Abstract:

Introduction:
Despite the availability of effective screening tools for colorectal (CRC), cervical (CxC), and breast (BC), cancer screening remains underutilized among ethnic minorities and the medically underserved. As part of a comprehensive cancer prevention project aimed at improving cancer screening and follow-up among medically underserved patients in Houston, Texas, we developed and implemented videos designed to increase utilization of fecal immunochemical test (FIT), Pap test, and mammography for CRC, CxC, and BC screening, respectively. The videos were designed for viewing in exam rooms at the point-of-care. Here we describe the deployment of the videos at Community Health Centers (CHC) within a safety net healthcare system.

Methods:
In Phase I, eight FIT and four Pap videos were adapted from existing videos or created anew and tailored to ethnic and linguistic subgroups (English, Spanish, Vietnamese). A testimonial-type format was employed with messaging to encourage patients to obtain a FIT/PAP screening test and discuss the test with their physicians. Video viewing was integrated into the patient flow at participating CHCs. Specifically, electronic medical records (EMR) were used to identify patients who were due or past due for either test. Videos were played on a computer screen while patients waited in the exam room. As direct tracking was not possible, the number of videos viewed was estimated based on the number of FIT/Pap tests ordered/completed (conservatively assuming that 60% of patients who obtained/completed the tests viewed the videos). In Phase II, four mammography videos were created and deployed targeting the same ethnic and linguistic subgroups.

Findings:
In Phase I, videos were deployed in 458 exam room computers at 13 CHCs. Over the three-year project period, an estimated 50,022 patients viewed the FIT video and 59,048 patients viewed the Pap test video. Over this time period, CRC screening completion (FIT) increased from 24% at baseline to 58.7% (total n = 118,318). CxC screening (PAP Test) completion increased from 29% at baseline to 38.4% (total n = 147,614). Clinic staff demonstrated positive attitudes toward the integration of the videos within clinic flow. In Phase II, the introduction of mammography videos posed logistical concerns for smooth integration into the clinic flow. Limited patient time in the exam room and interruption of nursing staff’s duties to set-up system for multiple video viewing were cited as concerns within busy clinic sites.

Discussion:
Targeted videos as a point-of-care can effectively be integrated into a high-volume clinical setting as a strategy to increase cancer screening utilization. Logistical considerations need to be taken into account when introducing additional educational videos so as to not impair with clinic flow.

Keywords:

Patient education, point of care, multimedia, cancer prevention.