Project ECHO: a Potential Best-Practice Tool for Training Healthcare Providers in Oral Cancer Screening and Tobacco Cessation

Abstract

The oral cancer pandemic and inadvertent tobacco consumption have rendered timely oral cavity screening and tobacco cessation essential, skills which most healthcare providers (HCPs) lack. Project BExtension for Community Healthcare Outcomes( ECHO) is a proven best-practice tool for virtual telementoring of primary care providers by experts at academic health centers, in managing complex medical conditions in rural, expert-deficient setups. For the first time, our organization in India has utilized this method for training HCPs in oral cancer screening, across the country and abroad. The program comprised eight, weekly, hour-long sessions, on oral cancer screening and tobacco cessation, hosted online by our Organization (hub) through the Zoom web-conferencing application, with 48 HCPs (spokes) attending from their respective locations (pan-India, n = 47; Libya, n = 1). Each session comprised one expert-led didactic and two participant-led case presentations, culminating with educative discussions. Participants filled out online, program-evaluation (pre and post) questionnaires having 10 similar, multiple-choice questions each (score for every correct response = 1); total responses were later statistically analyzed. Lesser participants completed the post-evaluation questionnaire which could be due to it being optional, their busy schedule, or apprehension of being assessed. The program evaluation results illustrate a significant knowledge gain among participants regarding oral cancer screening and tobacco cessation, i.e., from a mean knowledge score of 6.7 in pre-evaluation to 7.4 in post-evaluation (p < 0.05). Thus, the ECHO model can be utilized as a convenient, cost-effective, large-scale, best-practice, telementoring tool for training HCPs in oral cancer screening and tobacco cessation, especially in populous, resource-deficient countries.

Implementing cancer-screening programs by training primary care physicians in India – Findings from the National Institute of Cancer Prevention Research Project ECHO for Cancer Prevention

“…These ndings are similar to improvements reported among dentists and gynecologists undergoing similar training. (14,15) The study, however, shows no statistical difference in primary care physicians' implementation of cancer screening services in their healthcare organizations, at the end of the 3-month training compared to when they enrolled in the program. This highlights a critical gap in promoting cancer prevention objectives in India and indicates the need for further research to explore the barriers to implementation of cancer screening services in the national and the regional and/or local context.…”

“…The ECHO model is well suited to the Indian context in that it offers a virtual platform, is cost effective, and provides the ability to train physicians over a wide geographical spread in a limited time period. Globally, ECHO programs have shown evidence in improving provider knowledge and skills for treatment for several medical conditions such as Hepatitis C (12), Multiple Sclerosis (13), and behavioral disorders (14). Despite the growing number of studies evaluating ECHO, a recent systematic review by McBain and colleagues concluded that the evidence of effectiveness was modest compared to the widespread implementation of the model internationally.…”

“…Parallel to other studies published on the NICPR-ECHO program, this study contributes ndings showing improvements in knowledge noted in primary care physicians. (14,15,22) We acknowledge the limitations of this study, which revolve around the pre-post, one group design for the evaluation of the ECHO program. Participants may have learned about cancer screening from other sources than the ECHO training, which could have in uenced improvements noted on the post-test.…”

Programa De Superación Profesional Para El Equipo Básico De Salud Sobre El Programa Nacional De Detección Precoz Del Cáncer Bucal

“…El cáncer, en cualquiera de sus variantes y localizaciones, constituye un problema de salud para el hombre moderno (Laslo & Lehmann, 2019;Nethan et al, 2019), sobre todo porque es una enfermedad crónica que se incrementa de manera proporcional al envejecimiento de la población (Cruz et al, 2016;Peña et al, 2016;Nagao & Warnakulasuriya, 2020). No obstante, la existencia de factores relacionados con el estilo de vida, tales como los hábitos tóxicos, la dieta y la exposición a diversos agentes exógenos, afectan de forma negativa los índices de morbilidad y mortalidad de las enfermedades crónicas como las neoplasias (Cruz et al, 2016;Shao et al, 2019;Nethan et al, 2019;Deluche et al, 2020). Esto ha contribuido a que la incidencia de tumores malignos haya aumentado en Cuba, a tal punto, que en muchas provincias el cáncer constituye la segunda causa de muerte, solo precedido por las enfermedades cardiovasculares (Ford & Farah, 2013;AES, 2017;Nethan et al, 2019),y la primera en incidir en años potenciales de vida perdidos.…”

“…No obstante, la existencia de factores relacionados con el estilo de vida, tales como los hábitos tóxicos, la dieta y la exposición a diversos agentes exógenos, afectan de forma negativa los índices de morbilidad y mortalidad de las enfermedades crónicas como las neoplasias (Cruz et al, 2016;Shao et al, 2019;Nethan et al, 2019;Deluche et al, 2020). Esto ha contribuido a que la incidencia de tumores malignos haya aumentado en Cuba, a tal punto, que en muchas provincias el cáncer constituye la segunda causa de muerte, solo precedido por las enfermedades cardiovasculares (Ford & Farah, 2013;AES, 2017;Nethan et al, 2019),y la primera en incidir en años potenciales de vida perdidos. Por eso constituye en el presente, la causa de mayor impacto en la esperanza de vida al nacer (Miranda, 2014;Padilla et al, 2016;Shao et al, 2019;Deluche et al, 2020).…”