Jennifer L. Moss

Perspectives on Self-Sampling for Cancer Screening From Staff at Federally Qualified Health Centers in Rural and Segregated Counties: A Preliminary Qualitative Study

Background Self-sampling for colorectal and cervical cancer screening can address the observed geographic disparities in cancer burden by alleviating barriers to screening participation, such as access to primary care. This preliminary study examines qualitative themes regarding cervical and colorectal cancer self-sampling screening tools among federally qualified health center clinical and administrative staff in underserved communities. Methods In-depth interviews were conducted with clinical or administrative employees (≥18 years of age) from FQHCs in rural and racially segregated counties in Pennsylvania. Data were managed and analyzed using QSR NVivo 12. Content analysis was used to identify themes about attitudes towards self-sampling for cancer screening. Results Eight interviews were conducted. Average participant age was 42 years old and 88% of participants were female. Participants indicated that a shared advantage for both colorectal and cervical cancer self-sampling tests was their potential to increase screening rates by simplifying the screening process and offering an alternative to those who decline traditional screening. A shared disadvantage to self-sampling was the potential for inaccurate sample collection, either through the test itself or the sample collection by the patient. Conclusions Self-sampling offers a promising solution to increase cervical and colorectal cancer screening in rural and racially segregated communities. This study’s findings can guide future research and interventions which integrate self-sampling screening into routine primary care practice.

Follow‐Up After Receiving Abnormal Results From Self‐Sampled Colorectal and Cervical Cancer Screening Tests Among Underserved Patients

ABSTRACT Introduction Increasing cancer screening through at‐home self‐sampling test modalities is a public health priority. Patients with abnormal screening results should receive diagnostic follow‐up care; optimizing this process is a challenge. We conducted a mixed methods study to examine the cancer screening process among underserved patients who received abnormal results on a self‐sampled cancer screening test. Methods Participants were drawn from a parent study examining the impact of self‐sampled colorectal and cervical cancer screening tests among patients at federally qualified health centers in Pennsylvania. Those who had received abnormal results on their screening were completed a survey and semi‐structured interview about their experience ( n  = 5). We conducted mixed methods analysis to examine participants' (1) understanding and follow‐up care for abnormal results and (2) satisfaction with the self‐sampling cancer screening process. Results Quantitatively, participants indicated very high satisfaction with each self‐sampled cancer screening, and 60% preferred a self‐sampled test for their next cancer screening. Qualitatively, participants differed in the extent to which they seemed to understand their screening results, but they were generally satisfied with the self‐sampling process. In mixed methods analysis, participants' baseline knowledge about cancer screening supported better understanding of abnormal screening results, and participants' preference for their next cancer screening was related to their experiences with self‐sampling. Conclusions Among this sample of patients who received abnormal results on their self‐sampled colorectal or cervical cancer screening test, knowledge and understanding were not prerequisites for accessing follow‐up care. Satisfaction with the self‐sampling screening process was very high. These findings provide additional support for public health priorities to expand access to self‐sampling cancer screening tests.

Self-sampling tools to increase cancer screening among underserved patients: a pilot randomized controlled trial

Abstract Background Screening can reduce cancer mortality, but uptake is suboptimal and characterized by disparities. Home-based self-sampling can facilitate screening for colorectal cancer (with stool tests, eg, fecal immunochemical tests) and for cervical cancer (with self-collected human papillomavirus tests), especially among patients who face barriers to accessing health care. Additional data are needed on feasibility and potential effects of self-sampling tools for cancer screening among underserved patients. Methods We conducted a pilot randomized controlled trial with patients (female, ages 50-65 years, out of date with colorectal and cervical cancer screening) recruited from federally qualified health centers in rural and racially segregated counties in Pennsylvania. Participants in the standard-of-care arm (n = 24) received screening reminder letters. Participants in the self-sampling arm (n = 24) received self-sampling tools for fecal immunochemical tests and human papillomavirus testing. We assessed uptake of screening (10-week follow-up), self-sampling screening outcomes, and psychosocial variables. Analyses used Fisher exact tests to assess the effect of study arm on outcomes. Results Cancer screening was higher in the self-sampling arm than the standard-of-care arm (colorectal: 75% vs 13%, respectively, odds ratio = 31.32, 95% confidence interval = 5.20 to 289.33; cervical: 79% vs 8%, odds ratio = 72.03, 95% confidence interval = 9.15 to 1141.41). Among participants who returned the self-sampling tools, the prevalence of abnormal findings was 24% for colorectal and 18% for cervical cancer screening. Cancer screening knowledge was positively associated with uptake (P < .05). Conclusions Self-sampling tools can increase colorectal and cervical cancer screening among unscreened, underserved patients. Increasing the use of self-sampling tools can improve primary care and cancer detection among underserved patients. Clinical Trials Registration Number STUDY00015480.