Compliance with recommended cancer screenings among emergency department patients assessed by college research associates

Study objectives: The goal of this study is to assess the potential need for providing elements of cancer screening among emergency department (ED) patients. The specific objective of the study is to determine the compliance with the American Cancer Societyʹs (ACS) screening recommendations among a group of noncritical patients in an urban, community hospital ED as identified by research associates (RAs). Methods: This study was performed in an urban, community hospital ED. Participant inclusion criteria were adult (≥18 years) nonurgent patients during their ED visit. Patients were excluded from the study if they refused to participate, were judged to be too sick, clinical activities took precedence, or the RA could not communicate with them for any reason, such as language barrier or altered mental status. This was a convenience sample survey performed by RAs, prehealth professions college students. They served as case finders and data collectors during one 4-hour shift per week in the ED for an academic semester. There was no attempt at sampling; RAs were simply encouraged to approach and enroll as many adult patients as possible. The numbers of patients approached and subjects entered by each RA were included in their letter of evaluation. Following a scripted introduction, the following data were collected for each patient: (1) age, sex, and ethnicity; (2) whether he or she had a primary care practitioner (PCP) and location and timing of their latest visit; (3) compliance with ACS screening recommendations for oral, skin, cervical, breast (self-breast examination, clinical breast examination, mammography), colon-rectal (fecal occult blood test + sigmoidoscopy or colonoscopy), and prostate cancer (digital rectal examination, prostate-specific antigen) examinations. To be compliant with ACS recommendation, patients who were 40 years or older or female patients 18 years or older should have seen their PCP or appropriate specialist for screening yearly. Males between 20 and 39 years need a visit every 3 years for cancer screening to be compliant. No identifying information was collected. According to the institutional review board, informed consent was not required in this study under the survey exception. Results: Twenty-five RAs covered 60% of possible shifts during 8 weeks in the summer semester, 2003. Two thousand four hundred three patients were approached, and 1,574 patients (66%) were enrolled. Patientsʹ average age was 49.8 years (range 18 to 97 years); 46% of patients were male and 54% were female; 58% of patients were white, 21% were black, 17% were Hispanic, and 3% were other. A PCP was identified by 82% (male patients 72%, female patients 89%; white patients 88%, black patients 76%, Hispanic patients 70%). Forty-nine percent of patients said they had seen their PCP within 1 month, 31% within 6 months, 12% within 1 year, and 4% within 3 years. Stated compliance for cancer screening was oral 35%, skin 21%, Papanicolaou test 59%, breast self-examination 41%, clinical breast examination 63%, mammography 59%, colon-rectal 57%, digital rectal examination 51%, and prostate-specific antigen discussion 41%. Only 9% indicated they were in compliance with the interval for all their appropriate cancer screenings. Conclusion: RAs identified a large number of patients who indicated they were noncompliant with ACS-recommended cancer screenings among nonurgent ED patients. EDs can be an important venue for detecting persons in need of cancer screening.