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Bakhai S, Ansari M, Sadeghi C, Reynolds JL. Advancing health equity in improving breast cancer screening with the use of a mobile mammography bus in marginalised population: quality improvement project. BMJ Open Qual 2024; 13:e002482. [PMID: 38176952 PMCID: PMC10773337 DOI: 10.1136/bmjoq-2023-002482] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 12/02/2023] [Indexed: 01/06/2024] Open
Abstract
BACKGROUND Breast cancer, the second leading cause of cancer-related deaths in women in the USA, is effectively treated through early detection and screening. This quality improvement (QI) project aimed to improve mammography screening rates from the baseline of 50% to 60% within 12 months for patients aged 50-74 years at an Internal Medicine Clinic. METHODS We used the Plan, Do, Study, Act (PDSA) model. A multidisciplinary team used a fishbone diagram to identify barriers to suboptimal screening. The QI team created a driver diagram and process flow map. The mammogram screening rate was the outcome measure. Mammogram order and completion rates were the process measures. We implemented six PDSA cycles. Major interventions included the use of a nurse navigator, enhancements in health information technology, and education to patients, providers, and nursing staff. Mammograms were offered in a mobile bus, located in the hospital campus and in under-resourced inner-city neighbourhoods to improve the access. Data analysis was performed using monthly statistical process control charts. RESULTS The project exceeded its initial goal, achieving a breast cancer screening rate of 66% (n=490 of 744) during the study period and was sustainable at 69%, 3 months post-project. The mammogram order rate was 58% (n=432 of 744) and completion rate was 53% (n=231 of 432) within 12 months. CONCLUSIONS We attributed the success of this QI project to the education of patients, nurses and physicians, the use of a nurse navigator and engagement of a multidisciplinary team. Access to mobile mammography bus addressed the social determinants of health barriers in a marginalised population.
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Affiliation(s)
- Smita Bakhai
- Internal Medicine, University at Buffalo-The State University of New York, Buffalo, New York, USA
| | - Mohammad Ansari
- Department of Internal Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Cirous Sadeghi
- Department of Medicine, University at Buffalo Jacobs School of Medicine and Biomedical Sciences, Buffalo, New York, USA
| | - Jessica L Reynolds
- Medicine, University at Buffalo-The State University of New York, Buffalo, New York, USA
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Christensen K, Bauer AG, Burgin T, Williams J, McDowd J, Sutkin G, Bennett K, Bowe Thompson C, Berkley-Patton JY. "Black Women Don't Always Put Our Healthcare First": Facilitators and Barriers to Cervical Cancer Screening and Perceptions of Human Papillomavirus Self-Testing Among Church-Affiliated African American Women. COMMUNITY HEALTH EQUITY RESEARCH & POLICY 2024; 44:137-150. [PMID: 36125430 DOI: 10.1177/0272684x221115494] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/15/2023]
Abstract
Background: African American women are at greater risk for cervical cancer incidence and mortality than White women. Up to 90% of cervical cancers are caused by human papillomavirus (HPVs) infections. The National Institutes of Health (NIH) co-developed HPV self-test kits to increase access to screening, which may be critical for underserved populations. Purpose/Research Design: This mixed methods study used the Theory of Planned Behavior to examine attitudes, barriers, facilitators, and intentions related to receipt of cervical cancer screening and perceptions of HPV self-testing among church-affiliated African American women. Study Sample/Data Collection: Participants (N = 35) aged 25-53 participated in focus groups and completed a survey. Results: Seventy-four percent of participants reported receipt of cervical cancer screening in the past 3 years. Healthcare providers and the church were supportive referents of screening. Past trauma and prioritizing children's healthcare needs were screening barriers. Concerns about HPV self-testing included proper test administration and result accuracy. Conclusions: Strategies to mitigate these concerns (e.g., delivering HPV self-test kits to the health department) are discussed.
