Cancer Screening Among Rural and Urban Clinics During COVID-19: A Multistate Qualitative Study

Abstract

PURPOSE: The effects of COVID-19 have been understudied in rural areas. This study sought to (1) identify cancer screening barriers and facilitators during the pandemic in rural and urban primary care practices, (2) describe implementation strategies to support cancer screening, and (3) provide recommendations. METHODS: A qualitative study was conducted (N = 42) with primary care staff across 20 sites. Individual interviews were conducted through videoconference from August 2020 to April 2021 and recorded, transcribed, and analyzed using deductive and inductive coding (hybrid approach) in NVivo 12 Plus. Practices included federally qualified health centers, tribal health centers, rural health clinics, hospital/health system–owned clinics, and academic medical centers across 10 states including urban (55%) and rural (45%) sites. Staff included individuals serving in the dual role of health care provider and administrator (21.4%), health care administrator (23.8%), physician (19.0%), advanced practice provider (11.9%), or resident (23.8%). The interviews assessed perceptions about cancer screening barriers and facilitators, implementation strategies, and future recommendations. RESULTS: Participants reported multilevel barriers to cancer screening including policy-level (eg, elective procedure delays), organizational (eg, backlogs), and individual (eg, patient cancellation). Several facilitators to screening were noted, such as home-based testing, using telehealth, and strong partnerships with referral sites. Practices used strategies to encourage screening, such as incentivizing patients and providers and expanding outreach. Rural clinics reported challenges with backlogs, staffing, telehealth implementation, and patient outreach. CONCLUSION: Primary care staff used innovative strategies during the pandemic to promote cancer screening. Unresolved challenges (eg, backlogs and inability to implement telehealth) disproportionately affected rural clinics.

The 2020 U.S. cancer screening deficit and the timing of adults' most recent screen: A population-based quasi-experiment

“…Cancer screening could have been impacted by a number of federal, state, or local public health emergency policies, as well as by the changing priorities and capacities of health systems, and by individual social distancing behaviors (Cancino et al 2020; Richards et al 2020; DeJong, Katz, and Covinsky 2021). More recent research illuminated the role of financial stress and time costs as individual-level barriers to cancer screening, both of which may have compounded the strain on health systems attempting to resume cancer screening programs (Hanna et al 2022; Peoples et al 2022; Findling, Blendon, and Benson 2020).…”

“…However, subsequent research has found that in the later months of 2020, claims and records of cancer screenings returned to pre-pandemic levels (Chen et al 2021); DeGroff et al 2021; Labaki et al 2021; McBain et al 2021; Bello, Chang, and Massarweh 2022; Drescher et al 2022). Still, the pandemic created a major cancer screening deficit which may be difficult to address despite recent investment in “return to screening” initiatives (Chen et al 2021; Hanna et al 2022; Kelkar et al 2022). Even as America returns to screening, some are being left behind (Mafi et al 2022.…”

“…More recent research illuminated the role of financial stress and time costs as individual-level barriers to cancer screening, both of which may have compounded the strain on health systems attempting to resume cancer screening programs (Hanna et al 2022;Peoples et al 2022;Findling, Blendon, and Benson 2020).…”

Delivery of Cervical and Colorectal Cancer Screenings During the Pandemic in Community Health Centers

“…Contextual factors (eg, stay-at-home orders), organizational factors (eg, prioritizing response to acute illness), and/or patient-level factors (eg, fear of contracting COVID-19) likely explain the evidence that shows that fewer people received breast, cervical (CVC), and colorectal (CRC) cancer screenings during the COVID-19 timeframe 2–7 . Early evidence suggests better recovery for CRC than CVC screenings 5 . But these studies are limited in scope as they focus on one health center, a single state, or a specific program 8–12 .…”

“…But these studies are limited in scope as they focus on one health center, a single state, or a specific program 8–12 . And, very few existing studies have examined how cancer screening rates have recovered 5 . Early evidence suggests better recovery for CRC than CVC screenings, though it is unknown what factors or strategies contributed to this recovery 5 …”