Novel OutreachNovel OutreachApproachesApproaches

Ronda S. Henry-Tillman, M.D.Principal Investigator

Arkansas Special Populations AccessNetwork

ASPAN

Cancer Education Awareness ProgramCancer Education Awareness Program

Novel Outreach ApproachNovel Outreach ApproachStaff IntroductionStaff Introduction

� R. André Watson, B.S., A.S.� Community Outreach Coordinator

� William Rutledge, M.D.� Physician Educator

� Larry Belleton, B.S., A.S.� Outreach Specialist

Arkansas is rankedthe 11th highest in

the Nation forMortalities related

to Cancer.

Cancer Mortality Rates in ArkansasCancer Mortality Rates in Arkansas (by Race per 100,000)(by Race per 100,000)

0

10

20

30

40

50

60

70

80

90

American Cancer Society Facts and Figures for 2003

Novel Outreach ApproachNovel Outreach ApproachCancer Education Awareness ProgramCancer Education Awareness Program

• Increase cancerscreenings.

• Increase cancerawareness.

•Promote clinical trialinformation

CancersCancers• Breast• Prostate• Colorectal

PreventativeScreening

Cancer Education Awareness ProgramCancer Education Awareness Program

• Cancer Education Literaturefrom NCI.

• Literature & Television Stand.

• TV / VCR combo

• Cancer Education videos in thewaiting room.

• Poster Boards that depictBreast, Prostate, and Colorectalcancer information.

The Patient GeneratedScreening Forms (PGSF) is aintegral component of CEAP.

All patients, 40 and olderreceive this form.

The forms are filled out bythe patients while they arewaiting to be seen.

Form is given to physicianwhich prompts him to discussand order age appropriatescreening.

Patient Generated Screening Form

Cancer Education AwarenessCancer Education AwarenessProgramProgramResultsResults

� 1,787 (1052 Women & 735 Men)

� 91 patients referred for DRE & PSA

� 223 referred for Mammography

� 181 referred for Colonoscopy

Cancer Education AwarenessCancer Education AwarenessProgramProgram

Male

Prostate 8%

Colorectal 4%

Female

Breast 21%

Colorectal 9%

Novel Outreach ApproachNovel Outreach Approach Screening Behavior of PCPs Screening Behavior of PCPs

� Schapiro DV, Pamies RJ et al CancerScreening, Knowledge, Recommendationsand Practices of Physicians. Cancer 71 (3)839-43 1993 Feb 1.

� Sparks BT, Ragheb NE et al Breast CancerScreening in Rural Populations: A pilotstudy. Journal of Rural Health 12 (2) 120-91996 Spring

Physician

PatientVolume

AvailableConsultants

Receptionist

Patient’sInsurance

Status Patient’sConsent

Nurse

Cancer Screening InfluencesCancer Screening Influences

Novel Outreach ApproachNovel Outreach ApproachCEAPCEAP Physician EducatorPhysician Educator

� Physician to Physician

� Known to many of PCP’s in targetareas

� Provide CME opportunities for ruraldoctors and nurses

Role of Physician EducatorRole of Physician Educator

� Participate in educational and cancerscreening events

� Talk to PCP’s for feedback when theirnumbers decline

� Speak at community health events

� Supervise community SPN Grants (Dr.Nunn’s project)

Academic Detailing VisitsAcademic Detailing Visits

� Screening Guidelines for Breast,Prostate, and Colorectal Cancers.

� Clinical Trial Information

� C.M.E. Opportunity

Screening GuidelinesScreening Guidelines

Colorectal CancerColorectal Cancer (age 50 and over)� Flexible Sigmoidoscopy and Barium Enema every 5 years

or� A full Colonoscopy every 10 years

Breast CancerBreast Cancer

� Annual Mammogram beginning at age 40

Prostate CancerProstate Cancer� DRE and PSA annually at age 40 for African Americans� DRE and PSA annually at age 50 for All other men

Clinical TrialsClinical Trials

� STAR Trial

� SELECT Trial

� Various Treatment Trials

Pre & Post Test ContentPre & Post Test Content

• 14 Items

• 13 Multiple Choice

• 1 Open-ended Response

• 12 Knowledge Acquisition Items

• 2 Professional Practice Items

Pre & Post TestPre & Post Test1. What is your perception of your

screening practices ?

� Very Thorough

� Somewhat thorough

� Miss some patients

� Miss a lot of patients

� I don’t really know

2. When do you begin screening femalepatients ?

� 40 for screening mammograms

� 50 for screening colonoscopies

� 18 for cervical cancer

� All of the above

� I don’t know

3. What is the American Cancer Society’srecommended age to begin screeningmammograms ?

� At age 30

� At age 40

� At age 50

� At age 60

� I don’t know

4. Who should be screened for colorectalcancer ?

� Primarily Men

� Primarily Women

� Both genders equally

� No one

� I don’t Know

Physician Perceptions ofPhysician Perceptions ofTheir Screening PracticesTheir Screening Practices

Pre-Test Post-Test

Very Thorough 43% 43%Somewhat Thorough 57% 57%

KnowledgeKnowledgeofofScreeningScreeningGuidelinesGuidelines0

20

40

60

80

100

Colorectal 100 100

Prostate 42.9 57.1

Mammogram 71.4 100

Pap 71.4 100

Pre-Test Percent Correct

Post Test Percent Correct

Why the Physician Educator isWhy the Physician Educator isEssential to C.E.A.P.Essential to C.E.A.P.

