PCR060: Rapid adaptation of cancer screening practices during COVID-19: A multi-state qualitative study

Karim Hanna, MD; Brandylyn Arredondo; Melody Chavez; Laura Szalacha; Shannon Christy, PhD, BA, MA; Susan Vadaparampil, PhD, MPH; Usha Menon, PhD; Jessica Islam, PhD, MPH; Young-Rock Hong, PhD, MPH; Amir Alishahi Tabriz, MD, PhD, MPH; Jennifer Kue, PhD; Kea Turner, PhD, MA, MPH

Abstract

Context: The COVID-19 pandemic required primary care practices to rapidly adapt cancer screening procedures to comply with changing guidelines and policies.

Objective: This study sought to: 1) identify cancer screening barriers and facilitators during the COVID-19 pandemic; 2) describe cancer screening adaptations; and 3) provide recommendations.

Study design: A qualitative study was conducted (n= 42) with primary care staff. Individual interviews were conducted through videoconference from August 2020 – April 2021 and recorded, transcribed, and analyzed for themes using NVivo 12 Plus.

Setting: Primary care practices included federally qualified health centers, tribal health centers, rural health clinics, hospital/health system-owned, and academic medical centers located across ten states including urban (55%) and rural (45%) sites.

Population studied: Primary care staff included physicians (n=13), residents (n=10), advanced practice providers (n=9), and administrators (n=10).

Outcome measures: The interviews assessed perceptions about cancer screening barriers and facilitators, necessary adaptations, and future recommendations.

Results: Barriers to cancer screening included delays in primary and specialty care, staff shortages, lack of personal protective equipment, patient hesitancy to receive in-person care, postal service delays for mail-home testing, COVID-19 travel restrictions (for Mexico-US border-crossing patients) and organizational policies (e.g., required COVID-19 testing prior to screening). Facilitators included better care coordination and collaboration due to the pandemic and more time during telehealth visits to discuss cancer screening compared to in-person visits. Adaptations included delayed screening, patient triage (e.g., prioritizing patients overdue for screening), telehealth visits to discuss cancer screening, mail-home testing, coordinating cancer screenings (e.g., providing fecal immunochemical test materials during cervical cancer screening) and same-day cancer screening. Recommendations included more public health education about the importance of cancer screening during COVID-19, more mail-home testing, and expanded healthcare access (e.g., weekend clinic) to address patient backlogs for cancer screening.

Conclusions: Primary care staff developed innovative strategies to adapt cancer screening during the COVID-19 pandemic. Unresolved challenges (e.g., patient backlogs) will require additional implementation stra
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Jack Westfall
jwestfall@aafp.org 11/20/2021

This is a great topic and research study. Nice work. Thanks

Diane Harper
harperdi@med.umich.edu 11/21/2021

YES!! home based cancer screening --- please continue to encourage home based coloncancer screening. our population does not need to individually have a colonoscopy if they are average risk!! great work

Gillian Bartlett
gillian.bartlett@health.missouri.edu 11/23/2021

This is very interesting topic on prevention strategies - I think the focus on home based strategies is a critical. I look forward to seeing more of your work in this area.

Andy Pasternak
avpiv711@sbcglobal.net 11/28/2021

Great job capturing this data. Family docs really had to balance COVID risks with other health care concerns. This demonstrates some of those tradeoffs

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