Assessing Patient Barriers to Cancer Screening in Safety-Net Health Systems Público
Cotter, Megan (2016)
Abstract
Objective: We assessed patient needs and resources for colorectal cancer (CRC) and breast cancer screening at nine safety-net health systems that participated in the Community Health Initiatives CHANGE Grant program run by the American Cancer Society. Methods: Fifty-two key informant interviews were conducted by ACS staff during routine site visits to each of the nine safety-net systems in the summer of 2013. Questions were asked about intervention implementation, including successes, challenges, and lessons learned. A team of researchers from ACS and the Emory Preventive Research Center (EPRC) used constructs from the Consolidated Framework for Implementation Research (CFIR) to code transcripts and examine emerging themes using each primary care setting as a case. Segments on patient needs and resources were further analyzed using a constant comparative approach. Results: The needs and resources of patients varied by system and by type of cancer screening. Common patient barriers to screening included cost of services, lack of knowledge, fears of testing and diagnosis, transportation, language differences, and low literacy levels. To address these barriers, health systems made changes to informational materials, provided referrals and partnered with organizations providing free or low-cost services, or employed patient navigators or community health workers to help patients understand and navigate the health system. Conclusions: Patient barriers to accessing and receiving preventive care services arise at all levels of health care delivery, including patient, provider, organizational, and policy levels. CFIR constructs are useful for capturing this information, but changes to construct definitions could improve the data analysis process. By addressing patient barriers, safety-net health systems can play a critical role in improving access to cancer screening for underserved populations, thereby helping to reduce the burden of disease on underserved populations and potentially lowering cancer mortality rates.
Table of Contents
Chapter 1: Introduction 1
Colorectal Cancer 2
Breast Cancer 2
Importance of Cancer Screening 3
Colorectal Cancer Screening 4
Breast Cancer Screening 7
Disparities in Cancer Burden and Access to Screening 8
Safety-Net Health Systems 13
The Consolidated Framework For Implementation Research 14
Research Question 15
Chapter 2: Literature Review 16
Patient Barriers to Cancer Screening Services 16
Barriers to Colorectal Cancer Screening 17
Barriers to Breast Cancer Screening 21
Barriers to Cancer Screening for Disadvantaged Populations 23
Innovations for Improving Access to Cancer Screenings 27
Role of Safety-Net Systems in Addressing Patient Barriers to Screening 29
Federally Qualified Health Centers 31
Patient Centered Medical Homes 34
Consolidated Framework For Implementation Research 38
Patient Needs and Resources 40
Chapter 3: Methods 45
Introduction 45
Program Description 45
Study Sample 48
Data Analysis 50
Chapter 4: Results 55
Introduction 55
Cost 55
Knowledge 59
Fears 62
Transportation 64
Scheduling 66
Language 67
Literacy 69
Culture 70
Patient Navigation 71
Summary 73
Chapter 5: DISCUSSION 74
Financial Barriers 74
Knowledge Barriers 75
Patient Fears 76
Patient Navigation 77
Use of CFIR Construct to Assess Patient Needs and Resources 78
Limitations 80
Implications and Recommendations 81
References 84
About this Master's Thesis
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