Roberto Cardarelli DO MPH FAAFP Professor of Family and Community Medicine Chief of the Division of Community Medicine Director Kentucky Ambulatory Network 1 Kentucky Cancer Consortium June 19 2015 ID: 935382
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Slide1
A Community Engaged Approach: The Terminate Lung Cancer (TLC) Study
Roberto Cardarelli, DO, MPH, FAAFPProfessor of Family and Community MedicineChief of the Division of Community MedicineDirector, Kentucky Ambulatory Network
1
Kentucky Cancer Consortium
June 19, 2015
Slide2Funded by: CCTS/ATRN and Markey Cancer Center
7/2014-6/2016
2
Slide3Team
Roberto Cardarelli, DO, MPH (Principal Investigator)Tony Weaver, MDJamie Studts, PhD
Fran Feltner, DNPGretchen Holmes, PhDKathryn Cardarelli, PhD
Debra Armstrong, MSW, MPAJennifer Redmond, MPH, DrPHElmer Whitler, MPA
Karen Roper, PhD
Community/ATRN
Partners
David
Reese, MA
, MPH, FRSPH (Co-Principal Investigator)Dana Shaffer, DO HomePlace TeamMichelle Ledford (CHW Hazard)Barbara Justice (CHW Pikeville)Shirley Prater (CHW Morehead)Janet Kegley (Regional Coordinator)Helen Collett (Regional Coordinator)Ralph Fugate (Regional Coordinator)
3
Slide4Why do lung cancer screening (research)?
It’s Bad
Lung cancer is the leading cause of all cancer deaths in the United States
Current 5-year survival rate for all stages combined is only 16%
Worse in KY
#1 cause of cancer death in Kentucky, dramatically exceeding the national mortality rate (73.2 KY vs. 49.5 U.S. deaths per 100,000)
The 5-year survival rate is 52% for those diagnosed at a localized stage, however only 15% of lung cancers are detected prior to spread
4
New USPSTF Rec
Other national health organizations, including the American Cancer Society and the American Association for Thoracic Surgery, among others, have also published formal screening guidelines
Based on seminal findings of the National Lung Screening Trial, a large randomized trial that found a 20% relative reduction in lung cancer mortality through low-dose CT (LDCT) lung screening in current or former heavy smokers compared to plain chest x- rays
Slide5Why Study a Community Engaged Approach?
Provider education
Patient education
Community awareness?
5
NEW GUIDELINES
Slide6Aims
1.) Develop a community outreach campaign in Eastern Kentucky through a formative assessment involving high-risk target populations (Age 55-80, Smoking > 30 pack year, quit smoking <15 years ago),
2.) Implement the community outreach intervention in two regions in Eastern Kentucky (Morehead, Hazard) to assess the uptake of low-dose chest CTs (LDCTs), and
3.) Assess the impact of Community Health Workers (CHWs) in one of two campaign regions on the uptake of LDCT.
6
Slide7Methods
Focus Groups
Recruitment by CHWs
Train CHWs as Moderators
CAB development
Develop and Implement TLC Campaign
Qualitative analyses: Themes and messages
Team develops campaign with CAB rep and CAB input and review
Measurement
LDCT numbers
7
Slide8Study Regions
8
Slide9Focus Groups
2 groups in each region (10 people per group)Must meet criteria for lung cancer screening (Age 55-80, Smoking > 30 pack year, quit smoking <15 years ago)CHWs conducted the recruitment
CHWs were trained to moderate the focus groupsCommunity trustBuy-in
The right thing to doNew skill we provide to HomePlace Program$40 to participate (1-1.5 hours)1 person selected in each group to be on CAB (will get $40 for each study activity they participate in)1 CAB Representative to work with “Research Study Team”
9
Slide10Focus
Group Moderator Guide
Activity
Domains
Stem Question
Assess baseline understanding regarding lung cancer screening
Knowledge and attitudes
“What have you heard about screening for lung cancer?”
Review basic information regarding lung cancer screening
Lung cancer risk factors and current evidence regarding lung cancer screening
N/A
Assess receptivity to lung cancer screening
Message content
“Based on what you heard today about…what is the most important message that needs to be relayed to encourage you to be screened for lung cancer?”
Message appeals“What things will resonate with folks in terms of what benefits them or what they get out of it?”
Message design and implementation“If you were designing an ad about lung cancer screening, what things about the ad would make it trustworthy? engaging? relevant to you?” Message sources“What or who would you suggest would be the best way to deliver the message that would be considered trustworthy and relevant?” Message communication channels
“What channels or ways are best to get the message or advertise it?”
