- A1. Ethnically and Language-Concordant Clinical Trial Educational Intervention to Increase Diversity in Cancer Clinical Trial Participation
- A2. Increasing Breast Cancer Screening Rates for Orlando Health Team Members
- A3. Increasing Knowledge of Cancer Risk Assessment and Genetic Testing Through Education and High-Risk Women’s Program Launch
- A4. Mission Possible: Saving Firefighters From Lung Cancer
- A5. More Than an Arm or a Leg: Employing Whole-Human Care to Create Better Outcomes
- A6. Opportunities to Leverage Navigation and Other Evidence-Based Strategies to Increase Lung Cancer Screening in Appalachia
A1 Ethnically and Language-Concordant Clinical Trial Educational Intervention to Increase Diversity in Cancer Clinical Trial Participation
Tina Nghiem; Jackeline Castillo, LCSW; Fernando Bravo
Mary Crowley Cancer Research, Dallas, TX
Background: The Food and Drug Administration has provided guidance to increase the enrollment of underrepresented populations in clinical trials. Our dedicated cancer clinical research site in Dallas decided to target the Hispanic community. There are 2 main factors that inhibit Hispanic patient enrollment in clinical trials: distrust of clinical researchers and a language barrier.
Objectives: We attempted to mitigate these barriers by building trust with, increasing clinical trial awareness in, and providing clinical trial education for our local Spanish-speaking cancer community. We hope that our efforts will increase the percentage of Hispanic cancer patients who enroll in a clinical trial in the Dallas–Fort Worth metroplex.
Methods: We hosted a 2-hour Spanish clinical trials educational event entitled “Ensayos Clínicos en Cáncer.” The meeting was attended by 17 Hispanic cancer patients/family/friends who were interested in learning more about clinical trials. We utilized a voluntary and anonymous pre- and postmeeting questionnaire to assess the impact of the educational intervention. We developed a Likert scale questionnaire to assess whether we were addressing the proposed barriers to clinical trial participation. The questions were adapted from Ma et al and Hall et al. In addition, we asked the specific sociodemographic questions to determine barriers. The event was led by our investigator, clinical research nurse, clinical trial manager, and clinical social worker. We also had representation from Genentech’s Patient Inclusion & Health Equity team. The presentation covered the phases of clinical research, a patient’s journey in a clinical trial, psychosocial resources available at Mary Crowley Cancer Research, and FAQs about clinical trial participation.
Results: The response options were assigned a score of 1 to 5 (strongly agree=5, agree=4, neutral=3, disagree=2, and strongly disagree=1). Score means were calculated for each question on the premeeting and postmeeting survey. A comparison of the pre-/postmeeting survey means showed improvement in the attendees’ clinical trial knowledge and willingness to participate in clinical trials. However, there was not an improvement in trust when asked the question “Medical researchers do not tell people everything they really need to know about being in a research study.”
Conclusion: Survey results demonstrated that we improved the attendees’ clinical trial knowledge and willingness to participate in a clinical trial. We attribute this to educating the attendees in their native language. A barrier that was identified was mistrust of researchers, suggesting that additional interventions are necessary. The majority of attendees were uninsured/underinsured. Despite the attendees’ willingness to participate in a trial, the financial burdens may deter a patient from enrolling in a clinical trial. With only 17 attendees, we understand the results may not be representative of the entire Hispanic population in Dallas. We hope to conduct future Hispanic-focused sessions to gather more data.
Sources
American Community Survey (ACS) of Civilian Noninstitutionalized Populations for Dallas, Tarrant, Collin, and Denton Counties, Texas; 2019.
Diversity Plans to Improve Enrollment of Participants From Underrepresented Racial and Ethnic Populations in Clinical Trials; Draft Guidance for Industry; Availability. US Food and Drug Administration; 2022.
Hall MA, Camacho F, Lawlor JS, DePuy V, Sugarman J, Weinfurt K. Measuring trust in medical researchers. Med Care. 2006;44:1048-1053.
Huey RW, George GC, Phillips P, et al. Patient-reported out-of-pocket costs and financial toxicity during early-phase oncology clinical trials. Oncologist. 2021;26:588-596.
Ma GX, Tan Y, Blakeney NC, et al. The impact of a community-based clinical trial educational intervention among underrepresented Chinese Americans. Cancer Epidemiol Biomarkers Prev. 2014;23:424-432.
