Alaska Native Patient and Provider Perspectives on the Multitarget Stool DNA Test Compared With Colonoscopy for Colorectal Cancer Screening

Objective: Alaska Native (AN) people have among the world’s highest rate of colorectal cancer (CRC). We assessed perceptions of AN people and their health care providers of a new take-home multitarget stool DNA test (MT-sDNA; Cologuard) relative to colonoscopy. Methods: Cross-sectional surveys of AN people aged 40 to 75 years (mailed) and providers (online). Results: Participants included 1616 AN patients (19% response rate) and 87 providers (26% response rate; 57% AN people). Over half (58%) of patients preferred colonoscopy for CRC screening, while 36% preferred MT-sDNA. Unscreened patients were significantly more likely to state a preference for MT-sDNA than previously screened patients (42% vs 31%, P < .05) as were younger patients (<60 years old) compared with older patients (40% vs 30%, P < .05). Most providers thought that MT-sDNA would improve screening rates (69%), would recommend if available (79%), and be implementable (79%). Perceived barriers differed substantially between patients and providers in both type and magnitude. Leading colonoscopy barriers reported by patients were travel (44%) and bowel preparation (40%), while providers thought that fear of pain (92%) and invasiveness of the test (87%) were the primary barriers. For MT-sDNA, patients’ belief that colonoscopy was better (56%) and not knowing how to do the test (40%) were primary barriers, while providers thought stool collection (67%) and having a stool sample in their home (63%) were leading barriers. Conclusions: This study found that MT-sDNA has potential acceptability among AN people and their health care providers. Both groups reported a willingness to use MT-sDNA and did not perceive major barriers to its use. This preference was especially true of unscreened and younger patients. The majority of providers indicated they would use MT-sDNA if available and that it would improve CRC screening rates. In this population, where colonoscopy access is limited, MT-sDNA has the potential to improve CRC screening adherence.

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What’s the “Secret Sauce”? How Implementation Variation Affects the Success of Colorectal Cancer Screening Outreach

10.21203/rs.3.rs-29984/v1 ◽

2020 ◽

Author(s):

Jennifer Coury ◽

Edward J. Miech ◽

Patricia Styer ◽

Amanda F. Petrik ◽

Kelly E. Coates ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Health System ◽

Health Systems ◽

Health Care Providers ◽

Descriptive Analysis ◽

Care Providers ◽

Screening Rate ◽

Crc Screening ◽

Fecal Immunochemical Testing

Abstract Background Mailed fecal immunochemical testing (FIT) programs can improve colorectal cancer (CRC) screening rates, but health systems often vary implementation (i.e., adapt) these programs for their organizations. A health insurance plan implemented a mailed FIT program (named BeneFIT) and allowed participating health systems to adapt the program. This mixed-methods study explored which program adaptations might have achieved higher screening rates.Methods We used a multi-method approach. First, we conducted a descriptive analysis of CRC screening rates by key health system characteristics and program adaptations. Second, we applied Configurational Comparative Methods (CCMs) to determine potential explanatory factors consistent with higher screening rates. The main outcome measure was CRC screening rates.Results Seventeen health systems took part in at least one year of BeneFIT. The overall screening completion rate was 20% (4–28%) in Year 1, and 25% (12–35%) in Year 2 of the program. Health systems that used two or more adaptations had higher screening rates, and no single adaptation clearly led to higher screening rates. In Year 1, smaller systems (having < 2 clinics) with phone reminders (n = 2) met the implementation success threshold (≥ 19% screening rate) while larger systems were successful when offering a patient incentive (n = 4), scrubbing mailing lists (n = 4), or allowing mailed FIT returns with no other adaptations (n = 1). In Year 2, large systems (> 2 clinics) were successful with a phone reminder (n = 4) or a patient incentive (n = 3). Of the 10 systems that implemented BeneFIT in both years, seven improved in Year 2.Conclusions Health systems can choose between many adaptations and successfully implement a health plan’s mailed FIT program. Screening completion rates are positively associated with the number of adaptations implemented by a health system. Health system size emerged as an important contextual factor, with different solutions for larger than smaller health systems.Contributions to the Literature· Our paper analyzes adaptations that enable health care providers to implement mailed fecal immunochemical testing (FIT) programs in delivery systems.· Our results explore which adaptations made by health systems to mailed FIT programs are related to screening rate improvements. Our analysis shows that a health system’s organizational characteristics in combination with the adaptations themselves may affect resulting CRC screening rates and implementation.· Our paper describes different pathways that health care organizations can use to implement CRC screening outreach to improve the health of their populations. We show results of implementation flexibility and customizing CRC screening outreach to particular clinic environments.

