Prevention Care Management to improve Latina's Colorectal Cancer Screening
Background: Hispanics comprise 16% of the U.S. population, and 22% of Salt Lake County, Utah residents. In Utah, only 64% of Latinas have received appropriate CRC screening. Cancer is the leading cause of all-age mortality among Hispanics; among Latinas, CRC constitutes 10% of all cancer deaths in the United States. Few studies have looked at interventions to increase CRC screening among Latinas.
Methods: We initiated a Prevention Care Manager (PCM) led cancer intervention based on the CDC’s PCM health educator model to identify Latinas who were eligible for breast, cervical, and/or CRC screening (N=205). All participants completed a pre- and post-intervention survey. Results of the pre-intervention survey are presented for participants who were eligible for CRC screening (N=95). A subset of participants who were overdue for CRC screening were provided with a home based FIT. R was used to calculate two-sided Fisher’s Exact Tests for count data.
Results: The majority of participants who were age-eligible for a CRC screening were overdue (n=81, 85.3%). Those who were overdue for CRC screening were younger (50-59 years: 71.6% vs. ≥60 years: 28.4, p=0.01), and were more likely to report a high perceived likelihood of getting CRC (55.6%), compared to those who were up-to-date on CRC screening (21.4%, p=0.02). The top 3 barriers to CRC screening reported by overdue participants were: didn’t know about CRC test (n=24), cost of CRC test (n=14), and have not had any CRC problems (N=11). Those with low acculturation (62.5%) and education (75.0%) were more likely to report ‘didn’t know about the CRC test’ as a barrier than those with high acculturation (25.0%, p=0.02) and education (25.0%, p<0.01), respectively. Those who were employed were more likely to report cost as a barrier (85.7%) compared to unemployed participants (14.3%, p=0.03), whereas unemployed participants were more likely than employed participants to report ‘haven’t had any CRC problems’ as a barrier (27.3% vs. 72.7%, p=0.04). Of the 27 participants provided with a FIT, all completed the test, and all felt the FIT test was easy to use and reported they would use it again to screen for CRC. All participants said they felt reminders would help them be more compliant with CRC guidelines.
Implications: The majority of Latinas in our study were overdue for CRC screening. Barriers to CRC screening may be feasibly addressed with improved education on CRC screening guidelines and by utilizing low-cost, home-based FIT tools for low-income, uninsured populations. Latina’s relatively high mortality from CRC makes them a priority population for improving CRC screening. Our study demonstrates that home based FIT tests may be a viable option to increase CRC screening among this vulnerable population.