Compliance with recommended cancer screenings among emergency department patients assessed by college research associates.
Updated: Sep 11
Authors: Illuzzi F, Rush L, Bradley K
Ann Emerg Med 2004 44:S26
Objectives: The goal of this study was to assess the potential need for providing elements of cancer screening among emergency department patients. The specific objective of the study was to determine the compliance with the American Cancer Society's (ACS) screening recommendations among a group of non-critical patients in an urban, community hospital emergency department as identified by Research Associates (RAs).
Methods: This was a convenience sample survey performed by RAs, pre-health professions college students trained as case finders and data collectors. They served a 4-hour shift per week in the Emergency Department for 10 weeks of an academic semester. There was no attempt at sampling; RAs were simply encouraged to approach and enroll as many adult patients as possible. The numbers of patients approached and subjects entered by each RA were key components of their letter of evaluation.
Inclusion criteria were adult (≥ 18) non-urgent patients during their ED visit. Patients were excluded from the study if they refused to participate, were judged to be too sick, clinical activities took precedence or the RA could not communicate with them for any reason, such as language barrier or altered mental status. Following a scripted introduction, the following data were collected for each subject: 1) age, gender and ethnicity, 2) whether they had a primary care practitioner (PCP) and location and timing of their latest visit, 3) compliance with ACS screening recommendations for oral, skin, cervical, breast (self-breast exam, clinical breast exam, mammography), colon-rectal (fecal occult blood test + sigmoidoscopy or colonoscopy) and prostate cancer (digital rectal examination, prostate-specific antigen).
In order to be compliant with ACS recommendation, subjects who were ≥ 40 years of age or females ≥ 18 years of age should have seen their PCP or appropriate specialist for screening yearly. Males ≥ 20 and ≤ 39 years of age need a visit every 3 years for cancer screening to be compliant. No identifying information was collected. According to the IRB, informed consent was not required in this study under the survey exception.
Results: 25 RAs covered 60% of possible shifts over 8 weeks in the summer semester, 2003. Among the 2403 patients approached, 1574 subjects (66%) were enrolled. Subjects' average age was 49.8 (range 18-97); male 46% and female 54%; Caucasian 58%, African American 21%, Hispanic 17%, Other 3%. A PCP was identified by 82% (males 72%, females 89%; Caucasians 88%, African-Americans 76%, Hispanics 70%). Cumulatively, 40% said they had seen their PCP within one month, 66% within 6 months, 75% within one year, 79% within 3 years. Stated compliance for cancer screening was oral 35%, skin 21%, Pap smear 59%, self breast exam 41%, clinical breast exam 63%, mammography 59%, colon-rectal 57%, digital rectal exam 51%, PSA discussion 41%. Only 9% indicated they were in compliance with the time interval for all their appropriate cancer screenings.
For Pap test, 94% had been tested at some time with 65% having had the test within the preceding 12 months. Of those who had a Pap test > 12 months prior, 40% were told by a health professional that they did not need annual Pap testing Thus, according to history, 24% of women in the study needed a Pap test. Of those needing a Pap test, 82% said they had a PCP. (Continued…)
For mammograms, there were 781 subjects ≥ 40 years old. 727 (93%) said they had a mammogram at some time, with 558 (71%) having had it within the preceding year. Thus, by history, 23% of appropriate subjects needed a mammogram. 77% of these women had a PCP.
There were 309 subjects (29%) who needed a PCP visit, Pap test and/or mammogram. Of these subjects, 167 (54%) consented to follow-up contact and 114 (68%) of those were contacted. Among those contacted, 32 (28%) said they had complied with the suggestion to arrange for testing or visit given in the ED. Of those who did not make such follow-up arrangements, 18% cited financial reasons, and only 4% said they did not want to be screened. Among the 114 subjects contacted, only one rated the experience of enrollment in the study as negative.
Conclusion: Among non-urgent ED patients and visitors, RAs identified a large number of subjects who indicated they were not in compliance with ACS recommended Pap tests, mammograms and/or PCP annual visits. EDs can be an important venue for detecting persons in need of cervical and breast cancer screening.