Patient Testimonial in Spanish: Jose. Mary Crowley Cancer Research. Accessed July 22, 2023. https://www.youtube.com/watch?v=I9kH2Da7iUY
¿Que es un studio de investigacion clinica? Genentech YouTube page. Accessed July 22, 2023. https://www.youtube.com/watch?v=AYgcn_gdtEE&t=11s
Return to TopA2 Increasing Breast Cancer Screening Rates for Orlando Health Team Members
Jodi Burt, RT (R) (M)1; Amy Laughlin, MD, MSHP2; Sarah Childs, RN, BSN, OCN2; Jennifer Markiewicz, MS2; Nicole Santapola, BS2
1Orlando Health Orlando Regional Medical Center/Ambulatory Care Center;
2Orlando Health Cancer Institute, Orlando, FL
Background: Greater than 287,000 new breast cancer diagnoses in women were projected in the United States in 2022. It has been reported that early detection of breast cancer improves the 5-year survival rate to 91%. In 2021, the National Cancer Institute and American Cancer Society endorsed a Return-to-Screening Campaign.
Objective: To increase the proportion of eligible Orlando Health team members who had completed screening mammograms to 75% by May 2022.
Methods: Population Health provided a monthly report showing screening completed and eligible team members. This provided the percentages for our study. Orlando Health’s women’s imaging, a central location in downtown Orlando, provided 2 exam rooms from 8 AM to 1 PM on 2 Saturdays per quarter starting in December 2021. Internal communications provided consistent news with a multifaceted approach. Announcement of the events was sent through daily Team Member Updates, through hospital group emails, as an “event” on an e-news board, and through 1-minute spots on a weekly news feed.
Results: A total of 118 participants were screened during the grant period. By the end of 2022, 70% of insured team members received a screening mammogram. Participants who were screened included team members and their families. Overall, 20 were referred for further evaluation with suspicious findings. Of those with further follow-up, only one team member was found to have cancer, stage I. The patient was referred to a breast cancer navigator who followed her treatment into survivorship.
Conclusion: By seeing positive results, Orlando Health continues to offer Saturday appointments at this location. To expand to other Orlando Health hospital imaging locations, access to technicians and radiologists poses a challenge for weekend staffing. Providing preventative screenings to team members during nonwork hours increases compliance and reduces employer costs for late-stage findings. Consistent and regular communication internally through different communication modalities raises awareness and proves to be effective. In conjunction, Orlando Health offers a well-being program to include preventive screenings as part of the incentive.
Sources
Cancer Facts and Figures 2022. American Cancer Society. Accessed June 13, 2023. https://www.cancer.org/research/cancer-facts-statistics/all-cancer-facts-figures/cancer-facts-figures-2022.html
Joung RH, Nelson H, Mullett TW, et al. A national quality improvement study identifying and addressing cancer screening deficits due to the COVID-19 pandemic. Cancer. 2022;128:2119-2125. Accessed June 13, 2023. https://acsjournals.onlinelibrary.wiley.com/doi/full/10.1002/cncr.34157
Return to TopA3 Increasing Knowledge of Cancer Risk Assessment and Genetic Testing Through Education and High-Risk Women’s Program Launch
Lisa McGuire, MBA, BSBM
HCA Florida Healthcare, Ocala, FL
Background: With up to 10% of cancers caused by hereditary gene mutations, HCA Florida Ocala launched a High-Risk Women’s Program (HRWP) in Q2-2023 as a tool for early cancer detection among mammogram patients. Imaging center staff revealed they had scarce knowledge of risk assessment and cancer genetics as a beneficial screening tool for hereditary cancers. Even with precise scripting and outlined workflow, the staff’s confidence level was low in being able to explain the program and its benefits within their assigned role at each stage of the assessment and testing process.
Objectives: To increase imaging facility stakeholders’ knowledge of and confidence in cancer risk assessment and how genetic testing will aid in early detection of hereditary cancers and to ensure successful program implementation and compliance.
Methods: Three in-person presentations were delivered by the genetics nurse practitioner, HRWP project manager, and genetic testing provider to the breast imaging navigator, schedulers, registrars, marketers, and radiographer staff who have specified roles in the HRWP programmatic workflow at the imaging center. Education included hereditary cancer statistics, risk assessment showing the need for genetic testing and/or modified screening surveillance, designed imaging center workflow, impactful patient stories, and the benefits of a high-risk clinic to monitor quality and outcomes. At the end of training, employees were surveyed using a 5-point scale, examining their knowledge of cancer risk assessment and genetic testing before and after training.
Results: Employees strongly agreed, average score 4.45, that training and learning about genetic cancer risk illustrated why the HRWP will benefit the community as a new tool in early cancer detection as an identifier for enhanced screening and surveillance. Employees also strongly agreed, average score 4.36, that the new assessment and test offering will positively impact early cancer detection and improve patient outcomes. Employees agreed, average score 4.09, that they or someone they know has a personal or family history of cancer and has never had genetic testing. Prior to this education, they were not aware of risk assessment as a screening tool for genetic testing to screen for cancers, covered by insurance. They also agreed, average score 4.00, that this training has incited a desire to discuss genetic risk assessment with their healthcare provider, a friend, or family member.
