an individual's GP practice). The trial will be set in Yorkshire. Individuals soon to receive their invitation to attend BSS at one of the Hull and East Yorkshire Bowel Cancer Screening centre sites, will be randomly assigned to one of three groups: control (usual care; no input from GP practice), Intervention group A (primer letter/leaflet and a self-referral letter), Intervention group B (primer letter/leaflet and a patient navigation call). Attendance data will be obtained from the BCSP database (via National Health Service (NHS) Digital) 3 months after the last intervention. Regression analysis will compare uptake, and additional clinical outcomes, across the three groups. The analysis will be multivariate and adjust for several covariates including gender and area-level deprivation. ETHICS AND DISSEMINATION NHS ethical approval has been obtained from London-Harrow Research Ethics Committee. The results will be submitted for publication in a peer-reviewed journal and presented at conferences. TRIAL REGISTRATION NUMBER ISRCTN16252122; Pre-results.
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Affiliation(s)
- Lesley M McGregor
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Robert S Kerrison
- Research Department of Behavioural Science and Health, University College London, London, UK
| | - Trish Green
- Hull York Medical School, University of Hull, Hull, UK
| | - Una Macleod
- Hull York Medical School, University of Hull, Hull, UK
| | - Mark Hughes
- Hull and East Yorkshire Bowel Cancer Screening Centre, Hull and East Yorkshire Hospitals NHS Trust, Castle Hill Hospital, Hull, UK
| | | | - Stephen Morris
- Department of Applied Health Research, University College London, London, UK
| | - Colin Rees
- South Tyneside NHS Foundation Trust, South Tyneside District Hospital, South Shields, UK
| | - Christian von Wagner
- Research Department of Behavioural Science and Health, University College London, London, UK
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25
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Valverde PA, Calhoun E, Esparza A, Wells KJ, Risendal BC. The early dissemination of patient navigation interventions: results of a respondent-driven sample survey. Transl Behav Med 2018; 8:456-467. [PMID: 29800405 DOI: 10.1093/tbm/ibx080] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022] Open
Abstract
Patient navigators (PNs) coordinate medical services and connect patients with resources to improve outcomes, satisfaction, and reduce costs. Little national information is available to inform workforce development. We analyzed 819 responses from an online PN survey conducted in 2009-2010. Study variables were mapped to the five Consolidated Framework for Implementation Research (CFIR) constructs to explore program variations by type of PN. Five logistic regression models compared each PN type to all others while adjusting for covariates. Thirty-five percent of respondents were nurse navigators, 28% lay navigators, 20% social work (SW)/counselor navigators, 7% allied health navigators, and 10% were "other" types of PNs. Most were non-Hispanic White (71%), female (94%), and at least college educated (70%). The primary differences were observed among: the core intervention tasks; position structure; work setting; health conditions navigated; navigator race/ethnicity; personal cancer experiences; navigation training; and patient populations served. Lay PNs had fewer odds of identifying as Hispanic, work in rural settings and assist underserved populations compared to others. Nurse navigators showed greater odds of clinical responsibilities, work in hospital or government settings and fewer odds of navigating minority populations compared to others. SW/counselor navigators also had additional duties, provided greater assistance to Medicare patient populations, and less odds of navigating underserved populations than others. In summary, our survey indicates that the type of PN utilized is an indicator of other substantial differences in program implementation. CFIR provides a robust method to compare differences and should incorporate care coordination outcomes in future PN research.
