ASPAN Network Principal Investigator Approaches Novel...
Transcript of ASPAN Network Principal Investigator Approaches Novel...
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