Emergency department-based cancer screening interventions

Abstract

Background Emergency department patients are disproportionately non-adherent with the United States Preventive Services Task Force cancer screening recommendations, making the emergency department a target-rich environment for interventions aimed at increasing the uptake of cancer screening. Promotion of cancer screening in the emergency department has the potential to address health disparities and to reach patients that experience significant barriers to accessing preventive care. Topics of review This narrative review presents concise summaries of the four types of cancer screenings with grade A or B recommendations from the United States Preventive Services Task Force (breast, cervical, colorectal, and lung) and presents the potential enabling factors and challenges of utilizing the emergency department setting to increase cancer screening uptake. Past and ongoing efforts to promote cancer screening among emergency department patients are discussed, and critical knowledge gaps and research opportunities are highlighted. Conclusion Although there has been a paucity of research evaluating interventions that have the potential to increase cancer screening uptake among emergency department patients, the emergency department setting is uniquely positioned to address disparities in cancer screening uptake and contribute to progress towards national cancer screening goals. To be effective, interventions that aim to achieve this purpose must identify patients with screening needs, engage with patients regarding their knowledge and beliefs about screening, and provide an effective method to conduct or connect patients with screening procedures and subsequent follow-up.

Low Rates of Lung and Colorectal Cancer Screening Uptake Among a Safety-net Emergency Department Population

“…Increasing evidence has demonstrated that the ED is in a unique position to address disparities in cancer prevention and screening. 7 As demonstrated in this work, ED patients are disproportionally non-adherent with the USPSTF cancer screening recommendations and, thus, the ED is a desirable location to reach these populations that otherwise would not have access to preventive services. 20 Examples of success in addressing cancer prevention/screening in the ED include a randomized controlled trial by Adler et al 21 Their study demonstrated the feasibility and efficacy of a behavioral intervention to increase uptake of cervical cancer screening among ED patients at an urban, academic ED.…”

“…It has been reported that ED patients are disproportionately non-adherent with the USPSTF cancer screening recommendations. 7 Disparities in cancer screening, including socioeconomic status (SES) and racial/ethnic status are pervasive in the literature, and has been further exacerbated by the coronavirus 2019 pandemic. 8 Despite the fact that EDs serve as a safety net for vulnerable populations who suffer from health disparities, limited work has explored the missed opportunities for cancer screening among ED patients.…”

“…It has been reported that ED patients are disproportionately non-adherent with the USPSTF cancer screening recommendations. 7 …”

Worsened outcomes of newly diagnosed cancer in patients with recent emergency care visits: A retrospective cohort study of 3699 adults in a safety net health system

“…Little to no literature exists examining the association with eventual cancer diagnosis in association with an ED visit, offering opportunities for addressing cancer prevention and cancer screening in the context of an ED visit. 19 …”

Intervention during wait time: identification and referral of individuals non-adherent for colorectal cancer screening

“…Previous work has shown that the ED sees a high volume of patients who are not up-to-date with USPSTF cancer screening recommendations. For example, previous cross-sectional [ 12 ] and experimental work [ 13 ] using research associates to interview patients has demonstrated that a substantial proportion of women in the ED are not adherent with cervical and/or breast cancer guidelines (for a thorough review of ED-based cancer screening research, see Adler, Abar, and Chiao [ 14 ]). To date, however, limited work has been dedicated to developing scalable and sustainable methods for identifying ED patients in need of colorectal cancer screening.…”