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Affiliation(s)
- Kelsey Christensen
- Department of Family and Community Medicine, University of Illinois at Chicago College of Medicine, Chicago, IL, USA
| | - Alexandria G Bauer
- Center for Alcohol & Substance Use Studies, Rutgers University, Piscataway, NJ, USA
| | - Tacia Burgin
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Joah Williams
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Joan McDowd
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Gary Sutkin
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Kymberly Bennett
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
| | - Carole Bowe Thompson
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jannette Y Berkley-Patton
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
- Department of Psychology, University of Missouri-Kansas City College of Arts and Sciences, Kansas City, MO, USA
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Mosquera I, Todd A, Balaj M, Zhang L, Benitez Majano S, Mensah K, Eikemo TA, Basu P, Carvalho AL. Components and effectiveness of patient navigation programmes to increase participation to breast, cervical and colorectal cancer screening: A systematic review. Cancer Med 2023; 12:14584-14611. [PMID: 37245225 PMCID: PMC10358261 DOI: 10.1002/cam4.6050] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 04/03/2023] [Accepted: 04/26/2023] [Indexed: 05/30/2023] Open
Abstract
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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Affiliation(s)
- Isabel Mosquera
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Adam Todd
- School of PharmacyNewcastle University, Newcastle upon TyneUK
| | - Mirza Balaj
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Li Zhang
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Sara Benitez Majano
- Noncommunicable Diseases, Violence and Injuries Prevention Unit, Pan American Health OrganizationWashingtonDCUSA
- Inequalities in Cancer Outcomes Network, London School of Hygiene and Tropical MedicineLondonUK
| | - Keitly Mensah
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Terje Andreas Eikemo
- Centre for Global Health Inequalities Research (CHAIN), Department of Sociology and Political ScienceNorwegian University of Science and Technology (NTNU)TrondheimNorway
| | - Partha Basu
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
| | - Andre L. Carvalho
- Early Detection, Prevention & Infections Branch, International Agency for Research on CancerLyonFrance
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Champion VL, Paskett ED, Stump TE, Biederman EB, Vachon E, Katz ML, Rawl SM, Baltic RD, Kettler CD, Seiber EE, Xu WY, Monahan PO. Comparative Effectiveness of 2 Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening Among Women in the Rural US: A Randomized Clinical Trial. JAMA Netw Open 2023; 6:e2311004. [PMID: 37115541 PMCID: PMC10148202 DOI: 10.1001/jamanetworkopen.2023.11004] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 03/19/2023] [Indexed: 04/29/2023] Open
Abstract
Importance Women living in rural areas have lower rates of breast, cervical, and colorectal cancer screening compared with women living in urban settings. Objective To assess the comparative effectiveness of (1) a mailed, tailored digital video disc (DVD) intervention; (2) a DVD intervention plus telephonic patient navigation (DVD/PN); and (3) usual care with simultaneously increased adherence to any breast, cervical, and colorectal cancer screening that was not up to date at baseline and to assess cost-effectiveness. Design, Setting, and Participants This randomized clinical trial recruited and followed up women from rural Indiana and Ohio (community based) who were not up to date on any or all recommended cancer screenings. Participants were randomly assigned between November 28, 2016, and July 1, 2019, to 1 of 3 study groups (DVD, DVD/PN, or usual care). Statistical analyses were completed between August and December 2021 and between March and September 2022. Intervention The DVD interactively assessed and provided messages for health beliefs, including risk of developing the targeted cancers and barriers, benefits, and self-efficacy for obtaining the needed screenings. Patient navigators counseled women on barriers to obtaining screenings. The intervention simultaneously supported obtaining screening for all or any tests outside of guidelines at baseline. Main Outcomes and Measures Receipt of any or all needed cancer screenings from baseline through 12 months, including breast, cervical, and colorectal cancer, and cost-effectiveness of the intervention. Binary logistic regression was used to compare the randomized groups on being up to date for all and any screenings at 12 months. Results The sample included 963 women aged 50 to 74 years (mean [SD] age, 58.6 [6.3] years). The DVD group had nearly twice the odds of those in the usual care group of obtaining all needed screenings (odds ratio [OR], 1.84; 95% CI, 1.02-3.43; P = .048), and the odds were nearly 6 times greater for DVD/PN vs usual care (OR, 5.69; 95% CI, 3.24-10.5; P < .001). The DVD/PN intervention (but not DVD alone) was significantly more effective than usual care (OR, 4.01; 95% CI, 2.60-6.28; P < .001) for promoting at least 1 (ie, any) of the needed screenings at 12 months. Cost-effectiveness per woman who was up to date was $14 462 in the DVD group and $10 638 in the DVD/PN group. Conclusions and Relevance In this randomized clinical trial of rural women who were not up to date with at least 1 of the recommended cancer screenings (breast, cervical, or colorectal), an intervention designed to simultaneously increase adherence to any or all of the 3 cancer screening tests was more effective than usual care, available at relatively modest costs, and able to be remotely delivered, demonstrating great potential for implementing an evidence-based intervention in remote areas of the midwestern US. Trial Registration ClinicalTrials.gov Identifier: NCT02795104.
