Increasing uptake of colon cancer screening in a medically underserved population with the addition of blood-based testing

Background Adherence to colorectal cancer screening in the United States is suboptimal, particularly in medically underserved populations due to significant barriers to care. Unique accessible, low-cost, and non-invasive screening tests for this population could greatly benefit current rates. In this article, we assess patient preference and the impact of offering a blood-based test on screening rates in a cost-free health fair setting from April 2017 to April 2019. Methods Participants who met colorectal cancer screening eligibility criteria set forth by the United States Preventive Services Task Force were recommended to attend the colon cancer screening station. Those participants who elected to attend were offered various, accepted screening methods, and if they declined, were offered alternative blood-based testing. Screening rates, test outcomes, and the rate of follow up completion of colonoscopy were measured and compared with historic screening outcomes. Results Of 1401 participants who were recommended to attend, 640 (45.7%) participants were evaluated at the colon cancer screening station, of whom 460 were eligible for testing. Amongst these, none selected colonoscopy, 30 (6.5%) selected fecal immunochemical testing, and 430 (93.5%) selected blood-based testing. Only 2 participants returned the fecal immunochemical tests. In the blood test cohort, 88 were positive and 20 received a follow up colonoscopy. Conclusions Based on this assessment, blood-based testing is an effective method to increase screening rates in medically underserved populations, though efforts to further improve access to follow up colonoscopy are necessary.

Development of an Actionable Framework to Address Cancer Care Disparities in Medically Underserved Populations in the United States: Expert Roundtable Recommendations

PURPOSE: Cancer disparities persist among medically underserved populations despite widespread efforts to address them. We describe the development of a framework for addressing cancer care disparities across the cancer care continuum (CCC), guided by the CCC domains established by the Institute of Medicine/National Academies of Sciences, Engineering, and Medicine (IOM/NAS). MATERIALS AND METHODS: An environmental scan was conducted to identify strategies and associated experts who are providing or have successfully provided community- and/or patient-centric IOM/NAS-defined domain standards to our target populations. A multistakeholder expert roundtable working group was convened for framework development. A premeeting survey informed agenda development, documented expert practices for target populations, and identified priority areas for meeting focus. RESULTS: The environmental scan identified 84 unique experts across 8 stakeholder groups and 44 patient organizations; 50 were invited to the roundtable and 33 participated. They broadly represented disease sites, geography, and experience with target populations and all CCC domains. The premeeting survey (16 responses) identified coordination of care or patient navigation (66.7%), community engagement (60.0%), and healthcare system changes (53.3%) as priority focus areas. The experts identified access and treatment barriers or gaps within and between CCC domains, specified key notable practices to address these, and developed an actionable framework and recommendations for each priority focus area. CONCLUSION: The framework and recommendations are intended to guide researchers, healthcare leaders, advocates, community- and patient-focused service organizations, and policy leaders to address and promote health equity in cancer care access and treatment outcomes.

Increasing uptake of colon cancer screening in a medically underserved population with the addition of blood-based testing

Adherence to colorectal cancer screening is suboptimal, particularly in medically underserved populations. We report here on our assessment of the impact of offering a blood-based screening test on screening rates in a health fair setting. Patients attending student-run health fairs who met colon cancer screening guideline eligibility criteria received a recommendation to attend that screening station. Patients were offered recommended accepted screening methods, and if they declined they were offered blood-based testing. Screening rates, test outcomes, and the rate of follow up completion of colonoscopy were measured and compared with historic screening outcomes. Of 1401 screening eligible patients, 640 (45.7%) attended the colon cancer screening station, of whom 460 were eligible for assessment. Amongst these, none selected colonoscopy, 30 (6.5%) selected FIT, and 430 (93.5%) selected blood-based testing. Only 2 patients returned the FIT. For the blood test, 88 were positive, and 20 of these received a follow up colonoscopy. Based on this assessment, blood-based testing is an effective method to increase screening rates in medically underserved populations, though efforts to further improve access to follow up colonoscopy are necessary.

Medically Underserved Populations: The Athletic Trainer's Role

Context Health care cost continues to rise; the US continues to spend dramatically more money than other developed nations per individual without increased health outcomes. More individuals are finding it harder to get access to a health care provider, especially those in medically underserved areas and populations. Objective To increase the knowledge of the athletic training educator about medically underserved populations and the roles athletic trainers (ATs) play as leaders in health care delivery. Background Current and future physician shortages are known and are only going to increase as more than one-third of current primary care physicians are expected to retire in the next 10 years. Forty percent of the population lives in areas that are medically underserved and designated by the government as areas of professional medical shortage; patients in these areas are primarily served by primary care physicians. Synthesis As with access to physicians, access to ATs has been shown to be based upon socioeconomic status and presents more challenges for the medically underserved. Early access to health care providers has shown to be important in adolescents, as negative health behaviors can carry into adulthood, leading to poorer health-related outcomes throughout life. Recommendation(s) To ensure that athletic training educational programs include opportunities to provide service to the medically underserved, education on social determinates of health, and the means by which ATs can fill critical holes in providing care for these patients. More research is needed to validate ATs' roles in providing quality health care. Additionally, more research is needed around how AT education can help meet patient needs. Conclusion(s) As the athletic training profession continues to evolve and responds to the growing demands of the complex health care system, access to an AT may provide a vital bridge to overall health care for patients within medically underserved populations.