Purpose: Rural residents are less likely to engage in cancer risk-reduction behaviors than their urban counterparts. Rural cancer disparities may be related to limited access to and comprehension of ...cancer-related health information. The object of this study was to identify how rural residents access and understand cancer health promotion and prevention information. Sample: Twenty-seven residents of Central Virginia Methods: We used a qualitative design with semi-structured interviews and a focus group (n=27) with rural and non-rural residents living in Central Virginia to accomplish the study aim. Findings: Four themes were identified from the data: 1) non-rural Central Virginia residents seek health information from a variety of electronic sources, 2) rural Central Virginia residents typically seek health care information directly from health care professionals, 3) residents throughout Central Virginia encounter confusing health care information, and 4) rural residents report incorrect cancer-related information. Conclusions: Lack of internet access coupled with healthcare shortages may limit the ability of rural residents to contextualize and verify inaccurate health information. Nurses serving a rural population should consider assessing each rural patient's internet access and disseminating printed cancer health promotion materials to rural clients without internet access. Keywords: rural health; healthcare disparities; access to care; cancer health promotion; health literacy; cancer
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The cervical cancer burden is high among women living in Appalachia. Cigarette smoking, a cervical cancer risk factor, is also highly prevalent in this population. This project aims to increase ...smoking cessation among women living in Appalachia by embedding a smoking cessation program within a larger, integrated cervical cancer prevention program.
The broader program, the Take CARE study, is a multi-site research collaborative designed to address three risk factors for cervical cancer incidence and mortality: tobacco use, human papillomavirus (HPV) infection, and cervical cancer screening. Break Free is a primary care clinic-based implementation program that aims to promote smoking cessation among female smokers in Appalachia by standardizing clinical practice protocols. Break Free includes: (1) implementation of a tobacco user identification system in the Electronic Health Record, (2) clinic staff and provider training on the Ask, Advise and Refer (AAR) model, (3) provider implementation of AAR to identify and treat women who want to quit smoking within the next 6 months, (4) facilitated access to cessation phone counseling plus pharmacotherapy, and (5) the bundling of Break Free tobacco cessation with HPV vaccination and cervical cancer screening interventions in an integrated approach to cervical cancer prevention. The study spans 35 Appalachian health clinics across 10 healthcare systems. We aim to enroll 51 adult female smokers per health system (total N = 510). Baseline and follow-up data will be obtained from participant (provider and patient) surveys. The primary outcome is self-reported 12-month point prevalence abstinence among enrolled patients. All randomized patients are asked to complete follow-up surveys, regardless of whether they participated in tobacco treatment. Data analysis of the primary aims will follow intent-to-treat methodology. Secondary outcomes will assess program implementation and cost effectiveness.
Addressing high tobacco use rates is critical for reducing cervical cancer morbidity and mortality among women living in Appalachia. This study evaluates the implementation and effectiveness of a smoking cessation program in increasing smoking cessation among female smokers. If results demonstrate effectiveness and sustainability, implementation of this program into other health care clinics could reduce both rates of smoking and cervical cancer. Trial registration NCT04340531 (April 9, 2020).
Abstract
Background
The objectives are to: 1) describe engagement processes used to prioritize and address regional comprehensive cancer control needs among a Community-Academic Advisory Board (CAB) ...in the medically-underserved, rural Appalachian region, and 2) detail longitudinal CAB evaluation findings.
Methods
This three-year case study (2017–2020) used a convergent parallel, mixed-methods design. The approach was guided by community-based participatory research (CBPR) principles, the Comprehensive Participatory Planning and Evaluation process, and
Nine Habits of Successful Comprehensive Cancer Control Coalitions.
Meeting artifacts were tracked and evaluated. CAB members completed quantitative surveys at three time points and semi-structured interviews at two time points. Quantitative data were analyzed using analysis of variance tests. Interviews were audio recorded, transcribed, and analyzed via an inductive-deductive process.
