Improving colon cancer screening in community clinics

Davis, Terry C.; Arnold, Connie L.; Rademaker, Alfred; Bennett, Charles L.; Bailey, Stacy Cooper; Platt, Daci J.; Reynolds, Cristalyn; Liu, Dachao; Carias, Edson; Bass, Pat F.; Wolf, Michael S.

doi:10.1002/cncr.28272

Cited by 48 publications

(88 citation statements)

References 36 publications

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“…In a 2007 study by the authors in urban and rural community clinics, eligible male and female patients who were given a screening recommendation, illustrated information about screening written on a 4 th grade level and a demonstration of how to complete an FOBT by a clinic based research assistant were significantly more likely to complete an FOBT within six months than those who were only given a recommendation and FOBT kit [27]. Those that additionally received personal phone reminders were even more likely to complete the test.…”

Section: Discussionmentioning

confidence: 99%

“…Unlike other cancer screening tests, FOBTs and colonoscopy require patients to have clear understanding and confidence to prepare for or complete screening [27, 34]. In busy primary care practices providers commonly assume patients can follow the instructions.…”

Section: Discussionmentioning

confidence: 99%

“…Patients are rarely instructed on how to prepare for or completed CRC test or asked to confirm their understanding [34]. Improvement in our previous studies was most pronounced when patients were given simplified FOBT instructions and a demonstration with “teach back” to confirm their understanding [27]. …”

Section: Discussionmentioning

confidence: 99%

“…Questions about cancer screening knowledge, beliefs prior recommendation and education, self-efficacy and barriers were designed utilizing the Health Belief Model and Social Cognitive Theory [25–26]. Items were modified for use with colon cancer screening from validated questionnaires used in previous studies by the authors [27]. …”

Section: Methodsmentioning

confidence: 99%

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Barriers and Facilitators to Colorectal Cancer Screening Among Rural Women in Community Clinics by Heath Literacy

Davis¹,

Morris²,

Rademaker³

et al. 2017

J Womens Health, Issues Care

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Background Rural women lag rural men and urban women in colon cancer (CRC) screening completion. Objective To identify rural female patients’ knowledge, beliefs barriers, self-efficacy, prior recommendation and completion of CRC screening using an FOBT and to compare these factors by health literacy (HL) level. Methods This descriptive study was conducted between 2015 and 2016 in 4 rural community clinics in south Louisiana. Patients overdue for screening were given a structured interview by a research assistant. Results 339 women were enrolled, mean age 58.5, 32% had limited HL, 66% were African American. Most (91.7%) had heard of CRC, yet only 71% knew of any CRC screening tests. Women with adequate HL had greater knowledge of specific tests than those with limited HL (78.4% vs 56.6%, p<0.001). Only 25.7% had been given information on CRC testing; those with adequate HL were more likely to have received information (30.1% vs 16.8%; p=0.017). Most women (93.2%) indicated they would want to know if they had CRC, while 72.2% reported a provider had recommended CRC screening. Only 24.9% said a healthcare provider had ever given them an FOBT or that they had ever completed an FOBT (22.7%). There were no differences in women’s report of recommendation or completion by HL level. Self-efficacy for completing an FOBT was high; over 90% indicated they could get an FOBT, complete it and mail results to the lab. Level of confidence did not vary by literacy. Three of the four barrier items varied by HL with women with low HL being more likely to fear doing an FOBT because they thought FOBT instructions would be confusing (p=0.002), doing the test would be embarrassing (p=0.025) or messy (p=0.057). Conclusions Rural women are receptive to CRC screening and view FOBTs as effective. Rural community clinics need to provide low cost FOBTs with literacy, gender and culturally appropriate information.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Methodsmentioning

confidence: 99%

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Barriers and Facilitators to Colorectal Cancer Screening Among Rural Women in Community Clinics by Heath Literacy