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Rural-urban disparities in colorectal cancer screening: An insight from a statewide database.

Journal of Clinical Oncology ◽

10.1200/jco.2020.38.4_suppl.69 ◽

2020 ◽

Vol 38 (4_suppl) ◽

pp. 69-69

Author(s):

Renugadevi Swaminathan ◽

James D. Morris ◽

Terry C. Davis

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Health Care Providers ◽

Geographic Region ◽

Screening Tests ◽

Screening Colonoscopy ◽

Care Providers ◽

Rural Residents ◽

Crc Screening ◽

The Impact

69 Background: The Healthy People 2020 initiative aims to increase colorectal cancer (CRC) screening. The common CRC screening options are FIT, FOBT, sigmoidoscopy, and colonoscopy. Colonoscopy allows visualization of the entire colon and offers therapeutic benefit whereas stool tests are less invasive, cost-effective and are easily available. Inequities exist in CRC screening among rural residents which may be contributed to a lower level of education, income, health insurance and access to health care. The purpose of the study is to identify the impact of geographic region on the preference of CRC screening modality among Louisiana adults. Methods: We performed a retrospective cohort study among age-eligible Louisiana adults who had CRC screening either with colonoscopy or stool-based tests using the 2016 Behavioral Risk Factor Surveillance System database (n = 1372). We examined demographic characteristics among participants who had CRC screening with colonoscopy versus who had a stool-based test. Multivariable logistic regression analysis evaluated the association of geographic region and the preference of CRC screening. Results: Participants age 65-75 years old were 36% less likely to have a colonoscopy as compared to age 50-64 years (p = 0.0008). African Americans and Hispanic Americans were 34% (p < 0.006) and 55% (p = 0.057) less likely to have a colonoscopy as compared to Caucasian Americans, respectively. Medicaid and Medicare participants were 82% (p < 0.0001) and 52% (p < 0.0001) less likely to have a colonoscopy compared to participants with private insurance, respectively. After adjusting for age, race/ethnicity, education, income, and insurance the odds of screening colonoscopy was 29% lower for rural residents compared to urban residents of Louisiana (OR 0.71 95% CI 0.53 - 0.94). Conclusions: Individuals residing in rural parishes of Louisiana were more likely to have a stool-based test for CRC screening. Health care providers while considering the reliability and feasibility of CRC screening modality should also incorporate patient’s preferences while offering the screening tests to increase the rate of CRC screening.

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Cross-sectional adherence with the multi-target stool DNA test for colorectal cancer screening in a large, nationally insured cohort

International Journal of Colorectal Disease ◽

10.1007/s00384-021-03956-0 ◽

2021 ◽

Author(s):

Lesley-Ann Miller-Wilson ◽

Lila J Finney Rutten ◽

Jack Van Thomme ◽

A Burak Ozbay ◽

Paul J Limburg

Keyword(s):