Conclusion: Education and training provided insight as to why an HRWP will be impactful to the hospital system and local community, and showed the value of staff education prior to HRWP implementation. After program launch, the patients’ assessment completion rate was 96% at the end of the first month, compared to 70% across the enterprise. The genetic testing completion rate was 47% in the same timeframe, compared to 22% across the enterprise, making Ocala’s program launch HCA’s most successful to date. The genetic testing provider credits the program success to the observed knowledgeable and confident staff scripting to the patient about risk assessment and the value of early cancer screening. These results validated best practices of making staff true stakeholders in the launch of this innovative, early cancer detection program, ensuring successful program execution.
Source
The Genetics of Cancer. National Cancer Institute. Updated August 17, 2022. Accessed May 3, 2023. https://www.cancer.gov/about-cancer/causes-prevention/genetics#:~:text=Up%20to%2010%25%20of%20all,of%20getting%20cancer%20is%20increased
Return to TopA4 Mission Possible: Saving Firefighters From Lung Cancer
Karen Wilson, MN, RN, CTTS, CGRN
AdventHealth, Parker, CO
Background: Cancer is an epidemic for firefighters (FFs) and is the most dangerous job threat to them. The International Association of Fire Fighters states that from 2002 to 2019 cancer was the major cause of FF line-of-duty deaths. However, according to the US Preventive Services Task Force, FFs do not meet the requirements for an annual lung cancer screening.
Objective: An annual FF lung cancer screening program was created to detect lung cancer early.
Methods: The cost of a computed tomography (CT) scan was determined by the cancer center director. The hospital foundation was approached for financial support, and free CT scans for FFs were approved. To disseminate this free program, a flyer was developed. The hospital’s emergency medical services coordinator distributed the flyer and promoted the program to fire departments in the area. The lung nurse navigator contacted other FF agencies by phone and emailed a flyer. In addition, the lung nurse navigator reached out to state-level FF agencies to expand access to the screening. The lung nurse navigator also requested the hospital’s media coordinator to promote the program to the local media.
Results: Seventeen FFs received the screening in 2020. In 2021, 94 FFs within the hospital catchment area were screened; findings included a suspicious nodule that required a 6-month follow-up exam. In 2022, 91 FFs from several areas within the State of Colorado were screened, and again a suspicious nodule that required a short-interval follow-up was detected. Increased interest was evidenced by exponentially increasing lung screenings, and the lung nurse navigator frequently received calls about the program and made appointments.
Conclusion: Firefighters are a high-risk population for lung cancer, but their awareness is low; this can lead to being diagnosed with late-stage cancer. This program allows the FF population to be screened without cost. Lung screening is critical and having access to a screening program can provide FFs with peace of mind.
Sources
International Association of Fire Fighters. Cancer Awareness and Prevention Resources; 2023. IAFF. Accessed June 12, 2023. https://www.iaff.org/cancer/
Lung Cancer: Screening. US Preventive Services Task Force; March 9, 2021. Accessed June 12, 2023. https://www.uspreventiveservicestaskforce.org/uspstf/recommendation/lung-cancer-screening
Return to TopA5 More Than an Arm or a Leg: Employing Whole-Human Care to Create Better Outcomes
Lauren Schultz, MSN, RN, CNL, BMTCN; Caroline Williams Little, RN
Atrium Health Levine Cancer Institute, Charlotte, NC
Background: Research demonstrates that social factors such as poverty, absent social supports, and lower levels of education have significant consequences on health outcomes for vulnerable populations. When resources are lacking, individuals are far less likely to seek cancer prevention and screening services or seek care for existing health problems.
Objective: To expand 5 traditional cancer screening programs to provide community-based, whole-human, personalized navigation in 1 year, estimating 50% of total participants identify as having at least 1 barrier to care.
Methods: The Levine Cancer Disparities and Outreach team established a “one stop shop” for care by conducting free, community-based screenings in 5 cancer domains, with full assessment of barriers to care and navigation to resources. The programs targeted economically disadvantaged individuals living in rural and urban environments across 24 counties in North and South Carolina. All individuals screened were uninsured or underinsured. The programs also targeted diverse populations, including African Americans, Hispanics/Latinos, and Native Americans, who are at high risk of being diagnosed with cancer and experiencing worse outcomes. Utilizing a detailed navigation assessment, RN program coordinators used motivational interview-style communication to uncover socioeconomic barriers to care. Patients were then directly referred to specific community partner organizations or other referral sources.
