Oral Cancer Screening - Case Study Example

Oral Cancer Screening in African Americans in Baltimore City Study Design The proposed survey aims at portraying a clear picture of the morbidity and mortality rate associated with oral cancer. This will be achieved by conducting qualitative case series and cross-sectional studies which will help to determine the effects of this paradigm. The survey will also relate the intervention (I) that will be used to the exposure (E) given to the study group (P) with regard to the results of the outcome (O). A comparison study group (C) will also be used to help quantify the results. The survey will also involve experimental studies to ensure that study groups which will receive the proposed intervention and exposure are carefully monitored under the selected control conditions (Goodman, Yellowitz, & Horowitz, 1995). Therefore, to effectively examine oral cancer in African Americans the survey will use the cross-sectional study design. This study design is the best for quantifying the prevalence of the disease in the study population. It is also ethically safe, cheap, accurate and simple to adapt. The study design will run concurrently with a group-comparison study because when using the cross-sectional study design, the possibility of formulating unequal study group sizes and recall bias is high (Goodman, Yellowitz, & Horowitz, 1995). The survey will be conducted on African Americans in Baltimore city as they are under a high risk of suffering from oral cancer. However, this survey shall specifically deal with men aged 40 years and above and tobacco and alcohol users regardless of their age and sex. Particular attention will be paid to African Americans who have received directions to attend oral cancer screening tests. Heavy tobacco and alcohol users will again be screened for oral cancer at the end of a one year period still regardless of their age and sex (American Cancer Society, 1999). The survey will be conducted for a period of two years thereby allowing effective identification of patients suffering from localized tumors. This will give way for early diagnosis. In the process the morbidity and mortality rate of oral cancer within the African American population will decrease (American Cancer Society, 1999). Sample Design The universe of this survey will not rely on the whole African American population in Baltimore city because it will be extremely expensive. Also the socio-economic status, awareness and health care access of the African American population in Baltimore will affect the effectiveness of the survey. Therefore, the survey will be centered on African American males in the age bracket of 40 years and above as they make up the highest percentage of oral cancer victims in Baltimore. The survey will also be conducted on both females and males of all ages that are accustomed to using tobacco and alcohol. More focus will be placed on heavy alcohol and tobacco users and patients that have been recommended by their doctors to attend an oral cancer screening test (American Cancer Society, 1999). Before conducting the survey, Baltimore city will be divided into enumerated areas where random sampling of the study population will be done. Within the enumerated areas sampling will be conducted on each housing units whereby individuals within the housing units will be sampled in accordance to the defined criterion. African American population is a minor community with a high possibility of finding homeless people. Therefore, all homeless people within the enumerated areas suffering from oral cancer will be screened because there is a high possibility that they are heavy users of tobacco and alcohol. Therefore, the sampling frame will consist of simple random samples, systematic samples and cluster samples (U.S. Department of Health and Human Services, 2000). The African American population has got major distinctions between the rich, middle class and the poor. Therefore, the ultimate sampling elements of this survey project will focus on each class of the African American population in Baltimore. There are also old people who have been neglected by their family members or do not have any person to support and look after them while there are others who are well taken care off. The survey will also draw samples from the two groups. Lastly the survey will be conducted on both male and female alcohol and tobacco users. However, this group will be divided according to the frequency of their alcohol and tobacco use (American Cancer Society, 1999). As seen above the survey will rely on random, systematic and cluster samples to conduct the study. Therefore, a probability sampling design will be more efficient. However, certain study samples will require in-depth research such as the homeless people. Therefore, the probability sampling design will be complimented by the non-probability sampling design. This will further help to locate the main cause that leads to development of oral cancer in African Americans living in Baltimore (Goodman, Yellowitz, & Horowitz, 1995). The target population that is, African Americans, living in Baltimore is over 100,000 therefore; about 10,000 sample population from each enumerated area will be used to conduct the survey. A margin error of 5% will be used to indicate where the true value lies. The margin error will be obtained from the difference between the sample mean and population mean. The population mean is an estimation of the minimum size of sample required by the survey whereas the sample mean is calculated from the sample data (American Cancer Society, 1999). The number of respondents will be determined by the confidence level. This will create an assurance of accuracy because most of the survey results will be within the margin error. A 95% confidence level will also be used. A high survey response will be targeted. This will be achieved through creation of a beneficial relationship with the targeted population and use of appropriate survey topics and methods which will not be biased or uncomfortable to any targeted sample population. To accurately determine the sample size of the survey the number of completed survey responses will be divided by the estimated response rate of the targeted population size (Horowitz, Goodman & Yellowitz et al., 1996). Before selecting a respondent from any household, the owners will first be informed about the survey, reasons for conducting the survey and the overall benefits the survey will provide. A beneficial relationship will also be established such as promising to provide treatment and care to willing respondents. This will decrease rejection and resentment from the targeted household