Colorectal Cancer ◽

National Sample ◽

Adherence Rate ◽

Average Risk ◽

Cross Sectional ◽

Commercial Insurance ◽

Dna Test ◽

Crc Screening ◽

Stool Dna ◽

Insured Patients

Abstract Purpose Colorectal cancer (CRC) is the second most deadly cancer in the USA. Early detection can improve CRC outcomes, but recent national screening rates (62%) remain below the 80% goal set by the National Colorectal Cancer Roundtable. Multiple options are endorsed for average-risk CRC screening, including the multi-target stool DNA (mt-sDNA) test. We evaluated cross-sectional mt-sDNA test completion in a population of commercially and Medicare-insured patients. Methods Participants included individuals ages 50 years and older with commercial insurance or Medicare, with a valid mt-sDNA test shipped by Exact Sciences Laboratories LLC between January 1, 2018, and December 31, 2018 (n = 1,420,460). In 2020, we analyzed cross-sectional adherence, as the percent of successfully completed tests within 365 days of shipment date. Results Overall cross-sectional adherence was 66.8%. Adherence was 72.1% in participants with Traditional Medicare, 69.1% in participants with Medicare Advantage, and 61.9% in participants with commercial insurance. Adherence increased with age: 60.8% for ages 50–64, 71.3% for ages 65–75, and 74.7% for ages 76 + years. Participants with mt-sDNA tests ordered by gastroenterologists had a higher adherence rate (78.3%) than those with orders by primary care clinicians (67.2%). Geographically, adherence rates were highest among highly rural patients (70.8%) and ordering providers in the Pacific region (71.4%). Conclusions Data from this large, national sample of insured patients demonstrate high cross-sectional adherence with the mt-sDNA test, supporting its role as an accepted, noninvasive option for average-risk CRC screening. Attributes of mt-sDNA screening, including home-based convenience and accompanying navigation support, likely contributed to high completion rates.

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A Personalized Approach of Patient–Health Care Provider Communication Regarding Colorectal Cancer Screening Options

Medical Decision Making ◽

10.1177/0272989x18763802 ◽

2018 ◽

Vol 38 (5) ◽

pp. 601-613 ◽

Cited By ~ 3

Author(s):

M. Gabriela Sava ◽

James G. Dolan ◽

Jerrold H. May ◽

Luis G. Vargas

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Cancer Screening ◽

Colorectal Cancer Screening ◽

Health Care Provider ◽

Health Care Providers ◽

Care Provider ◽

Medical Decision ◽

Average Risk ◽

Care Providers

Background. Current colorectal cancer screening guidelines by the US Preventive Services Task Force endorse multiple options for average-risk patients and recommend that screening choices should be guided by individual patient preferences. Implementing these recommendations in practice is challenging because they depend on accurate and efficient elicitation and assessment of preferences from patients who are facing a novel task. Objective. To present a methodology for analyzing the sensitivity and stability of a patient’s preferences regarding colorectal cancer screening options and to provide a starting point for a personalized discussion between the patient and the health care provider about the selection of the appropriate screening option. Methods. This research is a secondary analysis of patient preference data collected as part of a previous study. We propose new measures of preference sensitivity and stability that can be used to determine if additional information provided would result in a change to the initially most preferred colorectal cancer screening option. Results. Illustrative results of applying the methodology to the preferences of 2 patients, of different ages, are provided. The results show that different combinations of screening options are viable for each patient and that the health care provider should emphasize different information during the medical decision-making process. Conclusion. Sensitivity and stability analysis can supply health care providers with key topics to focus on when communicating with a patient and the degree of emphasis to place on each of them to accomplish specific goals. The insights provided by the analysis can be used by health care providers to approach communication with patients in a more personalized way, by taking into consideration patients’ preferences before adding their own expertise to the discussion.