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Affiliation(s)
- Patricia A Valverde
- Department of Community and Behavioral Health, School of Public Health, Aurora, CO
| | - Elizabeth Calhoun
- University of Arizona, Office of the Senior Vice President for Health Sciences, Vice President for Population Health Sciences, Executive Director, Center for Population Science and Discovery, Roy P. Drachman Hall, Tucson, AZ
| | - Angelina Esparza
- Executive Staff Analyst/Chief Program Officer, Houston Department for Health and Human Services, Houston, TX
| | - Kristen J Wells
- Department of Psychology, San Diego State University, San Diego, CA
| | - Betsy C Risendal
- Department of Community and Behavioral Health, Colorado School of Public Health, Aurora, CO
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Gambla WC, Fernandez AM, Gassman NR, Tan MCB, Daniel CL. College tanning behaviors, attitudes, beliefs, and intentions: A systematic review of the literature. Prev Med 2017; 105:77-87. [PMID: 28867504 DOI: 10.1016/j.ypmed.2017.08.029] [Citation(s) in RCA: 26] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/15/2017] [Revised: 08/18/2017] [Accepted: 08/27/2017] [Indexed: 01/30/2023]
Abstract
Despite well-established links between exposure to ultraviolet radiation (UVR) and skin cancer, UVR-based tanning behaviors persist among college students. Understanding tanning motivations, perceptions, barriers, and demographic characteristics of this population is critical to modifying these behaviors, but is limited by variability in study design, sample size, and outcomes measured in the current literature. To help clarify the tanning behaviors of this population and provide a concise reference for future studies, this review examines existing reports to determine the comparability of tanning behaviors across multiple U.S. college populations. A systematic review of the literature was performed in July 2016 to identify studies investigating tanning behaviors among U.S. college students. Twenty-three studies met inclusion criteria. High rates of indoor tanning (IT) and outdoor tanning (OT) were found among college students. Key motivators included appearance, emotion, health perceptions, and the influence of parents, peers, and the media. Misconceptions regarding skin protection, low rates of sun protective behaviors, and tanning dependence were barriers against safe UVR exposure. Understudied demographic factors may account for variance in observed tanning behaviors, emphasizing the need for standardization efforts to consistently identify trends associated with geographical region, age, year in college, and sex. The findings presented in this review reaffirm that college students are at high risk for tanning-associated skin cancer, emphasizing the critical need for effective, targeted interventions. Improved interventions will reduce the burden of skin cancer within this group, ultimately contributing to longer, healthier lives.
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Affiliation(s)
- William C Gambla
- College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Alyssa M Fernandez
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States
| | - Natalie R Gassman
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States
| | - Marcus C B Tan
- College of Medicine, University of South Alabama, Mobile, AL, United States
| | - Casey L Daniel
- Division of Oncological Sciences, University of South Alabama Mitchell Cancer Institute, Mobile, AL, United States.
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28
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Ribisl KM, Fernandez ME, Friedman DB, Hannon PA, Leeman J, Moore A, Olson L, Ory M, Risendal B, Sheble L, Taylor VM, Williams RS, Weiner BJ. Impact of the Cancer Prevention and Control Research Network: Accelerating the Translation of Research Into Practice. Am J Prev Med 2017; 52:S233-S240. [PMID: 28215371 PMCID: PMC5812747 DOI: 10.1016/j.amepre.2016.08.026] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2016] [Revised: 07/29/2016] [Accepted: 08/18/2016] [Indexed: 12/18/2022]
Abstract
The Cancer Prevention and Control Research Network (CPCRN) is a thematic network dedicated to accelerating the adoption of evidence-based cancer prevention and control practices in communities by advancing dissemination and implementation science. Funded by the Centers for Disease Control and Prevention and National Cancer Institute, CPCRN has operated at two levels: Each participating network center conducts research projects with primarily local partners as well as multicenter collaborative research projects with state and national partners. Through multicenter collaboration, thematic networks leverage the expertise, resources, and partnerships of participating centers to conduct research projects collectively that might not be feasible individually. Although multicenter collaboration is often advocated, it is challenging to promote and assess. Using bibliometric network analysis and other graphical methods, this paper describes CPCRN's multicenter publication progression from 2004 to 2014. Searching PubMed, Scopus, and Web of Science in 2014 identified 249 peer-reviewed CPCRN publications involving two or more centers out of 6,534 total. The research and public health impact of these multicenter collaborative projects initiated by CPCRN during that 10-year period were then examined. CPCRN established numerous workgroups around topics such as: 2-1-1, training and technical assistance, colorectal cancer control, federally qualified health centers, cancer survivorship, and human papillomavirus. This paper discusses the challenges that arise in promoting multicenter collaboration and the strategies that CPCRN uses to address those challenges. The lessons learned should broadly interest those seeking to promote multisite collaboration to address public health problems, such as cancer prevention and control.
