Barriers and facilitators to involvement in cancer education opportunities among South Carolina cancer care professionals: A cancer training and diversity, equity, and inclusion training needs assessment.

INTRODUCTION: It is estimated that 1.9 million new cases of cancer will be diagnosed in 2023, with 33,890 occurring in South Carolina. Assessing the needs, barriers, and facilitators of healthcare professionals' (HCP) education in South Carolina is a step towards creating meaningful, equity-promoting cancer-based education/training. METHODS: We developed a mixed-methods REDCap survey instrument to assess HCP needs, which we disseminated via email to HCPs from divisions involved in cancer care in a South Carolina academic medical center health system. We analyzed quantitative data with univariate frequency analysis and employed an inductive content analysis approach for qualitative data. RESULTS: The response rate for the survey was 33.0% (95/284) and 44.2% (42/95) of respondents reported a perceived barrier to attending educational programming, with majority citing time. Most respondents (71.8%) self-identified as non-Hispanic White. HCPs reported having clear interests in trainings, particularly ones focused on additional training in diversity, equity, and inclusion (DEI). Other identified educational needs included cancer treatment updates, nutrition, mental health, and social risk factors. Receiving credits for the trainings was a motivator for both general topics and DEI topics (94.7% and 74.7%, respectively). CONCLUSIONS: There is a need to better align cancer education delivery for HCPs with their training needs and busy schedules as has been a demonstrated want by HCPs in topics that would increase knowledge and practice of DEI. As majority of respondents identified as non-Latine White, it is imperative to diversify the knowledge of the workforce to ensure that HCPs provide optimal care to patients from diverse backgrounds.

Development of an Electronic Health Record Self-Referral Tool for Lung Cancer Screening: One-Group Posttest Study.

BACKGROUND: Approximately 14 million individuals in the United States are eligible for lung cancer screening (LCS), but only 5.8% completed screening in 2021. Given the low uptake despite the potential great health benefit of LCS, interventions aimed at increasing uptake are warranted. The use of a patient-facing electronic health record (EHR) patient portal direct messaging tool offers a new opportunity to both engage eligible patients in preventative screening and provide a unique referral pathway for tobacco treatment. OBJECTIVE: This study sought to develop and pilot an EHR patient-facing self-referral tool for an established LCS program in an academic medical center. METHODS: Guided by constructs of the Health Belief Model associated with LCS uptake (eg, knowledge and self-efficacy), formative development of an EHR-delivered engagement message, infographic, and self-referring survey was conducted. The survey submits eligible self-reported patient information to a scheduler for the LCS program. The materials were pretested using an interviewer-administered mixed methods survey captured through venue-day-time sampling in 5 network-affiliated pulmonology clinics. Materials were then integrated into the secure patient messaging feature in the EHR system. Next, a one-group posttest quality improvement pilot test was conducted. RESULTS: A total of 17 individuals presenting for lung screening shared-decision visits completed the pretest survey. More than half were newly referred for LCS (n=10, 60%), and the remaining were returning patients. When asked if they would use a self-referring tool through their EHR messaging portal, 94% (n=16) reported yes. In it, 15 participants provided oral feedback that led to refinement in the tool and infographic prior to pilot-testing. When the initial application of the tool was sent to a convenience sample of 150 random patients, 13% (n=20) opened the self-referring survey. Of the 20 who completed the pilot survey, 45% (n=9) were eligible for LCS based on self-reported smoking data. A total of 3 self-referring individuals scheduled an LCS. CONCLUSIONS: Pretest and initial application data suggest this tool is a positive stimulus to trigger the decision-making process to engage in a self-referral process to LCS among eligible patients. This self-referral tool may increase the number of patients engaging in LCS and could also be used to aid in self-referral to other preventative health screenings. This tool has implications for clinical practice. Tobacco treatment clinical services or health care systems should consider using EHR messaging for LCS self-referral. This approach may be cost-effective to improve LCS engagement and uptake. Additional referral pathways could be built into this EHR tool to not only refer patients who currently smoke to LCS but also simultaneously trigger a referral to clinical tobacco treatment.

Results from the Delivery of a Community Health Worker Training to Advance Competencies in Cancer Genomics.

INTRODUCTION: Less than half of eligible Black women are assessed for genetic risk and only 28% engage in recommended hereditary breast and ovarian cancer (HBOC) risk-reducing interventions. CHWs are trusted individuals that work as a liaison between health systems and the community to improve access to services and support cancer prevention efforts, though they are an overlooked resource to support genetic risk assessment. To address the need and training gaps for CHWs, we developed and assessed an online training program to build CHW's competencies in cancer genomics and use of health information technologies to navigate high-risk individuals to appropriate genetic services. METHODS: The curriculum and 10 training modules were developed through engaging a panel of experts in a three-round Delphi process. Recruitment focused on CHWs who worked in clinical settings or groups providing outreach or health services to Black women. We assessed: changes in knowledge and attitudes about HBOC and genomics, as well as the perceptions about the quality and implementation of the training. RESULTS: Forty-six individuals expressed interest in the training after recruitment. Thirty eight individuals were eligible for the training and 26 completed the course. We found improvements in knowledge and genomics competencies immediately post-course, but the majority of these improvements were not sustained at 3-month follow-up. The training was highly rated for its relevance to CHW work and overall delivery. Top rated sessions included HBOC overview and family history collection. On average, participants reported discussing HBOC with 17 individuals at 3-month follow-up. CONCLUSION: Championing a diverse cancer and genomics workforce can help address the goals of the National Cancer Plan to improve early detection and health equity. Through this training, CHWs gained critical cancer and genomics knowledge that was then applied to their primary roles.