Colorectal Cancer Survivorship in Rural Communities: Assessment and Plan Development April 19, 2007 Eugene J. Lengerich, VMD, MS Associate Professor Epidemiology Division, Department of Public Health Sciences Department of Health Policy and - PowerPoint PPT Presentation

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Colorectal Cancer Survivorship in Rural Communities: Assessment and Plan Development April 19, 2007 Eugene J. Lengerich, VMD, MS Associate Professor Epidemiology Division, Department of Public Health Sciences Department of Health Policy and

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Title: Colorectal Cancer Survivorship in Rural Communities: Assessment and Plan Development April 19, 2007 Eugene J. Lengerich, VMD, MS Associate Professor Epidemiology Division, Department of Public Health Sciences Department of Health Policy and


1
Colorectal Cancer Survivorshipin Rural
Communities Assessment and Plan
DevelopmentApril 19, 2007Eugene J. Lengerich,
VMD, MSAssociate ProfessorEpidemiology
Division, Department of Public Health Sciences
Department of Health Policy and Administration
Penn State UniversityDirector, Community
Outreach and Education Penn State Cancer
Institute
2
Outline
  • Background
  • Methods
  • Preliminary Results
  • Limitations, Discussion, and Acknowledgements

3
The Appalachia Community Cancer NetworkSupported
by the National Cancer InstitutesCenter to
Reduce Cancer Health Disparities1 U01 CA114622
(2005-2010)
ACCN - Appalachian Areas of 7 States (KY, MD,
NY, OH, PA, VA, WV)
4
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5
Background
  • National Guidance
  • Lance Armstrong Foundation and
  • Centers for Disease Control and Prevention
  • A National Action Plan for Cancer Survivorship
    Advancing Public Health Strategies
  • Institute of Medicine
  • From Cancer Patient to Cancer Survivor Lost in
    Transition
  • Presidents Cancer Panel
  • Living Beyond Cancer Finding a New Balance
  • State Comprehensive Cancer Control
  • Pennsylvania
  • New York

6
Northern Appalachia Cancer Network,A Region of
the Appalachia Community Cancer Network
  • Setting
  • Appalachia
  • 52 Counties in Pennsylvania
  • 14 Counties in New York
  • Largely rural
  • Increased poverty
  • Limited access to health care
  • Began in 1992
  • Approach
  • Community-based participatory research (CBPR)
  • Evidence-based strategies
  • Advisory Committee
  • Academic, state (PA and NY), professional and
    community members

7
2006 Community Planning Grant from the Lance
Armstrong Foundationwith support from the Penn
State Cancer Institute
  • Objectives
  • Facilitate CRC screening by coalitions and
    partnerships
  • Assist coalitions and partnerships to improve CRC
    survivorship
  • Prepare for community-based participatory
    research in CRC survivorship

8
Specific Aims
  • Increase the CRC survivorship-related knowledge
    and beliefs of teams of three members from each
    of six local cancer coalitions or partnerships
  • Create a local CRC survivorship plan, including a
    resource directory, to address local barriers and
    enhance CRC survivorship in the communities
    represented by the six teams

9
Significance
  • Test
  • a local approach to complement national and state
    cancer control plans
  • Equip
  • rural coalitions and partnerships in CRC
    survivorship (and screening)
  • Enable
  • community-based participatory research on CRC
    survivorship in rural communities

10
Methods
11
Design
  • Design
  • Pre-post, multi-level, community intervention
    study
  • CBPR approach
  • Outcomes
  • Individual-level Knowledge and beliefs in
    public health and CRC-survivorship among
    individual members of coalitions and partnerships
  • Community-level Presence and content of
    community plans and resource directories for CRC
    survivorship
  • Analysis
  • Change in knowledge and beliefs McNemars test
    (plt0.05)
  • Content analysis by multiple reviewers (n3)

