Colorectal Cancer Detection Raising Public Awareness Outline Colorectal
Colorectal Cancer Detection: Raising Public Awareness
Outline • Colorectal cancer (CRC) incidence and age, NYC • Change in CRC death rate over time, NYC • CRC prevention and gaps in screening, NYC • Changing direction in public health • Provider tools and education • Public health detailing • Patient tools and media
CRC Incidence and Age, NYC, 2003 -2015, New York State Cancer Registry Source: DOHMH analysis of data from the New York State Cancer Registry, 2003 - 2015
CRC Incidence Rates in NYC, All Races Combined, Ages 20 – 49 Years, 1975 - 2015 *The Annual Percent Change (APC) is statistically significantly different: all rates are age-adjusted. Reference: Van Beck et al. JNCI Cancer Spectrum 2018; 2(4)
CRC Incidence Rates in NYC, White Adults, Ages 20 – 49, 1975 - 2015 *The Annual Percent Change (APC) is statistically significantly different: all rates are age-adjusted. Reference: Van Beck et al. JNCI Cancer Spectrum 2018; 2(4)
CRC Incidence Rates in NYC, Black Adults, Ages 20 – 49, 1975 - 2015 *The Annual Percent Change (APC) is statistically significantly different: all rates are age-adjusted. Reference: Van Beck et al. JNCI Cancer Spectrum 2018; 2(4)
Change in CRC Death Rate per 100, 000 Population, All Ages, NYC, 2003 -2016 Age-Adjusted Death Rate per 100, 000 25 21. 0 20 15 19. 0 18. 6 17. 2 17. 4 17. 0 16. 5 16. 1 15. 9 14. 0 13. 7 13. 9 10 5 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 Note: All data are age adjusted. Source: New York City DOHMH analysis of data from Vital Statistics. Death/Mortality Data 2000 -2016.
100 CRC Prevention: Timely Colonoscopy among NYC Adults Ages 50+ Years, 2003 -2017 90 80 Timely Colonoscopy (%) 70 65. 6 59. 7 60 52. 2 66. 0 67. 5 68. 6 68. 5 69. 0 69. 9 68. 5 69. 9 61. 7 55. 2 50 41. 7 40 30 20 10 0 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014 2015 2016 2017 Source: Analysis of data from the NYC Community Health Survey, 2003 -2017. Data are age-adjusted.
CRC Prevention: Colonoscopy by Age, NYC, 2017 Age % No colonoscopy in the past 10 years NYC CHS, 2017 45 – 49 years* 71. 7 50 – 74 years 31. 0 75+ years 29. 4 People (N) 320, 000 644, 000 123, 000 To increase screening we will need a change in practice. *45 is the ACS recommended age to begin screening, but we have yet to see if it will be covered. Source: DOHMH analysis of the NYC Community Health Survey 2017
How to Change Direction in Public Health: the DOHMH Experience • • • Recommendations for healthcare providers Healthcare provider tools Public health detailing for PCPs Colon cancer prevention public education Colon cancer prevention media
DOHMH CRC Prevention Recommendations for Healthcare Providers: CHI, 2009
DOHMH Healthcare Provider Tools: DERS Forms
Public Health Detailing Approach • Allow at least 9 -12 months for campaign development • Train knowledgeable and persuasive Health Department Representatives and teams • Disease content knowledge (DOHMH expertise) • Selling and communications skills • 12 -20 week campaigns; target is 2 visits per contact per campaign • Assess current practice: tailor presentation to each contact • “Sell” key recommendations and offer supporting campaign-specific materials
DOHMH Public Health Detailing Action Kits • • Clinical tools Provider resources Patient Education Developed using bestpractices and qualitative research methods • Expert interviews • Research existing campaigns/messaging • Provider interview • Consumer focus groups 2008 Action Kit
NYC DOHMH Key Recommendations for Change: Internal Medicine and Family Practice • Colon Cancer Screening 2004, 2006 • Refer patients aged 50 years, or with a family history of colon cancer, for a colonoscopy • Colonoscopy is the NYC–recommended screening method • Any screening method is better than no screening method at all • Colon Cancer Screening 2008 • Refer patients aged 50 years or patients aged 40 years with a family history of colon cancer for colonoscopy • Directly refer appropriate patients for colonoscopy rather than first sending patients to a gastrointestinal consultation Dresser MG et al. Public Health Detailing of Primary Care Providers Am J Prev Med 2012; 42(6 S 2): S 122–S 134)
Public Health Detailing of Primary Care Providers: NYC’s Experience, 2003– 2010 • DOHMH studied effectiveness of the CRC screening-focused Public Health Detailing Program in helping PCPs and their staff improve patient care Year Target Neighborhood Clinical Provider + Contacts Sites Contacts Staff per Site Contacts 2004 South Bronx, East & Central Harlem, North & Central Brooklyn 193 530 982 5 2006 Staten Island 254 599 1489 6 2008 South Bronx, East & Central Harlem, North & Central Brooklyn 189 413 1424 8 Dresser MG et al. Public Health Detailing of Primary Care Providers Am J Prev Med 2012; 42(6 S 2): S 122–S 134)
Self-Reported Changes in Clinical Practice: DOHMH Public Health Detailing Campaigns Year Measure 2004 2006 2008 Baseline Follow-up Recommends colonoscopy as the primary CRC screening method 26% 42% Has an office system in place to promote CRC screening 52% 62% Colonoscopy recommended 82% 97% FOBT (stool-based test) recommended 10% 1. 5% Uses DERS referral form for screening 9% 16% Dresser MG et al. Public Health Detailing of Primary Care Providers Am J Prev Med 2012; 42(6 S 2): S 122–S 134) CRC=colorectal cancer
DOHMH Colon Cancer Prevention Public Education
DOHMH Colon Cancer Prevention Media, 2019 • Targeted to NYC neighborhoods with high levels of CRC mortality • • • Bus shelter placement Staten Island ferry Ethnic newspaper ads Radio announcements Social media sharing • Translated to Spanish, Chinese, and for radio, Haitian Creole
Colon Cancer Prevention Media, 2019
Summary • Number of new cases of CRC each year is declining among New Yorkers ages 50+ • But it is increasing among ages 20 – 49 • Yearly deaths from CRC declined as screening increased • Screening at younger ages is a practice change • Change in public health practices may be facilitated by: • • • Recommendations for healthcare providers Healthcare provider tools Public health detailing for PCPs CRC prevention public education CRC cancer prevention media
Thank you! Questions?
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