Disseminator factors“How many ways or times do you think it would be needed for someone to hear or see the ad or information about…before it sticks?”Review available lung cancer screening materials (NOTE: These will be identified at the time focus groups will be performed)Reponses to publicly available lung cancer screening materials“Here are materials that we gathered about lung cancer screening that other organizations developed. What is your opinion about these items based on things we talked about earlier?”
10
Slide11Campaign Development
Design
Implement
Interpret Data and Develop Campaign
Review and Input by CAB
Formative Data
Themes and Messages
Exclude cross-over
Implement Campaign in the 2 Intervention Regions
Data
11
Slide1212
Slide13Focus Group Results
Slide14Focus Group Results
Terminate
Lung Cancer Focus Groups (N=54)
n*
%
Smoking status
Current smokers3463.0% Past smokers
2037.0% Average years quit smoking**, mean (SD)7.4(3.8)
Pack years, mean (SD) Current smokers55.3
(20.5)
Past smoker
61.7
(34.4)
Age, mean (SD)
61.76
(4.8)
Gender
Male
21
38.8%
Female
33
61.1%
Race/Ethnicity
White
54
100%
Marital Status
Married
37
71.2%
Divorced
6
11.5%
Widowed
5
9.6%
Separated
2
3.8%
Never married
2
3.8%
Number of children
None
35
67.3%
One
5
9.6%
Two
6
11.5%
Three or more
6
11.5%
Education level
Grades 1-8
10
19.2%
Grade 9-11
11
21.2%
High school/GED
23
44.2%
Some college
8
15.4%
College or above
0
0%
Employment status
Employed
8
15.4%
No work >1 year
1
1.9%
Homemaker
2
3.8%
Retired
26
50.0%
Unable to work
15
28.8%
General health status
Excellent/Very good
4
7.7%
Good
12
23.1%
Fair
20
38.5%
Poor
16
30.8%
*May not equal to 54 due to missing data
**For past smokers only
Slide15Focus Group Results
Terminate
Lung Cancer Focus Groups (N=54)
n*
%
Smoking status
Current smokers3463.0% Past smokers
2037.0% Average years quit smoking**, mean (SD)7.4(3.8)
Pack years, mean (SD) Current smokers55.3
(20.5)
Past smoker
61.7
(34.4)
Age, mean (SD)
61.76
(4.8)
Gender
Male
21
38.8%
Female
33
61.1%
Race/Ethnicity
White
54
100%
Marital Status
Married
37
71.2%
Divorced
6
11.5%
Widowed
5
9.6%
Separated
2
3.8%
Never married
2
3.8%
Number of children
None
35
67.3%
One
5
9.6%
Two
6
11.5%
Three or more
6
11.5%
Education level
Grades 1-8
10
19.2%
Grade 9-11
11
21.2%
High school/GED
23
44.2%
Some college
8
15.4%
College or above
0
0%
Employment status
Employed
8
15.4%
No work >1 year
1
1.9%
Homemaker
2
3.8%
Retired
26
50.0%
Unable to work
15
28.8%
General health status
Excellent/Very good
4
7.7%
Good
12
23.1%
Fair
20
38.5%
Poor
16
30.8%
*May not equal to 54 due to missing data
**For past smokers only
Slide1616
Cumulative
Terminate Lung Cancer Focus Group Results (54 participants)
Domains
Utterances and summative responses
Assess
baseline
understanding regarding lung cancer screening
Breathing test is screening for lung cancer
Computed Tomography (CT) scan-diagnostic
X-ray
Several “yes” would have done/will do screeningAll should be screened, especially if one smokesMany never heard of lung cancer screeningSmoking is blamed more than it causesWhat does pack years mean?Certain age should be screened
BiopsyPET scanBone scanUltrasoundCT causes cancer- doc told me thatMining adds riskEastern KY highest rate of lung cancerCenters of Disease Control and Prevention (CDC) making screening standardCough blood to be screenedNo screening- up to the Lord when time is up
Should be for young folks“Cancer” scary wordWilling to have LDCT after education session?Yes-several of all groupsDoctors are out for moneyGo to doc to get it/Why wouldn’t doctor order it?Two in one group (Lord will decide)One in another group “will think about it”Need to cough blood to have it?Coals miners and smokers should be testedMessage content:“Based on what you heard today, what is the most important message that needs to be relayed to encourage you to be screened for lung cancer?”
Early detection/catch it early has a better outcome Prevention
Cost/Insurance should pay for itTreatment availablePeace of mindHigh risk- it is worth itQuit smokingAgeBreathing is badNot going to hurtPicture of scanDo good once you have itJust need to ask for itFor your familyScreening availableGoing to die
Emphasize “low dose”
Black lung vs. Cancer-confusion
What if you do not want to know?
