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Golla V, Kaye DR. The Impact of Health Delivery Integration on Cancer Outcomes. Surg Oncol Clin N Am 2021; 31:91-108. [PMID: 34776068 DOI: 10.1016/j.soc.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Although integrated health care has largely been associated with increases in prices and static or decreased quality across many disease states, it has shown some successes in improving cancer care. However, its impact is largely equivocal, making consensus statements difficult. Critically, integration does not necessarily translate to clinical coordination, which might be the true driver behind the success of integrated health care delivery. Moving forward, it is important to establish payment models that support clinical care coordination. Shifting from a fragmented health system to a coordinated one may improve evidence-based cancer care, outcomes, and value for patients.
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Affiliation(s)
- Vishnukamal Golla
- Duke National Clinician Scholars Program, 200 Morris St, Suite 3400, DUMC Box 104427, Durham, NC 27701, USA; Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke-Margolis Policy Center; Durham Veterans Affairs Health Care System, Durham, NC, USA.
| | - Deborah R Kaye
- Department of Surgery, Division of Urology, Duke University Medical Center, Durham, NC, USA; Duke Cancer Institute, Durham, NC, USA; Duke-Margolis Policy Center
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2
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Heinig M, Schwarz S, Haug U. Self-selection for mammography screening according to use of hormone replacement therapy: A systematic literature review. Cancer Epidemiol 2021; 71:101812. [PMID: 33608235 DOI: 10.1016/j.canep.2020.101812] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Revised: 09/01/2020] [Accepted: 09/05/2020] [Indexed: 11/27/2022]
Abstract
Mammography screening participation may be influenced by the awareness of an increase in breast cancer risk due to hormone replacement therapy (HRT), which received particular attention upon publication of the Women's Health Initiative (WHI) trial results in 2002. Our aim was to synthesize evidence on a potential self-selection for mammography screening according to HRT use. We systematically searched the literature (MEDLINE, EMBASE, CINAHL) for studies reporting on the association between HRT use and mammography screening participation. Data were extracted independently by two reviewers. Overall, 2018 studies were identified. Of these, 32 studies from nine countries, predominantly from North America (50%) and Europe (28%), were included. In studies from all countries and 94% of all studies, higher mammography screening uptake among HRT users compared to non-users was reported. In all 21 studies reporting an odds ratio, the association was positive, and in about 70% of these studies, this association was ≥2. This also held true for studies exclusively using data collected before publication of the WHI findings in 2002 (63% of all studies). The association was not restricted to certain types of screening (organized vs. opportunistic) or certain types of HRT (combined vs. estrogen-only). We found a consistent and relevant association between mammography screening uptake and HRT use. This is of considerable relevance for the design and interpretation of studies investigating risk factors or evaluating preventive measures for breast cancer.
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Affiliation(s)
- Miriam Heinig
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany.
| | - Sarina Schwarz
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany.
| | - Ulrike Haug
- Department of Clinical Epidemiology, Leibniz Institute for Prevention Research and Epidemiology - BIPS, Achterstraße 30, 28359 Bremen, Germany; Faculty of Human and Health Sciences, University of Bremen, Grazer Str. 2, 28359 Bremen, Germany.
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Patel K, Gishe J, Liu J, Heaston A, Manis E, Moharreri B, Hargreaves M. Factors Influencing Recommended Cancer Screening in Low-Income African American Women in Tennessee. J Racial Ethn Health Disparities 2019; 7:129-136. [PMID: 31664677 DOI: 10.1007/s40615-019-00642-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2019] [Revised: 09/11/2019] [Accepted: 09/20/2019] [Indexed: 01/22/2023]
Abstract
OBJECTIVE This study examined the factors that predict recommended screening compliance to cervical, breast, and colorectal cancers in low-income African American women. It also examined obstacles to screenings by geographic region and screening status. METHODS As a part of the Meharry Community Networks Program (CNP) needs assessment, a 123-item community survey was administered to assess demographic characteristics, health care access and utilization, and screening practices for various cancers in low-income African Americans. For this study, only African American women 40 years and older (n = 308) were selected from the Meharry CNP community survey database. RESULTS There were several predictors to recommended screening such as being employed and having health insurance (P < 0.05). Additionally, the obstacles to screening posed a similar level of difficulty for participants from different geographic areas. DISCUSSION Sociodemographic differences and obstacles of screening need to be addressed in educational interventions aimed at improving cancer screenings.
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Affiliation(s)
- Kushal Patel
- Department of Public Health, Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-411, Nashville, TN, 37203, USA.
| | - Jemal Gishe
- Department of Public Health, Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-410, Nashville, TN, 37203, USA
| | - Jianguo Liu
- Department of Internal Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA
| | - Alexis Heaston
- Department of Public Health, Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-416, Nashville, TN, 37203, USA
| | - Elizabeth Manis
- Department of Public Health, Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-419, Nashville, TN, 37203, USA
| | - Bella Moharreri
- Department of Public Health, Health Administration and Health Sciences, Tennessee State University, 330 10th Avenue North, Suite D-419, Nashville, TN, 37203, USA
| | - Margaret Hargreaves
- Department of Internal Medicine, Meharry Medical College, 1005 Dr. D.B. Todd Jr. Blvd, Nashville, TN, 37208, USA
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Miles RC, Narayan AK, Lopez DB, Lehman CD, Harvey HB, Mishra V, Glover M, Flores EJ. Chronic Medical Illness as a Risk Factor for Poor Mammography Screening Adherence. J Womens Health (Larchmt) 2019; 28:1378-1383. [DOI: 10.1089/jwh.2018.7315] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Affiliation(s)
- Randy C. Miles
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Anand K. Narayan
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Diego B. Lopez
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Constance D. Lehman
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - H. Benjamin Harvey
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Vishala Mishra
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - McKinley Glover
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
| | - Efren J. Flores
- Department of Radiology, Massachusetts General Hospital, Boston, Massachusetts
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Smith RA, Andrews KS, Brooks D, Fedewa SA, Manassaram-Baptiste D, Saslow D, Wender RC. Cancer screening in the United States, 2019: A review of current American Cancer Society guidelines and current issues in cancer screening. CA Cancer J Clin 2019; 69:184-210. [PMID: 30875085 DOI: 10.3322/caac.21557] [Citation(s) in RCA: 352] [Impact Index Per Article: 70.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Each year, the American Cancer Society publishes a summary of its guidelines for early cancer detection, data and trends in cancer screening rates, and select issues related to cancer screening. In this issue of the journal, the current American Cancer Society cancer screening guidelines are summarized, and the most current data from the National Health Interview Survey are provided on the utilization of cancer screening for men and women and on the adherence of men and women to multiple recommended screening tests.
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Affiliation(s)
- Robert A Smith
- Vice-President, Cancer Screening, and Director, Center for Quality Cancer Screening and Research, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Kimberly S Andrews
- Director, Guidelines Process, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Durado Brooks
- Vice President, Cancer Control Interventions, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Senior Principal Scientist, Surveillance and Health Services Research, American Cancer Society, Atlanta, GA
| | | | - Debbie Saslow
- Senior Director, Human Papillomavirus-Related and Women's Cancers, Cancer Control Department, American Cancer Society, Atlanta, GA
| | - Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
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Rapid review of factors associated with flexible sigmoidoscopy screening use. Prev Med 2019; 120:8-18. [PMID: 30597228 DOI: 10.1016/j.ypmed.2018.12.018] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 12/04/2018] [Accepted: 12/24/2018] [Indexed: 01/19/2023]
Abstract
Flexible sigmoidoscopy (FS) screening has been shown to reduce colorectal cancer (CRC) incidence and mortality among screened adults. The aim of this review was to identify patient-related factors associated with the screening test's use. We searched PubMed for studies that examined the association between FS screening use and one or more factors. To determine the eligibility of studies, we first reviewed titles, then abstracts, and finally the full paper. We started with a narrow search, which we expanded successively (by adding 'OR' terms) until the number of new publications eligible after abstract review was <1% of the total number of publications. We then abstracted factors from eligible papers and reported the number of times each was found to be positively or negatively associated with FS screening use. We identified 42 papers, most of which reported studies conducted in the United States of America (n = 21, 50%) and the United Kingdom (n = 13, 31%). Across studies, a wide range of factors were examined (n = 123), almost half of which were found to be associated with FS screening use at least once (n = 60). Sociodemographic and health and lifestyle factors that were frequently positively associated with FS screening use included: male gender, higher socioeconomic status and a family history of CRC. Frequently positively associated psychosocial factors included low perceived barriers and high perceived benefits. Findings suggest that future research should focus on developing a theoretical framework of cancer screening behaviour to allow a greater level of consistency and specificity in measuring key constructs.
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Wender RC, Brawley OW, Fedewa SA, Gansler T, Smith RA. A blueprint for cancer screening and early detection: Advancing screening's contribution to cancer control. CA Cancer J Clin 2019; 69:50-79. [PMID: 30452086 DOI: 10.3322/caac.21550] [Citation(s) in RCA: 67] [Impact Index Per Article: 13.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
From the mid-20th century, accumulating evidence has supported the introduction of screening for cancers of the cervix, breast, colon and rectum, prostate (via shared decisions), and lung. The opportunity to detect and treat precursor lesions and invasive disease at a more favorable stage has contributed substantially to reduced incidence, morbidity, and mortality. However, as new discoveries portend advancements in technology and risk-based screening, we fail to fulfill the greatest potential of the existing technology, in terms of both full access among the target population and the delivery of state-of-the art care at each crucial step in the cascade of events that characterize successful cancer screening. There also is insufficient commitment to invest in the development of new technologies, incentivize the development of new ideas, and rapidly evaluate promising new technology. In this report, the authors summarize the status of cancer screening and propose a blueprint for the nation to further advance the contribution of screening to cancer control.