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Developmental and Behavioral Pediatricians' Attitudes Toward Screening for Fragile X

American Journal on Intellectual and Developmental Disabilities ◽

10.1352/1944-7558-188.4.284 ◽

2013 ◽

Vol 118 (4) ◽

pp. 284-293 ◽

Cited By ~ 6

Author(s):

Kruti Acharya ◽

Abigail Schindler

Keyword(s):

Health Care ◽

Newborn Screening ◽

Fragile X Syndrome ◽

Health Care Providers ◽

Response Rate ◽

Fragile X ◽

Educational Interventions ◽

Care Providers ◽

Cross Sectional Survey ◽

Cross Sectional

Abstract Developmental and behavioral pediatricians (DBP) diagnose and care for children with fragile X syndrome. Their attitudes toward FMR1 newborn screening (NBS) and FMR1 carrier testing in childhood could highlight potential pitfalls with FMR1 NBS. We conducted a cross-sectional survey with an adjusted response rate of 61%. Among DBP, 74% supported universal FMR1 NBS, preferring to identify both full mutations and premutations. DBP also support FMR1 testing of asymptomatic siblings. Although DBP support testing for premutations at various points in the lifespan, DBP are not familiar with the array of fragile X–associated disorders (FXAD). Targeted educational interventions are needed to ensure that all health care providers have the knowledge and competence to consent and to counsel families on FXAD.

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Preparedness and Approaches of Health Care Providers to Tackle the Transmission of COVID-19 Among South Gondar Zone Hospitals, Amhara, Ethiopia, 2020.

10.21203/rs.3.rs-57926/v1 ◽

2020 ◽

Author(s):

Minale Bezie Ambie ◽

Habtamu Gebrehana Belay ◽

Dagne Addisu Sewyew

Keyword(s):

Health Care ◽

Health Care Providers ◽

Overall Response Rate ◽

Response Rate ◽

Health Providers ◽

Care Providers ◽

Good People ◽

The Mean ◽

Age Range ◽

South Gondar

Abstract Objective: Preparedness and approaches of health care providers to tackle the transmission of covid-19 among South Gondar zonal hospitals 2020Result: In this study a total of 422 health providers were interviewed from south Gondar zonal hospitals and overall response rate was 100%. The mean range 35 ± 6 and minimum and maximum ranges of age were between 23 to 50 years and more than three fourth of the providers age range was > 35 years. Regarding professions 203(48.1%), 112(26.5%) were nurses and midwifes respectively. The result over all was not good; people were not prepared preparedness of essential materials, equipments including psychological buildings of health providers in each hospital.

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“Making Sense of a Disease That Makes No Sense”: Understanding Alzheimer’s Disease and Related Disorders Among Caregivers and Providers Within Alaska Native Communities

The Gerontologist ◽

10.1093/geront/gnaa102 ◽

2020 ◽

Author(s):

Jordan P Lewis ◽

Spero M Manson ◽

Valarie B Jernigan ◽

Carolyn Noonan

Keyword(s):

Alzheimer’S Disease ◽

Alzheimer's Disease ◽

Health Care ◽

Support Groups ◽

Health Care Providers ◽

Alaska Native ◽

Adult Population ◽

Memory Loss ◽

Cost Of Care ◽

Care Providers

Abstract Background and Objectives With the rate of Alzheimer’s disease and related dementias (ADRD) increasing among Alaska Indian/Alaska Native (AI/AN) people, the Alaska Native Health system is ill-prepared to meet the challenges associated with the growing population at risk of ADRD. The high cost of care, inadequate training of health care providers, and lack of supportive services for caregivers are especially concerning. Research Design and Methods Interviews were conducted with 22 AN caregivers for ANs with ADRD and 12 ANs and non-Native health care providers in communities across Alaska. Interviews lasted approximately 60 min and were transcribed verbatim. We employed directed content analysis to examine the major agreements and disagreements between the participants’ understandings of ADRD in each of the domains of Kleinman’s Explanatory Model of Illness. Results Caregivers and health care providers expressed concerns about the lack of understanding, resources, and awareness of ADRD among ANs in rural and urban communities. Both caregivers and providers recognized the need to obtain an early diagnosis, blend Western and traditional medicines, promote lifestyle and dietary changes, and foster training for caregivers. Health care providers acknowledged their limited exposure to AN understanding of ADRD and wish to receive culturally relevant training to better serve AN. Discussion and Implications As the older AN adult population grows, the need for culturally responsive training and support services will continue to increase. We recommend establishing rural outreach and support groups for caregivers, developing an understanding of how ANs view ADRD to train and educate health care providers, and implement screening early for memory loss during routine medical examinations.

