Cancer Screening and Education - Essay Example

Introduction: Cancer is the 2nd leading cause of death in US after cardiovascular diseases. Breast cancer is the most common cancer of females andaccounts for second leading cause of cancer related deaths in females. Colorectal and cervical cancers are supposed to be 3rd and 4th leading cause of cancer related deaths in females. Screening can reduce mortality from cancer by detecting abnormalities in earlier stages, thus any intervention can be done at an earlier stage when treatment is most often effective. Lack of health insurance serves as a major barrier to cancer screening compliance. Second major factor affecting compliance is awareness or misconceptions about screening programs. Education is an important tool to improve awareness which can serve multiple purposes. Compliance to screening rate can be increased and one person can educate others. Third factor could be different beliefs or cultural practices in different races. Material and Methods: Our goals for this study were: (1) To identify the effectiveness of education in changing individual’s perception and practice for screening program. (2) To identify the role of ethnicity/cultural beliefs in individual’s behavior and practice for screening programs (3) To identify financial or other barriers for cancer screening. (4) To identify the level of patient satisfaction of the SAVE program. Our study included participants of S.A.V.E. program. We included females of 18-80 years old in our study. Participants were given voluntary survey during their visit to S.A.V.E site. Surveys were provided in 3 different languages- English, Spanish and Portuguese. Survey included qualitative anonymous questionnaire. The survey questionnaire included Question about date of participant’s last Pap smear and mammogram. If the Pap smear was more than 3 year ago and the mammogram was more than 2 year ago, then mention the reason for delay. This time line has been selected considering one year delay from accepted guidelines for screening interval. Participants were also asked about their willingness for screening if these tests were not offered free of cost or if site for screening was not near to their community. Question was asked that are participants aware of current screening recommendations or they have any question regarding current recommendations. Questions were asked about participant’s awareness of various cancers before and after attending educational session at S.A.V.E. program. Questions were asked about participant’s health practices before and after attending educational session at S.A.V.E. program. Participants were asked to rate their satisfaction with different services offered by program. Our study hypotheses included 1 Lack of health insurance is a major barrier for cancer screening. 2 Financial access is more important for participants than geographical access. 3 Education positively changes participant’s knowledge about breast, cervical and colorectal screening. 4 Education positively changes participant’s health practice of self breast examination, fecal occult blood testing and life style. 5 Education positively affects participant’s willingness to encourage others for cancer screening. 6 Perception of services offered is impacted by the waiting time involved. 7 Screening behavior varied by language in which surveys were filled. 8 SAVE program participants receive quality health care that meets their expectations. Statistical Analysis Total 100 participants filled up survey forms. We analyzed data through SAS and SPSS softwares. Improvement in knowledge and practice were also stratified by age, language and quality of education for the analysis. Table 1 showed that most of our participants were in the age group of 40-60 years. In the age group of 65 had only 4 participants. So this age group was combined with the age group of 60-64 to create an age group ≥ 60 years. So now we had three age groups - ≤ 49, 49-59 and ≥ 60 years. From table 2 and table 3, we can conclude that major barrier for not having screening tests was lack of insurance. When participants were asked whether they will attend mammogram or pap smear if it were not free through S.A.V.E. program, majority of them answered either no or not sure (59/100). But same was not true for travel (17/100). Thus, cost/payment for screening test served as a major barrier. Location of screening site did not serve as a major barrier. For those participants who answered lack of health insurance as a barrier for not having screening test -22/34 participants answered that they would not have mammogram if it is not free and 18/25 participants answered that they would not have pap smear if it is not free. Table 7 showed that number of participants, who respond with higher level of knowledge, increased after participating in education program. Knowledge about Breast Cancer Before attending education program, 27(33 %) participants had low knowledge, 39 (48.75%) participants had medium knowledge and 14 (17.5 %) participants had high knowledge about breast cancer. These percentages changed to 5 %, 17.5 % and 77.5 % for low, medium and high knowledge after attending education program about breast cancer respectively. Knowledge of 37 (46.3 %) participants improved by 1 category, 17 (21.3%) by 2 category. 26(32.5%) participants had no changes in their level of knowledge. These changes were statistically significant with p value of < 0.0001. When stratified for the effect of age and quality of health education, none of them reached statistical significant level of 0.05. When stratified for the effect of language on improvement of knowledge, the effect was statistically significant with p value of 0.0126. The effect of language was maximally seen in participants who filled up the survey in Portuguese language as compared to those who filled up the survey in English and Spanish language. Portuguese surveys showed that 36.8 % of participants had improvement in knowledge by one level while 47.4 % participants had improvement in knowledge by two levels. Previous awareness about changes in recommendation for breast cancer screening did not reach statistical significant level; p value for Kruskal wallis test was 0.7096. Ability to perform breast self exams Before attending education program, 24 (29.26 %) participants had lower ability to perform self breast exam as compared to 38 (43.64%) participants with medium ability and 20 (24.39 %) participants with higher ability. After attending education program, ability/confidence to perform breast self exam was low in 6.1 % participants, medium in 19.5 % participants and high in 74.4 % of participants. Ability/confidence to perform self breast exam was not changed in 35 (42.7%) participants, while it improved by 1 level in 34 (41.5%) participants and by 2 levels in 13 (15.9%) participants. Overall changes in knowledge were significant after participating in educational program with p value of 60 years. Fecal occult blood testing did not show statistically significant improvement in participants who filled survey in Spanish language and participants with age group 0-49 years. Life style changes did not reach statistically significant level in Spanish and Portuguese participants and for any age group. Education positively affects participant’s willingness to encourage others for cancer screening. But it did not reach statistically significance level in Spanish participants and participants above age 60 years. Because of very low number of participants in group of fear of test, we could not test hypothesis of comfort given by our staff for positively changed behavior practice. SAVE program participants received quality health care as reviewed in service questionnaire. Long waiting time was associated with dissatisfaction with the program. Read More