Results: A total of 2883 patients were screened for cancer, and 40 cancers were diagnosed. All positive findings were navigated for follow-up treatment. Of the individuals who were screened, 62% (n=1792) were identified as having at least 1 barrier to care. Referrals included, but were not limited to, 935 individuals to a community partner for short- or long-term care; 448 individuals scheduled for another free cancer screening; 131 for food insecurity; 323 for tobacco cessation; 54 for primary care; and 82 for transportation. This method of providing whole-human care also resulted in a robust network of 177 community partners and improved trust and participation in health events.
Conclusion: Delivering comprehensive, whole-human care where most-at-risk individuals live created access points, resulted in a robust network of community partners, and improved identification of barriers to care and referral to resources. Identifying gaps in resources and navigating to solutions prior to a cancer diagnosis provides opportunity to build a bridge before the disparity gap can widen.
Sources
American Association for Cancer Research. AACR Cancer Disparities Progress Report 2022. ©2022. Accessed June 19, 2023. http://www.CancerDisparities ProgressReport.org/
Braveman P, Gottlieb L. The social determinants of health: it's time to consider the causes of the causes. Public Health Rep. 2014;129(suppl 2):19-31. doi: 10.1177/00333549141291S206.
Fallahian F, Nelson H, Pories S. The role of social determinants of health on cancer screening. American College of Surgeons Bulletin. 2022;107(6). June 1, 2022. Accessed June 19, 2023. https://www.facs.org/for-medical-professionals/news-publications/news-and-articles/bulletin/june-2022-volume-107-number-6/the-role-of-social-determinants-of-health-on-cancer-screening/
Return to TopA6 Opportunities to Leverage Navigation and Other Evidence-Based Strategies to Increase Lung Cancer Screening in Appalachia
Michael R. Gieske, MD; Savannah Dodson, MPH; Serena Phillips, DrPH, MPH; Allison Harvey, MPH, CHES®; Ashley Lile, MPH; Andrea Ferris, MBA; Timothy Mullett, MD, MBA, FACS; Rochelle Waddell, RN; Dina Avery, DSHc, MA, MAED; Robert Headrick, MD, MBA; Ronny Bell, PhD, MS; Heather Bittner Fagan, MD, MPH, FAAFP; Lauren McCauley-Hixenbaugh, MBA; Christine Crabtree-Ide, PhD, MPH; Mary Reid, PhD, MSPH; Janet Gruenberg, MEd; Michelle Futrell, MSN, MBA, RN; Elana Plotkin, CMP-HC; Leigh Boehmer, PharmD, BCOP
Association of Community Cancer Centers, Rockville, MD
Background: Rural Appalachian Lung Cancer Screening Initiative, led by the Association of Community Cancer Centers, the Appalachian Community Cancer Alliance, and advocacy partners, is a multiyear initiative recognized by the Cancer Moonshot program that seeks to improve lung cancer screening by identifying and addressing barriers that prevent rural Appalachian residents from accessing screening.
Objective: This region is markedly rural and is characterized by generational poverty and a lack of key resources including access to healthcare. The Alliance is focused on interdisciplinary, patient-centered approaches to cancer care delivery from prevention through survivorship. Optimizing lung cancer screening is one of its key priorities.
Methods: A targeted scan was conducted in 2022 to gather epidemiologic data and to identify current best practices for screening at the community (ie, healthcare system) and societal levels that could be applied to rural areas.
Results: The Appalachian states of Ohio, Kentucky, Pennsylvania, Virginia, and West Virginia have the highest rates of lung cancer incidence and mortality in the United States. Kentucky has both the highest incidence rate nationally (87.1%) and the highest mortality rate nationally (54.7%). In 2021, the US Preventive Services Task Force updated its lung cancer screening recommendations, making more high-risk individuals eligible for screening. Evidence-based strategies for healthcare systems to optimize lung cancer screening include identifying physician champions, assuming all administrative aspects after screening referral, collaborating to create cohesion across multidisciplinary teams, simplifying and standardizing imaging ordering forms and processes, utilizing navigators to reduce barriers, educating patients and conducting at-risk community outreach, and offering mobile screening. System strategies identified to increase year-over-year screening retention were to address barriers to access, provide navigation, centralize follow-up, automate reminder telephone calls for patients, and perform additional focused outreach to people with lower rates of adherence.
Conclusion: The next phase of the initiative includes work with healthcare sites in rural Appalachia to understand additional programmatic needs and to help implement enhanced screening programs. Supporting the use of navigation services will be a critical component to increase the rate of lung cancer screening.
Return to Top
