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Assessment of Colon & Prostate Cancer Screening
in WA
Peggy Hannon, PhD, MPH
Alliance for Reducing Cancer NW
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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
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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
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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
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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%
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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%)
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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
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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%)
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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
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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
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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
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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%)
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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%)
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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
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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