Prevalence of Shared Decision-making in Prostate Cancer Screening in New York State.

Current guidelines recommend that physicians use a shared decision-making (SDM) approach to engage with patients on the potential benefits and harms of prostate cancer screening based on their individual risk. In a sample of 4,118 men aged 55-69 from the 2018 New York State Behavioral Risk Factor Surveillance Survey (BRFSS), we compared the frequency of screening recommendations and SDM conversations according to four race/ethnic groups. In logistic regression, we evaluated the likelihood of SDM conversations between race/ethnic groups. Our findings suggest that the odds of never having a SDM conversation with their healthcare provider were significantly higher among Hispanic men (OR 95% CI: 2.10, 1.11-3.99) and other/multiracial men (OR, 95% CI: 3.08, 1.46-6.52) compared to white men, while black men had comparable odds (1.52, 0.98-2.34). The lower frequency of SDM conversation among Hispanic and other/multiracial men suggest a missed opportunity for healthcare providers to guide informed screening decisions.

Developing a Novel Interactive Colorectal Cancer Educational Session for First-Year Medical Students to Enhance Interest in Public Health.

Medical students need more exposure to and a greater understanding of their role in public health throughout their training, which may influence more of them to pursue careers in public health or change how they practice medicine in the future. A novel colorectal cancer education session was created for first year medical students to attempt to increase public health interest, improve colorectal cancer knowledge and discuss barriers to colorectal cancer screening. We constructed a novel integrated interactive peer led colorectal cancer educational session of panelists with a wide range of experiences in colorectal cancer and colorectal cancer screening. The session involved a didactic component, case presentation, and group exercises followed by assembly discussion. We surveyed first-year medical students over two consecutive years to assess their interest in public health, knowledge of colorectal cancer, and perceptions of barriers to colorectal cancer screening before and after the educational session. We also evaluated student satisfaction with the session. We compared the pre- and post-survey results to assess for changes in interest, knowledge and perceptions. 74.63% of students in 2018 and 67.7% in 2019 evaluated the session as excellent or good, with knowledge regarding colorectal cancer screening markedly increased after the educational session. Students reported knowledge and access to healthcare among the biggest patient barriers to colorectal cancer screening. Interest in public health increased by 7.5% and 5.6% in 2018 and 2019, respectively. The implementation of this interactive educational peer led exercise can increase interest in public health, improve knowledge of colorectal cancer prevention and facilitate discussions of colorectal cancer screening barriers. We hope to encourage other programs to adopt this preliminary model.

Updates, Controversies, and Emerging Approaches in Colorectal Screening.

Colorectal cancer (CRC) is the third most common cancer worldwide and the second leading cause of cancer-related deaths. Despite the threatening statistics, the US burden for CRC has been decreasing, which is likely multifactorial and has partial contribution from widespread timely screening, more advanced CRC treatment, and daily aspirin use in some patients. While overall death rate from CRC decreased by approximately a half between 1975 and 2012, epidemiologic studies demonstrate that CRC incidence is increasing in the younger population. This pattern has prompted the American Cancer Society (ACS) to revise their guidelines. In this review, we plan to discuss the most recent changes in guidelines, data to support them, controversies concerning CRC screening methods, age to start and to stop screening, and post-colonoscopy/polypectomy surveillance guidelines.

Screening and Treatment of Tobacco Use Disorder in Mental Health Clinics in New York State: Current Status and Potential Next Steps.

The prevalence of smoking is higher among individuals with serious mental illnesses than the general population. Evidence-based practices exist for tobacco cessation, but little is known about mental health clinics' tobacco cessation treatment practices/protocols. Mental health clinics in New York State were surveyed about their tobacco use treatment protocols and outdoor-smoking policies. One-third of clinics were not providing individual counseling for tobacco use disorder, 39% were not prescribing nicotine replacement therapy, and nearly half reported not prescribing bupropion or varenicline. Even smaller proportions reported implementing other clinical practice guidelines, with only 25.2% providing staff training and 20.3% having a dedicated staff member for coordinating tobacco use disorder treatment. Regarding outdoor smoke-free policies, 38% of clinics reported not allowing any tobacco use anywhere on grounds. Despite some successes, many clinics do not provide evidence-based tobacco use treatments, meaning important opportunities exist for mental health clinics and oversight agencies to standardize practices.

Chronic Disease Screening and Prevention Activities in Mental Health Clinics in New York State: Current Practices and Future Opportunities.

