ASPO Abstracts

Authors: Mkuu RS, Staras SA, Szurek SM, Gerend MA, Shenkman EA.

Category: Cancer Health Disparities
Conference Year: 2021

Abstract Body:
Purpose: Screening is credited with significant reductions in cervical cancer mortality. Compared to the general population, people with behavioral health (BH) conditions (e.g., mental illness and substance abuse) receive fewer cervical cancer screenings, are diagnosed at more advanced cancer stages, and are less likely to receive specialized treatment. As a result, people with BH conditions are 30% more likely to die from cancer compared to the general population. Despite the disparities, there is a gap in the literature in identifying unique barriers to cervical cancer screening among people with BH conditions. Moreover, there is a lack of evidence-based interventions to improve cancer screening tailored for adults with BH conditions. Methods: We conducted focus groups with primary care and BH clinicians and staff to examine barriers to cervical cancer screening among their patients with BH conditions to guide the future development of a tailored cervical cancer screening and follow-up intervention. Four focus groups were conducted among 26 clinicians (physicians, advanced practitioners, and nurses) and clinical staff from six clinics in North Florida. A semi-structured approach (surveys and open-ended questions) elicited perspectives about barriers to cervical cancer screening and follow-up among women with BH conditions. Guided by the Consolidated Framework for Implementation Science, thematic analysis was used to analyze verbatim transcripts from audiotaped focus groups. Results: Three major themes emerged as barriers: 1) pre-existing BH conditions and physical health comorbidities (e.g., diabetes) take priority over recommended screening during time-limited clinical visits, 2) women's lack of access to reliable communication such as a consistent mobile phone or internet results in difficulty in reaching women for follow-up, and 3) a lack of a robust systematic process in the clinic's workflow for shared decision making and patient reminders. Conclusion: Findings highlight the need for tailored interventions that address both clinic and patient barriers to cervical cancer screening. Multilevel interventions that address social determinants of health and are sensitive to the patients' BH needs are needed to facilitate follow-up with recommended care.

Keywords: Cervical Cancer Screening, screening, cancer prevention, Behavioral health conditions

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