Wednesday, July 12, 2017

Rural lag in colon-cancer screening can be erased by overcoming the reluctance to talk about it

Screening for colorectal cancer isn't as common in rural areas as it is in metropolitan areas, and that's one reason the rural death rate from it is higher. But health professionals in Idaho and Kentucky have launched simple screening-promotion programs that could provide examples for the rest of rural America.

Dr. Van Breeding talks with a patient. (WEKU-FM photo)
When Dr. Van Breeding of Whitesburg, Ky., found that only 19 percent of patients at Mountain Comprehensive Health Corp. had been screened, he said, "That's horrible! We've got to do better than that!" reports Dr. Kay Miller Temple for The Rural Monitor's Rural Health Information Hub:
"He said their effort started with everyone in their clinic talking about it: from check-in personnel to lab team members to providers — everyone started talking about colorectal cancer screening." Breeding told her, "We got everyone who had contact with the patient to talk about it, starting with a simple question: ‘Have you ever been screened for colon cancer?’" Breeding says the rate is now 73 percent, in "an area where its incidence and death rates are the highest in the country," Temple reports.

A similar approach was used at Clearwater Valley Hospital and Clinics and St. Mary’s Hospital and Clinics in Orofino and Cottonwood, Idaho, respectively. "Using an electronic record indicator, providers were reminded to talk to unscreened patients during any appointment scheduled for any reason," Templre reports. "In addition to talk, they mailed reminders to patients" and did community outreach.

The screening rate at the Idaho facilities was much better, 52 percent, but their quality-improvement director, Heather Hodges, said their goal was 70 percent. They are now at 69 percent and have set a new goal of 75 percent. The national rate is 60 percent; the rural rate is 58 percent and the metro rate is 63 percent. The National Colorectal Cancer Roundtable’s 2018 goal is 80 percent, which acknowledges that some patients will always choose not to be screened.

"Hodges said the subject of CRC screening is a bit distasteful, but this can’t prevent healthcare organizations from doing community outreach," Temple reports. Such outreach includes a much-latger-than-life-size colon, through which people can walk. Here's a video:

“Screening rates are lower in rural areas, where geography causes barriers like lack of access to providers and lack of specialists or access to those specialists,” Dr. Djenaba Joseph, medical director for the federal Centers for Disease Control and Prevention’s Colorectal Cancer Control Program, told Temple. “In some states, there are hundreds of miles between the patient and the nearest endoscopist. But, regardless of location, I tell everyone, rural and urban, you can improve rates by knowing your population. Know the number of endoscopists in your area, know the population you are trying to reach, know the income limits, and know insurance status.”

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