Bowel Cancer Screening Kits

Transcription

1 7/7/2011 Bowel Cancer Screening Kits Consultation with Ward End Elders Welfare Association Dr Zahida Shah, Director GOAL

2 Bowel Cancer Screening Kits Consultation with Ward End Elders Welfare Association Introduction South Birmingham PCT requested the support of Go-Woman! Alliance CIC, to organize a consultation event with South Asian elders living in the Birmingham area to establish the cause of a lack of colorectal cancer screening within this particular community. The consultation took place at Ward End Elders Welfare Association (WEEWA) on 7 July 2011, with 19 elders present. The Centre offers a variety of support, including meals and fitness activities to its client group, including a gym which contains equipment suitable for use by the over 55s and those with health conditions including arthritis, heart problems and diabetes. The Centre operates 4 days a week with separate gender provision. Mondays and Wednesdays the Centre is utilized by women over 55+, who use it as a place to socialize, exercise in the gym and for general health related information. The men use the Centre on Tuesdays and Thursdays. Our consultation took place on a Thursday as our intention was to assess the attitudes of men in relation to colorectal cancer screening, as it is well documented that men s take up of healthcare is lower than women 1. This report will provide an overview of the aims of the consultation, methodologies used to collect data and conclusions with recommendations for the future. However, it must be noted that this is a preliminary report based on a 2 hour consultation, and that further investigations would be essential to exploring future models and for replication purposes. 1 Although women live longer they are more likely to report a long-standing illness (National Statistics, 2001; Office for National Statistics,1996) and to have received medical treatment than men (Department of Health 2001;Office for National Statistics, 1998). 1

3 Aim of Colorectal Cancer Management Project The aim of the project was to increase the uptake of colorectal cancer screening in the South Asian population which was developed through a community engagement focus group consultation event that explored some of the underlying reasons why uptake was poor in the South Asian community. The project has a two-fold purpose: 1. To establish South Asian elders understanding of colorectal cancer and how to use the Fecal Occult Blood testing (FOBT) kits which have been developed as an early detection tool. This would be dictated through utilization of the educational model of health promotion 2. Identify through a focus group discussion the reasons behind poor uptake of colorectal cancer screening in the South Asian community which would form the basis for recommendations to be put forward to commissioners and providers to address the low uptake. Methodology The educational model of health promotion was used to raise awareness of colorectal cancer screening and the importance of testing and use of kits produced for this purpose. This method was used in conjunction with a focus group technique that generated much discussion from the cohort of elders involved. Sample: 18 elder men and 1 woman aged 55-79, participated in the consultation. All elders live in the Birmingham district of Hodge Hill and within close proximity of the Centre. All were from 3 ethnic groups Pakistani, Kashmiri and Arab. The sample was chosen through a targeted approach whereby a poster was developed inviting people from the age group who had received a letter, carers and those who had undertaken the test using the FOBT kit. The following table shows the sample in gender and ethnicity terms. As stated above, we visited the Centre on a day when men used the service; therefore women were not in attendance, except one, who is related to the organizers. 2

4 Demography Gender Ethnicity N1 Male Pakistani N2 Pakistani N3 Kashmiri N4 Kashmiri N5 Kashmiri N6 Kashmiri N7 Kashmiri N8 Kashmiri N9 Kashmiri N10 Kashmiri N11 Kashmiri N12 Kashmiri N13 Kashmiri N14 Kashmiri N15 Kashmiri N16 Kashmiri N17 Kashmiri N18 North African N19 Female Pakistani Methods An educational model of health promotion was used to inform the participants on bowel cancer, how to use the FOBT kit, symptoms to look out for and general lifestyle information on healthy living. The second phase was around exploring, through a focus group discussion, some of the reasons why uptake in bowel cancer screening using the FOBT kit was low in the South Asian community. Having identified some of the barriers which contributed to poor uptake this was an ideal opportunity to explore some of the solutions using the community development approach which would pave the way to submit recommendations to commissioners and providers to make the service accessible to this minority group. These questions were around the specific health issue that was being discussed and the screening kits that were developed for testing for this cancer and the use of this. 3

5 Questions Where you aware of Colorectal Cancer? Have you seen these Screening Kits? Have you seen a demonstration like this before? Do you see any reasons why you wouldn t use the FOBT kit knowing the information you do? Bowel cancer screening amongst the South Asian community is low why do you think that is? How can we improve people from the South Asian community undertaking Bowel cancer screening? What barriers do you see yourself or others from your community in doing the test at home? How can we educate the community about Bowel Cancer (Health promotion and education) Would you want this education session to run again? In addition, information by PCT staff was provided around: What colorectal cancer is How to use the screening kits Where to obtain kits from Location of drop in centres for sample collection, where these were not accessible to the elders, nurses were to follow up with further information The nurses also provided information on the availability of gloves for use with the kits and provision of vouchers. Barriers to inclusion: The PCT staff was keen to understand what barriers exist within the group to ensure that they were providing an inclusive service. The key barriers for this community were language and 4