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Affiliation(s)
- Victoria L. Champion
- School of Nursing, Indiana University, Indianapolis
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - Electra D. Paskett
- Comprehensive Cancer Center, The Ohio State University, Columbus
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus
| | - Timothy E. Stump
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
| | | | - Eric Vachon
- School of Nursing, Indiana University, Indianapolis
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
- Center for Health Services Research, Regenstrief Institute, Indianapolis, Indiana
| | - Mira L. Katz
- Comprehensive Cancer Center, The Ohio State University, Columbus
- Division of Health Behavior and Health Promotion, College of Public Health, The Ohio State University, Columbus
| | - Susan M. Rawl
- School of Nursing, Indiana University, Indianapolis
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
| | - Ryan D. Baltic
- Comprehensive Cancer Center, The Ohio State University, Columbus
| | - Carla D. Kettler
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
| | - Eric E. Seiber
- Division of Health Services Management and Policy, The Ohio State University, Columbus
| | - Wendy Y. Xu
- Division of Health Services Management and Policy, The Ohio State University, Columbus
| | - Patrick O. Monahan
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis
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Liu A, Garcia-Torres LC, Johnson C, Haver MK, Gwede CK, Christy SM. Cancer screening educational interventions in rural and farmworker communities: a systematic literature review. ETHNICITY & HEALTH 2023; 28:335-357. [PMID: 35499269 PMCID: PMC9626390 DOI: 10.1080/13557858.2022.2056145] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/28/2021] [Accepted: 03/16/2022] [Indexed: 05/05/2023]
Abstract
OBJECTIVES Men and women living in rural communities of the United States (US) are less likely than those in urban or suburban communities to be up to date with cancer screenings. Delayed screening contributes to later stage at diagnosis and higher cancer mortality for individuals living in rural areas. These effects may be compounded in some rural subpopulations (e.g. migrant and seasonal farmworkers). This systematic review examines educational interventions aimed at increasing colorectal, breast, prostate, oral, and/or cervical cancer screening in the rural US, with special consideration for the farmworker subpopulation. DESIGN Using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, our systematic literature review employed the following databases: Ovid MEDLINE, CINAHL Complete, Embase, and Web of Science. Search terms included, but were not limited to 'rural,' 'cancer screening,' 'farmworker,' and 'cancer prevention.' Eligible studies featured an educational intervention implemented in agricultural or rural US settings with a cancer screening behavioral outcome, male and/or female participants, and were published in English between 2002 and 2020. Article screening and data extraction were conducted by two independent reviewers. RESULTS Twenty-six articles were eligible. Of the six studies focused on the farmworker population (n=2,732), 61.75% of participants reported Hispanic ethnicity. Of the sixteen studies on unspecified rural communities reporting participant race/ethnicity (n=10,442), 39.29% reported Black/African American race. Efficacious interventions included culturally-targeted educational materials, lay health advisors (LHAs), and components that addressed practical barriers (e.g. financial or logistical). CONCLUSION Results demonstrate the value of LHAs and targeted education to increase screening for multiple cancer types in rural communities. Prospective research should incorporate and facilitate access to screening and provider-level and/or organizational-level interventions to increase overall impact. ABBREVIATIONS HPV: human papillomavirus; LHA: lay health advisors; MeSH: Medical Subject Headings; PRISMA: Preferred Reporting Items for Systematic Reviews and Meta-Analyses; RCT: randomized controlled trial; US: United States.