because they will not view the exercise as an invasion of their privacy and as a waste of time and resources thereby dooming it as a failed project (Ries, Kosary & Hankey et al., 1999). In each household males aged 40 years and above will be identified. If there is anyone among the identified group suffering from oral cancer or had previously suffered from related symptoms they will be selected. However, if they are healthy only one will be selected. Willing alcohol and tobacco users will all be selected as respondents. This is because tobacco and alcohol are the main elements that cause oral cancer. However, this selection criterion may leave out many willing respondents who may or may not be suffering from oral cancer (Horowitz, Goodman & Yellowitz et al., 1996). Data Collection The survey will utilize both the qualitative and quantitative approaches for data collection. This will help in gathering and utilizing results from sampling methods and study design used. Also it will be easier to assess and make various conclusions on the use of similar research data. The quantitative data collection method will involve formulation of questionnaires that will help interviewers to identify and select appropriate respondents. The interviewers will also be able to gather the required information from the respondents such as how long they have suffered from oral cancer and the root cause that made them become victims of this predicament. The questionnaires will be distributed to households in the enumerated areas and to the homeless portion of the African American population in Baltimore city (Goodman, Yellowitz, & Horowitz, 1995). On the other hand the qualitative data collection method will entail conduction of several interviews. The interviews will comprise semi-structured questions structured to effectively fit within different categories of the study population. Interview questions will mainly be close ended so as to get a more precise response from the respondents. The questions will mainly focus on the perception that African Americans residing in Baltimore city have oral cancer, determine if the health providers recommend their patients to seek oral cancer screening and the frequency of the recommended victims that actually attend oral cancer screening tests among others. The semi-structured questions will also give the respondents a chance to discuss issues that are not covered by the questions such as the risks caused by oral cancer phenomenon among others (Goodman, Yellowitz, & Horowitz, 1995). The questions both in the questionnaire and semi-structured questions will be formulated in a format that is understood by both the old and the young generation. This will ensure all the age groups that lie within the survey’s study parameters are able to express themselves comfortably and therefore answer the questions with ease and accuracy. The closed-ended questions will be in a multi-tick format ranging from 1-10 thus effectively covering the surveys objectives. This multi-instrument data collection approach is congruent because responses from an individual’s point of view will be gathered (American Cancer Society, 1999). To test for the viability of the proposed survey, study design, sample design and data collection methods, a pilot study was conducted. About twenty medical field officers were identified and each given pilot questionnaires focusing on the perception that African Americans residing in Baltimore city have oral cancer, determining if the health providers recommend their patients to seek oral cancer screening and the frequency of the recommended victims that actually attend oral cancer screening tests among others. The pilot study was conducted on one enumerated areas of Baltimore city. This study helped to determine the congruency of the survey and the nature of the questions on the questionnaires and semi-structured interviews. The pilot study helped to determine the concise, brevity and clearness of the questions. This led to the development of the multi-tick questions which were the most appropriate and efficient (U.S. Department of Health and Human Services, 2000). The selected interviewers were also asked to gauge the success of the survey from the experience they had. Eighteen of them gave their approval and recommendations and only two were dissatisfied because of the hard time they had experienced with the homeless people. However, this gave a clear picture of what to expect while on the field and thus be more prepared (Horowitz, Goodman &Yellowitz et al., 1996). The results gathered from the pilot study gave an impression of the African American population residing in Baltimore city as having a low perception of oral cancer. Most of them ignored the disease and paid less attention and care to oral cancer as compared to other types of cancer diseases. Most medical practitioners that were interviewed knew the risks and the essence of undertaking an oral cancer screening test and thus recommended most of their patients to have one (U.S. Department of Health and Human Services, 2000). However, the tendency for the medical practitioners keeping tabs on the frequency of their patients attending oral cancer screening test was low, a fact that did not encourage their patients to return or attend an oral cancer screening test even though the tests are conducted free of charge. The pilot study also depicted that most of the African American population in Baltimore suffered from oral cancer. Some had it from inheriting hereditary traits, others due to a change in lifestyle where their alcohol consumption and tobacco usage had gone high while a small percentage was due to poor feeding habits which deprived them essential elements that are required by the body (American Cancer Society, 1999). The interviewers were trained to be sensitive to their own biases and to determine that the interview questions did not have a hidden bias. The selected interviewers were trained by professional health officers from Baltimore city and Maryland for a period of two days. They familiarized themselves with medical ethic codes, oral cancer, its symptoms, causes, risks and effects. During the two day period each interviewer was handed a copy of the survey proposal to read and understand it so as to effectively grasp the objectives of the survey (U.S. Department of Health and Human Services, 2000). Furthermore, the interviewers were taught various approaches to use when contacting families in different households, making appointments and explaining the reason for conducting the survey. They were also taught methods of conducting the interview and efficient ways of handling the information they