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Affiliation(s)
- Kurt M Ribisl
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina.
| | - Maria E Fernandez
- Department of Health Promotion and Behavioral Sciences, University of Texas Health Science Center at Houston, Houston, Texas
| | - Daniela B Friedman
- Department of Health Promotion, Education, and Behavior, University of South Carolina, Columbia, South Carolina
| | - Peggy A Hannon
- Department of Health Services, University of Washington, Seattle, Washington
| | - Jennifer Leeman
- Department of Health Care Environments, University of North Carolina School of Nursing, Chapel Hill, North Carolina
| | - Alexis Moore
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Lindsay Olson
- Department of Health Behavior, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Marcia Ory
- Department of Health Promotion and Community Health Sciences, Texas A&M University, College Station, Texas
| | - Betsy Risendal
- Department of Community and Behavioral Health, University of Colorado Denver, Denver, Colorado
| | - Laura Sheble
- Department of Social Medicine, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Vicky M Taylor
- Department of Health Services, University of Washington, Seattle, Washington
| | - Rebecca S Williams
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina; Center for Health Promotion and Disease Prevention, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
| | - Bryan J Weiner
- Department of Health Policy, University of North Carolina at Chapel Hill, Chapel Hill, North Carolina
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Domingo JLB, Braun KL. Characteristics of Effective Colorectal Cancer Screening Navigation Programs in Federally Qualified Health Centers: A Systematic Review. J Health Care Poor Underserved 2017; 28:108-126. [PMID: 28238992 PMCID: PMC5487219 DOI: 10.1353/hpu.2017.0013] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
In the U.S., colorectal cancer (CRC) incidence and mortality have declined due to screening and improvements in early detection; however, racial/ethnic disparities in screening and mortality persist. Patient navigation has been shown to be effective in increasing CRC screening prevalence. This systematic review answered three questions about navigation in federally qualified community health centers (FQHCs): 1) Which navigation activities increased CRC screening prevalence? 2) What were the challenges to implementing these programs in FQHCs? 3) Which clinic protocols supported screening completion? Findings suggest that navigation services must be tailored to the specific screening test provided. Federally qualified community health centers report difficulty maintaining a current electronic medical records system and sustaining funding; they should establish excellent patient tracking systems (for follow-up and annual rescreening) and establish multiple protocols to facilitate screening completion. With the movement toward patient-centered care models, patient navigation will be integral to FQHCs and their clients.
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Honeycutt S, Hermstad A, Carvalho ML, Arriola KRJ, Ballard D, Escoffery C, Kegler MC. Practice to Evidence: Using Evaluability Assessment to Generate Practice-Based Evidence in Rural South Georgia. HEALTH EDUCATION & BEHAVIOR 2016; 44:454-462. [DOI: 10.1177/1090198116673360] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Evidence from formal evaluation of real-world practice can address gaps in the public health knowledge base and provide information about feasible, relevant strategies for varied settings. Interest in evaluability assessment (EA) as an approach for generating practice-based evidence has grown. EA has been central to several structured assessment processes that identify and select promising programs and evaluate those most likely to produce useful findings. The Emory Prevention Research Center used EA as part of an initiative to generate practice-based evidence for cancer prevention in southwest Georgia. Our initiative consisted of five steps: (1) environmental scan to identify potential programs, (2) program selection, (3) EA, (4) evaluation, and (5) dissemination. We identified nine programs, four of which completed a formal application, and conducted two EAs. EAs consisted of document review, site visits, and literature reviews. The EA purpose was to assess the program model, data availability, stakeholder interest in evaluation, feasibility of an outcome evaluation, and potential contribution to the literature. We conducted one outcome evaluation and one descriptive qualitative study; both were published in peer-reviewed journals. The outcome evaluation addressed knowledge gaps about strategies to promote colorectal cancer screening. Results led to the program’s inclusion in national resources for practitioners seeking evidence-based practices and helped the community organization expand and strengthen the program. As part of a structured assessment process, EA can identify programs most likely to produce useful results for dissemination and is a viable approach for local initiatives to generate practice-based evidence in rural or low-resource settings.