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Affiliation(s)
- Anni Liu
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | - Caitlyn Johnson
- Morsani College of Medicine, University of South Florida, Tampa, Florida
| | | | - Clement K. Gwede
- Morsani College of Medicine, University of South Florida, Tampa, Florida
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
| | - Shannon M. Christy
- Morsani College of Medicine, University of South Florida, Tampa, Florida
- H. Lee Moffitt Cancer Center and Research Institute, Tampa, Florida
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Falk D, Cubbin C, Salsman JM, Winkfield KM, Foley KL, Noel L, Jones B. Navigating Financial Barriers to Papanicolaou Tests and Mammograms for Young Adult Women Residing in Rural and Border Areas of Texas. J Adolesc Young Adult Oncol 2023; 12:159-167. [PMID: 35475705 PMCID: PMC10124170 DOI: 10.1089/jayao.2022.0013] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: Costs of Papanicolaou (Pap) tests and mammograms are a primary barrier for women aged 18-39 seeking screening and diagnostic services. Race/ethnicity and rural/border resident status compound their risks for delayed diagnosis, possibly resulting in higher mortality. Methods: We analyzed cross-sectional data from young adult (YA) women (aged 18-39) from a cancer education and patient navigation (PN) program in rural and border Texas from 2012 to 2016. Descriptive statistics, Chi-square tests, and logistic regressions summarized sociodemographic variables and receipt of PN, Pap tests, and mammograms. Results: The sample consisted of 1181 women aged 31.8 years (standard deviation 5.5) on average. A total of 795 (67.3%) received PN, 494 (41.8%) received a Pap test, and 121 (10.3%) received a mammogram. The YA women attending the program due to cost (odds ratio [OR]: 7.24; confidence interval [CI]: 4.74-11.05) and reporting 1 (OR: 3.84; CI: 2.40-6.14) or 2+ barriers (OR: 6.00; CI: 3.61-9.99) had higher odds of being navigated than those not concerned about cost and not identifying a barrier. The YA women attending due to cost (OR: 2.22, CI: 1.61-3.05) and receiving navigation (OR: 1.92; CI: 1.29-2.84) had higher odds of receiving a Pap test than their counterparts. The majority receiving a mammogram were worried about cost (85.1%); 40.5% had a family history of breast cancer, and a doctor or nurse recommended a mammogram for 15.7%. Conclusion: Detection of cervical and breast cancer in YA women residing in rural and border Texas may be improved with PN to assist with financial barriers to care and service coordination.
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Affiliation(s)
- Derek Falk
- Department of Social Sciences and Health Policy and Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - John M. Salsman
- Department of Social Sciences and Health Policy and Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Karen M. Winkfield
- Meharry-Vanderbilt Alliance, Nashville, Tennessee, USA
- Department of Radiation Oncology, Vanderbilt University Medical Center, Nashville, Tennessee, USA
| | - Kristie L. Foley
- Department of Social Sciences and Health Policy and Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
- Atrium Health Wake Forest Baptist Comprehensive Cancer Center, Medical Center Boulevard, Winston-Salem, North Carolina, USA
- Department of Implementation Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, North Carolina, USA
| | - Lailea Noel
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
| | - Barbara Jones
- Steve Hicks School of Social Work, The University of Texas at Austin, Austin, Texas, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
- Departments of Health Social Work, Oncology, Population Health, and Psychiatry, Dell Medical School, The University of Texas at Austin, Austin, Texas, USA
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Biederman E, Baltic R, Katz ML, Rawl S, Vachon E, Monahan PO, Stump TE, Kettler C, Carter L, Young G, Xu W, Paskett ED, Champion V. Increasing breast, cervical, and colorectal cancer screening among rural women: Baseline characteristics of a randomized control trial. Contemp Clin Trials 2022; 123:106986. [PMID: 36328234 DOI: 10.1016/j.cct.2022.106986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/02/2022] [Revised: 09/22/2022] [Accepted: 10/26/2022] [Indexed: 01/27/2023]
Abstract
BACKGROUND Rural women suffer disproportionately from breast, cervical, and colorectal cancer mortality compared to those in urban areas. Screening behaviors for these three cancers share many similar beliefs and barriers. Unfortunately, published interventions have not attempted to simultaneously bring women up to date with screening for three cancers (breast, cervical, and colorectal) even though multiple behavior change interventions are effective. The aim of this randomized controlled study was to compare the effectiveness of a mailed interactive and tailored DVD vs. DVD plus telephonic patient navigation (DVD + PN) vs. Usual Care (UC) to increase the percentage of rural women (aged 50-74) up to date for breast, cervical, and colorectal cancer screening. METHODS Nine hundred eighty-three participants needing one, two, or three cancer screening tests were consented and randomized to one of three groups. Prior to randomization, women were assessed for baseline characteristics including sociodemographics, health status, and cancer screening test beliefs. Screening status was assessed by medical record review. RESULTS At baseline, the average age of participants was 58.6 years. Nineteen percent of the sample was not up to date with screenings for all three cancers. Colorectal cancer had the highest percentage of women (69%) who were not up to date with screening followed by cervical (57%) and then breast cancer (41%). Sixty percent of women reported receiving a reminder for mammography; 30%, for cervical cancer screening; 15% for colonoscopy; and 6% for FOBT/FIT. DISCUSSION Increasing adherence to colorectal cancer screening may be the most urgent need among all screening tests. This clinical trial is registered at clinicaltrials.gov with identifier NCT02795104.