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Affiliation(s)
- Richard C Wender
- Chief Cancer Control Officer, American Cancer Society, Atlanta, GA
| | - Otis W Brawley
- Chief Medical Officer, American Cancer Society, Atlanta, GA
| | - Stacey A Fedewa
- Senior Principal Scientist, Department of Surveillance Research, American Cancer Society, Atlanta, GA
| | - Ted Gansler
- Strategic Director of Pathology Research, American Cancer Society, Atlanta, GA
| | - Robert A Smith
- Vice-President, Cancer Screening, Cancer Control Department, and Director, Center for Quality Cancer Screening and Research, American Cancer Society Atlanta, GA
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Primary care provider approaches to preventive health delivery: a qualitative study. Prim Health Care Res Dev 2018; 19:464-474. [PMID: 29307319 DOI: 10.1017/s1463423617000858] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
Abstract
AimThe objective of this study was to seek decision-making insights on the provider level to gain understanding of the values that shape how providers deliver preventive health in the primary care setting. BACKGROUND The primary care clinic is a core site for preventive health delivery. While many studies have identified barriers to preventive health, less is known regarding how primary care providers (PCPs) make preventive health decisions such as what services to provide, under what circumstances, and why they might choose one over another. METHODS Qualitative methods were chosen to deeply explore these issues. We conducted semi-structured, one-on-one interviews with 21 PCPs at clinics affiliated with an academic medical center. Interviews with providers were recorded and transcribed. We conducted a qualitative analysis to identify themes and develop a theoretical framework using Grounded Theory methods.FindingsThe following themes were revealed: longitudinal care with an established PCP-patient relationship is perceived as integral to preventive health; conflict and doubt accompany non-preventive visits; PCPs defer preventive health for pragmatic reasons; when preventive health is addressed, providers use multiple contextual factors to decide which interventions are discussed; and PCPs desired team-based preventive health delivery, but wish to maintain their role when shared decision-making is required. We present a conceptual framework called Pragmatic Deferral.
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Hamman MK, Kapinos KA. Affordable Care Act Provision Lowered Out-Of-Pocket Cost And Increased Colonoscopy Rates Among Men In Medicare. Health Aff (Millwood) 2017; 34:2069-76. [PMID: 26643627 DOI: 10.1377/hlthaff.2015.0571] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Colorectal cancer screening is one of the few cancer screenings with an "A" rating from the US Preventive Services Task Force, meaning that the procedure confers a substantial health benefit. However, 40 percent of people who should receive colorectal cancer screenings do not receive them. Colonoscopies are the most thorough method of screening because they allow physicians to view the entire length of the colon and remove polyps as needed. Billing methods that distinguish between screening and therapeutic procedures have kept expected colonoscopy costs high. However, the Affordable Care Act partially closed the so-called colonoscopy loophole and reduced expected out-of-pocket expenses for all Medicare beneficiaries. Using data from the Behavioral Risk Factor Surveillance System, we found that annual colonoscopy rates among men ages 66-75 increased significantly (by 4.0 percentage points) after the Affordable Care Act policy change, and we found some evidence of even larger increases among socioeconomically disadvantaged men. We found no significant increases among women, a result that may be explained by health behavior and other factors and that requires further study. Our research indicates that cost may be an important barrier to colorectal cancer screening, at least among men, and that making further policy changes to close remaining loopholes may improve screening rates.
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Affiliation(s)
- Mary K Hamman
- Mary K. Hamman is an assistant professor of economics at the University of Wisconsin-La Crosse
| | - Kandice A Kapinos
- Kandice A. Kapinos is an economist at the RAND Corporation in Arlington, Virginia
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Mistry DAH, French PW. Circulating Phospholipids as Biomarkers of Breast Cancer: A Review. Breast Cancer (Auckl) 2016; 10:191-196. [PMID: 27867299 PMCID: PMC5110222 DOI: 10.4137/bcbcr.s40693] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Revised: 09/14/2016] [Accepted: 09/15/2016] [Indexed: 01/13/2023] Open
Abstract
Breast cancer is the most common cancer in women and the second leading cause of cancer deaths in women. The key to surviving breast cancer is early detection and treatment. Current technologies rely heavily on imaging of the breast, and although considered the gold standard, they have their limitations. There is a need for a more accurate screening test for women of all ages, which can detect the cancer at a cellular level and before metastasis. There have been extensive studies into markers for breast cancer including protein and nucleic acid biomarkers, but to date, these have been unsuccessful. A growing field of interest is the association between breast cancer (tissue and cells) and lipids, which is documented in the literature, and may be considered as a leading candidate in the breast cancer detection space.
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Affiliation(s)
| | - Peter William French
- BCAL Diagnostics Pty Ltd, Sydney, NSW, Australia
- School of Medicine, University of New South Wales, Kensington, NSW, Australia
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Bar-Dayan Y, Boaz M, Landau Z, Zeev F, Jakubowicz D, Wainstein J. Using a public health station for screening of undiagnosed dysglycemia and hypertension. Prim Care Diabetes 2016; 10:324-328. [PMID: 26968251 DOI: 10.1016/j.pcd.2016.02.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/27/2015] [Revised: 02/04/2016] [Accepted: 02/05/2016] [Indexed: 11/15/2022]
Abstract
AIM Dysglycemia, diabetes and abnormal blood pressure screening can be conducted by trained volunteers and may identify unknown cases. The aim of the study was to examine the feasibility and effectiveness of operating a screening station in pubic setting supervised by diabetes unit. METHODS A cross-sectional analysis of a program offering free screening services to non-hospitalized subjects. From 1.1.2011 through 31.12.2013 trained volunteers measured height, weight, blood glucose and blood pressure at the main entrance of the hospital. Subjects were asked whether they had diabetes or hypertension. Dysglycemia was defined as blood glucose 141-199mg/dL and probable newly-identified diabetes as ≥200mg/dL. RESULTS 13,112 adults underwent screening. Among the screened individuals (age 55.3±14.9 years) 2215 (16.9%) reported diabetes and 3037 (23.2%) hypertension. Among subjects without known hypertension, 9.6% had blood pressure ≥140/90. Among the subjects without known diabetes, 5012 (46%) had glucose ≤110mg/dL, 2873 (26.4%) ≥126mg/dL, 1553 (14.3%) >140mg/dL and 170 (1.6%) ≥200mg/dL. Compared to subjects with blood glucose ≤140mg/dL, those with dysglycemia or diabetes were older (58.9±13.4 vs. 52.7±15.2 years, P<0.001), had elevated BMI (27.5±4.6kg/m(2) vs. 26.6±4.6kg/m(2), P<0.001), higher systolic (137.5±22.2mmHg vs. 132.2±21.3mmHg, P<0.001) and diastolic blood pressure (80.3±15.6mmHg vs. 78.6±13.7mmHg, P<0.001). Compared to subjects with blood glucose<200mg/dL, those with probable newly-identified diabetes were older (58.6±10.9 vs. 53.5±15.2, P<0.001), had elevated BMI (28.4±4.8kg/m(2) vs. 26.7±4.6kg/m(2), P<0.001), higher systolic (139.4±24.0mmHg vs. 132.8±21.4mmHg, P<0.001) and diastolic blood pressure (85.4±20.7mmHg vs. 78.8±13.9mmHg, P<0.001). CONCLUSIONS Screening supervised by healthcare center can identify individuals at high-risk for dysglycemia and abnormal blood pressure, who are referred for further diagnosis and treatment and may serve as a complementary step in primary health care setting.
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Affiliation(s)
- Yosefa Bar-Dayan
- Diabetes Unit, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel.
| | - Mona Boaz
- Epidemiology and Research Unit, Wolfson Medical Center, Holon, Israel; Ariel University, Ariel, Israel
| | - Zohar Landau
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Pediatric Endocrinology Unit, Wolfson Medical Center, Holon, Israel
| | - Feldbrin Zeev
- Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Diabetes Foot Care Unit, Wolfson Medical Center, Holon, Israel
| | - Daniela Jakubowicz
- Diabetes Unit, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Julio Wainstein
- Diabetes Unit, Wolfson Medical Center, Holon, Israel; Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
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Breast cancer screening initiation after turning 40 years of age within the PROSPR consortium. Breast Cancer Res Treat 2016; 160:323-331. [PMID: 27665586 DOI: 10.1007/s10549-016-3990-x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/23/2016] [Accepted: 09/19/2016] [Indexed: 01/10/2023]
Abstract
PURPOSE Although United States clinical guidelines differ, the earliest recommended age for average risk breast cancer screening is 40 years. Little is known about factors influencing screening initiation. METHODS We conducted a cohort study within the National Cancer Institute-funded Population-based Research Optimizing Screening through Personalized Regimens (PROSPR) consortium. We identified 3413 women on their 40th birthday in primary care networks at Geisel School of Medicine at Dartmouth (DH) and Brigham and Women's Hospital (BWH) during 2011-2013 with no prior breast imaging or breast cancer. Cumulative incidence curves and Cox modeling were used to determine time from the 40th birthday to first breast cancer screening, cohort exit, or 42nd birthday. We calculated hazards ratios and 95 % confidence intervals from multivariable Cox proportional hazards models. RESULTS Breast cancer screening cumulative incidence by the 42nd birthday was 62.9 % (BWH) and 39.8 % (DH). Factors associated with screening initiation were: a primary care visit within a year (HR 4.99, 95 % CI 4.23-5.89), an increasing number of primary care visits within a year (p for trend <0.0001), ZIP code of residence annual median household income ≤$52,000 (HR 0.79, 95 % CI 0.68-0.92), and health insurance type (Medicaid HR 0.72, 95 % CI 0.58-0.88; Medicare HR 0.55, 95 % CI 0.39-0.77; uninsured HR 0.37, 95 % CI 0.25-0.57). CONCLUSIONS Breast cancer screening uptake after the 40th birthday varies by health system, primary care visits, median household income, and health insurance type, suggesting the need for further exploration. Future research should evaluate screening performance metrics after initiation and consider cumulative benefits and risks associated with breast cancer screening over time.
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Coughlin SS, Thompson T. Physician Recommendation for Colorectal Cancer Screening by Race, Ethnicity, and Health Insurance Status Among Men and Women in the United States, 2000. Health Promot Pract 2016; 6:369-78. [PMID: 16210678 DOI: 10.1177/1524839905278742] [Citation(s) in RCA: 55] [Impact Index Per Article: 6.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
In this study, the authors examined whether men and women in the United States had received a physician recommendation to get a colorectal cancer screening test, by race, ethnicity, and health insurance status using data from the 2000 National Health Interview Survey. Among men and women who had had a doctor visit in the past year but who had not had a recent fecal occult blood test, about 94.6% (95% CI 94.0-95.2) reported that their doctor had not recommended the test in the past year. African Americans, Hispanics, and American Indians/Alaska Natives were less likely to report receiving a recommendation for endoscopy compared to Whites.