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Rohan EA, Slotman B, DeGroff A, Morrissey KG, Murillo J, Schroy P. Refining the Patient Navigation Role in a Colorectal Cancer Screening Program: Results From an Intervention Study. J Natl Compr Canc Netw 2016; 14:1371-1378. [PMID: 27799508 DOI: 10.6004/jnccn.2016.0147] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/10/2016] [Accepted: 07/13/2016] [Indexed: 01/16/2023]
Abstract
BACKGROUND Oncology patient navigators help individuals overcome barriers to increase access to cancer screening, diagnosis, and timely treatment. This study, part of a randomized intervention trial investigating the efficacy of patient navigation in increasing colonoscopy completion, examined navigators' activities to ameliorate barriers to colonoscopy screening in a medically disadvantaged population. METHODS This study was conducted from 2012 through 2014 at Boston Medical Center. We analyzed navigator service delivery and survey data collected on 420 participants who were navigated for colonoscopy screening after randomization to this intervention. Key variables under investigation included barriers to colonoscopy, activities navigators undertook to reduce barriers, time navigators spent on each activity and per contact, and patient satisfaction with navigation services. Descriptive analysis assessed how navigators spent their time and examined what aspects of patient navigation were most valued by patients. RESULTS Navigators spent the most time assessing patient barriers/needs; facilitating appointment scheduling; reminding patients of appointments; educating patients about colorectal cancer, the importance of screening, and the colonoscopy preparation and procedures; and arranging transportation. Navigators spent an average of 44 minutes per patient. Patients valued the navigators, especially for providing emotional/peer support and explaining screening procedures and bowel preparation clearly. CONCLUSIONS Our findings help clarify the role of the navigator in colonoscopy screening within a medically disadvantaged community. These findings may help further refine the navigator role in cancer screening and treatment programs as facilities strive to effectively and efficiently integrate navigation into their services.
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Affiliation(s)
- Elizabeth A Rohan
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
| | - Beth Slotman
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
| | - Amy DeGroff
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
| | - Kerry Grace Morrissey
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
| | - Jennifer Murillo
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
| | - Paul Schroy
- From Division of Cancer Prevention and Control, Centers for Disease Control and Prevention, Atlanta, Georgia; Westat, Rockville, Maryland; and Boston Medical Center, Department of Gastroenterology, Boston, Massachusetts
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Yang R, Liu X, Thakolwiboon S, Zhu J, Pei X, An M, Tan Z, Lubman DM. Protein Markers Associated with an ALDH Sub-Population in Colorectal Cancer. JOURNAL OF PROTEOMICS & BIOINFORMATICS 2016; 9:238-247. [PMID: 28503055 PMCID: PMC5423664 DOI: 10.4172/jpb.1000412] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
Abstract
ALDH has been shown to be a marker that denotes a sub-population of cancer stem cells in colorectal and other cancers. This sub-population of cells shows an increased risk for tumor initiation, metastasis, and resistance to chemotherapy and radiation resulting in recurrence and death. It is thus essential to identify the important signaling pathways related to ALDH1+ CSCs in colon cancer. The essential issue becomes to isolate pure sub-populations of cells from heterogeneous tissues for further analysis. To achieve this goal, tissues from colorectal cancer Stage III patients were immuno-stained with ALDH1 antibody. Target ALDH1+ and ALDH1- cells from the same tissue were micro-dissected using Laser Capture Microdissection (LCM). Captured cells were lysed and analyzed using LC-MS/MS where around 20,000 cells were available for analysis. This analysis resulted in 134 proteins which were differentially expressed between ALDH1+ and ALDH1- cells in three patient sample pairs. Based on these differentially expressed proteins an IPA pathway analysis was performed that showed two key pathways in cell to cell signaling and organismal injury and abnormalities. The IPA analysis revealed β-catenin, NFκB (p65) and TGFβ1 as important cancer-related proteins in these pathways. A TMA validation using immunofluorescence staining of tissue micro-arrays including 170 cases was used to verify that these key proteins were highly overexpressed in ALDH1+ cells in colon cancer tissues compared to ALDH1- cells.
