Kelsey C. Stoltzfus

Perspectives on self‐sampling for cancer screening among rural and urban women: Multilevel factors related to acceptability

AbstractPurposeSelf‐sampling tests may be used to overcome barriers to screening that are more prevalent in rural populations compared to urban populations. This study aims to qualitatively examine the attitudes toward established and novel self‐sampling tests for cervical and colorectal cancer among women, comparing themes from rural versus urban areas.MethodsWe recruited women (ages 45‐65) from 28 counties in Pennsylvania. Four focus groups were conducted with women from metropolitan counties, and 7 focus groups were conducted with women from nonmetropolitan counties. A brief survey was conducted prior to the focus group regarding general health and willingness to complete self‐sampling tests for cervical and colorectal cancer.FindingsWe identified 3 themes about the potential for self‐sampling for cancer screening: advantages and disadvantages of self‐sampling compared to traditional testing, impact of self‐sampling on patient interactions with their health care providers/clinics, and implications for improving/worsening access to quality health care services. We detected differences in responses from rural versus urban participants in the potential impact of self‐sampling for cancer screening.ConclusionsThere are several barriers and facilitators at the individual, interpersonal, and organizational levels that influence the feasibility of implementing self‐sampling for cancer screening in routine clinical practice. Rural participants face unique barriers to cancer screening across all levels. These findings can be used to guide interventions aimed at increasing the use of self‐sampling methods.

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.