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Affiliation(s)
- Erika Biederman
- The Ohio State University (OSU) Comprehensive Cancer Center, Suite 525, 1590 North High Street, Columbus, OH 43201, United States of America.
| | - Ryan Baltic
- The OSU Comprehensive Cancer Center, Suite 525, 1590 North High Street, Columbus, OH 43201, United States of America.
| | - Mira L Katz
- College of Public Health and the OSU Comprehensive Cancer Center, Suite 525, 1590 North High Street, Columbus, OH 43201, United States of America.
| | - Susan Rawl
- Indiana School of Nursing and the Indiana University Simon Comprehensive Cancer Center, 600 Barnhill Drive, NU345E Indianapolis, IN, United States of America.
| | - Eric Vachon
- Indiana University School of Nursing and Center for Health Services Research, Regenstrief Institute, 600 Barnhill Drive, NUW427 Indianapolis, IN, United States of America.
| | - Patrick O Monahan
- Department of Biostatistics and Health Data Science, School of Medicine & Fairbanks School of Public Health, Biostatistics and Data Management Core, Indiana University Simon Comprehensive Cancer Center, 410 W. 10(th) St., Suite 3000, Indianapolis, IN 46202, United States of America.
| | - Timothy E Stump
- Department of Biostatistics and Health Data Science, School of Medicine, 410 W. 10(th) St, Suite 3000, Indianapolis, IN 46202, United States of America.
| | - Carla Kettler
- Department of Biostatistics and Health Data Science, 410 W. 10(th) St., Suite 3000, Indianapolis, IN 46202, United States of America.
| | - Lisa Carter
- Memorial Sloan Kettering Cancer Center, 641 Lexington Avenue, 7(th) Floor, New York, NY 10022, United States of America.
| | - Gregory Young
- The Ohio State University, College of Medicine, Department of Biomedical Informatics, 1800 Cannon Dr., Columbus, OH 43210, United States of America
| | - Wendy Xu
- College of Public Health and The OSU Comprehensive Cancer Center, 1841 Neil Ave, Columbus, OH 43210, United States of America.
| | - Electra D Paskett
- College of Medicine and The Ohio State University (OSU) Comprehensive Cancer Center, Suite 525, 1590 North High Street, Columbus, OH 43201, United States of America.
| | - Victoria Champion
- Indiana School of Nursing and IU Comprehensive Cancer Center, 600 Barnhill Drive, NU317 Indianapolis, IN, United States of America.
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Champion VL, Monahan PO, Stump TE, Biederman EB, Vachon E, Katz ML, Rawl SM, Baltic RD, Kettler CD, Zaborski NL, Paskett ED. The Effect of Two Interventions to Increase Breast Cancer Screening in Rural Women. Cancers (Basel) 2022; 14:4354. [PMID: 36139515 PMCID: PMC9496655 DOI: 10.3390/cancers14184354] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Revised: 08/22/2022] [Accepted: 08/26/2022] [Indexed: 11/16/2022] Open
Abstract
Guideline-based mammography screening is essential to lowering breast cancer mortality, yet women residing in rural areas have lower rates of up to date (UTD) breast cancer screening compared to women in urban areas. We tested the comparative effectiveness of a tailored DVD, and the DVD plus patient navigation (PN) intervention vs. Usual Care (UC) for increasing the percentage of rural women (aged 50 to 74) UTD for breast cancer screening, as part of a larger study. Four hundred and two women who were not UTD for breast cancer screening, eligible, and between the ages of 50 to 74 were recruited from rural counties in Indiana and Ohio. Consented women were randomly assigned to one of three groups after baseline assessment of sociodemographic variables, health status, beliefs related to cancer screening tests, and history of receipt of guideline-based screening. The mean age of participants was 58.2 years with 97% reporting White race. After adjusting for covariates, 54% of women in the combined intervention (DVD + PN) had a mammogram within the 12-month window, over 5 times the rate of becoming UTD compared to UC (OR = 5.11; 95% CI = 2.57, 10.860; p < 0.001). Interactions of the intervention with other variables were not significant. Significant predictors of being UTD included: being in contemplation stage (intending to have a mammogram in the next 6 months), being UTD with other cancer screenings, having more disposable income and receiving a reminder for breast screening. Women who lived in areas with greater Area Deprivation Index scores (a measure of poverty) were less likely to become UTD with breast cancer screening. For rural women who were not UTD with mammography screening, the addition of PN to a tailored DVD significantly improved the uptake of mammography. Attention should be paid to certain groups of women most at risk for not receiving UTD breast screening to improve breast cancer outcomes in rural women.