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Affiliation(s)
- Rui Yang
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
| | - Xinhua Liu
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
- Experimental Center for Science and Technology, Shanghai University of Traditional Chinese Medicine, Shanghai 201203, China
| | - Smathorn Thakolwiboon
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
- Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok 10700, Thailand
| | - Jianhui Zhu
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
| | - Xiucong Pei
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
- Department of Toxicology, School of Public Health, Shenyang Medical College, Liaoning 110034, China
| | - Mingrui An
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
| | - Zhijing Tan
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
| | - David M Lubman
- Department of Surgery, University of Michigan Medical Center, Ann Arbor, Michigan 48109, USA
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Patient-Reported Attributions for Missed Colonoscopy Appointments in Two Large Healthcare Systems. Dig Dis Sci 2016; 61:1853-61. [PMID: 26971093 DOI: 10.1007/s10620-016-4096-3] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/09/2015] [Accepted: 02/24/2016] [Indexed: 12/28/2022]
Abstract
BACKGROUND Missed colonoscopy appointments (no-shows) can lead to wasted resources and delays in colorectal cancer diagnosis, an area of special concern in public health systems that often provide care for vulnerable patients. Our objective was to identify reasons for missed colonoscopy appointments in patients seeking care at two large public health systems in Houston, TX. METHODS We conducted a telephone survey of patients who missed their colonoscopy appointments at two tertiary care health systems. Using a structured survey instrument, we collected information on patient-specific and health services barriers. Patient-specific barriers included perceived procedural-related factors (e.g., difficulty in preparation), cognitive-emotional factors (e.g., fear or concern about modesty), and changes in health status (e.g., improvement or worsening of health). Health services barriers included logistical factors (e.g., travel-related difficulties) and appointment scheduling problems (inconvenient date or time). We examined differences in attributions for missed appointments between the two study sites. RESULTS Of 160 unique patients (102 Site A and 58 Site B) who missed their appointment during the study period, 153 (95.6 %) attributed their no-show to at least one of the listed barriers. Most respondents (125; 78.1 %) cited travel-related issues or scheduling problems as reasons for their missed appointment. Not having a ride or a travel companion was the most commonly reported travel-related issue. We also found significant differences for barriers between the two sites. CONCLUSIONS Most missed colonoscopy appointments resulted from potentially preventable travel- and scheduling-related issues. Because barriers to keeping colonoscopy appointments are different across health systems, each health system might need to develop unique interventions to reduce missed colonoscopy appointments.
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Roh S, Burnette CE, Lee KH, Lee YS, Goins RT. Correlates of Receipt of Colorectal Cancer Screening among American Indians in the Northern Plains. SOCIAL WORK RESEARCH 2016; 40:95-104. [PMID: 27257363 PMCID: PMC4886273 DOI: 10.1093/swr/svw006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/08/2015] [Revised: 08/25/2015] [Accepted: 09/14/2015] [Indexed: 05/22/2023]
Abstract
Research has consistently documented lower colorectal cancer (CRC) screening rates for racial and ethnic minority populations, with the lowest screening rates among American Indians (AIs). Given the low CRC screening rates among AIs residing in the Northern Plains region, the objective of this research was to identify CRC screening correlates for Northern Plains AIs. With a sample of 181 AIs age 50 years or older, the authors used Andersen's behavioral model to examine the following factors related to receipt of CRC screening: (a) predisposing factors-age, education, marital status, and gender; (b) need factors-personal and family history of cancer; and (c) enabling factors-having a particular place to receive medical care, annual health checkup, awareness of the availability of CRC screening, knowledge of CRC, and self-efficacy of CRC. Nested logistic regression identified the following correlates of receipt of CRC screening: (a) predisposing factors-older age; (b) need factors-having a personal history of cancer; and (c) enabling factors-having an annual health checkup, greater awareness of CRC screening, and greater self-efficacy of CRC. Given the findings, prevention and intervention strategies, including public awareness and education about CRC screening, are promising avenues to reduce cancer screening disparities among AIs.