12
Study Schema
Technical Assistance from NACN / PSCI / ACS
Recruit and Prepare (Proposed 6 coalitions)
Train on Colorectal Cancer Survivorship and
Process for Plan Development (Conference 1 May
2006)
Present CRC Survivorship Plans and Resource
Directory (Conference 2 October 2006)
Disseminate, Implement, and Research
Assess Barriers Needs Develop Plan
ASSESSMENT Knowledge and beliefs Survivorship
Plans and Resource Directories
ASSESSMENT Public health and survivorship
knowledge and beliefs
Revised 5/11/06
13
PRECEDE-PROCEED
Planning Model Starts with outcomes and works
back to strategies Assessment
PRECEDE Community Intervention PROCEED
14
Possible Assessment Methods
  • Coalition/Hospital Discussions
  • Key-informant interviews
  • Survivor interviews
  • Community forum
  • Focus groups
  • Survey

15
Preliminary Results
16
Participation
  • Recruited
  • 11 coalitions (8 in PA 3 in NY) and 4 hospitals
    (all in PA)
  • 32 individuals at initial conference (range 1-4
    per coalition/hospital)
  • MDs RNs Health Educators
  • Hospital Administrators
  • Survivors
  • Completed
  • 11 coalitions and 3 hospitals (93.3)
  • 16 of 32 individuals at initial conference
    returned to second conference (50.0)

17
Increase in Correct Responses Pre-Training versus Immediate Post-Training Increase in Correct Responses Pre-Training versus Immediate Post-Training Increase in Correct Responses Pre-Training versus Immediate Post-Training Increase in Correct Responses Pre-Training versus Immediate Post-Training Increase in Correct Responses Pre-Training versus Immediate Post-Training
Knowledge Total Pre-Training Immediate Post-Training p-value1
Knowledge Total N () N () p-value1
that PRECEED-PROCEED is a community health planning model2 30 8 (26.7) 25 (83.3) lt0.0001
that an enabling factor is an internal or external condition in health promotion theory 25 13 (52.0) 20 (80.0) 0.0391
of the sponsors of National Action Plan 28 1 (3.6) 11 (39.3) 0.0020
of the percentage of U.S. cancer survivors had CRC 28 12 (42.9) 25 (89.3) 0.0010
of the point at which CRC survivorship begins 28 21 (75.0) 27 (96.4) 0.0313
of the benefit of laparotomies as a treatment for CRC 24 9 (37.5) 19 (79.2) 0.0063
that memory problems are not common in CRC survivors2 27 14 (51.9) 23 (85.2) 0.0117
1McNemars Test. 2Statistically significant
increase at long-term assessment
18
Assessment MethodsUsed by Coalitions/Hospitals
Number Percentage
Resource Assessment 14 100.0
Cancer Data Review 14 100.0
Interviews of Survivors 12 85.7
Survey of Survivors, Community, Providers 12 85.7
Coalition/Partnership Discussion 11 78.6
Key Informant Interviews 11 78.6
19
Community Barriers to CRC Survivorship
  • Lack of transportation (n11 79)
  • Lack of psychosocial care (n8 57)
  • Low level of knowledge of community information
    and resources (n7 50)
  • Lack of ability to pay and coverage with health
    insurance (n7 50)
  • Lack of access to medical/surgical care (n5 36)

20
Previously Unknown Resourcesin the Community
  • Psychosocial care (n10 71)
  • Medical/surgical care (n4 29)
  • Transportation (n3 21)
  • Financial and insurance assistance (n3 21)

21
Contents of the Plans
  • Public knowledge of community resources (n13
    93)
  • Public access to community resources (n8 57)
  • Public knowledge about CRC treatment and side
    effects (n5 36)
  • Payment/insurance for CRC treatment and care
    (n4 29)
  • Public knowledge about screening guidelines (n4
    29)
  • Provider knowledge about screening guidelines
    (n3 21)
  • Access to psychosocial care for CRC (n3 21)

22
Posters and Abstracts At The Third Annual Summit
of thePennsylvania Cancer Control Consortium
  • Posters
  • Coalition for People Against Cancer (CPAC)
    (Clearfield County)
  • Indiana County Cancer Coalition
  • Abstracts
  • Elk County Cancer and Tobacco Education Coalition
  • Lawrence County Cancer Coalition
  • York Cancer Center

23
Limitations
  • Reliance upon donated time and resources
  • Capacity and process measures
  • Assessment methods were not mandated
  • CRC survivorship issues were broadened by some
    participants to be general cancer survivorship
    issues

