Leveraging Emergency Department Encounters to Improve Cancer Screening Adherence

Miles, Randy C.; Flores, Efrén J.; López, Diego B.; Sohn, Young-Jin; Gillis, Eleanor A.; Lehman, Constance D.; Narayan, Anand K.

doi:10.1016/j.jacr.2020.12.025

Cited by 5 publications

(6 citation statements)

References 25 publications

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“…Despite the fact that only 8.3% of participants reported that COVID-19 delayed their cancer screening, our findings found relatively high rates of patients overdue on screening compared to past studies conducted in the ED prior to the pandemic (overdue rates 12–33% for cervical, 9 – 11 12–46% for breast, 5 , 10 – 12 and 17–46% for CRC screening 5 , 12 , 13 ). Our higher rates of overdue screenings were probably due not to the pandemic but may have been related to the characteristics of our patient population.…”

Section: Discussioncontrasting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

“…Past studies of cancer screening adherence for eligible ED patients have found that 12-33% of women were overdue or had uncertain adherence with cervical cancer screening [9][10][11] ; 12-46% of women were overdue for breast cancer screening 5,[10][11][12] ; and 17-46% were overdue for CRC screening. 5,12,13 The percentage of patients overdue for cancer screenings has been significantly higher for those who have no insurance 5,9,10,13 or a primary care physician, 9,13 and patients with less education, 5,9,13 with mixed findings on the role of race and ethnicity, 5,9,[11][12][13] However, these studies occurred prior to the coronavirus 2019 (COVID-19) pandemic. Results from large national surveys showed that approximately 55% of respondents reported that they or someone in their household delayed or skipped routine medical care during the pandemic, 14,15 suggesting that rates of being overdue for cancer screening may be higher post-pandemic and/or more disparate for some groups of patients.…”

Section: Introductionmentioning

confidence: 99%

“…4 Patients without insurance are significantly less likely to be up to date with mammography and CRC screening than patients with insurance. 5 Emergency departments (ED) tend to serve in a safety-net capacity for underserved patients. 6 Hispanic and Black patients are significantly more likely to report higher ED utilization and no usual source of care than White patients.…”

Section: Introductionmentioning

confidence: 99%

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Characteristics and Barriers of Emergency Department Patients Overdue for Cancer Screening

Heinert,

Ahmed,

Guzman-Baez

et al. 2024

WestJEM

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People without reliable access to healthcare are more likely to be diagnosed with latestage cancer that could have been treated more effectively if diagnosed earlier. Emergency departments (ED) may be a novel place for cancer screening education for underserved patients. In this study we sought to determine patient characteristics and barriers to cancer screening for those patients who presented to a large, academic safety-net ED and were overdue for breast, cervical, and colorectal cancer screening since the coronavirus 2019 (COVID-19) pandemic.Methods: Adult ED patients eligible for at least one cancer screening based on US Preventive Serivces Task Force guidelines completed a web-based survey. We examined the association of demographic characteristics and having a personal physician with being overdue on screening using chi-square or the Fisher exact test for categorical variables and t-tests for continuous variables.Results: Of 221 participants, 144 were eligible for colorectal, 96 for cervical, and 55 for breast cancer screening. Of eligible patients, 46% (25/55) were overdue for breast cancer screening, 43% (62/144) for colorectal, and 40% (38/96) for cervical cancer screening. There were no significant characteristics associated with breast cancer screening. Being overdue for cervical cancer screening was significantly more likely for patients who were of Asian race (P = 0.02), had less than a high school diploma (P = 0.01), and were without a routine checkup within the prior five years (P = 0.01). Overdue for colorectal cancer screening was associated with patients not having insurance (P = 0.04), being in their 40s (P = 0.03), being Hispanic (P = 0.01), and not having a primary care physician (P = 0.01). Of 97 patients overdue for at least one screening, the most common barriers were cost (37%), lack of time (37%), and lack of knowledge of screening recommendations (34%). Only 8.3% reported that the COVID-19 pandemic delayed their screening. Conclusion:The ED may be a novel setting to target patients for cancer screening education. Future work that refers patients to free screening programs and primary care physicians may help improve disparities in cancer screening and cancer mortality rates for underserved populations.

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Section: Discussioncontrasting

confidence: 87%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Characteristics and Barriers of Emergency Department Patients Overdue for Cancer Screening

Heinert,

Ahmed,

Guzman-Baez

et al. 2024

WestJEM

View full text Add to dashboard Cite

show abstract

“…In a 2020 analysis of NHIS data that sought to estimate the number of patients in need of a cancer screening who also had at least one ED visit in the preceding year, researchers found that more than 14 million, 6 million, and 2 million ED patients were in need of breast, colorectal, or lung cancer screening, respectively [38]. These data underscore the ED's position as a target-rich environment to promote adherence with USPSTFrecommended cancer screenings, especially among hardto-reach groups, and to advance progress towards Healthy People 2030 goals.…”

Section: Introductionmentioning

confidence: 99%

Emergency department-based cancer screening interventions

2022

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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.

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Increasing Uptake of Lung Cancer Screening Among Emergency Department Patients: A Pilot Study

Adler,

Wood,

Fiscella

et al. 2024

The Journal of Emergency Medicine

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Leveraging Emergency Department Encounters to Improve Cancer Screening Adherence

Cited by 5 publications

References 25 publications

Characteristics and Barriers of Emergency Department Patients Overdue for Cancer Screening

Characteristics and Barriers of Emergency Department Patients Overdue for Cancer Screening

Emergency department-based cancer screening interventions

Increasing Uptake of Lung Cancer Screening Among Emergency Department Patients: A Pilot Study

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