Campaigns that Used the Cancer Awareness Measure (CAM)

Campaigns that Used the Cancer Awareness Measure (CAM)

          The British Journal of Cancer published two research studies that used the CAM to increase   cancer awareness among patients (Niksic et al., 2016; Power & Wardle, 2015). A study completed by Power and Wardle (2015) used a campaign to raise cancer awareness by promoting early presentation of potential cancer symptoms by giving patients information of symptoms of which they should be aware. The results increased the public awareness of some key symptoms of bowel cancer.  Niksic et al. (2016) used a campaign to raise cancer awareness by encouraging early testing to patients in England.  The study aimed to determine whether people with low cancer awareness and barriers to seeking medical help have a worse cancer survival rate.  The results showed that awareness of cancer symptoms and cancer survival are associated.  Campaigns should focus on improving cancer awareness through education.

Focus Group Using Digital Storytelling and Video

              An exciting and innovative way of learning is through digital education.  Patients today are more technologically savvy than in the past because they seek information about their healthcare through the internet, social media, and YouTube.  These may not be the best places to find the correct information, but providers have found that audiovisual media attracts and holds the attention of the patient (Cueva et al., 2016; Davis et al., 2017).  A random controlled trial by Cueva et al. (2016) combined the traditional way of oral and computer-based technology to engage patients by passing on information and telling stories.  The new technology uses a person’s voice with pictures and music to make short movies.  Short movies were created as part of educational messages for a cancer education course.  Facilitators guided stories that focused on messages related to cancer (Cueva et al., 2016).  Participants were able to create their own personal story, relaying factual information about their experience. Participants discussed their experience with the groups and the groups asked questions.  The participants offered feedback, which enhanced learning from those in the groups.  The digital stories utilized all of the senses for learning.  Pictures and words draw the participant into the story and the participant does not realize that they are learning.  Digital stories helped change the participants’ behavioral intentions.  

A multicomponent low literacy intervention was completed by Davis et al. (2017) that used a photonovella/versatile digital disk to educate patients about colorectal cancer.  Photonovella involves the use of a digital camera and is commonly used for participants with low literacy levels or children because topics are discussed and documented in patients’ own words, as they see them.  This education allows patients to relate to topics and the material that is being discussed more easily (Cueva et al., 2016; Davis et al., 2017).

Group education and storytelling could be a good way of learning for patients that like sharing and hearing the experiences of other patients.  In group sessions, patients volunteered to talk about their experiences undergoing a colonoscopy and discussing the reasons behind deciding to have the colorectal procedure (Cueva et al., 2016; Davis et al., 2017).  Patients that volunteered to facilitate the storytelling were trained in colorectal cancer facts and spoke about their experiences with facts and myths, which offered a sense of comfort to those in the groups (Cueva et al., 2016).  Patients identified and engaged with one another by sharing their fears or concerns about undergoing the colonoscopy.  Often, patients trusted another patient before they believed the provider.  Some patients realized that they had some of the same fears as the speaker.  Patient volunteers were honest about the experience regarding the prep, the invasiveness, or pain the patient may experience (Cueva et al., 2016).  Patients were encouraged to ask questions throughout the educational group, which decreased fears or barriers. Group participation was used to dispel myths and to reinforce the correct information. As a result of the digital storytelling format, participants stated that they had an increased understanding of the cancer information given (Cueva et al., 2016; Davis et al., 2017).

Decisional Aids

Two randomized controlled studies used decisional aids, such as educational booklets, digital video disc (DVDs), or interactive tools, to assist patients in increasing their knowledge about colorectal cancer (Hoffman et al., 2017; Kirkegaad et al., 2015).  A study done by Kirkegaad et al. (2015) employed focus groups with participants with low educational attainment.  The groups included men and women aged 50-74 and each group had ten participants.  Two researchers moderated the groups; sessions were broken into two parts with each part lasting about two hours.  The first part focused on participants’ perceptions of screenings, individual attitudes, knowledge about colorectal cancer, and individually perceived risk of getting colorectal cancer.  The second part of the study used a decisional aid that was discussed by the participants.  After using the decisional aid, the participants were asked if the decisional aid changed their perceptions about colorectal cancer.  The results that patients reported was that the decisional aid was presented in a clear and simple way.  The decisional aid was helpful to patients by helping them clearly understand the risks of colorectal cancer.

The second study was completed by Hoffman et al. (2017), in which 89 participants were randomized to view a culturally tailored decisional aid video about colorectal cancer.  Viewing of the video increased African Americans’ knowledge of colorectal cancer.  After three months, 23% of the participants had completed a colonoscopy. The study reported that 20% of the participants reported having increased knowledge about colorectal cancer.

Daly, Xu, and Levy (2014) used a three-dimensional colon model with polyps to educate patients about colorectal cancer in their study.  One hundred and seventeen healthcare providers received the colon model to use in the office.  The staff of 36 offices reported that they had used the model in the office for education before patients had a colonoscopy.  Physicians agreed that anatomical models are good instruments to use for patient education.  The physicians felt that the design of the model was good and that it facilitated effective demonstration of the colon and polyps.

