Dr. Raquel Zemtsov and her colleagues were recipients of a 2018 AHNS Community Service Award. Five awards of $1000 each are awarded annually by the AHNS Cancer Prevention Service.
Because we were fortunate to receive the American Head and Neck Society Community Service Award, the University of Cincinnati Head and Neck Cancer team was able to provide resources to our head and neck cancer screening attendees that aided in their follow-up. This grant enabled us to gain important information on factors that impact follow-up for patients who have difficulty accessing health care. Grant money was used to fund a screening-specific patient navigator who identified barriers to follow-up and provided targeted, individualized interventions. One such intervention was to provide bus passes to patients which the grant made possible. Our data demonstrated that the presence of a patient navigator significantly increased follow-up compared to other screenings where such a role was not present (p=0.0026). Copyright to a literacy tool was purchased using grant funding to allow our team to define the health literacy of populations at different screening sites, allowing us to better understand the needs of the patients we are serving.
For instance, our data demonstrated that health screening attendees at a public park compared to those screened in a healthcare setting had, on average, graded scores lower than a high-school grade reading level (p=0.008) and more individuals with marginal or inadequate health literacy (p=0.04). Those individuals in the park also had lower follow-up rates despite provision of the same resources (p=0.015). Further, of patients with a literacy barrier, only 20% followed-up.
Seeing the variance in health literacy and the impact it can have on follow-up, we investigated the reading level of the patient education materials disseminated at our screenings. The average grade-reading level was found to be 13.0, or that of a freshman in college. The National Institutes of Health recommends patient education materials be printed at or below a 6th grade reading level1. The remaining funds of the grant helped to cover printing costs of an informational pamphlet about head and neck cancer at a more appropriate reading level to reach a broader population. These pamphlets that provide general information about head and neck cancer is printed below a 6th grade reading level and will be distributed at both future screening events and our head and neck cancer clinic.
We were able to identify other barriers aside from literacy that affected follow-up. Limited knowledge regarding head and neck cancer, limited access to transportation, limited access to a telephone, and being a caregiver for another individual with health needs were found to impede individuals’ abilities to seek appropriate follow-up care. For instance, half of the patients who initially were not going to make follow-up due to misconceptions regarding head and neck cancer, education following the screening motivated them to make and attend appointments.
The information we have garnered from our screenings facilitated by the AHNS Community Service Award will help us provide more appropriate patient education materials and tools to facilitate recommended follow-up at our future screening events. This experience has also facilitated important discussions and projects regarding access and patient education at our institution outside of head and neck cancer screenings. Our next steps include incorporating patient navigators more consistently at screening events and editing our other educational materials to be at appropriate grade-reading levels.