Davis¹,

Morris²,

Rademaker³

et al. 2017

J Womens Health, Issues Care

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“…35-36 A detailed description of the survey, which was written on a 4th grade level and administered orally has been reported previously. 37-38 Literacy was assessed using the Rapid Estimate of Adult Literacy in Medicine (REALM). 39 Raw REALM scores (0-66) can be converted into reading grade levels that correlate with literacy skills.…”

Section: Methodsmentioning

confidence: 99%

Joint breast and colorectal cancer screenings in medically underserved women

Davis¹,

Arnold²,

Wolf³

et al. 2015

J Community Support Oncol

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Background Breast and colon cancer screening in rural community clinics is underused. Objective To evaluate the effectiveness and cost-effectiveness of alternative interventions designed to promote simultaneous screening for breast and colon cancer in community clinics. Methods A 3-arm, quasi-experimental evaluation was conducted during May 2008-August 2011 in 8 federally qualifed health clinics in predominately rural Louisiana. Baseline screening rates reported by the clinics was <10% for breast cancer (using mammography) and 1%-2% for colon cancer (using the fecal occult blood test [FOBT]). 744 women aged 50 years or older who were eligible for routine mammography and an FOBT were recruited. The combined screening efforts included: enhanced care; health literacy-informed education (education alone), or health literacy-informed education with nurse support (nurse support). Results Postintervention screening rates for completing both tests were 28.1% with enhanced care, 23.7% with education alone, and 38.7% with nurse support. After adjusting for age, race, and literacy, patients who received nurse support were 2.21 times more likely to complete both screenings than were those who received the education alone (95% confidence interval [CI], 1.12-4.38; P = .023). The incremental cost per additional woman completing both screenings was $3,987 for education with nurse support over education alone, and $5,987 over enhanced care. Limitations There were differences between the 3 arms in sociodemographic characteristics, literacy, and previous screening history. Not all variables that were significantly different between arms were adjusted for, therefore adjustments for key variables (age, race, literacy) were made in statistical analyses. Other limitations related generalizability of results. Conclusions Although joint breast and colon cancer screening rates were increased substantially over existing baseline rates in all 3 arms, the completion rate for both tests was modest. Nurse support and telephone follow-up were most effective. However, it is not likely to be cost effective or affordable in clinics with limited resources.

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Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review

et al. 2023

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Background Inequalities in cancer incidence and mortality can be partly explained by unequal access to high‐quality health services, including cancer screening. Several interventions have been described to increase access to cancer screening, among them patient navigation (PN), a barrier‐focused intervention. This systematic review aimed to identify the reported components of PN and to assess the effectiveness of PN to promote breast, cervical and colorectal cancer screening. Methods We searched Embase, PubMed and Web of Science Core Collection databases. The components of PN programmes were identified, including the types of barriers addressed by navigators. The percentage change in screening participation was calculated. Results The 44 studies included were mainly on colorectal cancer and were conducted in the USA. All described their goals and community characteristics, and the majority reported the setting (97.7%), monitoring and evaluation (97.7%), navigator background and qualifications (81.4%) and training (79.1%). Supervision was only referred to in 16 studies (36.4%). Programmes addressed mainly barriers at the educational (63.6%) and health system level (61.4%), while only 25.0% reported providing social and emotional support. PN increased cancer screening participation when compared with usual care (0.4% to 250.6% higher) and educational interventions (3.3% to 3558.0% higher). Conclusion Patient navigation programmes are effective at increasing participation to breast, cervical and colorectal cancer screening. A standardized reporting of the components of PN programmes would allow their replication and a better measure of their impact. Understanding the local context and needs is essential to design a successful PN programme.

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Improving colon cancer screening in community clinics

Cited by 48 publications

References 36 publications

Barriers and Facilitators to Colorectal Cancer Screening Among Rural Women in Community Clinics by Heath Literacy

Barriers and Facilitators to Colorectal Cancer Screening Among Rural Women in Community Clinics by Heath Literacy

Joint breast and colorectal cancer screenings in medically underserved women

Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review

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