Mary Glavassevich, RN, BA, MN,Sunnybrook Health Sciences Centre – Odette Cancer Centre, Toronto, Ontario, Canada

Cancer Screening: Barriers, Attitudes and Behaviors in a Population of Afro- Caribbean Adults Living in Toronto

Team members

• Mary Glavassevich, RN, BA, MN; Rosemary Irish, RN, BScN, CON(C); Tracey DasGupta, RN, MN; Colleen Hall, RN, MN(C); Pam Raye-Ilogu, RN, BScN; Linda Ramjohn, RN, BScN; Vera Hurlock, RN; Cynthia Robinson, MSW, RSW; Nadine Walters, BComm; Philiz Goh, BSc, BScN (C); Alison McAndrew, BA RAP with Margaret Fitch, RN, PhD, Sunnybrook Health Sciences Centre – Odette Cancer Centre, Toronto, Ontario, Canada

Greetings from…

• Sunnybrook Health Sciences Centre

Introduction• Screening for cancer is recommended for better overall

outcomes• Some ethnic groups may not be taking full advantage

of available screening opportunities• Research is limited in Canada about screening

behaviors in ethnic groups, including Afro-Caribbean populations

• Data from United States reveal disproportionately higher cancer incidence and mortality rates for immigrant minorities*

• The presence of a primary physician had a significant influence on breast cancer screening adherence**

*(Gany et al, 2006)**(Kinney et al, 2002)

Purpose

• To explore the awareness of a cross-sectional sample of Afro-Caribbean adults living in Toronto about screening for four common cancers: breast, prostate, cervix, and colorectal

• To identify possible barriers to screening for cancer within this population

Methods

• Exploratory descriptive design

• Convenience sample

• Hard copy paper survey with fourteen questions - four open-ended and ten closed-ended

• Descriptive statistics and a content analysis

• Focus group to validate findings

Demographics (N=213)

Response Rate = 58%

Gender

Male 45

Female 146

Marital Status

Married/

Common law

120

Single 46

Divorced/Sep

/Widow

36

Not born in Canada 189

Length of Time in Canada

(in years)

15 or less 26

16–20 37

>20 147

Demographics (N=213)

Age

Under 30 7

30 – 40 26

41 – 50 34

51 – 60 48

61 – 70 69

71 + 24

Education

<High School 22

High School 50

Some College/University

73

Completed College/University

68

Survey Results (N=213)

• Have a family doctor 201

• See a family doctor regularly 102

• Have not talked with family

doctor about screening for cancer 48

Survey Results (N=213)

Heard about:• Mammography 181 • Pap smear 172 • Colonoscopy 150 • PSA 125

Have had screening for:• Mammography 116 • Pap smear 129 • Colonoscopy 73• PSA 42

Survey Results (N=213)

Rating of importance of screening for cancer:

• Very important 195

• Somewhat important 11

• No response 7

Survey Results (N=213)

Where did you hear about screening for cancer?

• Doctor 146 • TV 83 • Family member 59 • Newspaper 53 • Radio 50 • Magazines 44 • Friends 41 • Church community 40 • Nurse 38

Question to Participants

• What do you think would help the people in your community to have screening for cancer done?

Community Based Education Considering Cultural Needs

• More direct and deliberate education programs targeting them where they work or where they live

• Education on why it is important and those presentations to be done by people of similar background in an interesting way

• Simple media communication in layman’s language

Decrease Fear Associated with Screening

• More education needed because some people get scared once the word cancer is mentioned

• Greater encouragement and education from their doctor

• Many women of color are afraid of the possibility of having cancer….we need to have experts in healthcare come to our churches and community centers to educate our people

Role of Physicians and Other Healthcare Providers

• This community takes a holistic approach but self evaluates first. A more caring and accessible medical capacity, i.e. not just MD, or RN, or others who can spend time educating and listening would encourage more testing earlier.

• More access to doctors in a timely fashion• Proposed dialogue between patient and family doctor

on education about cancer screening

Approach of Health Care Providers

• Don’t like the way the testing was handled, especially the mammograms, so painful

• My doctor never requested me to do these screening tests, he just took my blood pressure and other tests, not screening. Didn’t get any appointment from my doctor

Lack of Knowledge and Awareness

• I don’t feel I have cancer at the moment.• Need more information – I am interested in

doing it as I realize it is important• Didn’t think about it

Fear and Embarrassment Prevented Screening

• I am scared and feel like sometimes treatment doesn’t do well, the body rejects it. I heard that chemotherapy and radiation doesn’t do well in black people. I’ve seen so many people start these treatments and suffer so badly.

• Our people fear the worse, so they are reluctant to go for screening

• Some people are afraid or cowardly and may be embarrassed and ashamed

Focus Group Experience

• Purpose: To validate survey findings and deepen understanding of dissemination

• Participants: 2 focus groups held and 19 people participated

• Taped/transcribed verbatim and analyzed for content

Focus Group Findings:Validation

• Fear of cancer

• Lack of knowledge

• Need for trust with physician

• Unique cultural perspectives

Focus Group Findings:Understanding of

Dissemination

• Go to where the people are

• Credible spokespeople from within the community

Some Possible Solutions

• Education and encouragement• Culturally sensitive communication and

community focused education• More active involvement of doctors and other

healthcare providers• Credible spokespeople from within the

community

Conclusions• Screening for cancer is very important

• The rate of participation in screening for each of the four types of cancer varied

• Most people received information about cancer screening from a doctor; fewer people received information from a nurse

• Culturally appropriate education given in a sensitive manner with support and encouragement, including strategies to reduce fear, were suggested by the participants as ways to enhance cancer screening

Implications• Nurses and other healthcare professionals can play a

more significant role in providing information on cancer screening in the communities

• Further research is required to validate the results of the study and to form bonds within the community groups

• It is imperative to explore innovative ideas to provide community based education to increase knowledge and awareness of cancer screening