Message appeals
“What things will resonate with folks in terms of what benefits them or what they get out of it?”
See someone with lung cancer; testimony; TV visual
Link to family; grandparents want to see kids grow up
Cost issues/Free exams
Going to die/Increased survival
Fear to know/denial-barrier
Know symptoms
Feel better if you knew
Message design and implementation
“If you were designing an ad about lung cancer screening, what things about the ad would make it trustworthy, engaging, and relevant to you?”
Testimony, saved by screening
“Those TV visuals”
Link to family
Scare tactic don’t work; Too visual not good
Statistics of benefit; Facts
Simple message
Picture in ad
Picture of healthy lung and bad lung
All can get it
Young people should be the focus
Love yourself; Your life is important
Cost important
Family history of lung cancer
Message sources
“What or who would you suggest would be the best way to deliver the message that would be considered trustworthy and relevant?”
Family doc(tor)
Testimony; See visual
Heart doc(tor); Specialists
During annual exams
Insurance (Health) who cover screening should directly send info
Markey Cancer Center
Avoid company doc(tors); radiologists reading scans
Hospital
Church
Media 50/50 trustworthy
Many do not have computers
Message communication channels
“What channels or ways are best to get the message or advertise it?”
Doctor offices and exam rooms- place flyers and information
Medical provider; During annual exam
Internet, Google, Bing
Flyer in grocery store (Walmart, Food City, Lowes)
Commercials/TV
Mayo clinic.com
WebMD
Direct mail
Newspaper advertisement; insert story
Radio
Community meetings
Billboard
Employers/Businesses
Health Department
Mobile unit
Talk shows
Library
Word of mouth
Cancer Society
To high schools; get them young
Advertisement
No computer
Facebook
Slide1717
Cumulative
Terminate Lung Cancer Focus Group Results (54 participants)
Domains
Utterances and summative responses
Assess
baseline
understanding regarding lung cancer screening
Breathing test is screening for lung cancer
Computed Tomography (CT) scan-diagnostic
X-ray
Several “yes” would have done/will do screeningAll should be screened, especially if one smokesMany never heard of lung cancer screeningSmoking is blamed more than it causesWhat does pack years mean?Certain age should be screened
BiopsyPET scanBone scanUltrasoundCT causes cancer- doc told me thatMining adds riskEastern KY highest rate of lung cancerCenters of Disease Control and Prevention (CDC) making screening standardCough blood to be screenedNo screening- up to the Lord when time is up
Should be for young folks“Cancer” scary wordWilling to have LDCT after education session?Yes-several of all groupsDoctors are out for moneyGo to doc to get it/Why wouldn’t doctor order it?Two in one group (Lord will decide)One in another group “will think about it”Need to cough blood to have it?Coals miners and smokers should be testedMessage content:“Based on what you heard today, what is the most important message that needs to be relayed to encourage you to be screened for lung cancer?”
Early detection/catch it early has a better outcome Prevention
Cost/Insurance should pay for itTreatment availablePeace of mindHigh risk- it is worth itQuit smokingAgeBreathing is badNot going to hurtPicture of scanDo good once you have itJust need to ask for itFor your familyScreening availableGoing to die
Emphasize “low dose”
Black lung vs. Cancer-confusion
What if you do not want to know?
Message appeals
“What things will resonate with folks in terms of what benefits them or what they get out of it?”
See someone with lung cancer; testimony; TV visual
Link to family; grandparents want to see kids grow up
Cost issues/Free exams
Going to die/Increased survival
Fear to know/denial-barrier
Know symptoms
Feel better if you knew
Message design and implementation
“If you were designing an ad about lung cancer screening, what things about the ad would make it trustworthy, engaging, and relevant to you?”
Testimony, saved by screening
“Those TV visuals”
Link to family
Scare tactic don’t work; Too visual not good
Statistics of benefit; Facts
Simple message
Picture in ad
Picture of healthy lung and bad lung
All can get it
Young people should be the focus
Love yourself; Your life is important
Cost important
Family history of lung cancer
Message sources
“What or who would you suggest would be the best way to deliver the message that would be considered trustworthy and relevant?”
Family doc(tor)
Testimony; See visual
Heart doc(tor); Specialists
During annual exams
Insurance (Health) who cover screening should directly send info
Markey Cancer Center
Avoid company doc(tors); radiologists reading scans
Hospital
Church
Media 50/50 trustworthy
Many do not have computers
Message communication channels
“What channels or ways are best to get the message or advertise it?”