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Affiliation(s)
- Steven S Coughlin
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, Centers for Disease Control and Prevention in Atlanta, Georgia, USA
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Garrison GM, Traverse CR, Fish RG. A Case Study of Visit-Driven Preventive Care Screening Using Clinical Decision Support: The Need to Redesign Preventive Care Screening. Health Serv Res Manag Epidemiol 2016; 3:2333392816650344. [PMID: 28462279 PMCID: PMC5266452 DOI: 10.1177/2333392816650344] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2016] [Accepted: 04/20/2016] [Indexed: 01/22/2023] Open
Abstract
Introduction: In the traditional model of care, an annual visit was dedicated to the task of assessing and delivering preventive care. With the move away from annual physicals, primary care physicians are addressing preventive services at every clinic visit often aided by electronic clinical decision support (CDS) systems. Methods: We conducted a case study of a visit-driven CDS system in use at a primary care clinic. Steady-state performance was assessed via control charts of quality metrics, data regarding completion of recommendations, and an analysis of screening intervals achieved with patient visits. Results: Under this visit-driven CDS system, quality metric performance was poor and declining. Almost half of the patients were not screened (46.5%), and the other half were overscreened the majority of the time (83.3%). Recommended preventive services were ordered less than half the time (42.6%), despite CDS reminders. Discussion: Various barriers and systematic inefficiencies combined to produce ineffective screening in this visit-driven CDS preventive service delivery system. As a result, we conclude a visit-driven system cannot produce optimal results. In order to improve performance, preventive services should be delivered separately from clinical visits, perhaps by a “preventive service ranger” (PSR) utilizing the CDS system to review each patient once annually. Under such a system, patients would receive preventive services in an organized and efficient fashion, potentially leading to better continuity, higher quality metrics that are mathematically predictable, and improved satisfaction.
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Affiliation(s)
| | | | - Robert G Fish
- Department of Family Medicine, Mayo Clinic, Rochester, MN, USA
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15
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Hamman MK, Kapinos KA. Colorectal Cancer Screening and State Health Insurance Mandates. HEALTH ECONOMICS 2016; 25:178-191. [PMID: 25521438 DOI: 10.1002/hec.3132] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/10/2011] [Revised: 10/17/2014] [Accepted: 11/05/2014] [Indexed: 06/04/2023]
Abstract
Colorectal cancer (CRC) is the third most deadly cancer in the USA. CRC screening is the most effective way to prevent CRC death, but compliance with recommended screenings is very low. In this study, we investigate whether CRC screening behavior changed under state mandated private insurance coverage of CRC screening in a sample of insured adults from the 1997 to 2008 Behavioral Risk Factor Surveillance Survey (BRFSS). We present difference-in-difference-in-differences (DDD) estimates that compare insured individuals age 51 to 64 to Medicare age-eligible individuals (ages 66 to 75) in mandate and non-mandate states over time. Our DDD estimates suggest endoscopic screening among men increased by 2 to 3 percentage points under mandated coverage among 51 to 64 year olds relative to their Medicare age-eligible counterparts. We find no clear evidence of changes in screening behavior among women. DD estimates suggest no evidence of a mandate effect on either type of CRC screening for men or women.
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Affiliation(s)
- Mary K Hamman
- Department of Economics, University of Wisconsin, La Crosse, La Crosse, WI, USA
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16
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Donohoe J, Marshall V, Tan X, Camacho FT, Anderson R, Balkrishnan R. Predicting Late-stage Breast Cancer Diagnosis and Receipt of Adjuvant Therapy: Applying Current Spatial Access to Care Methods in Appalachia. Med Care 2015; 53:980-8. [PMID: 26465126 PMCID: PMC4610181 DOI: 10.1097/mlr.0000000000000432] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
PURPOSE The 2-step floating catchment area (2SFCA) method of measuring access to care has never been used to study cancer disparities in Appalachia. First, we evaluated the 2SFCA method in relation to traditional methods. We then examined the impact of access to mammography centers and primary care on late-stage breast cancer diagnosis and receipt of adjuvant hormonal therapy. METHODS Cancer registries from Pennsylvania, Ohio, Kentucky, and North Carolina were linked with Medicare data to identify the stage of breast cancer diagnosis for Appalachia women diagnosed between 2006 and 2008. Women eligible for adjuvant therapy had stage I, II, or III diagnosis; mastectomy or breast-conserving surgery; and hormone receptor-positive breast cancers. Geographically weighted regression was used to explore nonstationarity in the demographic and spatial access predictor variables. RESULTS Over 21% of 15,299 women diagnosed with breast cancer had late-stage (stages III-IV) diagnosis. Predictors included age at diagnosis [odds ratio (OR)=0.86; P<0.001], insurance status (OR=1.32; P<0.001), county primary care to population ratio (OR=0.95; P<0.001), and primary-care 2SFCA score (OR=0.96; P=0.006). Only 46.9% of eligible women received adjuvant hormonal therapy, and predictors included comorbidity status (OR=1.18; P=0.047), county economic status (OR=1.32; P=0.006), and mammography center 2SFCA scores (OR=1.12; P=0.021). CONCLUSIONS Methodologically, the 2SFCA method offered the greatest predictive validity of the access measures examined. Substantively, rates of late-stage breast cancer diagnosis and adjuvant hormonal therapy are substandard in Appalachia.
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Affiliation(s)
- Joseph Donohoe
- Mountain-Pacific Quality Health Foundation, Helena, MT, 59602, USA
| | - Vince Marshall
- College of Pharmacy, University of Michigan, Ann Arbor, MI, 48109, USA
| | - Xi Tan
- School of Pharmacy, West Virginia University, Morgantown, WV, 26506, USA
| | - Fabian T. Camacho
- School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Roger Anderson
- School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
| | - Rajesh Balkrishnan
- School of Medicine, University of Virginia, Charlottesville, VA, 22908, USA
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Camacho F, Hwang W, Kern T, Anderson RT. Receipt of Regular Primary Care and Early Cancer Detection in Appalachia. J Rural Health 2014; 31:269-81. [PMID: 25370354 DOI: 10.1111/jrh.12097] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
PURPOSE The objective was to examine the impact of regular primary care encounters (PCE) on early breast cancer detection in an Appalachian sample of Medicare beneficiaries diagnosed 2006-2008. Determinants of PCE were investigated and a mediation analysis was conducted where PCE was a mediator to cancer stage. METHODS A total of 3,589 cases were identified from Appalachian areas in Pennsylvania, Kentucky, Ohio, and North Carolina, and health care services were examined 2 months to 2 years prior to diagnosis. A regular care PCE variable was constructed with 4 ordinal levels: none, any, "annual," and "semi-annual." Association of PCE with stage, mortality and covariables was conducted using ordinal logistic regressions and Cox Proportional Hazards survival models. RESULTS Sixty-eight percent of the cases had semi-annual PCE. Regular PCE was strongly associated with late-stage cancer rates (39%-13% by increasing PCE level, P < .0001) and 5-year all-cause mortality (42%-24%, P < .0001). Subgroup analysis revealed variations by hypertension and urban status, with nonhypertensives with no PCE being at particularly increased risk. Significant determinants of PCE included age, rural/urban status, comorbidity, dual Medicaid insurance, Appalachian region economic classification, state, select comorbidities, hypertension, and minimum distance to provider. Mediation analysis results were consistent with lower number of comorbidities leading to increased late cancer detection due to patients having a decreased PCE. CONCLUSION PCE is an important determinant of cancer detection, with a dose-response relationship. Variations exist by geography and hypertension. Comorbidity may influence both PCE and late-stage rates with partial mediation through PCE.
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Affiliation(s)
- Fabian Camacho
- Department of Public Health Science, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Wenke Hwang
- Department of Public Health Science, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Teresa Kern
- Department of Public Health Science, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
| | - Roger T Anderson
- Department of Public Health Science, College of Medicine, The Pennsylvania State University, Hershey, Pennsylvania
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Liu BY, O'Malley J, Mori M, Fagnan LJ, Lieberman D, Morris CD, Buckley DI, Heintzman JD, Carney PA. The association of type and number of chronic diseases with breast, cervical, and colorectal cancer screening. J Am Board Fam Med 2014; 27:669-81. [PMID: 25201936 PMCID: PMC4273642 DOI: 10.3122/jabfm.2014.05.140005] [Citation(s) in RCA: 37] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/29/2022] Open
Abstract
PURPOSE The purpose of this study was to examine associations between the number and types of patients' chronic diseases and being up to date for breast, cervical, and colorectal cancer screening. METHODS Data were abstracted from medical charts at 4 primary care clinics located in 2 rural Oregon communities. Eligibility criteria included being at least 55 years old and having at least 1 clinic visit in the past 2 years. RESULTS Of 3433 patients included, 503 (15%) had no chronic illness, 646 (19%) had 1, 786 (23%) had 2, and 1498 (44%) had ≥3 chronic conditions. Women with asthma/chronic lung disease and with cardiovascular disease were less likely to be up o date for mammography screening (odds ratio [OR], 0.59; 95% confidence interval [CI], 0.43-0.80), and those with chronic digestive disorders were more likely to be up to date for mammography (OR, 1.31; 95% CI, 1.03-1.66) compared with those without chronic conditions. Women with arthritis, diabetes mellitus, and hypertension were less likely to be up to date for cervical cancer screening (OR, 0.38; 95% CI, 0.21-0.68) compared with those without chronic conditions. Men with cardiovascular disease were less likely to be up to date for colorectal cancer screening (adjusted OR, 0.59; 95% CI, 0.44-0.80), and women with depression were less likely to be up to date (OR, 0.71; 95% CI, 0.56-0.91) compared with men and women without chronic conditions. CONCLUSION Specific chronic conditions were found to be associated with up-to-date status for cancer screening. This finding may help practices to identify patients who need to receive cancer screening.
