Introduction: Despite the widespread availability of preventative tests and procedures, colorectal cancer (CRC) remains one of the leading causes of cancer deaths in the United States. While national CRC screening rates have increased, they have languished in rural areas. Routine screening is most effective in reducing CRC mortality when accompanied by timely diagnostic follow-up, but transportation barriers are a hindrance to continuity of care. Distances between homes and providers exacerbate the problem in rural areas. We examined reported transportation barriers in seven counties at both patient and clinic levels as part of a collaborative endeavor with a rural health system in Southern Illinois to characterize current conditions and design multilevel interventions to increase screening and follow-up in rural populations.
Methods: Semistructured interviews and focus groups were conducted with six patients and forty providers across eleven primary care sites and two colonoscopy providers. Interview domains included screening barriers and facilitators. Interview transcripts and field notes underwent text analysis with inductive codes. Themes such as financial resources, transport reliability, and time constraints were used to create subcategories and refine analysis. Transportation was discussed at multiple levels of influence in screening decisions, planning, and completion. Here we present a detailed analysis of how distance and transportation were discussed.
Results: Limited regional provider availability dictates that medical visits require long travel times for many patients. Patients described travel distance and discomfort during transit to colonoscopies as obstacles. Those who had an easier time arranging transportation relied on social support, but encountered issues coordinating time off work. Staff had varying knowledge of available transportation and clinics had different levels of resources to support patients. Travel assistance included referral to transport services, public transport vouchers, and reimbursement. Some clinics did not offer travel assistance, or only provided help in cases of urgent medical need. Outsourced transport service reliability was variable and often required advance notice, which affected colonoscopy scheduling. Some sites that offered transport assistance cited poor communication among clinic staff and role specialization as reasons that patient needs were not met.
Discussion: Patient need communication and provider and staff education regarding community transportation present opportunities to reduce transportation barriers. Evidence-based interventions such as dedicated non-emergency medical transport services are needed to address reliability, infrastructure needs, and the hardships of taking time off work for appointments. In designing multilevel interventions, researchers must consider differences in financial and human resources across sites and limited staff and patient time.
Citation Format: Chanelle Y. Chua, Julia Maki, Marci Moore-Connelley, Jean Hunleth, Kevin Oestmann, Sonya Izadi, Liz Rolf, Graham Colditz, Aimee James. Bridging the gap: Characterizing transportation barriers in rural southern Illinois [abstract]. In: Proceedings of the Eleventh AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2018 Nov 2-5; New Orleans, LA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2020;29(6 Suppl):Abstract nr B115.