Mary Glavassevich, RN, BA, MN,

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Cancer Screening Barriers, Attitudes and
Behaviors in a Population of Afro- Caribbean
Adults Living in Toronto
Mary Glavassevich, RN, BA, MN, Sunnybrook Health
Sciences Centre Odette Cancer Centre, Toronto,
Ontario, Canada
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Team members

• Mary Glavassevich, RN, BA, MN Rosemary Irish,
  RN, BScN, CON(C) Tracey DasGupta, RN, MN
  Colleen Hall, RN, MN(C) Pam Raye-Ilogu, RN,
  BScN Linda Ramjohn, RN, BScN Vera Hurlock, RN
  Cynthia Robinson, MSW, RSW Nadine Walters,
  BComm Philiz Goh, BSc, BScN (C) Alison
  McAndrew, BA RAP with Margaret Fitch, RN, PhD,
  Sunnybrook Health Sciences Centre Odette Cancer
  Centre, Toronto, Ontario, Canada

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Greetings from

• Sunnybrook Health Sciences Centre

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Introduction

• Screening for cancer is recommended for better
  overall outcomes
• Some ethnic groups may not be taking full
  advantage of available screening opportunities
• Research is limited in Canada about screening
  behaviors in ethnic groups, including
  Afro-Caribbean populations
• Data from United States reveal disproportionately
  higher cancer incidence and mortality rates for
  immigrant minorities
• The presence of a primary physician had a
  significant influence on breast cancer screening
  adherence
• (Gany et al, 2006)
• (Kinney et al, 2002)

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Purpose

• To explore the awareness of a cross-sectional
  sample of Afro-Caribbean adults living in Toronto
  about screening for four common cancers breast,
  prostate, cervix, and colorectal
• To identify possible barriers to screening for
  cancer within this population

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Methods

• Exploratory descriptive design
• Convenience sample
• Hard copy paper survey with fourteen questions -
  four open-ended and ten closed-ended
• Descriptive statistics and a content analysis
• Focus group to validate findings

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Demographics (N213)

• Response Rate 58

Gender Gender
Male 45
Female 146
Not born in Canada 189
Length of Time in Canada (in years) Length of Time in Canada (in years)
15 or less 26
1620 37
gt20 147
Marital Status Marital Status
Married/ Common law 120
Single 46
Divorced/Sep /Widow 36
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Demographics (N213)
Age
Under 30 7
30 40 26
41 50 34
51 60 48
61 70 69
71 24
Education
ltHigh School 22
High School 50
Some College/University 73
Completed College/University 68
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Survey Results (N213)

• Have a family doctor 201
• See a family doctor regularly 102
• Have not talked with family
• doctor about screening for cancer 48

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Survey Results (N213)

• Heard about
• Mammography 181
• Pap smear 172
• Colonoscopy 150
• PSA 125
• Have had screening for
• Mammography 116
• Pap smear 129
• Colonoscopy 73
• PSA 42

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Survey Results (N213)

• Rating of importance of screening for cancer
• Very important 195
• Somewhat important 11
• No response 7

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Survey Results (N213)

• Where did you hear about screening for cancer?
• Doctor 146
• TV 83
• Family member 59
• Newspaper 53
• Radio 50
• Magazines 44
• Friends 41
• Church community 40
• Nurse 38

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Question to Participants

• What do you think would help the people in your
  community to have screening for cancer done?

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Community Based Education Considering Cultural
Needs

• More direct and deliberate education programs
  targeting them where they work or where they live
  
• Education on why it is important and those
  presentations to be done by people of similar
  background in an interesting way
• Simple media communication in laymans language

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Decrease Fear Associated with Screening

• More education needed because some people get
  scared once the word cancer is mentioned
• Greater encouragement and education from their
  doctor
• Many women of color are afraid of the possibility
  of having cancer.we need to have experts in
  healthcare come to our churches and community
  centers to educate our people

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Role of Physicians and Other Healthcare Providers

• This community takes a holistic approach but self
  evaluates first. A more caring and accessible
  medical capacity, i.e. not just MD, or RN, or
  others who can spend time educating and listening
  would encourage more testing earlier.
• More access to doctors in a timely fashion
• Proposed dialogue between patient and family
  doctor on education about cancer screening

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Approach of Health Care Providers

• Dont like the way the testing was handled,
  especially the mammograms, so painful
• My doctor never requested me to do these
  screening tests, he just took my blood pressure
  and other tests, not screening. Didnt get any
  appointment from my doctor

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Lack of Knowledge and Awareness

• I dont feel I have cancer at the moment.
• Need more information I am interested in doing
  it as I realize it is important
• Didnt think about it

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Fear and Embarrassment Prevented Screening

• I am scared and feel like sometimes treatment
  doesnt do well, the body rejects it. I heard
  that chemotherapy and radiation doesnt do well
  in black people. Ive seen so many people start
  these treatments and suffer so badly.
• Our people fear the worse, so they are reluctant
  to go for screening
• Some people are afraid or cowardly and may be
  embarrassed and ashamed

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Focus Group Experience

• Purpose To validate survey findings and deepen
  understanding of dissemination
• Participants 2 focus groups held and 19 people
  participated
• Taped/transcribed verbatim and analyzed for
  content

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Focus Group FindingsValidation

• Fear of cancer
• Lack of knowledge
• Need for trust with physician
• Unique cultural perspectives

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Focus Group FindingsUnderstanding of
Dissemination

• Go to where the people are
• Credible spokespeople from within the community

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Some Possible Solutions

• Education and encouragement
• Culturally sensitive communication and community
  focused education
• More active involvement of doctors and other
  healthcare providers
• Credible spokespeople from within the community

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Conclusions

• Screening for cancer is very important
• The rate of participation in screening for each
  of the four types of cancer varied
• Most people received information about cancer
  screening from a doctor fewer people received
  information from a nurse
• Culturally appropriate education given in a
  sensitive manner with support and encouragement,
  including strategies to reduce fear, were
  suggested by the participants as ways to enhance
  cancer screening

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Implications

• Nurses and other healthcare professionals can
  play a more significant role in providing
  information on cancer screening in the
  communities
• Further research is required to validate the
  results of the study and to form bonds within the
  community groups
• It is imperative to explore innovative ideas to
  provide community based education to increase
  knowledge and awareness of cancer screening