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Affiliation(s)
- Betty Y Liu
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - Jean O'Malley
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - Motomi Mori
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - Lyle J Fagnan
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - David Lieberman
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - Cynthia D Morris
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - David I Buckley
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - John D Heintzman
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland
| | - Patricia A Carney
- From the Department of Family and Preventive Medicine, University of Utah, Salt Lake City (BYL); the Department of Public Health and Preventive Medicine, Division of Biostatistics (JO, MM), the Department of Family Medicine (LJF, DIB, JDH, PAC), the Department of Internal Medicine, Division of Gastroenterology (CDM), the Department of Medical Informatics and Clinical Epidemiology (CDM, DIB), and the Department of Public Health and Preventive Medicine (DIB, PAC) Oregon Health & Science University, Portland.
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Gupta M, Beebe TJ, Dunagan KT, Schleck CD, Zinsmeister AR, Talley NJ, Locke GR, Iyer PG. Screening for Barrett's esophagus: results from a population-based survey. Dig Dis Sci 2014; 59:1831-50. [PMID: 24652109 PMCID: PMC4387565 DOI: 10.1007/s10620-014-3092-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/26/2013] [Accepted: 02/20/2014] [Indexed: 12/20/2022]
Abstract
BACKGROUND Screening for Barrett's esophagus (BE) and adenocarcinoma (EAC) is controversial, but interest remains in finding the optimal method. Attitudes on screening within the community are unknown. We aimed to assess these attitudes via a survey. STUDY A mixed-mode survey was conducted in adults >50 years to assess awareness regarding BE, willingness to participate in screening, and preferences regarding method of screening. Methods evaluated were sedated endoscopy (sEGD), unsedated transnasal endoscopy (uTNE) and video capsule (VCE). RESULTS A total of 136 from 413 (33%) adults responded [47% males, mean (SD) age 63 (10.2) years], and 26% of responders knew of BE at baseline. After reading the information on BE, 72% were interested in screening. A history of undergoing screening tests and GI symptoms were predictive of interest. Unsedated techniques were preferred by 64% (VCE: 56% and uTNE: 8%) versus sEGD (36%). CONCLUSIONS The majority of adults were willing to undergo screening for BE/EAC, with a preference for unsedated techniques.
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Affiliation(s)
- Milli Gupta
- Division of Gastroenterology, University of Calgary, Calgary, AB, Canada
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20
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Shuaib W, Vijayasarathi A, Johnson JO, Salastekar N, He Q, Maddu KK, Khosa F. Factors affecting patient compliance in the acute setting: an analysis of 20,000 imaging reports. Emerg Radiol 2014; 21:373-9. [DOI: 10.1007/s10140-014-1209-1] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2013] [Accepted: 02/20/2014] [Indexed: 11/28/2022]
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21
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Jimbo M, Shultz CG, Nease DE, Fetters MD, Power D, Ruffin MT. Perceived barriers and facilitators of using a Web-based interactive decision aid for colorectal cancer screening in community practice settings: findings from focus groups with primary care clinicians and medical office staff. J Med Internet Res 2013; 15:e286. [PMID: 24351420 PMCID: PMC3875904 DOI: 10.2196/jmir.2914] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Revised: 11/18/2013] [Accepted: 11/22/2013] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Information is lacking about the capacity of those working in community practice settings to utilize health information technology for colorectal cancer screening. OBJECTIVE To address this gap we asked those working in community practice settings to share their perspectives about how the implementation of a Web-based patient-led decision aid might affect patient-clinician conversations about colorectal cancer screening and the day-to-day clinical workflow. METHODS Five focus groups in five community practice settings were conducted with 8 physicians, 1 physician assistant, and 18 clinic staff. Focus groups were organized using a semistructured discussion guide designed to identify factors that mediate and impede the use of a Web-based decision aid intended to clarify patient preferences for colorectal cancer screening and to trigger shared decision making during the clinical encounter. RESULTS All physicians, the physician assistant, and 8 of the 18 clinic staff were active participants in the focus groups. Clinician and staff participants from each setting reported a belief that the Web-based patient-led decision aid could be an informative and educational tool; in all but one setting participants reported a readiness to recommend the tool to patients. The exception related to clinicians from one clinic who described a preference for patients having fewer screening choices, noting that a colonoscopy was the preferred screening modality for patients in their clinic. Perceived barriers to utilizing the Web-based decision aid included patients' lack of Internet access or low computer literacy, and potential impediments to the clinics' daily workflow. Expanding patients' use of an online decision aid that is both easy to access and understand and that is utilized by patients outside of the office visit was described as a potentially efficient means for soliciting patients' screening preferences. Participants described that a system to link the online decision aid to a computerized reminder system could promote a better understanding of patients' screening preferences, though some expressed concern that such a system could be difficult to keep up and running. CONCLUSIONS Community practice clinicians and staff perceived the Web-based decision aid technology as promising but raised questions as to how the technology and resultant information would be integrated into their daily practice workflow. Additional research investigating how to best implement online decision aids should be conducted prior to the widespread adoption of such technology so as to maximize the benefits of the technology while minimizing workflow disruptions.
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Affiliation(s)
- Masahito Jimbo
- University of Michigan, Departments of Family Medicine and Urology, Ann Arbor, MI, United States.
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22
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Powell AA, Bloomfield HE, Burgess DJ, Wilt TJ, Partin MR. A Conceptual Framework for Understanding and Reducing Overuse by Primary Care Providers. Med Care Res Rev 2013; 70:451-72. [DOI: 10.1177/1077558713496166] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Primary care providers frequently recommend, administer, or prescribe health care services that are unlikely to benefit their patients. Yet little is known about how to reduce provider overuse behavior. In the absence of a theoretically grounded causal framework, it is difficult to predict the contexts under which different types of interventions to reduce provider overuse will succeed and under which they will fail. In this article, we present a framework based on the theory of planned behavior that is designed to guide overuse research and intervention development. We describe categories of primary care provider beliefs that lead to the formation of intentions to assess the appropriateness of services, and propose factors that may affect whether the presence of assessment intentions results in an appropriate recommendation. Interventions that have been commonly used to address provider overuse behavior are reviewed within the context of the framework.
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Affiliation(s)
- Adam A. Powell
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Hanna E. Bloomfield
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Diana J. Burgess
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Timothy J. Wilt
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
| | - Melissa R. Partin
- Center for Chronic Disease Outcomes Research, Minneapolis VA Health Care System, Minneapolis, MN, USA
- Department of Medicine, University of Minnesota, Minneapolis, MN, USA
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Raychaudhuri S, Mandal S. Current status of knowledge, attitude and practice (KAP) and screening for cervical cancer in countries at different levels of development. Asian Pac J Cancer Prev 2013; 13:4221-7. [PMID: 23167318 DOI: 10.7314/apjcp.2012.13.9.4221] [Citation(s) in RCA: 28] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
Cancer of the uterine cervix is a worldwide menace taking innumerable womens' lives. The literature is vast and a large number of studies have been conducted in this field. Analyses have shown significant differences exist in terms of screening and HPV testing facilities among high income and low to middle income countries. In addition, acute lack of awareness and knowledge among the concerned population is particularly noted in rural areas of the low income countries. A detailed review of Indian case studies revealed that early age of marriage and childbirth, multiparity, poor personal hygiene and low socio-economic status among others are the principal risk factors for this disease. This review concludes that a two pronged strategy involving strong government and NGO action is necessary to minimize the occurrence of cervical cancer especially in low and medium income countries.
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Affiliation(s)
- Sreejata Raychaudhuri
- Department of Community Medicine, North Bengal Medical College, Susrutanagar, Darjeeling, West Bengal, India.
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Ahmed NU, Pelletier V, Winter K, Albatineh AN. Factors explaining racial/ethnic disparities in rates of physician recommendation for colorectal cancer screening. Am J Public Health 2013; 103:e91-9. [PMID: 23678899 DOI: 10.2105/ajph.2012.301034] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES Physician recommendation plays a crucial role in receiving endoscopic screening for colorectal cancer (CRC). This study explored factors associated with racial/ethnic differences in rates of screening recommendation. METHODS Data on 5900 adults eligible for endoscopic screening were obtained from the National Health Interview Survey. Odds ratios of receiving an endoscopy recommendation were calculated for selected variables. Planned, sequenced logistic regressions were conducted to examine the extent to which socioeconomic and health care variables account for racial/ethnic disparities in recommendation rates. RESULTS Differential rates were observed for CRC screening and screening recommendations among racial/ethnic groups. Compared with Whites, Hispanics were 34% less likely (P < .01) and Blacks were 26% less likely (P < .05) to receive this recommendation. The main predictors that emerged in sequenced analysis were education for Hispanics and Blacks and income for Blacks. After accounting for the effects of usual source of care, insurance coverage, and education, the disparity reduced and became statistically insignificant. CONCLUSIONS Socioeconomic status and access to health care may explain major racial/ethnic disparities in CRC screening recommendation rates.
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Affiliation(s)
- Nasar U Ahmed
- Department of Epidemiology, Robert Stempel College of Public Health and Social Work, Florida International University, Miami, FL 33199, USA.