Results
Through 13 meetings, Prevention and Early Detection Action Teams created causal models and prioritized four cancer control needs: human papillomavirus vaccination, tobacco control, colorectal cancer screening, and lung cancer screening. These sub-groups also began advancing into planning and intervention proposal development phases. As rated by 49 involved CAB members, all habits significantly improved from Time 1 to Time 2 (i.e., communication, priority work plans, roles/accountability, shared decision making, value-added collaboration, empowered leadership, diversified funding, trust, satisfaction; all
p
< .05), and most remained significantly higher at Time 3. CAB members also identified specific challenges (e.g., fully utilizing member expertise), strengths (e.g., diverse membership), and recommendations across habits.
Conclusion
This project’s equity-based CBPR approach used a CPPE process in conjunction with internal evaluation of cancer coalition best practices to advance CAB efforts to address cancer disparities in rural Appalachia. This approach encouraged CAB buy-in and identified key strengths, weaknesses, and opportunities that will lay the foundation for continued involvement in cancer control projects. These engagement processes may serve as a template for similar coalitions in rural, underserved areas.
Abstract
Introduction: Smoking in the United States has steadily declined over the past several years; however, rural Virginia Appalachian communities have a substantially higher than average smoking ...prevalence than the rest of the country. A major challenge in providing effective and sustainable cigarette-cessation services to Virginia Appalachia is the geographic and economic diversity of the region, combined with much of the population residing in poor, medically underserved rural areas. Previous research has suggested that community health workers (CHWs) may be valuable in regions with limited financial and medical resources by acting as a bridge between patients and providers when access is limited by distance, health care provider shortages, and cultural stigma. The purpose of this study was to assess the feasibility and success of using CHWs for smoking-cessation services in two Virginia Appalachian health care settings.
Methods: Study enrollees were recruited from two sites: a local-family-owned pharmacy and a Federally Qualified Health Center (FQHC) in the Appalachian region of Virginia. Inclusion criteria were daily adult smokers (18+) who were patients at the clinic or the community pharmacy, and self-identified as ready to quit in the next 30 days. Enrollees were defined as individuals for whom a consent form and baseline assessment were completed. Enrollees were subset into a participant group defined as enrollees who completed at least the first session of the eight-session intervention plan. We used an intention-to-treat framework in calculating enrollee and participant quit rates. The program was designed to have eight sessions, with scheduling at the discretion of the CHW and participant. Sessions five and eight were to be completed by the respective health care provider for the clinic and pharmacy. Sessions one and two were completed by the CHW in person with the participant, and sessions three, four, six, and seven were completed by the CHW over the phone. During the sessions, CHWs helped participants develop skills in identifying and addressing barriers to a successful cigarette quit, providing support in adhering to their quit plan, and discussing challenges and barriers they were facing in their quit attempt.
Results: Twenty-three individuals were enrolled in the study, with twenty distinguished as participants. The enrollee quit rate was 22%, with a participant quit rate of 25%. Overall, we found a statistically significant decrease in all participants' average cigarettes smoked per day over the eight sessions. Almost all participants failed to complete sessions 5 and 8 with their health care provider. All participants highly rated the program with 100% satisfaction on flexibility of scheduling, level of comfort, positivity, and helpfulness of the CHW.
Conclusion: The use of CHWs in Virginia Appalachian communities within our pilot study for cigarette cessation services appears promising. Challenges were noted in attendance to sessions five and eight in the clinic setting. This may speak to the difficulty of going back to their care provider due to challenges in scheduling, concerns about cost of visit, and transportation. The flexibility of working with CHWs, in their own community, over meeting with care providers may provide a benefit to the use of CHWs in future smoking-cessation programs. Future research should explore expanded integration of CHWs into comprehensive tobacco-cessation services in health care settings including the cost-benefit analysis and sustainability of the CHW model.
Citation Format: Lindsay Hauser, Catherine Labgold, Roger Anderson, Fabian Camacho. Community health worker led smoking cessation intervention in Virginia Appalachia abstract. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr B21.