6 awareness of provision. However, the gender dimension also came into play as a crucial barrier as has been documented in previous research and statistical data: Men do not have better health [than women] but ignore symptoms, fail to seek medical help and present with advanced disease 2... The diseases that men are more prone to, such as cancer, circulatory diseases, bronchitis and liver disease are ones that are often fatal if help is not sought early in the course of the disease 3 This aversion to seeking medical help amongst men cuts across ethnic boundaries and is important to bear in mind when transmitting knowledge of new medical interventions and preventative measures. It is therefore vitality important to disseminate any information around these areas to women relatives, carers and agencies working with male clients. Preliminary Findings The consultation s aim of disseminating information on the area of colorectal cancer, the use and availability of screening kits and to dispel myths around cancer where achieved during the session. Much follow up discussions were generated by the elders with questions and comments ranging from: Why is cancer more prevalent today in a highly advanced, medical and technological age? If you don t smoke you will not get cancer. I eat healthily and keep fit therefore will not get cancer Once you get cancer it is terminal What causes cancer? The staff was able to provide information on these and challenge misconceptions in an informative way, which helped the elders understanding of the nature of cancer in general and colorectal cancer in particular, the causes of cancer and screening measures. The latter point was of particular significance, as the nurses/staff were able to explain that bowel cancer was one of the most treatable cancers, due to the screening process, early detection 2 British Journal of Health Psychology (2006), 00, Kirby, Kirby, & Farah,

7 which impacted on the success rate of the treatment. Again this was of particular interest to the cohort, as their conceptions had been challenged, nevertheless more work will need to be done in order to continue with the message of early screening as a preventative measure but also for treatment to be successful in cases were colorectal cancer has been detected. Of particular interest to the group, was the fact that the Centre Manager had undergone treatment for the removal of polyps in the bowel. The manager described his experience of how these were detected and encouraged elders to seek early medical help, via the information provided by the PCT staff and any follow up support that was offered. He also offered to circulate information on the screening kits to other colleagues and contacts to ensure wider dissemination and awareness raising of the issue of colorectal cancer. Conclusions & future recommendations The consultation proved to be a very informative session for both PCT staff and the elders involved. It was particularly important to assess the views of South Asian elder men, as there is a resistance amongst men in general to seek medical help and in particular amongst Minority Ethnic communities where the biggest barrier to take up of a service is the lack of awareness of its existence. Whilst the event achieved its aim of raising awareness of colorectal cancer and its screening, it is recommended that such events are replicated to include carers, elder South Asian women and service providers within the voluntary sector who work with these groups. We recommend that a similar event be undertaken with women over 55 and women carers of elders, who can further cascade the information into their communities, in the very near future. It is also important for staff within the PCT and health services in general to use the minority language skills of staff within this sector when disseminating information at such events, as the medical knowledge they have will be invaluable when transmitted in the language of the cohort involved in future consultations. In the absence of appropriate staff within the health services, it is essential that interpreters are used in order that the information has been consumed comprehensively. Whilst the aim of this consultation was to provide important data on South Asian elders understanding of colorectal cancer and its screening, it is by no means an exhaustive study in this area, but a very, preliminary data collection exercise, which may feed into a larger study in the future, examining, the above issues within a health inequalities framework. The framework would need to consider tackling any emergent inequalities to provide a universal service based on need and not differences based on socio-economic background, knowledge and understanding of service take up and/or any other differentiating indicators. 6

8 GOAL would recommend future research be undertaken using both qualitative and quantitative methods of data collection, with a wider sample, which would address the issue of tackling health inequalities in a broader framework that would provide the basis for future interventions and service provision within the health services and that recognizes the diversity of its patients. Such research and its findings would support embedding of good practice, provision of a seamless service and addressing the needs of the diverse communities in Birmingham. References: National Statistics, 2001; Office for National Statistics,1996 Department of Health 2001;Office for National Statistics, 1998 Patterns of self-referral in men with symptoms of prostate disease, Susan Hale, Sarah Grogan and Sara Willott Staffordshire University, UK University of Birmingham, UK - British Journal of Health Psychology (2006), 00, 1 18 Kirby, R., Kirby, M. G., & Farah, R. N. (2000). Men s health. London: Isis Medical Media. 7