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25
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Partin MR, Powell AA, Bangerter A, Halek K, Burgess JF, Fisher DA, Nelson DB. Levels and variation in overuse of fecal occult blood testing in the Veterans Health Administration. J Gen Intern Med 2012; 27:1618-25. [PMID: 22810358 PMCID: PMC3509310 DOI: 10.1007/s11606-012-2163-9] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/27/2012] [Revised: 06/14/2012] [Accepted: 06/21/2012] [Indexed: 12/24/2022]
Abstract
BACKGROUND Policy-makers have called for efforts to reduce overuse of cancer screening tests, including colorectal cancer screening (CRCS). Overuse of CRCS tests other than colonoscopy has not been well documented. OBJECTIVE To estimate levels and correlates of fecal occult blood test (FOBT) overuse in a national Veterans Health Administration (VHA) sample. DESIGN Observational PARTICIPANTS Participants included 1,844 CRCS-eligible patients who responded to a 2007 CRCS survey conducted in 24 VHA facilities and had one or more FOBTs between 2003 and 2009. MAIN MEASURES We combined survey data on race, education, and income with administrative data on region, age, gender, CRCS procedures, and outpatient visits to estimate overuse levels and variation. We coded FOBTs as overused if they were conducted <10 months after prior FOBT, <9.5 years after prior colonoscopy, or <4.5 years after prior barium enema. We used multinomial logistic regression models to examine variation in overuse by reason (sooner than recommended after prior FOBT; sooner than recommended after colonoscopy, barium enema, or a combination of procedures), adjusting for clustering of procedures within patients, and patients within facilities. KEY RESULTS Of 4,236 FOBTs received by participants, 885 (21 %) met overuse criteria, with 323 (8 %) sooner than recommended after FOBT, and 562 (13 %) sooner than recommended after other procedures. FOBT overuse varied across facilities (9-32 %, p<0.0001) and region (12-23 %, p< .0012). FOBT overuse after prior FOBT declined between 2003 and 2009 (8 %-5 %, p= .0492), but overuse after other procedures increased (11-19 %, p= .0002). FOBT overuse of both types increased with number of outpatient visits (OR 1.15, p<0.001), but did not vary by patient demographics. More than 11 % of overused FOBTs were followed by colonoscopy within 12 months. CONCLUSIONS Many FOBTs are performed sooner than recommended in the VHA. Variation in overuse by facility, region, and outpatient visits suggests addressing FOBT overuse will require system-level solutions.
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Affiliation(s)
- Melissa R Partin
- Center for Chronic Disease Outcomes Research, Minneapolis Veterans Affairs Medical Center, Minneapolis, MN 55417, USA.
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Suh B, Shin DW, Kim SY, Park JH, Chang WY, Lim SP, Yim CY, Cho BL, Park EC, Park JH. Mode of primary cancer detection as an indicator of screening practice for second primary cancer in cancer survivors: a nationwide survey in Korea. BMC Cancer 2012. [PMID: 23181637 PMCID: PMC3517745 DOI: 10.1186/1471-2407-12-557] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND While knowledge and risk perception have been associated with screening for second primary cancer (SPC), there are no clinically useful indicators to identify who is at risk of not being properly screened for SPC. We investigated whether the mode of primary cancer detection (i.e. screen-detected vs. non-screen-detected) is associated with subsequent completion of all appropriate SPC screening in cancer survivors. METHODS Data were collected from cancer patients treated at the National Cancer Center and nine regional cancer centers across Korea. A total of 512 cancer survivors older than 40, time since diagnosis more than 2 years, and whose first primary cancer was not advanced or metastasized were selected. Multivariate logistic regression was used to examine factors, including mode of primary cancer detection, associated with completion of all appropriate SPC screening according to national cancer screening guidelines. RESULTS Being screen-detected for their first primary cancer was found to be significantly associated with completion of all appropriate SPC screening (adjusted odds ratio, 2.13; 95% confidence interval, 1.36-3.33), after controlling for demographic and clinical variables. Screen-detected cancer survivors were significantly more likely to have higher household income, have other comorbidities, and be within 5 years since diagnosis. CONCLUSIONS The mode of primary cancer detection, a readily available clinical information, can be used as an indicator for screening practice for SPC in cancer survivors. Education about the importance of SPC screening will be helpful particularly for cancer survivors whose primary cancer was not screen-detected.
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Affiliation(s)
- Beomseok Suh
- Department of Family Medicine & Health Promotion Center, Seoul National University Hospital, Seoul, Republic of Korea
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McCall-Hosenfeld JS, Weisman CS, Camacho F, Hillemeier MM, Chuang CH. Multilevel analysis of the determinants of receipt of clinical preventive services among reproductive-age women. Womens Health Issues 2012; 22:e243-51. [PMID: 22269668 PMCID: PMC3345071 DOI: 10.1016/j.whi.2011.11.005] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2011] [Revised: 08/24/2011] [Accepted: 11/22/2011] [Indexed: 11/25/2022]
Abstract
BACKGROUND We investigated the impact of individual- and county-level contextual variables on women's receipt of a comprehensive panel of preventive services in a region that includes both urban and rural communities. METHODS Outcome variables were a screening and vaccination index (a count of Papanicolaou test, blood pressure check, lipid panel, sexually transmitted infections [STI] or HIV test, and influenza vaccination received in the past 2 years) and a preventivecounseling index (a count of topics discussed in the past 2 years: Smoking and tobacco, alcohol or drugs, violence and safety, pregnancy planning or contraception, diet/nutrition, and STIs). Contextual covariates from the Area Resource File (2004-2005) were appended to prospective survey data from the Central Pennsylvania Women's Health Study. Individual-level variables included predisposing, enabling, and need-based measures. Contextual variables included community characteristics and healthcare resources, including a measure of primary care physician (PCP) density specifically designed for this study of women's preventive care. Multilevel analyses were performed. RESULTS We found low overall use of preventive services. In multilevel models, individual-level factors predicted receipt of both screening and vaccinations and counseling services; significant predictors differed for each index. One contextual variable (PCP density) predicted receipt of screenings and vaccinations. CONCLUSIONS Women's receipt of preventive services was determined primarily by individual-level variables. Different variables predicted receipt of screening and vaccination versus counseling services. A contextual measure, PCP density, predicted receipt of preventive screenings and vaccinations. Individual variability in women's receipt of counseling services is largely explained by psychosocial factors and seeing an obstetrician-gynecologist.
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Abstract
While consensus has grown that primary care is the essential access point in a high-performing health care system, the current model of primary care underperforms in both chronic disease management and prevention. The Patient Centered Medical Home model (PCMH) is at the center of efforts to reinvent primary care practice, and is regarded as the most promising approach to addressing the burden of chronic disease, improving health outcomes, and reducing health spending. However, the potential for the medical home to improve the delivery of cancer screening (and preventive services in general) has received limited attention in both conceptualization and practice. Medical home demonstrations to date have included few evidence-based preventive services in their outcome measures, and few have evaluated the effect of different payment models. Decreasing use of hospitals and emergency rooms and an emphasis on improving chronic care represent improvements in effective delivery of healthcare, but leave opportunities for reducing the burden of cancer untouched. Data confirm that what does or does not happen in the primary care setting has a substantial impact on cancer outcomes. Insofar as cancer is the leading cause of death before age 80, the PCMH model must prioritize adherence to cancer screening according to recommended guidelines, and systems, financial incentives, and reimbursements must be aligned to achieve that goal. This article explores capacities that are needed in the medical home model to facilitate the integration of cancer screening and other preventive services. These capacities include improved patient access and communication, health risk assessments, periodic preventive health exams, use of registries that store cancer risk information and screening history, ability to track and follow up on tests and referrals, feedback on performance, and payment models that reward cancer screening.
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Affiliation(s)
- Mona Sarfaty
- Department of Family and Community Medicine, Thomas Jefferson University, Philadelphia, PA 19107, USA.
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Kadiyala S, Strumpf EC. Are United States and Canadian cancer screening rates consistent with guideline information regarding the age of screening initiation? Int J Qual Health Care 2011; 23:611-20. [PMID: 21890706 DOI: 10.1093/intqhc/mzr050] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/19/2022] Open
Abstract
OBJECTIVE To understand whether US and Canadian breast, colorectal and prostate cancer screening test utilization is consistent with US and Canadian cancer screening guideline information with respect to the age of screening initiation. DESIGN Cross-sectional, regression discontinuity. SETTING Canada and the US. PARTICIPANTS Canadian and American women of ages 30-60 and men of ages 40-60. INTERVENTIONS None. Main Outcomes Measures Mammography, prostate-specific antigen (PSA) and colorectal cancer test use within the past 2 years. METHODS We identify US and Canadian compliance with age screening information in a novel manner, by comparing test utilization rates of individuals who are immediately on either side of the guideline recommended initiation ages. RESULTS US mammography utilization within the last 2 years increased from 33% at age 39 to 48% at age 40 and 60% at age 41. US colorectal cancer test utilization, within the last 2 years, increased from 15% at age 49 to 18% at age 50 and 28% at age 51. US PSA utilization within the last 2 years increased from 37% at age 49 to 44% at age 50 and 54% at age 51. In Canada, mammography utilization within the last 2 years increased from 47% at age 49 to 57% at age 50 and 66% at age 51. CONCLUSION American and Canadian cancer screening utilization is generally consistent with each country's guideline recommendations regarding age. US and Canadian differences in screening due to guidelines can potentially explain cross-country differences in breast cancer mortality and affect interpretation of international comparisons of cancer statistics.
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James AS, Daley CM, Engelman K, Greiner KA, Ellerbeck E. Process evaluation of recruitment for a cancer screening trial in primary care. Health Promot Pract 2011; 12:696-703. [PMID: 21471439 PMCID: PMC3319739 DOI: 10.1177/1524839910366402] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Many cancer screening studies are conducted in primary care settings, yet few systematically analyze recruitment challenges found at these sites. During a randomized trial promoting colorectal cancer screening, we implemented a process evaluation of recruitment. Recruiters maintained logs that registered the numbers of patients entering the clinic, approached by recruiters, declining to participate, and reasons for nonapproach and nonparticipation. One half of age-eligible patients were approached (n = 1,489), and half of those who met basic eligibility requirements agreed to engage further (n = 527). A small proportion of patients (n = 98) completed the 15-min assessment before their appointment. Major reasons for nonapproach included previous approach, patients called to the exam room, and appearing ill. The major reason for nonparticipation was "not interested"; a few patients did not want to share contact information. Some participants exited the assessment midway because of further ineligibility or time limitations. Best-practice recommendations for recruitment in primary care are discussed.
