1. Assessment of Colon & Prostate Cancer Screening in WA Peggy Hannon, PhD, MPH Alliance for Reducing Cancer NW

2. Baseline Assessment Questions Colon cancer screening Rates of screening in WA Who gets screened? Physician knowledge, attitudes, practices Prostate cancer screening & IDM Rates of screening & IDM in WA Who gets screened? Physician knowledge, attitudes, practices for screening and IDM

3. Assessment Methods BRFSS analysis, 2001-2002 data Core questions for colon cancer screening and prostate cancer screening State-added questions for colon screening in 2002 Physician Survey Primary care providers practicing in WA 397 completed surveys, 72% response rate

4. Assessment Methods, contin’d Insurance claims analyses Medicare, Medicaid, PPO, HMO Available data ranged from 2000 – 2004 Studied all colon cancer screening tests & PSA for prostate cancer screening Literature review Community Guide recommendations

5. Colon Cancer Screening Findings WA BRFSS 2001-2002, participants 50 years of age and older (N = 3643) Current FOBT (in past year) -- 25% Current Flexible Sigmoidoscopy or Colonoscopy (in past 5 years) -- 42% Currently screened by any method -- 52%

6. Colon Cancer Screening Findings 2002 BRFSS asked unscreened participants the most important reason they were not screened Lack of awareness (50%) No physician recommendation (29%) Unwilling (19%) No insurance (2%)

7. Colon Cancer Screening Findings Physicians’screening recommendations 93% recommend FOBT 56% recommend flexible sigmoidoscopy 88% recommend colonoscopy 76% rec. one or more screening tests in agreement with USPSTF guidelines

8. Colon Cancer Screening Findings Physician mechanisms to complete screening 33% have mechanism to encourage return of FOBT kits 65% have mechanism to ensure patients complete screening and follow-up tests referred to another provider Perceived patient barriers (% physicians reporting as major or minor barrier) Fear of finding cancer (89%) Anxiety about tests (94%) Unaware of screening (92%)

9. Interventions Sought in RFP General systems for provider recommendations and referral Improve provider knowledge & recommendations for screening Improve clinical tracking & performance of screening Guiding test completion and follow-up of positive tests Targeted interventions for underserved groups

10. Prostate Cancer Screening Findings WA BRFSS 2001-2002 (N = 1431) 61% of men ages 50+ were screened for prostate cancer in the past year 39% screened with PSA and DRE 13% screened with DRE only 9% screened with PSA only No questions about IDM Similar to national screening rates

11. Prostate Cancer Screening Findings 90% of physicians recommend DRE & 83% recommend PSA Most recommend starting testing at ages 45-50 & yearly screening 55% collect family history of prostate cancer for 75%+ of male patients

12. Prostate Cancer Screening Findings 74% of physicians always/almost always discuss benefits/risks of PSA Few report always using educational materials to discuss benefits/risks of PSA Written materials (9%) Videotapes (0.3%) Websites (6%)

13. Prostate Cancer Screening Findings Issues discussed by majority of physicians Efficacy of PSA in detecting prostate cancer (64%) PSA may prompt further tests (64%) Issues discussed by minority of physicians Efficacy of treatment options for prostate cancer (35%) Possible side effects of treatment for prostate cancer (35%)

14. Interventions Sought in RFP Provider-targeted interventions Provider discussion of risks and benefits Provider collection of family history of PCa Placing IDM tools/cues in providers’ offices Consumer-targeted interventions Placing IDM tools in community settings Forums to increase capacity to make informed decisions

15. Conclusions Baseline assessment has been very useful in shaping the CCCP’s first RFPs ARCNW’s Cancer Screening workgroup and partners have also benefited Future directions Preliminary studies for grant applications