Doctor offices and exam rooms- place flyers and information
Medical provider; During annual exam
Internet, Google, Bing
Flyer in grocery store (Walmart, Food City, Lowes)
Commercials/TV
Mayo clinic.com
WebMD
Direct mail
Newspaper advertisement; insert story
Radio
Community meetings
Billboard
Employers/Businesses
Health Department
Mobile unit
Talk shows
Library
Word of mouth
Cancer Society
To high schools; get them young
Advertisement
No computer
Facebook
Slide1818
Cumulative
Terminate Lung Cancer Focus Group Results (54 participants)
Domains
Utterances and summative responses
Assess
baseline
understanding regarding lung cancer screening
Breathing test is screening for lung cancer
Computed Tomography (CT) scan-diagnostic
X-ray
Several “yes” would have done/will do screeningAll should be screened, especially if one smokesMany never heard of lung cancer screeningSmoking is blamed more than it causesWhat does pack years mean?Certain age should be screened
BiopsyPET scanBone scanUltrasoundCT causes cancer- doc told me thatMining adds riskEastern KY highest rate of lung cancerCenters of Disease Control and Prevention (CDC) making screening standardCough blood to be screenedNo screening- up to the Lord when time is up
Should be for young folks“Cancer” scary wordWilling to have LDCT after education session?Yes-several of all groupsDoctors are out for moneyGo to doc to get it/Why wouldn’t doctor order it?Two in one group (Lord will decide)One in another group “will think about it”Need to cough blood to have it?Coals miners and smokers should be testedMessage content:“Based on what you heard today, what is the most important message that needs to be relayed to encourage you to be screened for lung cancer?”
Early detection/catch it early has a better outcome Prevention
Cost/Insurance should pay for itTreatment availablePeace of mindHigh risk- it is worth itQuit smokingAgeBreathing is badNot going to hurtPicture of scanDo good once you have itJust need to ask for itFor your familyScreening availableGoing to die
Emphasize “low dose”
Black lung vs. Cancer-confusion
What if you do not want to know?
Message appeals
“What things will resonate with folks in terms of what benefits them or what they get out of it?”
See someone with lung cancer; testimony; TV visual
Link to family; grandparents want to see kids grow up
Cost issues/Free exams
Going to die/Increased survival
Fear to know/denial-barrier
Know symptoms
Feel better if you knew
Message design and implementation
“If you were designing an ad about lung cancer screening, what things about the ad would make it trustworthy, engaging, and relevant to you?”
Testimony, saved by screening
“Those TV visuals”
Link to family
Scare tactic don’t work; Too visual not good
Statistics of benefit; Facts
Simple message
Picture in ad
Picture of healthy lung and bad lung
All can get it
Young people should be the focus
Love yourself; Your life is important
Cost important
Family history of lung cancer
Message sources
“What or who would you suggest would be the best way to deliver the message that would be considered trustworthy and relevant?”
Family doc(tor)
Testimony; See visual
Heart doc(tor); Specialists
During annual exams
Insurance (Health) who cover screening should directly send info
Markey Cancer Center
Avoid company doc(tors); radiologists reading scans
Hospital
Church
Media 50/50 trustworthy
Many do not have computers
Message communication channels
“What channels or ways are best to get the message or advertise it?”
Doctor offices and exam rooms- place flyers and information
Medical provider; During annual exam
Internet, Google, Bing
Flyer in grocery store (Walmart, Food City, Lowes)
Commercials/TV
Mayo clinic.com
WebMD
Direct mail
Newspaper advertisement; insert story
Radio
Community meetings
Billboard
Employers/Businesses
Health Department
Mobile unit
Talk shows
Library
Word of mouth
Cancer Society
To high schools; get them young
Advertisement
No computer
Facebook
Slide1919
Slide2020
Slide21Campaign
WebsiteGuidelines, CMS/USPSTF Crosswalk, and SDM disseminated to 450+ providers in interventions regions2nd letter to the same 450+ providers marketing website and roundtable events
Morehead roundtable event64,000 post cards printed- being disseminated to 60+ primary care office, Ag extension offices, and health departments in the intervention regionsAds running every 2 –weeks in 17 community newspapers
Morehead region NPR- ads twice daily for 6-monthsHazard region working with 2 radio stations to also have adsWalMart, FoodCity, Lowes corporate office said “NO”
-CARRY OVER FUNDS>>?direct mailers
21
Slide22Value-added to the Community
>85% of budget to Eastern KY
$10,000 Campaign
Awareness dissemination
Patient voice-inform other campaigns
22
Slide23Next steps
In process of campaign implementationLDCT ratesRandom phone surveys23
Slide24Thank you!
Questions?Roberto.Cardarelli@uky.edu(859) 323-371124