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Affiliation(s)
- Victoria L. Champion
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Patrick O. Monahan
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Timothy E. Stump
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Erika B. Biederman
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Eric Vachon
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Mira L. Katz
- Division of Health Behavior and Health Promotion, The Ohio State University, Columbus, OH 43210, USA
| | - Susan M. Rawl
- School of Nursing, Indiana University, Indianapolis, IN 46202, USA
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
| | - Ryan D. Baltic
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Carla D. Kettler
- Indiana University Melvin and Bren Simon Comprehensive Cancer Center, Indianapolis, IN 46202, USA
- Department of Biostatistics and Health Data Science, Indiana University School of Medicine, Indianapolis, IN 46202, USA
| | - Natalie L. Zaborski
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
| | - Electra D. Paskett
- Comprehensive Cancer Center, The Ohio State University (OSU), Columbus, OH 43210, USA
- Division of Cancer Prevention and Control, Department of Medicine, College of Medicine, The Ohio State University, Columbus, OH 43210, USA
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Falk D, Foley K, Weaver KE, Jones B, Cubbin C. An Evaluation of Breast and Cervical Cancer Screening Outcomes in an Education and Patient Navigation Program in Rural and Border Texas. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2022; 37:1043-1052. [PMID: 33150556 PMCID: PMC8096853 DOI: 10.1007/s13187-020-01918-8] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Accepted: 10/30/2020] [Indexed: 06/11/2023]
Abstract
This study examines breast and cervical cancer screening uptake in a cancer education and patient navigation (PN) program for residents of rural and border counties in Texas by level of participation (education only, PN only, or education and PN). Data collected from March 1, 2012, to November 5, 2016, included 6663 follow-up surveys from participants aged 21-74. Logistic regression models assessed program participation on the odds of completing breast or cervical cancer screening. For women aged 40-74 years (N = 4942; mean age = 52 years), 58.4% reported a mammogram within 6 months on average from initial contact. In the breast cancer screening model, women who only received PN (OR: 6.06, CI: 4.87-7.53) or who participated in both the education plus PN program (OR: 3.33, CI: 2.77-4.02) had higher odds of mammogram screening compared to women who only received education. For women aged 21-64 years (N = 6169; mean age = 46 years), 37.7% received a Papanicolaou (Pap) test within 6 months on average from initial contact. In the Pap screening model, both education and PN (OR: 3.23, CI: 2.66-3.91) and PN only (OR: 2.35, CI: 1.88-2.93) groups had higher odds of screening for cervical cancer compared to those only receiving education. Graphed predicted probabilities examined significant interactions between race/ethnicity/language and program participation (P < 0.0001) for both screenings. PN, solely or in combination with education, is an effective strategy to increase screening for breast and cervical cancer, beyond educational outreach efforts alone, among un-/underserved, racially/ethnically diverse women in rural and border Texas counties.
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Affiliation(s)
- Derek Falk
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA.