Colorectal cancer is the third leading cause of cancer death in the USA, yet is highly preventable and detectable at an early stage through screening. Virginia Cooperative Extension (VCE) implemented ...a worksite colon cancer awareness program to increase colorectal cancer screening rates and preventive lifestyle behaviors among its employees. The Colon Cancer–Free Zone program is designed using best practice principles of worksite health programs and includes information sessions covering the topics of colorectal cancer, screening guidelines, insurance coverage, and preventive lifestyle behaviors. It is conducted in a campaign format that includes a strategic communication strategy targeting relevant screening barriers and facilitators, peer champions, and incentives. The program was implemented with VCE employees statewide utilizing a web-based system for the information sessions, and resulted in broad participation, a significant increase in screening self-efficacy (4.15 ± 0.64 vs 3.81 ± 0.76,
ρ
= 0.006), changes in diet and physical activity (50% and 40% of participants, respectively), and a 20.6% increase in the employee colorectal cancer screening rate. A Colon Cancer–Free Zone toolkit was developed for use by Extension Agents to implement the program at worksites in their service communities.
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EMUNI, FIS, FZAB, GEOZS, GIS, IJS, IMTLJ, KILJ, KISLJ, MFDPS, NLZOH, NUK, OBVAL, OILJ, PNG, SAZU, SBCE, SBJE, SBMB, SBNM, UKNU, UL, UM, UPUK, VKSCE, ZAGLJ
Tobacco use after a cancer diagnosis can increase risk of disease recurrence, increase the likelihood of a second primary cancer, and negatively impact treatment efficacy. The implementation of ...system-wide comprehensive tobacco cessation in the oncology setting has historically been low, with over half of cancer clinicians reporting that they do not treat or provide a referral to cessation resources. This quality improvement study evaluated the procedures for assessing and documenting tobacco use among cancer survivors and referring current smokers to cessation resources at the University of Virginia Cancer Center. Process mapping revealed 20 gaps across two major domains: electronic health record (EHR), and personnel barriers. The top identified priority was inconsistent documentation of tobacco use status as it impacted several downstream gaps. Eleven of the 20 gaps were deemed a high priority, and all were addressed during the implementation of the resulting Tobacco Treatment Program. Prioritized gaps were addressed using a combination of provider training, modifications to clinical workflow, and EHR modifications. Since implementation of solutions, the number of unique survivors receiving cessation treatment has increased from 284 survivors receiving cessation support during Year 1 of the initiative to 487 in Year 3. The resulting Tobacco Treatment Program provides a systematic, personalized, and sustainable comprehensive cessation program that optimizes the multifaceted workflow of the Cancer Center and has the potential to reduce tobacco use in a population most in need of cessation support.
Abstract
Introduction: The Geographic Management of Cancer Health Disparities Program (GMaP) is a national NCI program with the goal of increasing cancer health disparities (CHD) research. GMaP ...Region 1 North (R1N) is one of seven GMaP Regional “hubs” based at NCI-designated cancer centers (CCs) across the country, covering the states of DE, KY, ME, MD, NH, VA, VT, WV, and the District of Columbia. The National Outreach Network (NON) is a national NCI program with the goal of conducting cancer education and outreach in underserved communities to reduce CHD. NON Community Health Educators (CHEs) are based at 38 NCI-designated CCs across the country. Six NCI-designated CCs with NON CHEs fall within the GMaP R1N coverage area.
Methods: GMaP R1N staff and NON CHEs within the R1N coverage area met bimonthly to collaborate on the Screen to Save (S2S): NCI Colorectal Cancer (CRC) Outreach and Screening Initiative. The goal of S2S was to educate underserved communities on CRC and CRC screening. NON CHEs conducted the projects in diverse urban and rural communities within their CC catchment areas. Participants attended a CRC education event that provided an inflatable colon or a PowerPoint presentation and completed demographic and pre-/post-event surveys to gauge their knowledge of CRC screening. Surveys were submitted to NCI Center to Reduce Cancer Health Disparities program staff for review and data entry. Raw data files were returned to NON CHEs and shared with GMaP R1N staff for analysis. R1N staff provided research expertise to compare results between urban and rural S2S participants.
