Enhancing Colon Cancer Screening in Homeless Populations: Educating Providers on Patient Barriers

Abstract

Purpose: This quality improvement project aimed to increase provider knowledge of the barriers and challenges homeless individuals face in accessing colorectal cancer (CRC) screening and determine if primary care providers’ understanding of this issue would influence their willingness to conduct CRC screening with this population. Background: In the United States (US), CRC is the third most common and the second most fatal cancer in men and women. CRC screening reduces morbidity and mortality by 60%. However, the national CRC screening ranges from 9.5% to 18.8% of the homeless population. To improve this disparity, continuing education of providers on the barriers and challenges homeless individuals face in accessing CRC screening is necessary. Methods: Guided by the Model for Improvement, participants completed online education that included a pretest, an educational video, and a posttest. The pretest was administered to assess the providers’ knowledge of homeless patients’ unique challenges. It included questions about providers’ attitudes toward performing CRC screenings for homeless patients. The educational video delivered targeted education to healthcare providers, emphasizing the barriers to CRC screening this patient population faces. The posttest assessed the providers’ understanding of this issue and willingness to provide CRC screening. Results: Two primary care providers from different locations at a community health center completed the educational video and the retrospective pretest and posttest. Following the education, all providers expressed a greater willingness to perform CRC screening for individuals experiencing homelessness. However, only 50% of the providers successfully completed all components of the educational intervention. While the providers’ responses to other outcome measures were favorable, the median changes in the Likert scale scores were modest. Conclusions: The online education provided increased primary care providers’ willingness to conduct CRC screening for homeless patients. The providers reported an increased understanding of the barriers to CRC screening faced by homeless patients and felt better equipped to address these barriers. However, the changes in median scores for all outcomes were modest, the sample size was small, and 50% of providers did not complete all aspects of the educational intervention, raising questions about the effectiveness of the education and underscoring the need for additional educational efforts.