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Affiliation(s)
- Soonhee Roh
- is assistant professor, School of Social Work, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069; is assistant professor, School of Social Work, Tulane University, New Orleans. is associate professor, School of Social Work, Wichita State University, Wichita, KS. is associate professor, School of Social Work, San Francisco State University. is professor, Western Carolina University, Cullowhee, NC. The data used in the study were collected with support from the University of South Dakota School of Health Sciences Research and Scholarship Seed Grants. The lead author would like to acknowledge Dr. Robin Miskimins for her mentoring on a Seed Grants for School of Health Sciences for Dr. Roh
| | - Catherine E Burnette
- is assistant professor, School of Social Work, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069; is assistant professor, School of Social Work, Tulane University, New Orleans. is associate professor, School of Social Work, Wichita State University, Wichita, KS. is associate professor, School of Social Work, San Francisco State University. is professor, Western Carolina University, Cullowhee, NC. The data used in the study were collected with support from the University of South Dakota School of Health Sciences Research and Scholarship Seed Grants. The lead author would like to acknowledge Dr. Robin Miskimins for her mentoring on a Seed Grants for School of Health Sciences for Dr. Roh
| | - Kyoung Hag Lee
- is assistant professor, School of Social Work, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069; is assistant professor, School of Social Work, Tulane University, New Orleans. is associate professor, School of Social Work, Wichita State University, Wichita, KS. is associate professor, School of Social Work, San Francisco State University. is professor, Western Carolina University, Cullowhee, NC. The data used in the study were collected with support from the University of South Dakota School of Health Sciences Research and Scholarship Seed Grants. The lead author would like to acknowledge Dr. Robin Miskimins for her mentoring on a Seed Grants for School of Health Sciences for Dr. Roh
| | - Yeon-Shim Lee
- is assistant professor, School of Social Work, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069; is assistant professor, School of Social Work, Tulane University, New Orleans. is associate professor, School of Social Work, Wichita State University, Wichita, KS. is associate professor, School of Social Work, San Francisco State University. is professor, Western Carolina University, Cullowhee, NC. The data used in the study were collected with support from the University of South Dakota School of Health Sciences Research and Scholarship Seed Grants. The lead author would like to acknowledge Dr. Robin Miskimins for her mentoring on a Seed Grants for School of Health Sciences for Dr. Roh
| | - R Turner Goins
- is assistant professor, School of Social Work, University of South Dakota, 414 E. Clark Street, Vermillion, SD 57069; is assistant professor, School of Social Work, Tulane University, New Orleans. is associate professor, School of Social Work, Wichita State University, Wichita, KS. is associate professor, School of Social Work, San Francisco State University. is professor, Western Carolina University, Cullowhee, NC. The data used in the study were collected with support from the University of South Dakota School of Health Sciences Research and Scholarship Seed Grants. The lead author would like to acknowledge Dr. Robin Miskimins for her mentoring on a Seed Grants for School of Health Sciences for Dr. Roh
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Joseph DA, Redwood D, DeGroff A, Butler EL. Use of Evidence-Based Interventions to Address Disparities in Colorectal Cancer Screening. MMWR Suppl 2016; 65:21-8. [PMID: 26915961 DOI: 10.15585/mmwr.su6501a5] [Citation(s) in RCA: 24] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/02/2022] Open
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer death among cancers that affect both men and women. Despite strong evidence of their effectiveness, CRC screening tests are underused. Racial/ethnic minority groups, persons without insurance, those with lower educational attainment, and those with lower household income levels have lower rates of CRC screening. Since 2009, CDC's Colorectal Cancer Control Program (CRCCP) has supported state health departments and tribal organizations in implementing evidence-based interventions (EBIs) to increase use of CRC screening tests among their populations. This report highlights the successful implementation of EBIs to address disparities by two CRCCP grantees: the Alaska Native Tribal Health Consortium (ANTHC) and Washington State's Breast, Cervical, and Colon Health Program (BCCHP). ANTHC partnered with regional tribal health organizations in the Alaska Tribal Health System to implement provider and client reminders and use patient navigators to increase CRC screening rates among Alaska Native populations. BCCHP identified patient care coordinators in each clinic who coordinated staff training on CRC screening and integrated client and provider reminder systems. In both the Alaska and Washington programs, instituting provider reminder systems, client reminder systems, or both was facilitated by use of electronic health record systems. Using multicomponent interventions in a single clinical site or facility can support more organized screening programs and potentially result in greater increases in screening rates than relying on a single strategy. Organized screening systems have an explicit policy for screening, a defined target population, a team responsible for implementation of the screening program, and a quality assurance structure. Although CRC screening rates in the United States have increased steadily over the past decade, this increase has not been seen equally across all populations. Increasing the use of EBIs, such as those described in this report, in health care clinics and systems that serve populations with lower CRC screening rates could substantially increase CRC screening rates.
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Affiliation(s)
- Djenaba A Joseph
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, CDC, Atlanta, Georgia
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