Lay Health Educators

Lay health educators (LHE) were used to increase colorectal screening rates in a randomized controlled study (Tong et al., 2017).  There were three hundred and twenty-nine participants.  The participants were divided into two groups, an intervention group and the control group.  Over a three-month period, the intervention group received colorectal cancer education.  The control group received education regarding nutrition and physical activity delivered by the health educator.  The results indicated that a culturally appropriate approach to an educational intervention delivered by the LHE increased CRC screenings in the population tested.

Another randomized control trial using LHE to educate patients using printed materials was completed by Jo et al. (2017). The intervention used LHE’s to contact patients to make sure that they understood the information that they received and provided education about the materials.  After post-intervention surveys were completed, the results suggested that the outreach by the LHE to the patients yielded greater knowledge about colorectal cancer.

Focus Group

In two articles, the researchers used focus groups to educate the participants on colorectal screenings (Cooper & Geib, 2016; Crookes, Njoku, Rodriguez, Mendez, & Jandorf, 2014).  The Centers for Disease Control (CDC) used focus groups to promote the Prevention’s Screen for Life campaign (Cooper & Geib, 2016).  The groups for the CDC were structured differently in that the CDC asked participants at the beginning of each group what they knew about colorectal cancer and if they could identify the risk factors.  Participants were asked if they were due for colorectal screening and why they had not scheduled an appointment.  The directness was deliberate to let the participants know early the seriousness of the education that would be presented.  Professional moderators facilitated semi-structured discussions and educated patients. The researcher found that many participants lacked awareness of alternative screenings and general cancer knowledge, but they gained knowledge by watching the movies and asking questions.   Similar to the study by Cooper and Geib (2016), determining a patient’s awareness, barriers, or fears is critical to determining a patient’s willingness to get screened (Crookes, Njoku, Rodriguez, Mendez, & Jandorf, 2014).  Crookes et al. (2014) performed a randomized controlled trial using group education for two targeted groups whose colorectal screening rates remain low. The groups were divided into two different cultural groups, Blacks and Latinos.  Education about screening, peer testimony, and pre- and post- knowledge tests were given in one-hour sessions.  From 2010-2012, 66 education programs were provided, with 1,065 participants. The mean knowledge score related to understanding colorectal cancer and colorectal screenings showed a significant increase.  Sixty-eight percent of the participants who had not had a prior colonoscopy reported that they intended to get a colonoscopy due to the program.

Printed Education

Three different research trials showed that using printed educational materials can offer different educational learning experiences through both factual gist-based information (Cueva, Cueva, Dignan, & Landis 2016; Smith et al., 2015; Weyl et al., 2015).  In a random controlled trial completed by Cueva et al. (2016), booklets were used to educated Alaskan natives about cancer screening exams.  The booklets used native cultural values and were designed to connect with the readers and to communicate factual medical information in a culturally respectful way.  The booklets reached readers at a physician’s office and encouraged them to read the booklet to raise awareness.  Organizers felt that the booklets were a good way to discuss, receive, and disseminate cancer screenings among Alaskan Natives.  Booklets had the necessary language for patients to make informed choices and included information that supported living well and encouraged decision making choices.  Booklets contained accurate risk reduction information as well as information about cancer screenings.  Surveys were taken to assess the knowledge that patients received from the booklets.  Feedback came from cancer survivors, in-person training, and health education training.  One hundred percent of the patients that read the booklets reported that they liked the booklet.  Ninety-six percent of the patients reported learning about cancer and 82 people felt that the booklet supported their patients reported learning about cancer and 82 people felt that the booklet supported their learning.  Ninety percent reported that the books were helpful, 87% reported that the books were easy to understand, and 84% reported that their knowledge was increased by reading the booklet (Cueva, Cueva, Dignan, & Landis, 2016).  Over 20,000 booklets had been distributed since 2010 to people throughout the United States.

Gist-based education is another form of printed educational material that gives patients just the facts, which are broken down and direct in easy-to-read, self-explanatory words.  Some patients like the gist form of information because the information is less technical and is written in a way that they understand best (Smith et al., 2015).  A randomized controlled trial was performed by Smith et al. (2015) using two control groups.  One group received standard information regarding colorectal cancer and the second group received standard information plus the gist plus the facts.  The study ran from July 2012 to March 2013 with 2,216 participants in the facts group and 2,236 participants in the gist plus facts group.  Overall, the study showed that the gist plus facts group had a higher knowledge base regarding colorectal cancer knowledge.

A quasi-experimental study was completed by Weyl et al. (2015) to evaluate the efficacy of mailed educational materials to patients who were in need of colorectal screening.  One hundred and sixty-seven patients participated in the study which consisted of them receiving educational materials educating them on colorectal cancer post-discharge from the hospital.  Semi-structured telephone calls were conducted to identify factors that influence colorectal cancer screening rates.  The findings showed that slightly more patients who remembered receiving educational materials in the mail completed the screening.

