Preventive screenings down 94 percent due to COVID-19

July 23, 2020 - by Aisling Carroll

 

“In my years as a urologist and prostate cancer surgeon, I’ve never been more concerned for my patients than now,”

said Dr. David Samadi, director of Men’s Health and Urologic Oncologist at St. Francis Hospital in New York, in a July 2020 press release. “By putting off preventive services and screenings to avoid potential exposure to COVID-19, will very likely lead to another huge health crisis of a significant increase in undiagnosed cancer cases in the next few years.”

More and more clinicians and patient advocacy associations across the country are fretting over the recent lack of screenings for time-sensitive diseases such as cancer and diabetic retinopathy, which is the leading cause of blindness in American adults.

In March and April 2020, screenings for both screeched to a halt. Many were canceled or postponed in order to mitigate the risk of COVID-19 spreading and to preserve staff capacity, personal protective equipment and beds. At the same time, patients also chose to delay due to fear of catching the coronavirus during screening appointments or to heed stay-at-home orders.

Preventive screenings dropped by as much as 94 percent

According to analysis by Epic published in May 2020, appointments for screenings of prostate cancer dropped by 60 percent while screening appointments for breast, colon and cervical cancer tanked 94 percent, 86 percent and 94 percent respectively. The study reviewed data from 2.7 million patients across 23 states.

Data from a June 2020 study by Harvard University and Phreesia, a health tech company, and published by the Commonwealth Fund, also found that patient visits to ophthalmologists fell 79 percent. This is significant because diabetic patients receive annual eye scans by ophthalmologists to spot sight-threatening disease (i.e., diabetic retinopathy).

Fallout from delayed preventive screenings

With patients not being screened for fast-growing diseases during COVID-19, it follows that doctors are not catching them. An ABC News report in May 2020, for example, stated that the number of new skin cancers diagnosed at the University of Pennsylvania Health System decreased some 80 percent in March 2020 from early February.

The fallout from delayed cancer diagnoses will likely decrease survival rates because the disease will be at a more advanced stage and less treatable.

“There can be no doubt that the COVID-19 pandemic is causing delayed diagnosis and suboptimal care for people with cancer,” wrote Dr. Ned Sharpless, director of the National Cancer Institute, in an editorial published in the journal Science in June 2020.

He predicts 10,000 more people will die from breast or colorectal cancer in the U.S. over the next decade because of COVID-19’s impact on oncology care.

Overcoming patient fear by putting safety precautions in place

To stave off such dire predictions, health care systems must tackle the root of why patients are eschewing preventive screenings: fear and anxiety.

According to a May 2020 survey by the American College of Emergency Physicians, 70 percent of consumers said they are very or somewhat concerned about contracting the coronavirus if they receive care for issues not related to COVID-19 at a health care facility.

From the start of the pandemic, health care centers have established significant new safety protocols and workflows to protect patients and staff. The overwhelming majority separate COVID-19 patients, require masks, take everyone’s temperature before they can enter, regularly test staff for COVID-19, enable social distancing, reduce time spent in the waiting room, sanitize rooms between patients, bar visitors and much more.

Taken together, these safety precautions reinforce a frequent refrain from health care executives: the hospital is safer than the grocery store.

Communicating “we’re safe” with more visual and specific content

Of course, just because health care systems put extensive safety precautions in place does not mean that patients know about them.

Starting in March and April 2020, however, most health systems added COVID-19-related content to their web sites, newsletters and other external communications, which included a variation of “we’re keeping you safe”-type messages.

Although many sites posted helpful bulleted lists and FAQs on patient safety, there were limited images and videos.

Towards the end of April 2020, health systems recognized that patients aren’t always going to take their word for it; they would have to show them, as well as tell them, about their safety protocols and processes if they hoped to bring patients back for in-person, preventive screenings.

