Qualitative Analysis of Colorectal Cancer Screening in Rural Nebraska

Colorectal cancer care equity in underserved communities: Innovative solutions for screening, outreach & capacity in rural Washington

BACKGROUND

Colorectal cancer (CRC) mortality hotspots in rural Washington, notably Yakima and Richland, identified an 8-year earlier median age of death in non-white patients. Post-pandemic data from WA State Department of Health and MultiCare's electronic health records revealed a 40 ​% decrease in CRC screenings.

METHODS

During a 2023 CRC prevention summit, barriers and solutions were discussed focusing on rural Hispanic laborers as this population is often seen at partner locations, Yakima Valley Farm Workers Clinic (YVFWC).

RESULTS

Community outreach-Our team established a presence at Yakima's largest health fair, Fiesta de Salud. We also provided screening resources at Richland's farmers' markets. Planned events-- We will network with local community leaders and health providers to actualize screening (stool-based testing, hands-on endoscopy training).

CONCLUSION

Persistent CRC mortality disparities in Washington State underscores the need for targeted interventions. Partnering with organizations and engaging in community outreach aims to increase screening rates and enhance education.

Mailed Outreach and Patient Navigation for Colorectal Cancer Screening Among Rural Medicaid Enrollees: A Cluster Randomized Clinical Trial

Importance

Approximately 60 million adults live in rural regions of the US, which historically have low rates of colorectal cancer (CRC) screening and follow-up. Rural residents enrolled in Medicaid have particularly low CRC screening and follow-up rates.

Objective

To determine the effectiveness and implementation of a collaborative Medicaid health plan-clinic program of mailed fecal immunochemical test (FIT) outreach and patient navigation to colonoscopy following an abnormal FIT result when implemented in rural clinics as part of standard care.

Design, Setting, and Participants

This cluster randomized clinical trial was conducted at 28 rural clinic units in Oregon affiliated with 3 Medicaid health plans. The clinics were randomized to the intervention (n = 14) or to usual care (n = 14). Participants were Medicaid enrollees (aged 50-75 years) due for CRC screening. The intervention was delivered from May 11, 2021, through June 4, 2022, and analyses were performed from June 2023 through September 2024.

Intervention

The stepwise intervention involved (1) mailed FIT outreach and (2) patient navigation to colonoscopy following an abnormal FIT result. Implementation support included practice facilitation, training, collaborative learning, and patient tracking tools.

Main Outcomes and Measures

The primary effectiveness outcome was completion of any CRC screening within 6 months of eligibility determination. An additional effectiveness outcome was follow-up colonoscopy completion within 6 months of an abnormal FIT result. Implementation was measured as (1) the proportion of intervention-eligible enrollees who were mailed an FIT and who were sent an advance notification or reminder and (2) the proportion with an abnormal FIT result who were offered patient navigation.

Results

This study included 5614 Medicaid enrollees (2613 in intervention clinics and 3001 in usual care clinics). Enrollees had a mean (SD) age of 58.2 (5.5) years; most (4940 [88.0%]) were aged 50 to 64 years. A total of 2948 enrollees (52.5%) were female, 325 (6.2%) were Hispanic and 3774 (67.2%) were White, and 4457 (79.4%) lived in rural regions. Compared with Medicaid enrollees in usual care clinics, enrollees in intervention clinics had a higher adjusted 6-month proportion of any CRC screening completion (11.8% vs 4.5%; difference, 7.3 [95% CI, 5.3-9.2] percentage points). Implementation was 100% (all 1489 intervention-eligible enrollees) for mailed FIT outreach, 88.5% for advance notification, 78.1% for reminders, and 57.9% for patient navigation.

Conclusions and Relevance

In this cluster randomized clinical trial of rural clinics, mailed FIT outreach and patient navigation boosted participation in CRC screening among Medicaid enrollees. More efforts are needed to address low participation in both FIT testing and follow-up colonoscopy.

Trial Registration

ClinicalTrials.gov Identifier: NCT04890054.

Colorectal Cancer Outcomes: A Comparative Review of Resource-Limited Settings in Low- and Middle-Income Countries and Rural America

Background/Objectives: Colorectal cancer remains a significant global health challenge, particularly in resource-limited settings where patient-centered outcomes following surgery are often suboptimal. Although more prevalent in low- and middle-income countries (LMICs), segments of the United States have similarly limited healthcare resources, resulting in stark inequities even within close geographic proximity. Methods: This review compares and contrasts colorectal cancer outcomes in LMICs with those in resource-constrained communities in rural America, utilizing an established implementation science framework to identify key determinants of practice for delivering high-quality colorectal cancer care. Results: Barriers and innovative, community-based strategies aimed at improving patient-centered outcomes for colorectal cancer patients in low resource settings are identified. We explore innovative approaches and community-based strategies aimed at improving patient-centered outcomes, highlighting the newly developed colorectal surgery fellowship in Sub-Saharan Africa as a model of innovation in this field. Conclusions: By exploring these diverse contexts, this paper proposes actionable solutions and strategies to enhance surgical care of colorectal cancer and patient outcomes, ultimately aiming to inform global health practices, inspire collaboration between LMIC and rural communities, and improve care delivery across various resource settings.

Knowledge and Attitudes toward Colorectal Cancer among Healthcare Workers: A Pilot Cross-Sectional Survey in Thailand

BACKGROUND

Colorectal cancer is an important public health problem in Thailand. The health workforce is one of the key strategies to reduce the burden of cancer. They are not only involved in patient care, but they can improve public knowledge of cancer within their community. This study aimed to explore the knowledge and attitudes toward colorectal cancer among Thai healthcare workers.

METHODS

A cross-sectional pilot study was conducted from October 2021 to March 2022. Convenience sampling was used to recruit study participants who worked in selected primary healthcare units or hospitals located in different regions across the country. The data on demographics and health behavior, knowledge of using the Fecal Immunochemical Test (FIT), and knowledge and attitudes toward colorectal cancer were collected using self-administered questionnaires. Descriptive statistics were used for data analysis.

RESULTS

A total of 300 healthcare workers were recruited in the study. The majority of participants presented a healthy lifestyle: 74% were in the healthy weight range, 68% had never consumed alcohol, and 99.3% were never smokers. More than 70% of participants provided correct answers to questions about the use of a FIT kit. The mean score for knowledge of colorectal cancer was 12.16 + 2.16 (out of 14) and 240 (80%) participants were considered to have adequate knowledge. Also, colorectal cancer knowledge was associated with age of participants (p<0.05). Most of the participants (76.2-92.3%) had positive attitudes toward colorectal cancer screening, however about half of them thought that a colonoscopy could be painful, uncomfortable, and embarrassing.

CONCLUSIONS

Overall, the majority of participants had adequate knowledge of colorectal cancer and positive attitudes toward its screening. The present study provided overview information on practical guidance for undertaking a nationwide survey in the future.