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Affiliation(s)
- Aimee S James
- Department of Surgery, Washington University in Saint Louis, School of Medicine, Saint Louis, MO 63110, U.S.A
| | - Christine M Daley
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
| | - Kimberly Engelman
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
| | - K. Allen Greiner
- Department of Family Medicine, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
| | - Edward Ellerbeck
- Department of Preventive Medicine and Public Health, University of Kansas Medical Center, Kansas City, KS 66160, U.S.A
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Coughlin SS, Sabatino SA, Shaw KM. What Factors are Associated with Where Women Undergo Clinical Breast Examination? Results from the 2005 National Health Interview Survey. ACTA ACUST UNITED AC 2011; 2:32-43. [PMID: 19212451 DOI: 10.2174/1874189400802010032] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
BACKGROUND Recent studies have suggested that clinical breast examination (CBE) rates may vary according to patient, provider and health care system characteristics. OBJECTIVE To examine the locations where U.S. women received a CBE and other general preventive health, and to examine predictors of location of receipt of general preventive health care (including a recent CBE). DESIGN Age-specific and age-adjusted rates of CBE use were calculated using Statistical Analysis Software (SAS) and SUDAAN. A multivariate analysis was carried out using logistic regression techniques. PARTICIPANTS Women aged 40 years and older (n = 10,002) who participated in the 2005 National Health Interview Survey (NHIS). MEASUREMENTS Recent CBE use was defined as within the past two years. RESULTS Among all women, 65% reported a CBE within two years. The highest rate was found among women receiving routine care from doctors' offices and health maintenance organizations (HMOs) (68.5%). CBE use was somewhat lower among women receiving routine care from clinics or health centers (62.9%), and substantially lower among women receiving care from "other" locations (28.4%) or not reporting receiving preventive care (25.3%). Low income women (p < .01) and those with less than a high school education (p < .01) are more likely to go to a hospital than higher SES women. Women with health insurance are much more likely than women without health insurance to go to a doctor's office or HMO, and less likely to be seen at a clinic or health center (p < .01 in both instances). In multivariate analysis, women who received routine care in a location other than a clinic or health center, doctor's office or HMO, or hospital outpatient department (OPD) were less likely to have received a CBE within the past two years (adjusted OR = 0.4, 95% CI = 0.3, 0.7) compared to those at a doctor's office or HMO. CONCLUSIONS After adjusting for patient factors, clinics/health centers and hospital OPDs performed as well as doctors' offices/HMOs in delivering CBE. However, women receiving care in other locations were less likely to report CBE.
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Affiliation(s)
- Steven S Coughlin
- Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Atlanta, GA, USA
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Hall MJ, Ruth K, Giri VN. Rates and predictors of colorectal cancer screening by race among motivated men participating in a Prostate Cancer Risk Assessment Program. Cancer 2011; 118:478-84. [PMID: 21751189 DOI: 10.1002/cncr.26315] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2011] [Revised: 04/07/2011] [Accepted: 05/06/2011] [Indexed: 11/09/2022]
Abstract
BACKGROUND Screening by fecal occult blood test and lower endoscopy has lowered colorectal cancer (CRC) mortality, but compliance gaps persist. Of concern are possible disparities in uptake of CRC screening between white and African American men. The goal of this study was to assess for disparities in uptake of CRC screening among men participating in a high-risk prostate cancer clinic. If present, such disparities could support hypotheses for further research examining racial differences in awareness and patient preferences in undergoing CRC screening. METHODS Baseline data on a racially diverse cohort of men aged 50 to 69 years at increased risk of prostate cancer collected via the Prostate Cancer Risk Assessment Program at Fox Chase Cancer Center were analyzed. Predictors of uptake of CRC screening were assessed using multivariate logistic regression. RESULTS Compared with whites, African American men had statistically significantly lower uptake of fecal occult blood testing (African American 49.0% vs white 60.7%, P = .035), lower endoscopy (African American 44.1% vs white 58.5%, P = .011), and any CRC screening (African American 66.2% vs white 76.3%, P = .053). Predictors of uptake of lower endoscopy among African American men included older age (odds ratio [OR], 3.61; 95% confidence interval [CI], 1.87-6.97), family history of CRC (OR, 3.47; 95% CI, 1.30-9.25), and insurance status (OR, 1.90; 95% CI, 1.04-3.46). CONCLUSIONS Despite awareness of cancer risk and motivation to seek prostate cancer screening through a specialized prostate cancer risk assessment program, evidence supporting compliance gaps with CRC screening among men was found. Tailored messages to younger African American men with and without a family history of CRC are needed.
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Affiliation(s)
- Michael J Hall
- Cancer Prevention and Control Program, Fox Chase Cancer Center, Philadelphia, Pennsylvania, USA
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Day LW, Espey DK, Madden E, Segal M, Terdiman JP. Screening prevalence and incidence of colorectal cancer among American Indian/Alaskan natives in the Indian Health Service. Dig Dis Sci 2011; 56:2104-13. [PMID: 21234688 PMCID: PMC3112488 DOI: 10.1007/s10620-010-1528-3] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/18/2010] [Accepted: 12/09/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Studies on colorectal cancer (CRC) screening and incidence among American Indian/Alaska Natives (AI/AN) are few. AIMS Our aim was to determine CRC screening prevalence and to calculate CRC incidence among AI/AN receiving care within the Indian Health Service (IHS). METHODS A retrospective cohort study of AI/AN who utilized IHS from 1996 to 2004. AI/AN who were average-risk for CRC and received primary care within IHS were identified by searching the IHS Resource Patient Management System for selected ICD-9/CPT codes (n = 142,051). CRC screening prevalence was calculated and predictors of screening were determined for this group. CRC incidence rates were ascertained for the entire AI/AN population ages 50-80 who received IHS medical care between 1996 and 2004 (n = 283,717). RESULTS CRC screening was performed in 4.0% of average-risk AI/AN. CRC screening was more common among women than men (RR = 1.6, 95% CI 1.4-1.7) and among AI/AN living in the Alaska region compared to the Pacific Coast region (RR = 2.5, 95% CI 2.2-2.8) while patients living in the Northern Plains (RR = 0.4, 95% CI 0.3-0.4) were less likely to have been screened. CRC screening was less common among patients with a greater number of primary care visits. The age-adjusted CRC incidence among AI/AN ages 50-80 was 227 cancers per 100,000 person-years. CONCLUSIONS CRC was common among AI/AN receiving medical care within IHS. However, CRC screening prevalence was far lower than has been reported for the U.S. population.
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Affiliation(s)
- Lukejohn W Day
- Division of Gastroenterology, San Francisco General Hospital (3D), 1001 Potrero Avenue, San Francisco, CA 94110, USA.
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Migongo AW, Charnigo R, Love MM, Kryscio R, Fleming ST, Pearce KA. Factors Relating to Patient Visit Time With a Physician. Med Decis Making 2011; 32:93-104. [DOI: 10.1177/0272989x10394462] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
This study sought to identify factors that increase or decrease patient time with a physician, determine which combinations of factors are associated with the shortest and longest visits to physicians, quantify how much physicians contribute to variation in the time they spend with patients, and assess how well patient time with a physician can be predicted. Data were acquired from a modified replication of the 1997–1998 National Ambulatory Medical Care Survey, administered by the Kentucky Ambulatory Network to 56 primary care clinicians at 24 practice sites in 2001 and 2002. A regression tree and a linear mixed model (LMM) were used to discover multivariate associations between patient time with a physician and 22 potentially predictive factors. Patient time with a physician was related to the number of diagnoses, whether non-illness care was received, and whether the patient had been seen before by the physician or someone at the practice. Approximately 38% of the variation in patient time with a physician was accounted for by predictive factors in the tree; roughly 33% was explained by predictive factors in the LMM, with another 12% linked to physicians. Knowledge of patient characteristics and needs could be used to schedule office visits, potentially improving patient flow through a clinic and reducing waiting times.
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Affiliation(s)
- Alice W. Migongo
- Department of Biostatistics (AWM), University of Kentucky, Lexington, Kentucky
- Departments of Statistics and Biostatistics (RC, RK), University of Kentucky, Lexington, Kentucky
- Department of Family and Community Medicine (MML, KAP), University of Kentucky, Lexington, Kentucky
- Departments of Epidemiology and Health Services Management (STF), University of Kentucky, Lexington, Kentucky
| | - Richard Charnigo
- Department of Biostatistics (AWM), University of Kentucky, Lexington, Kentucky
- Departments of Statistics and Biostatistics (RC, RK), University of Kentucky, Lexington, Kentucky
- Department of Family and Community Medicine (MML, KAP), University of Kentucky, Lexington, Kentucky
- Departments of Epidemiology and Health Services Management (STF), University of Kentucky, Lexington, Kentucky
| | - Margaret M. Love
- Department of Biostatistics (AWM), University of Kentucky, Lexington, Kentucky
- Departments of Statistics and Biostatistics (RC, RK), University of Kentucky, Lexington, Kentucky
- Department of Family and Community Medicine (MML, KAP), University of Kentucky, Lexington, Kentucky
- Departments of Epidemiology and Health Services Management (STF), University of Kentucky, Lexington, Kentucky
| | - Richard Kryscio
- Department of Biostatistics (AWM), University of Kentucky, Lexington, Kentucky
- Departments of Statistics and Biostatistics (RC, RK), University of Kentucky, Lexington, Kentucky
- Department of Family and Community Medicine (MML, KAP), University of Kentucky, Lexington, Kentucky
- Departments of Epidemiology and Health Services Management (STF), University of Kentucky, Lexington, Kentucky
| | - Steven T. Fleming
- Department of Biostatistics (AWM), University of Kentucky, Lexington, Kentucky
- Departments of Statistics and Biostatistics (RC, RK), University of Kentucky, Lexington, Kentucky
- Department of Family and Community Medicine (MML, KAP), University of Kentucky, Lexington, Kentucky
- Departments of Epidemiology and Health Services Management (STF), University of Kentucky, Lexington, Kentucky
| | - Kevin A. Pearce
- Department of Biostatistics (AWM), University of Kentucky, Lexington, Kentucky
- Departments of Statistics and Biostatistics (RC, RK), University of Kentucky, Lexington, Kentucky
- Department of Family and Community Medicine (MML, KAP), University of Kentucky, Lexington, Kentucky
- Departments of Epidemiology and Health Services Management (STF), University of Kentucky, Lexington, Kentucky
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Abstract
BACKGROUND Research regarding the association between mental health and colorectal cancer (CRC) screening has produced mixed results. Variations may be explained by methodology, including whether potential confounders such as frequency of healthcare visits are considered. OBJECTIVE We examined the association between mental health and CRC screening, before and after controlling for demographics, comorbidities, and outpatient visit frequency. DESIGN Observational study based on a retrospective cohort. SUBJECTS A total of 855 veterans receiving care at a Veterans Affairs Medical Center. MEASURES Medical record data were used to assess CRC screening rates and mental health status (number of diagnoses and the presence of depression, anxiety, posttraumatic stress disorder, substance, or psychotic disorders). Logistic regression was used to estimate the association between mental health diagnoses and CRC screening, before and after controlling for covariates. RESULTS Bivariate analyses suggested that CRC screening rates were higher for patients with a history of one or more mental health diagnoses (57% vs. 47%, P < 0.01). However, adjusting for timing of mental health diagnosis and outpatient visit frequency resulted in significant negative associations between CRC screening and all measures of mental health except posttraumatic stress disorder. CONCLUSIONS Estimates of the association between mental health and CRC screening that do not adjust for outpatient visit frequency may be misleading. Veterans with mental health diagnoses were significantly less likely to be screened for CRC than their counterparts with no mental health diagnoses and an equal number of outpatient visits.