� Better Communication Physician toPhysician

� Frequent reinforcement ofscreening guidelines

� Opportunity to provide CME

Community Cancer EducationCommunity Cancer EducationAwareness Program (CCEAP)Awareness Program (CCEAP)

SPN Pilot GrantSPN Pilot Grant

Research Design & Methods

� Baseline Data 203 chart reviews pts>40

� Rural vs. Urban

� Intervention

Community Cancer EducationCommunity Cancer EducationAwareness Program (CCEAP)Awareness Program (CCEAP)

SPN Pilot GrantSPN Pilot GrantSpecific Aim 1 increase screening referrals for

breast, prostate, colorectal.

Specific Aim 2 increase PCP’s knowledgeattitudes, and beliefs regarding importance ofscreening.

Specific Aim 3 Enhance patient knowledge,attitudes, and beliefs regarding screeningpractices.

Rural vs. UrbanRural vs. Urban

� 2 control clinics / 2 intervention clinics� Physician characteristics� Patient income� Patient ethnicity� Clinic size

Preliminary Screening Rates vs.Preliminary Screening Rates vs.National Screening RatesNational Screening Rates

American Cancer Society Cancer Prevention & Early Detection Facts & Figures 2003

50 and OverProstateDRE & PSA 5%57%40 and OverBreastMammogram19%63%50 and OverColorectalColonoscopy10%23%

AgeAgeRequirementRequirement

CancerCancerSiteSite

ScreeningScreeningTypeTypeArkansasArkansas

UnitedUnitedStatesStates

87% African American

71% Female

29% Male

N = 203

InterventionsInterventions

� TV / VCR Combo

� Educational literature

� Patient Generated ScreeningQuestionnaire

� Custom Loop Video

CEAP vs. CCEAPCEAP vs. CCEAP

CustomCustomLoopLoopVideoVideo

Evaluation & Follow-upEvaluation & Follow-up

� The patient record review

� The structured interview

� Final Measurement & Analysis

Benton

Washington

BooneCarroll

Sebastian

Yell

Crawford

Searcy

Marion

NewtonMadison

Scott

Logan

Pope

JohnsonFranklin

Baxter

Van Buren

Conway

Poinsett

Jefferson

Cleveland

Little River

Independence

Sharp

Fulton

Stone

White

GrantHot SpringsPike

Sevier

Jackson

Lawrence

Randolph

Izard

Cleborne

Faulkner

DallasClark

Howard

Perry

GarlandMontgomeryPolk

Clay

Greene

Cross

Lonoke

Prairie

Miller

Columbia UnionAshley

Chicot

Drew

Bradley

Desha

CalhounOuachita

Lafayette

Lincoln

Saline

Crittenden

MississippiCraighead

Monroe

Saint Francis

Lee

Phillips

Woodruff

Pulaski

Arkansas

NevadaHempstead

Original 15ASPANTarget

Counties

Geographic LocationsGeographic Locations

Geographic LocationsGeographic Locations

Central

Southwest

Benton

Washington

Northwest

BooneCarroll

Sebastian

Yell

Crawford

Searcy

Marion

NewtonMadison

Scott

Logan

Pope

JohnsonFranklin

Baxter

Van Buren

Conway

Poinsett

Jefferson

Cleveland

Little River

Independence

Sharp

Fulton

Stone

White

GrantHot SpringsPike

Sevier

Jackson

Lawrence

Randolph

Izard

Cleborne

Faulkner

DallasClark

Howard

Perry

GarlandMontgomeryPolk

Clay

Greene

Cross

Lonoke

Prairie

Miller

Columbia UnionAshley

Chicot

Drew

Bradley

Desha

CalhounOuachita

Lafayette

Lincoln

Saline

Crittenden

MississippiCraighead

Monroe

Saint Francis

Lee

Phillips

Woodruff

Pulaski

Arkansas

Southeast

Northeast

NevadaHempstead

13 Activity CEAPClinics

4 CCEAP Clinics

11 Counties forCEAP Expansion

Arkansas Special PopulationArkansas Special PopulationAccess Network (ASPAN)Access Network (ASPAN)

� Arkansas Cancer Coalition� Arkansas Department of Health� Arkansas Medical, Dental,

Pharmaceutical Association� Arkansas Minority Health

Commission� Arkansas Prostate Cancer

Foundation

� Cancer Information Service� Faith based organizations� Little Rock Black Nurses

Association� Mississippi County Arkansas

Economic Opportunity Council� National Black Leadership

Initiative on Cancer� The Witness Project®

Thanks