Beliefs and Barriers

Studies by Arnold, Rademaker, Liu, and Davis (2017), Basch, Basch, Zybert, and Wolf (2016), and Ely, Levy, Daly, and Xu (2015) examined patient barriers and fears for refusing colorectal screening and how education was used to address those fears.  The researchers for all studies realized that identifying and addressing barriers to colorectal cancer can and will save lives but determining there is a barrier and identifying the barriers then educating patients about on the barriers can be challenging.  Basch, Basch, Zybert, and Wolf (2016) performed a randomized controlled trial to assess how well educational interventions promoted colorectal cancer screenings.  Baseline surveys were conducted by telephone between February 2011 and December 2012 in which barriers were assessed with a series of questions.  Results found that the number one reason cited for not getting screened was being afraid of the procedure.  There was a wide range of patient fears, but the results showed an increase from the baseline presurvey to the post-survey in a decrease of the barriers.

Ely, Levy, Daly, and Xu (2015) ran a clinical trial for 641 subjects in 2008 using pre- and post-surveys.  Participants were randomized into four groups.  Educational materials and a follow up questionnaire were completed by two of the groups.  Interventions increased starting with usual care, physician chart reminders, a mailing list to include educational information, and the same mailings plus a phone call encouraging screening.  After identifying barriers and receiving education, patients’ beliefs changed in a favorable direction about CRS.

Health literacy was believed to be a barrier for the lack of colorectal cancer in a study completed by Arnold, Rademaker, Liu, and Davis (2017).  Pre- and post-survey assessments were given after education to assess the effectiveness of a health literacy intervention. Participants were reported to have positive attitudes toward screenings with an 83% screening completion rate among the participants.

Multiple Alternative Approaches to Education

Researchers in several studies used multiple alternative approaches to determine if patients learned more using different methods (Basch et al.2015: Briant et al., 2015; Cauresma et al., 2018; Chiu, Hung, Lin, & Chen, 2016; Jo et al.,2017; Rawl et al., 2015).  A randomized controlled trial completed by Basch et al. (2015) explored using alternative education interventions to increase CRS between 2011 and 2013.  Participants in separated groups received one of three different types of an educational intervention about colorectal cancer.  Data showed that screening results were higher for the group that received telephone education along with the printed education, suggesting the importance of verbally educating patients.

A randomized controlled trial from 2012 to 2015 by Cauresma et al. (2018) used educational sessions, telephone follow-up calls, and brochures to educate patients on colorectal cancer screenings.  A total of 304 participants completed pre- and post-surveys to assess their knowledge before and after the interventions.  Surveys found that overall, colorectal cancer knowledge had increased but many barriers as to why patients do not get screened for colorectal cancer existed and suggested that more education is given to patients to help overcome those fears.  Education over a longer period may be needed as well as innovative treatment strategies to get people with busy schedules into the doctor’s office (Cauresma et al., 2018).

A study of a four-week educational program that included an information session, follow-up calls, and telephone counseling was completed by Chiu, Hung, Lin, and Chen (2016) between 2014 and 2015.  Chiu et al. (2016) completed a randomized controlled trial to evaluate if patients could be educated about colon cancer using health education and a telephone counseling program.  Health education raised patients’ awareness about their health and gave them the knowledge to make decisions.  Reducing anxiety, reducing health-related risk factors, increasing knowledge, and increasing involvement in one’s health care was what the telephone counseling by professionals aimed to do.  Patients were called and educated with evidence-based facts about colon rectal cancer. Chiu et al. (2016) concluded that patients make better decisions regarding screenings when they have better knowledge about colorectal cancer.  The results of the study showed that the experimental group had significantly better knowledge about colorectal cancer.  The health education and telephone counseling were an easy way of improving knowledge and improving attitudes about cancer.

A randomized controlled trial completed by Rawl et al. (2015) used telephone counseling plus brochures versus non-tailored print brochures in an attempt to increase colorectal screening.  Data were collected at baseline and three months post-intervention.  Patients received a tailored education based on their perceived risks.  Results showed that the groups that received brochures along with tailored education had higher percentages or increased knowledge about colorectal screening.

A study by Jo et al. (2017) used a two-arm cluster randomized controlled trial to assess the use of a printed brochure versus a printed brochure plus lay health educators’ outreach.  There were 348 participants recruited, 50 to 75 years of age.  At six months post-intervention, the group that used the brochure plus the LHE had a greater increase in reported knowledge.

A randomized trial completed at a health fair by Briant et al. (2015) used two methods to increase colorectal cancer knowledge to participants at a health fair.  The first method used a health educator to provide colorectal cancer information at a booth.  The second method was to provide a tour through a large inflatable walk-through colon model with depictions of polyps, colorectal cancer, and healthy tissue.  Pre- and post-tests were used to look for changes in knowledge about colorectal screening before and after participating in the health fair.  There were 273 participants at the health fair, and the results were that the inflated colon was an innovative way for participants to remember what they learned about colorectal cancer.  Overall, the group that used the inflatable colon had higher knowledge at post-test than participants that received education at the booth.

All of these studies demonstrate that using multiple interventions for the education of patients resulted in increased colorectal screening rates.

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