In response to the COVID-19 public health crisis in 2020, PCORI launched an initiative to enhance existing research projects so that they could offer findings related to COVID-19. The initiative funded this study and others.
The COVID-19 pandemic disrupted cancer screening. Although screening has restarted, questions remain about how screening has changed since the onset of the pandemic, and the perspectives of patients and health systems about these changes.
(1) To identify the barriers to and facilitators of effective cancer screening and prevention during the COVID-19 pandemic from the perspectives of health system administrators, clinicians, and staff; (2) To identify patient knowledge, attitudes, and beliefs about cancer screening and prevention during the COVID-19 pandemic
|20 health system administrators, clinicians, and clinical support staff; 61 adult patients due for breast, cervical, colorectal, or lung cancer screening who did or did not receive screening and received care at 2 health systems in Indiana
|Barriers to and facilitators of cancer screening and prevention during the COVID-19 pandemic; patient knowledge, attitudes, and beliefs about cancer screening and prevention during the COVID-19 pandemic
|Data Collection Timeframe
|January 2021–March 2022
This mixed-methods study examined how the COVID-19 pandemic affected adult cancer screening in two health systems in Indiana.
Between January 2021 and March 2022, researchers conducted key informant interviews with 20 health system administrators, clinicians, and staff to identify the barriers to and facilitators of effective cancer screening and prevention during the COVID-19 pandemic.
Also, between August 2021 and February 2022, researchers conducted semi structured interviews with patients to identify patient knowledge, attitudes, and beliefs about cancer screening and prevention during the COVID-19 pandemic. The semi structured interviews included 61 patients who were due for breast, cervical, colorectal, or lung cancer screening within two health systems in central Indiana. Of these patients, 52% completed a screening in 2020; 54% were White, 39% were Black, and 7% identified as other races. The average age was 56, and 77% were female.
Researchers analyzed interview transcripts and identified themes.
Patients, community members, and health system representatives helped design the study.
Healthcare system staff and clinicians shifted clinical services from in-person delivery to telehealth delivery during a statewide government shutdown. For example, colonoscopy screening for average-risk patients shifted to home-based stool test screening. Health system staff and clinicians reported a few barriers to screening:
- A lack of systemwide strategies to address cancer prevention and a lack of infrastructure for cancer screening during the government-ordered shutdown
- Clinical staffing shortages due to alternate employment opportunities, burnout, and COVID-19-related and other illnesses
- Patients who were afraid to get cancer screening due to COVID-19 concerns
In addition, patient surveys found that:
- Some patients felt reassured by COVID-19 precautions implemented by health systems, while other patients reported that precautions were a barrier to cancer screening.
- Patients reported that they did not trust information about COVID-19. Some patients said they did their own research to find COVID-19 information.
- Patients who did not receive cancer screening during the pandemic were more likely to report that they delayed or avoided medical care due to concerns related to COVID-19 (48% non-screened versus 16% screened; p=0.006).
Researchers interviewed health system staff, clinicians, and patients in Indiana. Results may differ in other locations.
Conclusions and Relevance
This study described barriers and facilitators to cancer screening during the COVID-19 pandemic.