An Innovative Strategy to Reach the Underserved for Colorectal Cancer Screening

Abstract

Hispanics are an underserved population in terms of colorectal cancer (CRC). CRC is the second leading cause of cancer incidence among Hispanic men and women and Hispanics have lower screening rates than non-Hispanic whites. The overall purpose of this project was to provide CRC information, education, and fecal occult blood test (FOBT) kits to Hispanics in a rural three-county region of Washington State. We held a series of 47 community health fair events that incorporated the use of a giant inflatable, walk-through colon model with physical depictions of healthy tissue, polyps, and CRC. We used a pre/post-design to look for changes in familiarity with CRC before and after walking through the colon among adults 18 and older (n=947). McNemar's test analysis indicated significant differences in the distribution of the percentage of correct participant responses to CRC-related questions from pre- to post-test after an educational tour of the colon. Results from logistic regression analysis identified multiple participant characteristics associated with self-reported likelihood of being screened for CRC in the three months following post-test. We distributed 300 free FOBT kits to be analyzed at no charge to the end-user to attendees aged 50 and older who toured the inflatable colon; 226 FOBT kits (75.3%) were returned for analysis. The use of the inflatable colon was an innovative way to attract people to learn about CRC and CRC screening modalities. Furthermore, the response to our distribution of FOBT kits indicates that if given the opportunity for education and access to services, this underserved population will comply with CRC screening.

Geographic and population-level disparities in colorectal cancer testing: A multilevel analysis of Medicaid and commercial claims data

“…For example, if rural patients are more burdened with competing demands, structural barriers to accessing care (e.g., transportation), and costs of care, then systems may need to prioritize FOBT/FIT with colonoscopy follow-up on abnormal tests. Launching FOBT/FIT kit campaigns may be particularly impactful in addressing screening disparities in rural and Medicaid populations as they help reduce structural and geographic barriers to CRC screening and have demonstrated effectiveness and cost-effectiveness in these populations (Briant et al, 2015; Charlton et al, 2014; Hillyer et al, 2011; Coronado et al, 2011; Gupta et al, 2013b). …”

Who Performs Colonoscopy? Workforce Trends Over Space and Time

“…Notwithstanding the need for more research on quality of colonoscopies performed by nongastroenterologists, one must realize that using only gastroenterologists to perform colonoscopy in rural areas is not likely to be feasible, given their limited availability, and consider as a consequence that a broader range of CRC screening modalities might be necessary under these conditions . Interventions with targeted outreach (eg, mailed FIT kits) and education in rural areas have shown high success rates for FIT and FOBT completion. Primary care providers are uniquely situated to offer individuals less invasive screening tests such as FIT and FOBT without additional training and with minimal time commitment.…”

Barriers and Facilitators of Colorectal Cancer Screening in a Federally Qualified Health Center (FQHC)

“…Potential barriers included cost, 17 time, 18 poor/confusing instructional materials, 17 transportation to FIT return sites, 19 limited drop-off sites or return site hours of operation (recommended by local clinic administrators), fear of abnormal findings, 17,20 embarrassment, 21 lack of motivation, 21 and forgetfulness. 18 Potential facilitators included a prepaid postage with proper return address 22 ; more drop-off sites (recommended by local clinic administrators); reminders by phone, email, text, or mail 19 ; better test instructions 23 ; additional colorectal cancer screening educational materials 17 ; or more time spent with the clinician. 17 Patient participants were asked to respond with yes, no, or prefer not to answer to each barrier and facilitator.…”