24
Summary
  • Surpassed aims, with a high response rate
  • Increased knowledge of key community members
  • Conducted 14 community assessments
  • Identified barriers and previously unknown
    resources
  • Developed community plans and resource
    directories
  • Employed methods of CBPR and PRECEDE-PROCEED
  • Linked CRC screening to survivorship issues

25
CRC Survivorship Coalitions and Hospitals
  • ACTION Health Colorectal Cancer Task Force
    (Columbia, Montour, Northumberland, Snyder, and
    Union Counties) (PA)
  • Chautauqua County Partners for Prevention (NY)
  • Coalition for People Against Cancer (CPAC)
    (Clearfield County) (PA)
  • Crawford County Cancer Coalition (PA)
  • Delaware County Cancer Coalition (NY)
  • Elk County Cancer and Tobacco Education Coalition
    (PA)
  • Greene County Cancer Coalition (PA)
  • Indiana County Cancer Coalition (PA)
  • Lancaster General Hospital (PA)
  • Lawrence County Cancer Coalition (PA)
  • Mount Nittany Medical Center (PA)
  • Wellness Council of the Southern Tier (NY)
  • Wyoming County Cancer/Tobacco Coalition (PA)
  • York Cancer Center (PA)

26
CRC Survivorship Planning Committee
  • NACN
  • Regina Allen
  • Marcy Bencivenga
  • Brenda Kluhsman
  • Eugene Lengerich
  • Community Coalitions
  • Marcia Anderson
  • PSCI Community Outreach and Education
  • Diane Sheehan
  • CRC Survivor
  • Mary Beth Miele
  • American Cancer Society
  • Deirdre Weaver
  • Centers for Disease Control and Prevention
  • Laura Zauderer
  • Lance Armstrong Foundation
  • Haley Justice
  • PSCI Survivorship Program
  • Elana Farace
  • PSU Continuing Education
  • Bonnie Bixler

27
References
  • Butterfoss FD, Kegler MC. Toward a comprehensive
    understanding of community coalitions moving
    from practice to theory. In DiClemente RJ,
    Crosby RA, Kegler MC, editors. Emerging theories
    in health promotion practice and research. San
    Francisco (CA) Jossey-Bass 2002. p. 15793.
  • Green LW, Kreuter MW. CDCs planned approach to
    community health as an application of PRECEDE and
    an inspiration for PROCEED. J Health
    Educ199223(3)140-7.
  • Israel BA, Schulz AJ, Parker EA, Becker AB.
    Review of community-based research assessing
    partnership approaches to improve public health.
    Annu Rev Public Health 199819173-202.
  • Huan B, Wyatt S, Tucker T, Bottorff D, Lengerich
    E, Hall HI. Cancer death rates Appalachia,
    1994-98. 1994-1998. MMWR 200251(24)527-9.
  • Klushman BC, Bencivenga M, Ward AJ, Lehman E,
    Lengerich EJ. Initiatives of eleven rural
    Appalachian cancer coalitions in Pennsylvania and
    New York. Prev Chronic Dis. serial online 2006
    Oct. Available from http//www.cdc.gov/pcd/issues
    /2006/oct/06_0045.htm.
  • Lengerich EJ, Tucker T, Powell RK, Colsher P,
    Lehman E, Ward AJ, Siedlecki JC, Wyatt SW. Cancer
    incidence in Kentucky, Pennsylvania, and West
    Virginia Disparities in Appalachia. J Rural
    Health 200521(1)39-47.
  • Lengerich EJ, Wyatt SJ, Rubio A, Beaulieu J,
    Coyne CA, Fleisher L, Ward AJ, Brown PK. The
    Appalachia Cancer Network cancer control
    research among a rural, medically underserved
    population. J Rural Health 200420(2)181-87.
  • Ward AJ, Coffey Kluhsman B, Lengerich EJ,
    Piccinin AM. The impact of cancer coalitions on
    the dissemination of colorectal cancer materials
    to community organizations in rural Appalachia.
    Prev Chronic Dis serial online 2006 Apr.
    Available from http//www.cdc.gov/pcd/issues/2006
    /apr/05_0087.htm.

28
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