assessment of colon & prostate cancer screening in wa peggy hannon, phd, mph alliance for...
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Assessment of Colon & Prostate Cancer Screening
in WA
Peggy Hannon, PhD, MPH
Alliance for Reducing Cancer NW
Baseline Assessment Questions Colon cancer screening
Rates of screening in WA Who gets screened?
Physician knowledge, attitudes, practices Prostate cancer screening & IDM
Rates of screening & IDM in WA Who gets screened?
Physician knowledge, attitudes, practices for screening and IDM
Assessment Methods BRFSS analysis, 2001-2002 data
Core questions for colon cancer screening and prostate cancer screening
State-added questions for colon screening in 2002
Physician Survey Primary care providers practicing in WA 397 completed surveys, 72% response rate
Assessment Methods, contin’d Insurance claims analyses
Medicare, Medicaid, PPO, HMO Available data ranged from 2000 – 2004 Studied all colon cancer screening tests & PSA
for prostate cancer screening
Literature review Community Guide recommendations
Colon Cancer Screening Findings WA BRFSS 2001-2002, participants 50 years of
age and older (N = 3643) Current FOBT (in past year) -- 25% Current Flexible Sigmoidoscopy or Colonoscopy (in
past 5 years) -- 42% Currently screened by any method -- 52%
Colon Cancer Screening Findings 2002 BRFSS asked unscreened participants the
most important reason they were not screened Lack of awareness (50%) No physician recommendation (29%) Unwilling (19%) No insurance (2%)
Colon Cancer Screening Findings Physicians’screening recommendations
93% recommend FOBT 56% recommend flexible sigmoidoscopy 88% recommend colonoscopy 76% rec. one or more screening tests in agreement
with USPSTF guidelines
Colon Cancer Screening Findings Physician mechanisms to complete screening
33% have mechanism to encourage return of FOBT kits 65% have mechanism to ensure patients complete screening and
follow-up tests referred to another provider
Perceived patient barriers (% physicians reporting as major or minor barrier) Fear of finding cancer (89%) Anxiety about tests (94%) Unaware of screening (92%)
Interventions Sought in RFP General systems for provider recommendations
and referral Improve provider knowledge & recommendations for
screening Improve clinical tracking & performance of screening
Guiding test completion and follow-up of positive tests
Targeted interventions for underserved groups
Prostate Cancer Screening Findings
WA BRFSS 2001-2002 (N = 1431) 61% of men ages 50+ were screened for prostate
cancer in the past year 39% screened with PSA and DRE 13% screened with DRE only 9% screened with PSA only
No questions about IDM
Similar to national screening rates
Prostate Cancer Screening Findings
90% of physicians recommend DRE & 83% recommend PSA
Most recommend starting testing at ages 45-50 & yearly screening
55% collect family history of prostate cancer for 75%+ of male patients
Prostate Cancer Screening Findings
74% of physicians always/almost always discuss benefits/risks of PSA
Few report always using educational materials to discuss benefits/risks of PSA Written materials (9%) Videotapes (0.3%) Websites (6%)
Prostate Cancer Screening Findings
Issues discussed by majority of physicians Efficacy of PSA in detecting prostate cancer (64%) PSA may prompt further tests (64%)
Issues discussed by minority of physicians Efficacy of treatment options for prostate cancer
(35%) Possible side effects of treatment for prostate cancer
(35%)
Interventions Sought in RFP Provider-targeted interventions
Provider discussion of risks and benefits Provider collection of family history of PCa Placing IDM tools/cues in providers’ offices
Consumer-targeted interventions Placing IDM tools in community settings Forums to increase capacity to make informed
decisions
Conclusions Baseline assessment has been very useful
in shaping the CCCP’s first RFPs ARCNW’s Cancer Screening workgroup
and partners have also benefited Future directions Preliminary studies for grant applications