Compliance with recommended cervical and breast cancer screenings among emergency department patients and visitors assessed by research associates.
Author: Illuzzi F, Rush L, Lat C, Rose A, Bradley K
Objective: The goal of this study was to assess the potential need for providing elements of cervical and breast cancer screening among emergency department patients and visitors. The specific objective of the study was to determine the compliance with the American Cancer Society's (ACS) Pap test and mammography screening recommendations among a group of non-critical patients and visitors 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 minimum of one 4-hour shift per week in the Emergency Department during a summer academic semester. There was no attempt at sampling. RAs were simply encouraged to approach and enroll as many adult women patients and visitors 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, female, non-urgent patients and visitors ≥ 20 years old. Potential subjects 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, ethnicity, and insurance status, 2) whether they had a primary care practitioner (PCP) and location and timing of their latest visit, 3) compliance with ACS screening recommendations for cervical and breast cancer screening, i.e., Pap test and, for subjects ≥ 40 years old, mammography. In order to be compliant with ACS recommendation, subjects should have: 1) seen their PCP, 2) had a Pap test and, 3) if appropriate, a mammogram yearly. Informed consent was obtained from all subjects enrolled in the study.
Results: Twenty (20) RAs served 114 four-hour shifts over seven weeks in the summer semester, 2005. Among the 1463 patients and visitors approached, 1095 subjects (75%) were enrolled and 1080 (74%) completed the study. Subjects' average age was 51.5 years (range 20-102 years); African American 18%, Caucasian 62%, Hispanic 18%, Other 2%; 74% said they had private insurance or Medicare supplemented by private insurance, 18% government coverage and 8% no insurance. A PCP was identified by 996 subjects (92%); for those with private insurance, 96% said they had a PCP, Medicare (95%), Medicaid (89%) and those without insurance 56%. Eighty-five percent (85%) had seen their PCP within one year recommended for cancer screening.
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.
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.