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Hollowell K, Olmsted CL, Richardson AS, Pittman HK, Bellin L, Tafra L, Verbanac KM. American Society of Clinical Oncology-recommended surveillance and physician specialty among long-term breast cancer survivors. Cancer 2010; 116:2090-8. [PMID: 20198707 DOI: 10.1002/cncr.25038] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND It is unclear whether it is appropriate to transfer the follow-up care of breast cancer (BrCa) survivors from cancer specialists to primary care physicians (PCPs). This contemporary study compared physician specialty and documented the long-term surveillance of survivors who underwent surgery at an American academic center. METHODS Women in this institutional review board-approved study underwent breast surgery between 1996 and 2006. Data were collected for 270 patients with stage I to III BrCa (mean follow-up, 6 years). Charts were reviewed based on American Society of Clinical Oncology (ASCO) guidelines for recommended surveillance frequency and care. RESULTS The majority of patients (90%; n = 242) were followed by specialists with 10% (n = 28) followed by PCPs. Patients with advanced disease and a greater risk of disease recurrence more often received specialist care. Patients followed by specialists were more often seen at ASCO-recommended intervals (eg, 89% vs 69% of patients followed by a PCP at follow-up Year 6; P < .01); however, many patients were followed inconsistently. Breast disease was often not the focus of PCP visits or mentioned in clinic notes (18% patients). Women seen by specialists were more likely to have documented clinical examinations of the breast (93% vs 44% at Year 6), axilla (94% vs 52%), or annual mammograms (74% vs 48%; P = .001-.02). CONCLUSIONS Consistent compliance with surveillance guidelines and chart documentation needs improvement among all providers; however, specialists more consistently met ASCO guidelines. If transfer of care to a PCP occurs, it should be formalized and include follow-up recommendations and defined physician responsibilities. Providers and patients should be educated regarding surveillance care and current guidelines incorporated into standard clinical practice.
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Affiliation(s)
- Kerry Hollowell
- Department of Surgery, The Brody School of Medicine, East Carolina University, Greenville, North Carolina 27858, USA
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Leone LA, Campbell MK, Satia JA, Bowling JM, Pignone MP. Race moderates the relationship between obesity and colorectal cancer screening in women. Cancer Causes Control 2010; 21:373-85. [PMID: 19941158 PMCID: PMC2836407 DOI: 10.1007/s10552-009-9469-x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2009] [Accepted: 11/03/2009] [Indexed: 11/28/2022]
Abstract
OBJECTIVE To determine if the relationship between obesity and usage of colorectal cancer (CRC) screening in women varies when stratifying by race. METHODS Using nationally representative data from the 2005 National Health Interview Survey, we examined the relationship between obesity and CRC screening for white and African-American women aged 50 and older. Screening usage variables indicated if a woman was up-to-date for any CRC screening test, colonoscopy, or FOBT. We used multivariable logistic regression models that included interaction terms to determine if race moderates the obesity-screening relationship. We also calculated adjusted up-to-date colonoscopy rates using direct standardization to model covariates. RESULTS The relationship between obesity and screening differed by race for any CRC screening test (P = 0.04 for interaction) and for colonoscopy (P = 0.01 for interaction), but not for FOBT. Obese white women had a lower adjusted colonoscopy rate (30.2%, 95% CI 25.9-34.8) than non-obese white women (39.1%, 95% CI 36.1-42.2). Obese African-American women, on the other hand, had a higher adjusted colonoscopy rate (41.2%, 95% CI 31.6-51.4) than their non-obese counterparts (35.6%, 95% CI 28.3-43.6). Overall, adjusted colonoscopy rates were lowest among obese white women. CONCLUSIONS Obesity is associated with lower CRC screening rates in white, but not African-American women.
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Affiliation(s)
- Lucia A Leone
- Lineberger Comprehensive Cancer Center, University of North Carolina at Chapel Hill, 27599-7294, USA.
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The role of general practitioners in promoting cervical cancer screening: a field survey in a rural area of Crete, Greece. Eur J Cancer Prev 2010; 19:160-6. [DOI: 10.1097/cej.0b013e328333d072] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Shokar NK, Carlson CA, Weller SC. Informed decision making changes test preferences for colorectal cancer screening in a diverse population. Ann Fam Med 2010; 8:141-50. [PMID: 20212301 PMCID: PMC2834721 DOI: 10.1370/afm.1054] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Abstract
PURPOSE We wanted to better understand patient preferences and decision making about options for colorectal cancer screening. Consistency in patient preferences could improve patient-clinician communication about tests by simplifying and focusing discussions. METHODS In a cross-sectional sample of primary care patients, cognitive ranking tasks were used to estimate patient preferences for fecal occult blood testing, flexible sigmoidoscopy, colonoscopy, and double-contrast barium enema before and after consideration of 13 test attributes, such as accuracy and scientific evidence. Patients also ranked the 13 test attributes and attribute descriptions in terms of importance. Friedman's nonparametric test was used to measure overall discrimination among items, and the average Pearson correlation coefficient (r) among participants was used to measure the degree of consistency in choices. RESULTS Participants (n = 168) averaged 62.1 years of age, and 64.3% were of minority racial ethnicity. For test-specific attributes, preferences were for high test accuracy (r = 0.63, P < .001), amount of colon examined (r = 0.64, P < .001), strong scientific evidence for efficacy (r = 0.59, P < .001), minimum discomfort (r = 0.50, P < .001), and low risk of complications (r = 0.38, P < .001). When all 13 attributes were considered together, agreement dropped (r = 0.13, P < .001), but attributes considered most important for decision making were test accuracy, scientific evidence for efficacy, amount of colon examined, and need for sedation. Test preferences showed moderate agreement (r = 0.20, P < .001), and choices were fairly consistent before and after exposure to test-specific attributes (kappa = 0.17, P = .007). Initially the modal choice was fecal occult blood testing (59%); however, after exposure to test specific attributes, the modal choice was colonoscopy (54%). CONCLUSION Participants were clear about the attributes that they prefer, but no single test has those attributes. Preferences were varied across participants and were not predictable; clinicians should discuss the full range of recommended tests for colorectal cancer with all patients.
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Affiliation(s)
- Navkiran K Shokar
- Department of Family Medicine, University of Texas Medical Branch, Galveston, Texas 77555-1123, USA.
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Guessous I, Dash C, Lapin P, Doroshenk M, Smith RA, Klabunde CN. Colorectal cancer screening barriers and facilitators in older persons. Prev Med 2010; 50:3-10. [PMID: 20006644 DOI: 10.1016/j.ypmed.2009.12.005] [Citation(s) in RCA: 135] [Impact Index Per Article: 9.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/02/2009] [Revised: 12/02/2009] [Accepted: 12/06/2009] [Indexed: 12/20/2022]
Abstract
BACKGROUND This systematic review identifies factors that are most consistently mentioned as either barriers to or facilitators of colorectal cancer (CRC) screening in older persons. METHODS A systematic literature search (1995-2008) was conducted to identify studies that reported barriers to or facilitators of CRC screening uptake, compliance or adherence specifically for older persons (> or = 65 years). Information on study characteristics and barriers and facilitators related to subjects; healthcare providers; policies; and screening tests were then abstracted and analyzed. RESULTS Eighty-three studies met the eligibility criteria. Low level of education, African American race, Hispanic ethnicity, and female gender were the most frequently reported barriers, whereas being married or living with a partner was the most frequently reported facilitator. The most cited barrier related to healthcare providers was lack of screening recommendation by a physician; having a usual source of care was a commonly reported facilitator. Lack of health insurance, and dual coverage with Medicare and Medicaid were the most frequently reported barriers, whereas Medicare's coverage of screening colonoscopy was consistently reported as a facilitator. CONCLUSIONS Barriers to, and facilitators of, CRC screening among older persons are reported. Particular attention should be paid to modifiable factors that could become the focus of interventions aimed at increasing CRC screening participation in older persons.
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Affiliation(s)
- Idris Guessous
- Department of Epidemiology, Rollins School of Public Health, Emory University, Atlanta, GA, USA.