gathered. Lastly, they were taught to be accurate while collecting data and to maintain confidentiality. Before the end of the training seminar each interviewer was given a chance to conduct a trial interview with their partners where they were monitored and corrected on the mistakes that they performed. The training seminar was later followed up by a meeting to clarify on any queries and doubts that the interviewers had before the actual interviewing process begun (Goodman, Yellowitz, & Horowitz, 1995). The survey will be monitored by the collaboration of a group of people, for instance the advocacy who will monitor the progress made and the relevance of the survey in accordance to its objectives. Public health officers will also play a part in monitoring the survey. Furthermore, they will designate federal funding to support the project. Project officers will also monitor the survey by regulating data collection, evaluation and research methods and monitoring their ongoing processes (Ries, Kosary & Hankey et al., 1999). The above will meet after every 4 to 6 weeks for about an hour with the interviewers and officers doing the field work. The day of the meetings will however be scheduled early or in advance. Each will discuss their findings and give their recommendations while those conducting the field work will explain their progress, complications they encounters and seek advice to overcome them. Any problem or inconvenience will also be solved. Confidentiality during the meetings will highly be maintained and any person failing to observe this will be disseminated from the group (Horowitz, Goodman, Yellowitz et al., 1996). The survey is approximated to take a period of two years to enable accurate and reliable results to be collected. This will ensure all the research parameters are covered. Also the goal of the survey will be fully attained. The survey will require about USD20, 000 to ensure all the necessary steps of the survey are carried out. All the plans and financial needs of the survey like paying the interviewers and providing incentives to respondents and their family members will also be conducted. Also thorough project research will be conducted thus formulating results that are accurate and realistic. This will thus result to a decrease in the mortality and morbidity rate caused by oral cancer. Furthermore, the perception that the African American residents residing in Baltimore city have towards oral cancer will change enabling more people to seek oral cancer screening tests (Goodman, Yellowitz, & Horowitz, 1995). Questioner Design The items used to formulate this survey were collected from different sources which are books outlined in the reference list. However, I also came up with others were also used. This is because the selected interviewers are residents of Baltimore city and therefore are familiar with the lifestyle, language and behavior of the African American residents. Thus they will simply adapt relevant strategies and measures that will easily help their respondents to answer the questions with ease. However, the questions were formulated to suit the understanding and comfort level of all types of respondents so as to prevent the occurrence of such a situation. The questionnaire design approach used in this survey proposal has been adopted from the principles outlined by Sudman and Bradburn (Resource B) interviewer-administered approach. Thus the questions formulated can easily tackle sensitive areas that are related to the objectives of the survey. For instance, shorter questions that will enable respondents to be frank with their response have been utilized. Respondents are allowed to describe or answer the questions in a language and mode that they are comfortable in so that they can exhaustively express themselves. Respondents are also allowed to identify questions that they do not understand, feel uncomfortable answering or detect bias in them. This will enable the interviewer to easily paraphrase the questions to a format that is most suitable to the respondent (American Cancer Society, 1999). The questions used may appear to be biased to some people therefore, resulting to a non-responsive behavior. The questions maybe to broad this will give the respondent a hard time trying to answer them. This may also consume a great deal of time. Also the questions may be too shallow making the respondent to give very little information which might be of minimal help when compiling the results and information gathered. Some people may find it hard to understand the questions and therefore will need time and translation of the questions into simpler terms. This will also consume a lot of time which should be utilized performing other functions of the survey. The response given by the respondents may not be accurate because some respondents may be tempted to be bias or will willingly give false information. The respondents may also give negative response as they may perceive the survey exercise as an invasion of their private lives, a waste of resources and time. Also respondents may become arrogant and to some extent chase away the interviewers. Regardless of the above mishaps that may occur the overall format of the survey is satisfactory. It will yield reliable information that will help reduce the morbidity and mortality rates caused by oral cancer in the African American population residing in Baltimore. Also the perception of the African American residents in Baltimore city towards oral cancer will change and become positive. This will make them become more careful in an attempt of preventing this disease. Also educational programs that support the recognition of the disease and also give preventive and treatment measures will be introduced. Indirectly, users of alcohol and tobacco will drastically decrease. Word Count: 3050 References American Cancer Society. (1999). Cancer Facts and Figures (pp. 38-67). Atlanta, GA: American Cancer Society. Goodman, H. S., Yellowitz, J. A., Horowitz, A. M. (1995). Oral Cancer Prevention: The Role of Family Practitioners. Archives of Family Medicine, 4, 628-636. Horowitz, A. M., Goodman, H. S., Yellowitz, J. A., Nourjah, P. A. (1996). The Need for Health Promotion in Oral Cancer Prevention and Early Detection. Journal of Public Health Dentistry, 56 (6), 319-30. Ries, L. A. G., Kosary, C. L., Hankey, B. F., Miller, B. A., Clegg, L., Edwards, B. K. (Eds). (1999). SEER Cancer Statistics Review, 1973-1996 (pp.57-117). Bethesda, MD: National Cancer Institute. U.S. Department of Health and Human Services. (2000). Healthy people 2010 (pp. 12-57). Washington, DC: U.S. Department of Health and Human Services, Government Printing Office. Read More