To understand mental health clinics' chronic disease screening and prevention activities, we surveyed mental health clinics in New York State regarding 16 preventive services. Both numerical and qualitative data were collected. Responding clinics (123, 24.7%) were most likely to report having up-to-date screening/management of tobacco use (114, 92.7%) and were most likely to refer out for infectious disease and cancer screening (57.7%-62.6%). Compared to private/non-profit clinics, county- and state-operated clinics were more likely to refer out for infectious disease screening and to ensure up-to-date: lipid disorder screening, abnormal glucose screening, HIV screening, and cancer screenings. Clinics reported a need for: (1) hiring more (dedicated) medical staff; (2) providing staff trainings; (3) educating patients; and (4) integrating with patients' primary care providers. Implementing proven approaches-and developing new ones-for enhanced chronic disease prevention activities through improvements in policy, staffing, and reimbursement is warranted in mental health clinics.

Benefits, Cost, and Activities of Patient Navigation (PN) Program for Colorectal Cancer Screening at the Charles B. Wang Community Health Center (CBWCHC).

To evaluate the benefits of a PN program for colorectal cancer (CRC) screening at Charles B. Wang Community Health Center (CBWCHC) in New York City from June 2012 to May 2015, estimate the cost of implementation, and describe time allocation patterns of PN activities. Semi-structured interviews were conducted with key informants of the CBWCHC in 2015. The electronic PN database was used to evaluate the program's effectiveness. New York State Department of Health budgeting and cost data were used to estimate the implementation cost. Self-reported activities of PNs were used to analyze time allocation patterns. A total of 3723 screen-eligible patients were contacted by PNs and 2552 (68.5%) completed at least one CRC screening test. Of these, 266 (10.4%) patients were diagnosed with precancerous polyps and two patients were diagnosed with CRC. The CRC screening rate at CBWCHC increased from 56% to 60% during the program period. The total cost was estimated to be $295,296.51 (in 2014 dollar terms). Overall, this relatively inexpensive CRC screening PN program was effective in increasing CRC screening in a low-income Asian-American community.

Evaluation of patient-focused interventions to promote colorectal cancer screening among new york state medicaid managed care patients.

BACKGROUND: The objective of this study was to evaluate an ongoing initiative to improve colorectal cancer (CRC) screening uptake in the New York State (NYS) Medicaid managed care population. METHODS: Patients aged 50 to 75 years who were not up to date with CRC screening and resided in 2 NYS regions were randomly assigned to 1 of 3 cohorts: no mailed reminder, mailed reminder, and mailed reminder + incentive (in the form of a $25 cash card). Screening prevalence and the costs of the intervention were summarized. RESULTS: In total, 7123 individuals in the Adirondack Region and 10,943 in the Central Region (including the Syracuse metropolitan area) were included. Screening prevalence in the Adirondack Region was 7.2% in the mailed reminder + incentive cohort, 7.0% in the mailed reminder cohort, and 5.8% in the no mailed reminder cohort. In the Central Region, screening prevalence was 7.2% in the mailed reminder cohort, 6.9% in the mailed reminder + incentive cohort, and 6.5% in the no mailed reminder cohort. The cost of implementing interventions in the Central Region was approximately 53% lower than in the Adirondack Region. CONCLUSIONS: Screening uptake was low and did not differ significantly across the 2 regions or within the 3 cohorts. The incentive payment and mailed reminder did not appear to be effective in increasing CRC screening. The total cost of implementation was lower in the Central Region because of efficiencies generated from lessons learned during the first round of implementation in the Adirondack Region. More varied multicomponent interventions may be required to facilitate the completion of CRC screening among Medicaid beneficiaries.

The role of a state health agency in promoting cancer prevention at the community level: examples from New York State.

Cancer is a major cause of morbidity and mortality in the U.S. and more work is needed to decrease the number of new cancer cases and the number of cancer cases diagnosed at a late stage. In New York State, about 106,000 people are diagnosed with cancer each year, 37% of which are diagnosed in adults aged 45-64 years and 55% in those aged ≥65 years. State health agencies are in a unique role to support implementation of cancer prevention strategies at the local level that may have a large impact on the burden of cancer by changing the context in which an individual makes health decisions. The New York State Department of Health, with support through the CDC, is implementing an 18-month cancer prevention demonstration project in two counties aimed at increasing access to nutritious foods, promoting exclusive breastfeeding and decreasing barriers to obtainment of cancer screening. The specific activities being used by the two counties are highlighted, and promising results after the first 6 months of the project are described. Lessons learned from these projects will be reported at regular intervals and used to inform development of larger, statewide initiatives aimed at reducing cancer incidence and death in New York State.