JMIR Publications

ABSTRACT

Background:

Background:

Delays in completing cancer screening diminish the preventive benefits of early detection, particularly among women receiving care in Federally Qualified Health Centers (FQHCs). Although many patients receive Short Message Service (SMS) reminders and complete screening, less is known about how quickly they complete testing or which patient-level and structural factors are associated with delays.

Objective:

Objectives: This study examined factors associated with time to cancer screening completion among women aged 50 years or older who received SMS reminders and completed screening across a large, 56-clinic Federally Qualified Health Center (FQHC) network in Texas. The study also compared time to completion across HPV/Pap, mammography, and fecal immunochemical test (FIT)/Cologuard screening.

Methods:

Methods:

We conducted a secondary data analysis using electronic health record data from a 56-clinic FQHC network in Texas. The cohort included women aged 50 years or older who were overdue for Human papillomavirus (HPV)/Pap testing, mammography, or FIT/Cologuard screening, received at least three SMS reminders, and completed screening after the intervention. Due to missingness across the health-related social-needs measures, the adjusted analysis was restricted to 551 patients with complete covariate data. The outcome was the number of days from the initial SMS reminder to documented completion of the overdue screening test in the electronic health record. Kaplan-Meier methods were used to estimate time to completion by screening modality. A multivariable Cox proportional hazards model assessed associations of screening modality, sociodemographic and clinical characteristics, and self-reported health-related social needs with the rate of screening completion.

Results:

Results:

Screening was completed by 212 patients overdue for HPV/Pap testing, 138 overdue for mammography, and 201 overdue for FIT/Cologuard screening. The estimated median time to completion was 72.5 days (95% confidence interval [CI] 64-86) for HPV/Pap screening and 52.0 days for both mammography (95% CI 43-64) and FIT/Cologuard screening (95% CI 52-53). In the adjusted model, screening completion was faster for FIT/Cologuard screening (hazard ratio [HR] 1.65, 95% CI 1.34–2.05) and mammography (HR 1.41, 95% CI 1.11–1.78) than for HPV/Pap screening. Reporting a transportation limitation was associated with slower screening completion (HR 0.74, 95% CI 0.55–0.99).

Conclusions:

Conclusions:

Transportation barriers were associated with longer time to cancer screening completion among women aged 50 years or older who received care at FQHCs and completed screening. HPV/Pap screening was completed more slowly than mammography and FIT/Cologuard screening, suggesting that patients overdue for cervical cancer screening may benefit from additional follow-up, navigation, and transportation support to facilitate more timely completion. Patients receiving care in FQHC settings often face socioeconomic and structural vulnerabilities. Even among patients who ultimately complete screening, prolonged delays may reduce opportunities for timely detection and follow-up and may diminish the potential benefits of cancer screening.