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An Electronic Questionnaire to Survey Colorectal Cancer Screening Status and Identify High-Risk Cohorts in Large Health Care Organizations

American Journal of Medical Quality ◽

10.1177/1062860620937236 ◽

2020 ◽

pp. 106286062093723

Author(s):

Christopher T. Soriano ◽

Thomas J. McGarrity ◽

Junjia Zhu ◽

Justin Loloi ◽

Laurie P. Peiffer ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

High Risk ◽

Human Resources ◽

Health Care Organizations ◽

Response Rate ◽

Patient Questionnaire ◽

Screening Practices ◽

Crc Screening ◽

Incidence And Mortality

Though improved screening practices have reduced the incidence and mortality of colorectal cancer (CRC), screening rates continue to be suboptimal. This is especially true of high-risk individuals, who are difficult for clinicians to identify during a typical health care encounter. The authors developed an electronic patient questionnaire that determined an individual’s CRC screening status and identified high-risk individuals. The questionnaire was administered to employees through the Department of Human Resources. The response rate was 44.7%; 81.2% of respondents aged ≥50 years were up-to-date on CRC screening; 878 high-risk individuals were identified, 77.7% of whom were up-to-date on CRC screening. However, among high-risk individuals aged 40 to 49 years, only 45.8% reported up-to-date CRC screening. The questionnaire was effective in measuring CRC screening rates and identifying high-risk individuals. Dissemination by the Department of Human Resources was novel, effective, and was not dependent on a health care encounter to assess screening or high-risk status.

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Opportunity is the greatest barrier to providing palliative care to advanced colorectal cancer patients: a survey of oncology clinicians

Current Oncology ◽

10.3747/co.25.4021 ◽

2018 ◽

Vol 25 (5) ◽

Cited By ~ 1

Author(s):

M. A. Earp ◽

A. Sinnarajah ◽

M. Kerba ◽

P. A. Tang ◽

J. Rodriquez-Arguello ◽

...

Keyword(s):

Colorectal Cancer ◽

Health Care ◽

Palliative Care ◽

Health Care System ◽

Health Care Providers ◽

Rural Areas ◽

Theoretical Domains Framework ◽

Standard Of Care ◽

Care Providers ◽

Care System

Palliative care (pc) is part of the recommended standard of care for patients with advanced cancer. Nevertheless, delivery of pc is inconsistent. Patients who could benefit from pc services are often referred late—or not at all. In planning for improvements to oncology pc practice in our health care system, we sought to identify barriers to the provision of earlier pc, as perceived by health care providers managing patients with metastatic colorectal cancer (mcrc). We used the Michie Theoretical Domains Framework (tdf) and Behaviour Change Wheel (bcw), together with knowledge of previously identified barriers, to develop a 31-question survey. The survey was distributed by e-mail to mcrc health care providers, including physicians, nurses, and allied staff. Responses were obtained from 57 providers (40% response rate).The most frequently cited barriers were opportunity-related—specifically, lack of time, of clinic space for consultations, and of access to specialist pc staff or services. Qualitative responses revealed that resource limitations varied by cancer centre location. In urban centres, time and space were key barriers. In rural areas, access to specialist pc was the main limiter. Self-perceived capability to manage pc needs was a barrier for 40% of physicians and 30% of nurses. Motivation was the greatest facilitator, with 89% of clinicians perceiving that patients benefit from pc. Based on the Michie tdf and bcw model, interventions that best address the identified barriers are enablement and environmental restructuring. Those findings are informing the development of an intervention plan to improve oncology pc practices in a publicly funded health care system.

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