| | - Kristie Foley
- Department of Implementation Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Kathryn E Weaver
- Department of Social Sciences & Health Policy, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
- Department of Implementation Science, Wake Forest School of Medicine, Medical Center Boulevard, Winston-Salem, NC, 27157, USA
| | - Barbara Jones
- Steve Hicks School of Social Work, The University of Texas at Austin, 1 University Station D3500, Austin, TX, 78712, USA
- Departments of Health Social Work, Oncology, Population Health, and Psychiatry, Dell Medical School, The University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z1100, Austin, TX, 78712, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z1100, Austin, TX, 78712, USA
| | - Catherine Cubbin
- Steve Hicks School of Social Work, The University of Texas at Austin, 1 University Station D3500, Austin, TX, 78712, USA
- LIVESTRONG Cancer Institutes, Dell Medical School, The University of Texas at Austin, 1601 Trinity St., Bldg. B, Stop Z1100, Austin, TX, 78712, USA
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10
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Impact of Community Health Workers on Access to Care for Rural Populations in the United States: A Systematic Review. J Community Health 2021; 47:539-553. [PMID: 34817755 DOI: 10.1007/s10900-021-01052-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/12/2021] [Indexed: 10/19/2022]
Abstract
Community Health Worker (CHW) interventions have shown potential to reduce inequities for underserved populations. However, there is a lack of support for CHW integration in the delivery of health care. This may be of particular importance in rural areas in the Unites States where access to care remains problematic. This review aims to describe CHW interventions and their outcomes in rural populations in the US. Peer reviewed literature was searched in PubMed and PsycINFO for articles published in English from 2015 to February 2021. Title and abstract screening was performed followed by full text screening. Quality of the included studies was assessed using the Downs and Black score. A total of 26 studies met inclusion criteria. The largest proportion were pre-post program evaluation or cohort studies (46.2%). Many described CHW training (69%). Almost a third (30%) indicated the CHW was integrated within the health care team. Interventions aimed to provide health education (46%), links to community resources (27%), or both (27%). Chronic conditions were the concern for most interventions (38.5%) followed by women's health (34.6%). Nearly all studies reported positive improvement in measured outcomes. In addition, studies examining cost reported positive return on investment. This review offers a broad overview of CHW interventions in rural settings in the United States. It provides evidence that CHW can improve access to care in rural settings and may represent a cost-effective investment for the healthcare system.
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Aleshire ME, Adegboyega A, Escontrías OA, Edward J, Hatcher J. Access to Care as a Barrier to Mammography for Black Women. Policy Polit Nurs Pract 2020; 22:28-40. [PMID: 33076774 DOI: 10.1177/1527154420965537] [Citation(s) in RCA: 26] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022]
Abstract
Racial disparities in breast cancer screening, morbidity, and mortality persist for Black women. This study examines Black women's mammography beliefs and experiences with specific focus on barriers to mammography access in an urban city in the South East, United States. This retrospective, qualitative study used Penchansky and Thomas' conceptualization of health care access as the framework for the data analysis. In-depth, semistructured interviews were conducted with 39 Black women. Structural and personal factors continue to create barriers to mammography among Black women. Barriers to mammography were identified for each of the Penchansky and Thomas five dimensions of access to care: accessibility, affordability, availability, accommodation, and acceptability. Clinical practice strategies to increase mammography screening in Black women must be multifactorial, patient-centered, and culturally congruent. Policy development must address the structural barriers to mammography screening through expansion of health insurance coverage and increased accessibility to health care.
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Affiliation(s)
- Mollie E Aleshire
- School of Nursing, University of Louisville, Louisville, Kentucky, United States
| | | | - Omar A Escontrías
- Office of Community Outreach and Engagement, The University of Arizona Cancer Center, Phoenix, United States
| | - Jean Edward
- College of Nursing, University of Kentucky, Lexington, United States
| | - Jennifer Hatcher
- Office of Community Outreach and Engagement, The University of Arizona Cancer Center, Phoenix, United States
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12
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Interventions to increase breast and cervical cancer screening uptake among rural women: a scoping review. Cancer Causes Control 2020; 31:965-977. [PMID: 32840707 DOI: 10.1007/s10552-020-01340-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2019] [Accepted: 08/13/2020] [Indexed: 02/07/2023]
Abstract
PURPOSE Despite widespread promotion of breast and cervical cancer (BCC) screening, uptake remains low in rural communities. Barriers to healthcare, which often result in poorer health outcomes, differentially impact residents of rural communities. Effective interventions addressing the unique needs of rural women may target these barriers and increase BCC screening participation. Our objective is to review and assess the published literature on interventions to increase BCC screening in rural communities. METHODS A systematic scoping review of PubMed/Medline was performed to identify BCC screening interventions conducted in rural settings. English language articles from peer-reviewed journals published from January 2006 to October 2019 were included if they reported results for BCC screening interventions in rural communities in the United States. RESULTS We reviewed 228 articles and identified eight articles consistent with our inclusion criteria. Studies varied in sample population characteristics, geographic location, design, and mode of intervention delivery. Interventions included patient navigation strategies, educational outreach programs, peer counseling, and small media initiatives. Interventions focused on promoting uptake of initial or one-time screening rather than targeted repeat screening, and few studies detailed the cost-effectiveness of the interventions. CONCLUSION This review may inform efforts to develop strategies to increase BCC screening among rural women. Additional cancer prevention and control research gaps in rural communities include the examination of the theoretical foundations, design, delivery, and cost-effectiveness of BCC screening interventions for rural communities. Future research might focus on methods to promote repeat BCC screening and effective translation of these interventions for other rural populations.
