Posted by James
In this study, we explored the perspectives of 187 low-income and primarily minority women recruited in four C/MHCs, regarding factors that encouraged or hindered them from participating in cancer screening behaviors. Our findings suggest a taxonomy of barriers and facilitators of cancer screening in this under-served population. Barriers were grouped into three major categories of perceptions of cancer screening behaviors: patients’ attitudes and beliefs, social network experience and accessibility of services.
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Posted by James
Social Network Experience
Social network experience as a facilitator of cancer (Generic Nolvadex 10mg treating breast cancer that has spread to other sites in the body) screening. Some patients regarded their friends or family as a source of encouragement to undergo cancer screening. The concepts grouped under this category included advice from family members (spouse, children or siblings), advice from friends, family history of cancer, knowing someone with cancer (Xeloda drug used to treat stage III colon cancer in patients who had surgery to remove the cancer) or other related health-promotion programs in the popular media. Another source of encouragement that was found to be even more important than advice from family and friends was medical advice from healthcare professionals, such as doctors, nurses or medical assistants.
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Posted by James
Participants
A total of 187 women were interviewed out of 457 subjects who were approached for participation in the study. Of those approached, 14% refused consent, 26% were ineligible by age, 5% were ineligible because they were transient rather than established users of the C/MHC and 14% did not show up for a scheduled interview after agreeing to participate. Most patients had received at least one of the three tests previously (178 patients had mammograms, 179 had Pap tests, 106 had hFOBTs and 35 had sigmoidoscopies). Of the 187 women interviewed, 44% were African-American, and 51% were Latina. About 39% had at least a high-school education. Of the 64 patients who provided information on their income status, 92% reported earning less than $25,000 annually. The women interviewed indicated that most prior tests were for screening rather than for diagnostic reasons, accounting for over 90% of Pap tests and mammography (161 of 179 tests and 164 of 178 tests, respectively). Seventy-seven percent of home hFOBTs (82 of 106 tests) were for screening, while 49% of sigmoidoscopies (17 of 35) were done for diagnostic reasons.
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Posted by James
Participants
The target population for this study comprised women age 50-69 that were followed in the C/MHCs. Trained research assistants approached women in the waiting area who appeared to be in the targeted age range, introduced the project and then proceeded to obtain informed consent if the patient was receptive. Women who consented to be interviewed were first screened for eligibility. To be eligible, patients had to have at least one prior visit to the C/MHC where they were recruited; be between the ages of 50 and 69; be fluent in English, Spanish or Creole; and identify the C/MHC as their usual source of primary care. Recruitment was limited to women in the above-stated age range because they, for the most part, need screening for all three target cancers (Rheumatrex 2.5mg treating certain types of cancer, severe psoriasis, or rheumatoid arthritis in certain patients). Extending the age range to include younger women for whom Pap tests are recommended would have reduced the number of interviewees eligible for breast and colon cancer screening. Each patient interview took approximately 30-60 minutes to complete and was conducted in English, Spanish or Creole (depending on the patient’s preference) by trained research assistants with undergraduate degrees. All research assistants were blinded to patients’ medical history. The study was reviewed and approved by the Institutional Review Boards of both Clinical Directors Network and Dartmouth Medical School.
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Posted by James
BACKGROUND
Cancer from all causes is the second leading cause of death in the United States. This burden is particularly high among blacks and Hispanics, as compared to Caucasians. A continued increase in cancer deaths among low-income minority women is due, in part, to lower screening rates and later detection of cancer, with African-American and Hispanic women having some of the lowest rates of cancer (Generic Casodex treating prostate cancer) screening. As such, efforts directed at increasing the cancer screening rates in low-income minority women are important in order to decrease the burden due to cancer deaths experienced by this population. Moreover, empirical evidence suggests that use of screening tests in routine medical care helps reduce cancer deaths and improve survival rates. An in-depth understanding of the factors associated with both appropriate utilization and underutilization of cancer screening services is a necessary first step in efforts aimed at increasing overall cancer (canadian Nolvadex is an anti-estrogen used to treat or prevent breast cancer) screening rates. Ample literature is available on the beliefs and perceptions of cancer causes, its progression and treatment. However, little is known about patients’ perceptions of cancer screening behaviors among low-income, minority women, 50 years and older for whom these services are most often recommended.
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Posted by James
California Cancer Registry collects information on every case of cancer diagnosed or treated in California. Standard data are abstracted from the medical record for each case by trained tumor registrars, according to Cancer Reporting in California: Volume 1, Abstracting and Coding Procedures for Hospitals and computerized using C/NET, a software package developed for tumor registries. C/NET meets all reporting requirements of the Surveillance, Epidemiology and End Results (SEER) program, the American College of Surgeons and the California Cancer Reporting System. The quality of data is maintained through periodic training programs for hospital registrars and field abstractors, reabstraction of a 10% sample of case finding, and computer edits for completion and consistency. Additional audits of case finding and data abstraction are conducted by the California Department of Health Services. Completeness of coverage is Completeness is estimated to be higher than 99% annually from 1988 through 1998.
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Posted by James
Modeling
Cost-effectiveness modeling of colorectal screening programs was done using a model developed at the Office for Technology Assessment (Washington, DC) and described in detail elsewhere. This model estimates the net present value of lifetime costs and years of life gained in a cohort of 100,000 50-year-old persons over a 35-year period from different colorectal cancer screening strategies using specified assumptions about the natural history of colorectal cancer and the adenoma or carcinoma sequence, the sensitivity and specificity of each screening technology for early cancer and polyps, the cost of screening, follow-up and postpolypecto-my surveillance procedures, and the incremental costs of treating colorectal cancer. Costs were taken from 2000 Medicare reimbursement rates. Costs were discounted to their present value at 5% per year. The main assumptions of the model are summarized in Table 1. Justification of model assumptions are based on reviews of the published literature. Read the rest of this entry »
