Transcript Style E 42 by 48

“The 50 – Year Project: Examining Colorectal Cancer Screening History Among
Peninsula Institute for Community Health Patients Aged 50 Years and Older”
Jewel S. Goodman, MPA, PhD(c)1; Stacey B. Plichta, ScD1; Angela Futrell, RN2; and Syed Kalamuddin, DDS, MPH2
1 College of Health Sciences, Old Dominion University, Norfolk, Virginia and 2Peninsula Institute for Community Health, Newport News, Virginia
About PICH
Focus Group Results, cont.
• The Peninsula Institute for Community Health (PICH), a
private, non-profit community health center established in 1978,
served an estimated 24,440 unduplicated insured and uninsured
patients in 2005. Uninsured patients pay based upon family size
and income. PICH has three primary care practices, a community
dental project, a Health Care for the Homeless program, two
school-based health centers, and a pharmacy program to
increase access to prescription medications for low-income and
uninsured patients receiving care from area safety-net providers.
•
Screening History: When asked if they had a Fecal Occult Blood
Test (FOBT) performed, most (n=8, 80%) reported no and when
asked if they had been referred for the colonoscopy screening, more
than half (n=6, 60%) had not. Those referred for a colonoscopy
presented with symptoms such as incontinence, blood in stool, and
bowel movement inability, not age.
• One MD, one PA, two Referral Specialists, three LPNs, and one
RN responded. When asked to describe the selection criteria used to
select patients to refer for the FOBT or the Colonoscopy screening,
participants responded: abdominal pain, frequent urination, rectal
exam results, constipation, Irritable Bowel Syndrome, rectal bleeding,
change in stool, acid reflux, family history, age, and medical history.
•
Establishing and Increasing Level of Knowledge: When asked if
they knew what a colonoscopy screening examination entailed,
participants revealed they were familiar with the term and its link to
cancers. A patient stated, “the closest I can come would be cancer
of the rectum or the organs that involved in elimination.” One
participant stated, “it is something to do with the intestine, the colon,
the rectum and the anus”. Among those patients who were referred,
they reported the physicians and medical staff failed to provide any
explanation of why the procedure was necessary, what the results
would show, nor what would happen to them during the screening.
Patients agreed that informational handouts would be beneficial to
age-appropriate patients not experiencing any symptoms.
• When asked to list all factors that patients have shared with them
concerning non-compliance with referrals for the screening, medical
staff reported: bad prior experience in the health system, men feel
violated by the procedure, patient thinks the procedure is painful, no
insurance, history of non-compliance, uncomfortable with an
instrument in the rectum, no symptoms, no current problems, and
afraid of the possible results.
Background and Purpose
• In the US, Colorectal Cancer (CRC) is reportedly the second
leading cause of cancer-related deaths. A person’s lifetime risk of
developing CRC is approximately 6%, with nearly all (90%) CRC
cases occurring after age 50. CRC is preventable with timely and
accurate colon screening and subsequent removal of polyps that
result in development of cancer. Medical research suggests it may
take 10 years for this to occur, but the colonoscopy screening
examination allows recognition of polyps years before they become
dangerous. Screening begins at age 50 years and over and can
reduce mortality rates of colon cancer.
•
Over the past 20 years, CRC rates among whites has
decreased, but remained constant among African Americans. Of all
racial / ethnic groups in the US, African Americans have the highest
mortality rates among CRC fatalities. Both men and women are at
equal risk.
• The overall goals of the project were to: actively engage existing
patients in discussing their experience with receiving referrals from
their PICH physicians to have the colonoscopy screening
performed, particularly if they are age-appropriate; and to
demonstrate any methods by which PICH could ultimately improve
its available pool of resources to assist patients in meeting the
recommendations of their physicians as it relates to having the
colonoscopy performed. Surveys were administered and focus
groups, medical staff interviews, and a medical records review
were conducted.
Focus Group Results
• Demographics: Participants (n=10) were evenly distributed as
male and female, majority African American (n=9, 90%), and
between the ages of 50 - 59 years (n=6, 60%) with a mean age of
53.7 years. More than half (n=6, 60%) reported a household
annual income of $20,000 or less; 40% (n=4) reported Medicaid
or Medicare as current health insurance, and another 30% (n=3)
reported not having health insurance.
•
Determining the Levels of Responsibilities and Follow-up:
Participants discussed having nursing staff create a document to
accompany medical records of all patients aged 50 years and older
to assist physicians in appropriate referrals, “maybe the nurse could
do something...tell the doctor, hey look, this here man is 52 and he
ain’t got no blood in the stool or nothing, but we still need to send
him out for the thing [colonoscopy screening] just cause of his age.”
Among those patients who were referred, but had not complied
because they did not have insurance, discussion entailed PICH
providing resources to assist patients. “See, I have Medicaid and
Medicare, so mines will probably be covered, but somebody ain’t got
no insurance, what about them, what do you tell them.” Participants
suggested PICH provide the colonoscopy screening at a reduced
rate as it does with other extended services so that patients can
afford it; provide the contact information for facilities that have
cheaper rates for the screening; contact information for medical
centers that provide the screening free-of-charge; and lastly, provide
the additional facets necessary such as transportation assistance.
Medical Records Review Results
• Of the 55 medical records reviewed, majority were male (n=32,
58%); 38 had not been referred by their PICH physician for a
Colonoscopy nor a FOBT. Of the remaining 17 medical records, two
had been referred for the FOBT but no test results in file; 10 had
been referred for the Colonoscopy, but no results in file; five had
been referred for the Colonoscopy and had participated in the
screening; four within the past year; majority female (n=4) and
ranged in ages from 50 - 57 years.
Medical Staff Interview Results
Survey Administration Results
• Forty-eight (48) participants completed the survey administered
at the 16th Annual Screening Event. Most were female (n=29, 60%);
African American (n=39, 81%); and between the ages of 50 – 59
years (n=20, 42%) with a mean age of 56 years. The event was
open to the public, approximately half (n=27, 56%) were PICH
patients.
• Of the 15 patients aged 60 years and older, nearly all (n=14,
93%) had a FOBT. The majority (n=13, 87%) had been referred for
and completed the Colonoscopy screening, with more than half (n=8,
62%) within the past 12 months. One participant was referred but
failed to follow-up due to transportation.
•
Of the 20 patients aged 50 – 59 years, almost half (n=9, 45%)
had a FOBT; two-thirds (n=14, 70%) had not been referred for the
Colonoscopy screening; 30% (n=6) had been referred for the
Colonoscopy and nearly all (n=5, 83%) had the screening completed.
One participant did not follow-up reported transportation problems.
Four of the five patients who had the screening performed had either
Medicare or Medicaid health insurance coverage and one had no
insurance.
Discussion
• A standard protocol for referrals must be implemented so that all
age-appropriate patients are referred at the primary care physician
level. This project illustrated that although patients are not afraid of
the fecal occult blood test, they need more education about the
Colonoscopy and what the screening can detect, the impact on their
overall health, and increased awareness of free cancer screening
events. A collaboration with screening specialists is recommended.