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S R SC, Rajaguru H. Comparison Analysis of Linear Discriminant Analysis and Cuckoo-Search Algorithm in the Classification of Breast Cancer from Digital Mammograms. Asian Pac J Cancer Prev 2019; 20:2333-2337. [PMID: 31450903 PMCID: PMC6852837 DOI: 10.31557/apjcp.2019.20.8.2333] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2019] [Indexed: 01/03/2023] Open
Abstract
Objective: Breast cancer is the most common invasive severity which leads to the second primary cause of death among women. The objective of this paper is to propose a computer-aided approach for the breast cancer classification from the digital mammograms. Methods: Designing an effective classification approach will assist in resolving the difficulties in analyzing digital mammograms. The proposed work utilized the Mammogram Image Analysis Society (MIAS) database for the analysis of breast cancer. Five distinct wavelet families are used for extraction of features from the mammograms of MIAS database. These extracted features are statistical in nature and served as input to the Linear Discriminant Analysis (LDA) and Cuckoo-Search Algorithm (CSA) classifiers. Results: Error rate, Sensitivity, Specificity and Accuracy are the performance measures used and the obtained results clearly state that the CSA used as a classifier affords an accuracy of 97.5% while compared with the LDA classifier. Conclusion: The results of comparative performance analysis show that the CSA classifier outperforms the performance of LDA in terms of breast cancer classification.
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Affiliation(s)
- Sannasi Chakravarthy S R
- Department of Electronics and Communication Engineering, Anna University (Bannari Amman Institute of Technology), Sathyamangalam, India
| | - Harikumar Rajaguru
- Department of Electronics and Communication Engineering, Anna University (Bannari Amman Institute of Technology), Sathyamangalam, India
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Bernardo BM, Zhang X, Beverly Hery CM, Meadows RJ, Paskett ED. The efficacy and cost-effectiveness of patient navigation programs across the cancer continuum: A systematic review. Cancer 2019; 125:2747-2761. [PMID: 31034604 DOI: 10.1002/cncr.32147] [Citation(s) in RCA: 75] [Impact Index Per Article: 15.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2018] [Revised: 03/04/2019] [Accepted: 03/27/2019] [Indexed: 12/11/2022]
Abstract
Published studies regarding patient navigation (PN) and cancer were reviewed to assess quality, determine gaps, and identify avenues for future research. The PubMed and EMBASE databases were searched for studies investigating the efficacy and cost-effectiveness of PN across the cancer continuum. Each included article was scored independently by 2 separate reviewers with the Quality Assessment Tool for Quantitative Studies. The current review identified 113 published articles that assessed PN and cancer care, between August 1, 2010, and February 1, 2018, 14 of which reported on the cost-effectiveness of PN programs. Most publications focused on the effectiveness of PN in screening (50%) and diagnosis (27%) along the continuum of cancer care. Many described the effectiveness of PN for breast cancer (52%) or colorectal cancer outcomes (51%). Most studies reported favorable outcomes for PN programs, including increased uptake of and adherence to cancer screenings, timely diagnostic resolution and follow-up, higher completion rates for cancer therapy, and higher rates of attending medical appointments. Cost-effectiveness studies showed that PN programs yielded financial benefits. Quality assessment showed that 75 of the 113 included articles (65%) had 2 or more weak components. In conclusion, this review indicates numerous gaps within the PN and cancer literature where improvement is needed. For example, more research is needed at other points along the continuum of cancer care outside of screening and diagnosis. In addition, future research into the effectiveness of PN for understudied cancers outside of breast and colorectal cancer is necessary along with an assessment of cost-effectiveness and more rigorous reporting of study designs and results in published articles.
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Affiliation(s)
- Brittany M Bernardo
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Xiaochen Zhang
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Chloe M Beverly Hery
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio
| | - Rachel J Meadows
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio
| | - Electra D Paskett
- Division of Population Sciences, Comprehensive Cancer Center, The Ohio State University, Columbus, Ohio.,Division of Epidemiology, College of Public Health, Ohio State University, Columbus, Ohio.,Arthur G. James Cancer Hospital and Richard J. Solove Research Institute, Columbus, Ohio.,Division of Cancer Prevention and Control, Department of Internal Medicine, College of Medicine, The Ohio State University, Columbus, Ohio
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