Stephenson Cancer Center - Cancer Center Support Grant - Understanding Key Factors and Processes Affecting Follow-up of Abnormal Cancer Screening Tests in American Indian Patients

University Of Oklahoma Hlth Sciences Ctr, Oklahoma City OK

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Abstract

Project Summary/Abstract American Indian populations in the United States (US) experience major disparities compared to the general population in incidence and mortality for cervical cancer (CC) and colorectal cancer (CRC). Highly effective evidence-based screening tests exist for CC and CRC, but in order to be effective diagnostic testing must be completed when the initial screening result is positive. In Indian Health Service, Tribal and Urban Indian (ITU) healthcare facilities in Oklahoma, initial screening for CC includes Papanicolaou (Pap) smear testing either alone or with high-risk human papilloma virus (hrHPV) co-testing. Initial screening for CRC typically relies on stool-based tests (e.g., fecal immunofluorescence testing testing). Unfortunately, many persons with positive initial screens do not receive timely diagnostic colposcopy after a positive CC screen or colonoscopy after a positive stool-based CRC screen, likely contributing to worse outcomes. A clear understanding of the factors and processes of care that impede or facilitate follow-up to diagnostic testing after CC or CRC screening in American Indian persons has never been reported. Completion of diagnostic follow-up is influenced by individual-, structural-, and system-level factors, including social determinants of health (SDOH). Economic deprivation, lack of health insurance, geographic travel barriers, distrust of the healthcare system, lack of knowledge and communication about screening procedures, and others may impede diagnostic testing. This study uses a multilevel approach to identify barriers and facilitators to diagnostic colposcopy and colonoscopy among American Indian patients in Oklahoma who receive care in ITU clinical settings. The study has the following specific aims: 1) To conduct semi-structured interviews of patients, providers, staff and administrators at ITU clinic facilities, and, when applicable, providers and staff at non-ITU specialist facilities; and 2) To understand clinic flow processes and the organizational climate for process improvement from initial screening through completion of colposcopy or colonoscopy in ITU clinic facilities. This study will identify critical points in the process of healthcare in which navigated intervention would help ensure smooth progression from screening to diagnostic testing. Detailed flow maps will be created for each cancer for each participating ITU site and specialist practices performing diagnostic testing. To assess organizational climate and practice readiness for improving diagnostic testing, the Change Process Capability Questionnaire will be administered to each ITU practice. Taken together, Aims 1 and 2 set the stage for navigation-based implementation studies to improve completion of diagnostic testing.