Tuesday October 10, 2023
Patients who primarily spoke Somali were found to show more willingness to receive a screening for colorectal cancer (CRC) when presented with a video intervention, according to a study published in BMJ Open Quality. Clinic flow was only minimally disrupted by the implementation of this intervention.
Nearly 30% of adults in the United States do not get their appropriate screening for CRC, even as it remains the third leading cause of cancer-related deaths. Patients with limited English proficiency have an even lower screening rate. Somali-speaking patients make up the largest population of non–native English-speaking patients at Mayo Clinic Rochester Internal Medicine Primary Care Clinic, but the smallest percentage of patients receiving screenings for CRC. Providing culturally and linguistically appropriate education might be able to help overcome the disparity. The aim of this study was to develop and implement an educational video for clinic visits for those reluctant to get a CRC screening among patients speaking Somali and its effect on screening rates thereafter.
Screening disparities in CRC were collected retrospectively for all patients aged 50 to 75 years. Although patients aged 45 to 49 years were excluded due to small sample size, they were included in the video implementation cohort. Seventy-five percent of English-speaking patients had completed a screening for CRC compared with 46.3% of Somali-speaking patients. The improvement measure of the study was patients who spoke Somali meeting the United States Preventive Services Task Force guideline for screening in CRC. This was measured by determining if patients were more agreeable to getting the screening. The primary outcome measure was number of screenings ordered for assessing the effectiveness of the video.
A background exploration of the quality gap was conducted, using stakeholder interviews with Somali interpreters from Mayo Clinic and local community health workers. The principles of ensuring baseline understanding of screening, dispelling misconceptions, and emphasizing cultural values were highlighted in a script based on the stakeholder conversations.
The video intervention was shown to all patients who spoke Somali who were eligible for a CRC screening and attending an appointment in the clinic. Patient thoughts on screening for CRC were collected before and after the video was played and a screening scheduled if the patient was agreeable after the video.
The video was shown to 38 patients within 6 months. In the first 3 months after the intervention was implemented, the willingness to have a screening for CRC improved from 36.4% to 100% of patients after the video was shown; overall, 32 of the 38 patients agreed to have a test at the end of the 6-month implementation.
The baseline proportion of screened patients who spoke Somali and were aged 50 to 75 years increased from 46% before the intervention to 50.7% after the 6 months where the intervention was implemented.
Video demonstration was found not to be largely disruptive to the workflow of the clinic. When asked to score the disruptiveness on a scale of 1 to 5, with 1 being the least disruptive, 27% of physicians gave a 1, 45% gave a 2, and 27% gave a 3; no survey respondents gave a 4 or 5.
There were some limitations to this study. The sample size for the intervention was small, as the number of eligible patients who visited the office in the study time period was small. Resource limitation was also faced in this study, as it was difficult to create an intervention in an uncommon language.
The researchers concluded that the disparities in screening for CRC in patients with limited English proficiency can benefit from an educational intervention using videos. These interventions can improve the willingness of patients who speak Somali to schedule an appointment for CRC screening.
Yao R, Sykora D, Olson EM, et al. Improving colorectal cancer screening disparities among Somali-speaking patients in an internal medicine residency clinic. BMJ Open Qual. 2023;12(4):e002391. doi:10.1136/bmjoq-2023-002391