Results: There were a total of 328 participants in S2S (n=200 urban; n=128 rural) in the GMaP R1N/NON coverage area. The median age of urban participants was 59.5 vs. 49.0 for rural participants. 95% of urban participants and 96.1% of rural participants reported having health insurance (public or private). 92.9% of urban and 88.1% of rural participants attained at least a high school diploma or GED. 76.5% of urban and 41.4% of rural participants reported ever being screened for CRC by any method. The percent increase between pre- and post-test scores for the educational intervention was 15% for urban vs. 13.3% for rural participants, with an overall percent increase in knowledge of 14.2%.
Conclusions: The urban and rural participants were similar in educational and health insurance attainment levels. Urban residents reported much higher rates of previous CRC screening than rural residents, but this is likely due to the fact that more rural participants were younger than the recommended CRC initial screening age at the time (age 50). The S2S educational intervention was effective in increasing knowledge of CRC screening among both rural and urban participants, with similar increase between the two groups. Overall, this project demonstrated that two different yet complementary programs, GMaP and NON, can work together by utilizing program strengths to successfully implement an educational intervention conducted across a wide and diverse geographic area.
Citation Format: Mark Cromo, Rhonda Boozer-Yeary, Melinda L. Rogers, Katelyn Schifano, Jenna Schiffelbein, Katherine L. Jones, Marcela Blinka, Julia F. Houston, Betsy Grossman, Lindsay Hauser, James Zabora, Mark B. Dignan, Tracy Onega. Integrating research and outreach to increase CRC screening knowledge in underserved communities: The Geographic Management of Cancer Health Disparities Program and National Outreach Network Screen to Save partnership abstract. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr A015.
The Center to Reduce Cancer Health Disparities (CRCHD), NCI, implemented Screen to Save, NCI's Colorectal Cancer Outreach and Screening Initiative to promote awareness and knowledge of colorectal ...cancer in racial/ethnic and rural populations.
The initiative was implemented through CRCHD's National Outreach Network (NON). NON is a national network of Community Health Educators (CHE), aligned with NCI-designated Cancer Centers across the nation. In phases I and II, the CHEs focused on the dissemination of cancer-related information and implementation of evidence-based educational outreach.
In total, 3,183 pre/post surveys were obtained from male and female participants, ages 50 to 74 years, during the 347 educational events held in phase I. Results demonstrated all racial/ethnic groups had an increase in colorectal cancer-related knowledge, and each group strongly agreed that the educational event increased the likelihood that they would engage in colorectal cancer-related healthful behaviors (e.g., obtain colorectal cancer screening and increase physical activity). For phase II, Connections to Care, event participants were linked to screening. Eighty-two percent of the participants who obtained colorectal cancer screening during the 3-month follow-up period obtained their screening results.
These results suggest that culturally tailored, standardized educational messaging and data collection tools are key change agents that can serve to inform the effectiveness of educational outreach to advance awareness and knowledge of colorectal cancer.
Future initiatives should focus on large-scale national efforts to elucidate effective models of connections to care, related to colorectal cancer screening, follow-up, and treatments that are modifiable to meet community needs.
Purpose: Rural residents are less likely to engage in cancer risk-reduction behaviors than their urban counterparts. Rural cancer disparities may be related to limited access to and comprehension of ...cancer-related health information. The object of this study was to identify how rural residents access and understand cancer health promotion and prevention information. Sample: Twenty-seven residents of Central Virginia Methods: We used a qualitative design with semi-structured interviews and a focus group (n=27) with rural and non-rural residents living in Central Virginia to accomplish the study aim. Findings: Four themes were identified from the data: 1) non-rural Central Virginia residents seek health information from a variety of electronic sources, 2) rural Central Virginia residents typically seek health care information directly from health care professionals, 3) residents throughout Central Virginia encounter confusing health care information, and 4) rural residents report incorrect cancer-related information. Conclusions: Lack of internet access coupled with healthcare shortages may limit the ability of rural residents to contextualize and verify inaccurate health information. Nurses serving a rural population should consider assessing each rural patient's internet access and disseminating printed cancer health promotion materials to rural clients without internet access.
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