Effect of Offering Assistance on Preventive Screening Willingness in the EmergencyDepartment

Authors: Jo-Ann Rammal, Kayla Orow, Yasin Almri, Nasser Mahdi, Yara Chamaa, Eva

Quigley, Jeremiah Vidal, Keith Bradley, Joseph Miller, Matthew T. Ball, Howard A. Klausner

Objectives: To evaluate whether offering scheduling assistance changes willingness to

schedule preventive screenings among emergency department (ED) patients initially

reluctant to schedule, and to identify which demographic subgroups are most willing to

schedule when assistance is offered.

Methods: This multicenter cross-sectional survey was conducted across 11 EDs in the

National Alliance of Research Associate Programs (NARAP) network. A convenience

sample of patients was surveyed by research students between March 2017 and

December 2025 on screening history for primary care practitioner (PCP) visits, tobacco

cessation, and four cancer types: lung, breast, cervical, and colorectal. Participants not up to date who reported very unlikely, unlikely, or not sure to schedule within 30 days were asked whether offering assistance would change their likelihood. Multivariable ordinal logistic regression evaluated associations between demographics and scheduling likelihood with assistance, adjusting for site.

Results: Of 31,740 patients surveyed, the number not up to date (or identified as needing the service) was 7,429 for PCP visits, 10,110 for tobacco cessation (Quitline), 2,733 for colorectal, 1,941 for Pap tests, 1,087 for mammograms, and 589 for lung screening; of these, the number initially reluctant (very unlikely, unlikely, or not sure) was 2,568, 8,117, 1,381, 838, 411, and 373, respectively. Offering assistance increased the proportion reporting likely or very likely to 40.0% for PCP visits, 34.4% for Papanicolaou (Pap) tests, 24.4% for mammograms, 22.3% for colorectal screening, 22.0% for lung screening, and 10.3% for Quitline calls. In multivariable analysis (values are OR [95% CI]), several demographic groups showed significantly higher odds of scheduling with assistance. For PCP visits: female sex (1.39 [1.20–1.60], p<0.001), African American/Black (1.50 [1.23– 1.81], p<0.001), Asian American and Pacific Islander (AAPI)/Other (1.26 [1.03–1.54], p=0.026), less than high school (1.47 [1.16–1.86], p=0.002), GED/high school (1.38 [1.13– 1.69], p=0.002), some college (1.39 [1.11–1.75], p=0.004), and no/other insurance (1.28 [1.05–1.57], p=0.014). For Quitline calls: African American/Black (1.39 [1.24–1.55], p<0.001), AAPI/Other (1.15 [1.01–1.32], p=0.035), Hispanic/Latino (1.26 [1.10–1.44], p<0.001), less than high school (1.36 [1.18–1.57], p<0.001), GED/high school (1.15 [1.03– 1.29], p=0.011), and no/other insurance (1.30 [1.11–1.52], p=0.001). For mammograms: less than high school (2.29 [1.27–4.13], p=0.006), despite this group's lower baseline willingness, and GED/high school (1.94 [1.17–3.21], p=0.010). For Pap tests: older age, lower likelihood (0.97 [0.96–0.98], p<0.001); Hispanic/Latino (1.43 [1.01–2.03], p=0.047) and less than high school (1.84 [1.20–2.82], p=0.005), higher likelihood. For colorectal: older age, lower likelihood (0.98 [0.96–0.99], p<0.001); African American/Black (1.74 [1.34–2.24], p<0.001) and Hispanic/Latino (1.65 [1.19–2.29], p=0.003), higher likelihood. No demographic variable was significant for lung screening.

Conclusion: Offering scheduling assistance increased willingness among initially

reluctant ED patients across all screening types, with the greatest impact for PCP visits

and Pap tests. Lower-education patients showed higher willingness to schedule with

assistance for mammograms and Pap tests; for mammograms, this occurred despite their lower baseline willingness, suggesting they may benefit disproportionately from help. Minority race and ethnicity were also associated with higher willingness when assistance was offered. These findings suggest that offering scheduling assistance in the ED may help engage underserved patients in preventive care.