Whether it’s Dr. Amy Williams providing a guided tour of what a patient can expect when they walk into Mayo Clinic for an appointment or a Tidelands Health video of how a patient is greeted, screened and provided a mask by a Safe Care Navigator outside the front entrance, health systems have been posting videos on their respective sites and YouTube channels to dive deep into the details and build trust.

In a similar vein, many health systems have moved away from just one or two web pages about patient and staff safety during COVID-19 to entire dedicated areas with multiple pages and links. For example, the Mount Sinai Safety Hub has a video on cleaning protocols, among several others, and Q&A on various safety-related topics.

Just like health systems have created more videos that are narrower in scope, they have applied the same approach to their blogs, transitioning from more general safety pieces to specific ones tailored for select populations. In Northwell’s “Dear Doctor” series, they strike at the heart of a fearful patient toying with the idea of getting screened for breast cancer in the blog post “My annual mammogram was postponed because of the COVID pandemic: Is it safe for me to reschedule?”

In her response, Dr. Nina S. Vincoff writes, “Studies have shown that having annual mammograms beginning at age 40 reduces your risk of breast cancer death by 40%.“

According to Chris Gasiewski, Director of Corporate Communications for Northwell Health in New York, these types of blog posts have garnered strong engagement.

Additionally, in its Facebook Live videos, such as, “Are hospitals safe?” Northwell’s Stephen Bello addresses minimizing COVID-19 while ensuring individuals get the care they need. They have had “views in the millions, not the thousands.” He believes the reason for patients widely watching (and reading, in the case of the blog posts) is because Northwell is “creating content that people are looking for.”

Engaging the media to engage patients

On the other side of the country, six health systems in greater Los Angeles have banded together to ensure residents don’t forgo care. They are running multilingual radio and TV ads, which they’ve been posting on their social media channels, with the message, “Life may be on pause. Your health isn’t. We’re here to take care of you.”

Providence, UCLA Health, Keck Medicine of USC, Kaiser Permanente, Dignity Health and Cedars-Sinai have also launched these public service announcements called BetterTogether.Health on web sites, billboards, newspapers and magazines.

As well as paid media, some health care systems have also been trying to forge stronger ties with both local reporters (to line up interviews with their clinicians and executives) and editors (to place op-eds and articles). The goal for each is the same: to raise awareness around screening.

For example, the Contra Costa Herald ran this Sutter Health piece in June 2020, “Pittsburg radiology tech shares her story: COVID postpones mammogram, breast cancer discovered.” It discussed mammographer Norma Lester-Atwood attending her regular mammogram as soon as screening resumed, and how a follow-up biopsy revealed a tumor.

The article also included the steps Sutter is taking to keep patients safe while getting screened, as well a section on “Resources to help with health insurance disruption.”

Given millions of people are losing their employer-sponsored health insurance or can’t afford to pay for the costs associated with screenings due to the recession, some health systems are increasing their communications around payment options (e.g., grace periods).

Going direct to the patient, in a personalized way

To effectively coax patients back to preventive screening, health care systems across the country are supplementing their public information tactics. They’re using proactive, direct and personal communication in the form of phone calls, texts and emails.

As well as working the phones to reschedule patients whose screenings were postponed by the health care system or delayed by the patient during the early days of the pandemic, some staff are calling again shortly before the patient comes in. During these calls, they often walk the patient through what they can expect in terms of safety protocols, and what’s expected of them, such as not bringing others to the screening.

Some patients are receiving this same information by email and text, the latter being what many prefer. Conversational messaging eases the burden on staff, requiring significantly less time than placing calls and playing phone tag.

This peace of mind could not be more urgent as a July 2020 Gallup poll found a record 65 percent of Americans saying that the coronavirus situation is getting worse.

Given this number, patients will understandably continue to be fearful about coming in for preventive scans. As such, health care systems will need to increase their focus on assurance messaging and exhaustive communications so the “second public health crisis” does not come to pass. ♥

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