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Wender RC, Altshuler M. Can the Medical Home Reduce Cancer Morbidity and Mortality? Prim Care 2009; 36:845-58; table of contents. [DOI: 10.1016/j.pop.2009.07.009] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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Griffin JM, Burgess D, Vernon SW, Friedemann-Sanchez G, Powell A, van Ryn M, Halek K, Noorbaloochi S, Grill J, Bloomfield H, Partin M. Are gender differences in colorectal cancer screening rates due to differences in self-reporting? Prev Med 2009; 49:436-41. [PMID: 19765609 DOI: 10.1016/j.ypmed.2009.09.013] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/24/2009] [Revised: 09/10/2009] [Accepted: 09/10/2009] [Indexed: 10/20/2022]
Abstract
OBJECTIVE Studies have found that women are less likely than men to undergo colorectal cancer (CRC) screening. While one source of these disparities may be gender differences in barriers and facilitators to screening, another may be differences in reporting bias. METHOD In this study of 345 male and female veterans, conducted in 2006 in Minneapolis, MN, we examined CRC screening adherence rates by gender using medical records and self-report and assessed whether any differences were due to reporting bias. RESULTS We found a significantly higher rate of colonoscopy use among men when using self-report data, but no significant differences in either overall or test-specific screening adherence when using medical record data. Analyses examining the prevalence and determinants of concordance between self-report and medical records screening revealed that compared to women, men were less accurate in reporting sigmoidoscopy and colonoscopy and over-reported screening by colonoscopy. Men were also more likely to have missing self-report data and how missing data were handled affected differences in screening behavior. Accuracy in screening behavior was not explained by demographic variables, good physical or mental health, or physician recommendation for screening. CONCLUSIONS Reported gender disparities in CRC screening adherence may be a result of reporting bias.
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Affiliation(s)
- Joan M Griffin
- Center for Chronic Disease Outcomes Research, Minneapolis VA Medical Center, Minneapolis, MN 55417, USA.
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Kadiyala S. Are U.S. cancer screening test patterns consistent with guideline recommendations with respect to the age of screening initiation? BMC Health Serv Res 2009; 9:185. [PMID: 19821991 PMCID: PMC2770463 DOI: 10.1186/1472-6963-9-185] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 10/12/2009] [Indexed: 11/30/2022] Open
Abstract
BACKGROUND U.S. cancer screening guidelines communicate important information regarding the ages for which screening tests are appropriate. Little attention has been given to whether breast, colorectal and prostate cancer screening test use is responsive to guideline age information regarding the age of screening initiation. METHODS The 2006 Behavioral Risk Factor Social Survey and the 2003 National Health Interview Surveys were used to compute breast, colorectal and prostate cancer screening test rates by single year of age. Graphical and logistic regression analyses were used to compare screening rates for individuals close to and on either side of the guideline recommended screening initiation ages. RESULTS We identified large discrete shifts in the use of screening tests precisely at the ages where guidelines recommend that screening begin. Mammography screening in the last year increased from 22% [95% CI = 20, 25] at age 39 to 36% [95% CI = 33, 39] at age 40 and 47% [95% CI = 44, 51] at age 41. Adherence to the colorectal cancer screening guidelines within the last year increased from 18% [95% CI = 15, 22] at age 49 to 19% [95% CI = 15, 23] at age 50 and 34% [95% CI = 28, 39] at age 51. Prostate specific antigen screening in the last year increased from 28% [95% CI = 25, 31] at age 49 to 33% [95% CI = 29, 36] and 42% [95% CI = 38, 46] at ages 50 and 51. These results are robust to multivariate analyses that adjust for age, sex, income, education, marital status and health insurance status. CONCLUSION The results from this study suggest that cancer screening test utilization is consistent with guideline age information regarding the age of screening initiation. Screening test and adherence rates increased by approximately 100% at the breast and colorectal cancer guideline recommended ages compared to only a 50% increase in the screening test rate for prostate cancer screening. Since information regarding the age of cancer screening initiation varies across countries, results from this study also potentially have implications for cross-country comparisons of cancer incidence and survival statistics.
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Affiliation(s)
- Srikanth Kadiyala
- Department of Pharmacy, Pharmaceutical Outcomes Research Policy Program, University of Washington, Seattle, Washington, USA.
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Bazargan M, Ani C, Bazargan-Hejazi S, Baker RS, Bastani R. Colorectal cancer screening among underserved minority population: discrepancy between physicians' recommended, scheduled, and completed tests. PATIENT EDUCATION AND COUNSELING 2009; 76:240-247. [PMID: 19150198 DOI: 10.1016/j.pec.2008.12.005] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/21/2008] [Revised: 11/18/2008] [Accepted: 12/06/2008] [Indexed: 05/27/2023]
Abstract
OBJECTIVE This study examines the correlates of: (1) health care provider recommendation of CRC testing; (2) provider scheduling for recommended CRC testing using sigmoidoscopy, colonoscopy, or double-contrast barium enema; and (3) adherence to CRC scheduling among underserved minority populations. METHODS Medical record and schedule logbook reviews and interviewer-administered surveys. SETTING Large urban safety-net, outpatient primary care setting in Los Angeles County. PARTICIPANTS 306 African-American and Latino patients aged 50 years and older. RESULTS A vast majority of minority patients do not receive standard CRC testing in urban safety-net primary care settings. Of those patients who were actually scheduled for sigmoidoscopy or colonoscopy, almost half completed the procedure. Completing CRC testing was associated with marital status, co-morbid chronic physical conditions, number of risk factors for colorectal cancer, and lower perceived barriers to CRC testing. CONCLUSION Effective interventions to reduce CRC mortality among underserved minority populations require an integrated approach that engages patients, providers, and health care systems. PRACTICE IMPLICATIONS Designing interventions that (1) increase physician-patient communications for removing patients' perceived barriers for CRC testing and (2) promote a non-physician-based navigator system that reinforces physicians' recommendation are strongly recommended.
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Affiliation(s)
- Mohsen Bazargan
- Department of Family Medicine, Charles Drew University of Medicine & Science, Los Angeles, CA 90059, USA.
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Fernandez ME, Lin J, Leong-Wu C, Aday L. Pap smear screening among Asian Pacific Islander women in a multisite community-based cancer screening program. Health Promot Pract 2009; 10:210-21. [PMID: 19372282 DOI: 10.1177/1524839909332798] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
This study assessed screening completion rates (SCR) and sociodemographic factors associated with Pap test screening among previously nonadherent, foreign-born Asian Pacific Islander (API) women across four sites participating in a community-based cancer screening program called ENCOREplus. At intake, 926 out of 1,140 women were nonadherent to recommended Pap test screening guidelines. Most participants were age 51 and older, had a high school education or higher, had been in the U.S. less than a decade, had annual household incomes less than $10,000, and were uninsured. Women with limited resources were more likely to get a Pap test after participating in ENCOREplus. Women from the Glendale site were almost 18 times more likely to get a Pap test than API women in other sites. Over half of the women in Glendale reported that help getting low cost Pap tests and having translators available were instrumental in completing screening.
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Affiliation(s)
- Maria E Fernandez
- Center for Health Promotion and Prevention Research (CHPPR), School of Public Health, University of Texas-Health Science Center at Houston, Texas 77030, USA.
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Abstract
Cancer screening is one of the most common requests directed to primary care physicians in the office setting. In this article, we look at current recommendations, evidence for, and controversy surrounding screening for cancers of the lung, colon, and prostate, which together account for 51% of cancer deaths in men. We also look at screening for testicular cancer, which, although a relatively minor contributor to cancer mortality, is a prototypically male cancer with a proposed screening test.
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Buetow S, Janes R, Steed R, Ihimaera L, Elley CR. Why don't some women return for cervical smears? A hermeneutic phenomenological investigation. Health Care Women Int 2008; 28:843-52. [PMID: 17907011 DOI: 10.1080/07399330701563251] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
Abstract
To enhance understanding of how having a cervical smear can lead some women not to keep up-to-date with this test, a hermeneutic (interpretative) phenomenological study was undertaken. Participants were six purposively selected New Zealand women -- predominantly Māori -- at least 6 months overdue for a follow-up cervical screen in the previous 6 years. Each woman gave an in-depth interview. Transcribed and analyzed via a general inductive approach, the interviews suggested that the smears can violate women's positive aloneness with their bodies, and magnify aloneness as a negative state. Overdueness for the test avoids these effects. To minimize such effects, primary health care needs to acknowledge and address these issues, for example by providing an opportunity to connect the aloneness to trusted others.
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Affiliation(s)
- Stephen Buetow
- Department of General Practice and Primary Health Care, University of Auckland, Auckland, New Zealand.
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Nyante SJ, Gammon MD, Malone KE, Daling JR, Brinton LA. The association between oral contraceptive use and lobular and ductal breast cancer in young women. Int J Cancer 2008; 122:936-41. [PMID: 17957781 DOI: 10.1002/ijc.23163] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
Recent reports indicate that the incidence of lobular breast cancer is increasing at a faster rate than ductal breast cancer, which may be due to the differential effects of exogenous hormones by histology. To address this issue, we examined whether the relationship between oral contraceptive use and incident breast cancer differs between lobular and ductal subtypes in young women. A population-based sample of in situ and invasive breast cancer cases between ages 20 and 44 were recruited from Atlanta, GA; Seattle-Puget Sound, WA and central New Jersey. Controls were sampled from the same areas by random-digit dialing, and were frequency matched to the expected case age distribution. Odds ratios (ORs) and 95% confidence intervals (95% CIs) were calculated using polytomous logistic regression. Among the 100 lobular cancers, 1,164 ductal cancers, and 1,501 controls, the odds ratios for oral contraceptive ever use were 1.10 (95% CI = 0.68-1.78) for lobular cancers and 1.21 (95% CI = 1.01-1.45) for ductal cancers, adjusted for study site, age at diagnosis, and pap screening history. Our results suggest that the magnitude of the association between ever use of oral contraceptives and breast cancer in young women does not vary strongly by histologic subtype. These results are similar to previous studies that report little difference in the effect of oral contraceptive use on breast cancer by histology.
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Affiliation(s)
- Sarah J Nyante
- Department of Epidemiology, University of North Carolina at Chapel Hill, Chapel Hill, NC 27599, USA.
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Coughlin SS, Leadbetter S, Richards T, Sabatino SA. Contextual analysis of breast and cervical cancer screening and factors associated with health care access among United States women, 2002. Soc Sci Med 2008; 66:260-75. [PMID: 18022299 DOI: 10.1016/j.socscimed.2007.09.009] [Citation(s) in RCA: 170] [Impact Index Per Article: 10.6] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/18/2006] [Indexed: 11/27/2022]
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Patient-centered prevention strategies for cardiovascular disease, cancer and diabetes. ACTA ACUST UNITED AC 2007; 4:656-66. [DOI: 10.1038/ncpcardio1029] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2006] [Accepted: 08/16/2007] [Indexed: 01/08/2023]
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