Within-Person Changes in Cancer Screening and Patient-Provider Communication Before and During COVID-19 in Kansas and...

The objective is to quantify within-person changes before versus during COVID-19 in (1) sources of health information, (2) patient-provider communication channels, and (3) time since last mammogram, Pap test, colonoscopy, and stool-kit screening among paired respondents in 123 counties within The University of Kansas Cancer Center's (KUCC) catchment area.

The study aims to assess changes in patients' information seeking habits and evaluate whether screening intervals for mammograms, Pap tests, colonoscopies, and stool-kit use have lengthened or shortened.

We conducted a paired pre-/during COVID-19 survey of the same patients across 123 counties in the KUCC catchment area. The survey instrument included items adapted from the Health Information National Trends Survey (HINTS) and the Behavioral Risk Factor Surveillance System (BRFSS) modules (validated/pilot-tested), along with investigator-developed items covering information sources, patient-provider communication, and timing of selected cancer screenings. Within-person changes were tested using McNemar's tests for binary variables and Stuart-Maxwell tests for multi-category outcomes.

Among paired respondents (N = 751), information sources shifted from print to digital: internet use increased from 12.8% to 33.5% (+ 22.2%), email from 25.8% to 40.6% (+ 14.8%), while brochure use decreased from 43.1% to 26.6% (-16.5%; McNemar p < 0.050). Provider communication shifted toward EHR, email, text, and video (+ 25.7%, + 23.2%, + 24.9%, and + 10.0%, respectively; all p < 0.05). Screening timing changed significantly for mammography (χ² = 27.0), colonoscopy (χ² = 46.1), and stool test (χ² = 25.1), but not for Pap test (χ² = 3.07; p = 0.69).

This study documents a shift from print to digital channels for health information and patient-provider communication, along with changes in screening timing for mammography, colonoscopy, and stool tests (with Pap timing unchanged). These findings highlight the importance of supporting multi-channel digital outreach to sustain preventive screening beyond the pandemic.