Cancer Treatment for Poor Populations in the United States

Cancer Treatment for Poor Populations in the United States

The Selected Chronic Health Issue and Population

The selected chronic health concern is treating cancer, and the main focus will be on poor populations in the United States. This covers the socioeconomic parameters that hinder effective management and dealing with cancer in these poor societies, lack of resources, and lack of funds to seek treatment in health care facilities.

Geographic Region and Important Characteristics of the Population

The United States has many low-income urban, suburban, and rural communities. Often, these communities suffer from significant inequalities as compared to the richer regions of the country, primarily being faced with increased risks for cancer development and fatal outcomes. Notably, the Mississippi Delta, rural Appalachia, inner-city neighborhoods, and Native American reservations are some of the crucial regions in this regard (Weinstein et al., 2020). Also, regarding cancer treatment and patient rights to health care, each of these areas has its challenges. Such communities display essential features like lower health literacy, barriers to health care access, geographical access to healthcare facilities, high costs, and social factors that hinder them from accessing healthcare services (Chu & Majumdar, 2022).

Patterns of Cancer in Poor Community Using Epidemiologic Features of Person, Place, and Time

Several social factors inherent in impoverished populations or low-income communities greatly impact the treatment and prognosis of cancer, which leads to poor patient outcomes. The living standards are one of the distinctions; poor housing standards put occupants in contact with known carcinogens such as asbestos, lead, and radon. The lack of ventilation in these houses can worsen respiratory diseases and other health-related problems. Furthermore, the diet diversity in such areas is generally characterized by high unhealthy food accessibility (Matsuoka & Hori, 2019). Fruits and vegetables, whole grain products, and fresh meat are often scarce, but fast foods and small shops selling junk foods, which are poor nutrient foods, are widespread and abundant. This nutritional imbalance raises the risk of obesity and other chronic illnesses like diabetes and heart disease, which can worsen the prognosis for cancer and make treatment more difficult.

Also, stress levels are significantly worse in the regions with lower income; this is because poverty remains a major source of stress, which gets in the way of building a healthy immune system and contributes to cancer and slow recovery. Stress arising from the constant financial pressure as well as instability can cause cortisol to rise and other stress hormones to act, thus degrading overall health (Insel et al., 2020). The other core cause is low education standard; a person with minimal education may not comprehend simple or elaborate health information, and, hence, they cannot easily follow the doctor’s advice, adhere to the treatment plans, or have skills in managing the health system (Garvey et al.,2020). Such an issue can lead to late diagnosis, low levels of compliance with the prescribed treatment, and thus poorer survival rates among cancer patients.

Communities with lower incomes in the United States are disproportionately affected by cancer; distinct patterns emerge based on geographic and demographic characteristics (Matsuoka & Hori, 2019). Due to increased obesity, smoking, and inadequate access to preventive screenings, these populations have higher rates of avoidable malignancies, including cervical, colorectal, and lung cancers. Within these communities, racial and ethnic minorities—African Americans and Hispanics in particular—face additional healthcare disparities that lead to higher rates of cancer incidence and death (Niino & Matsuda, 2019). There are gender differences as well; women die at higher rates from cancers of the breast and cervical as a result of delayed detection and treatment.

The trends in cancer incidence in communities with limited incomes are greatly determined by geography. Due to worsening environmental conditions and poor-quality air, there are high incidences of cancer within densely populated areas that have low incomes, with very few specialized care and medical facilities. Native American reservations present high incidences of cancer attributable to their low socioeconomic status and limited access to amenities and healthcare services (Siegel et al., 2018). Noteworthy, the gap between cancer mortality and incidence and poverty level and income of regions has persisted over time. For instance, in COVID-19 cases, these differences have been aggravated by halting healthcare and rationing cancer treatment. Targeted approaches that improve access to healthcare, medical knowledge, and social factors of health are needed to lessen these differences (Siegel et al., 2018).

Health Outcome to Improve for This Population

The objective is to enhance early identification, which is a health outcome that has to be enhanced specifically for cancer patients with low incomes. Notably, more treatment choices, usually with better and less invasive forms of treatment, are possible when a tumor is detected at an early stage (CDC, 2024). Tumors are more likely to be diagnosed at an early stage when more attention is paid to increasing the availability of such screens as mammograms and colonoscopies. Besides increasing survival rates, it might decrease the financial costs for the patients as well as the overall healthcare system (Heard, 2018). Furthermore, early identification creates a chance for less invasive and cheaper treatments and improves patients’ functionality, including their ability to work and provide for their families and societies.

Evidence Supporting the Importance of Early Cancer Diagnosis

Recent data consistently reveals the imperative much need to enhance early detection of cancer and subsequent treatment to reduce mortality and enhance the quality of life of the affected patients, particularly in developing nations. Studies demonstrate that early detection of cancers like cervical, breast, and cancers of the colon is highly enhanced by screening exercises like mammograms, Pap tests, and colonoscopies. This means that such diseases can be diagnosed early, which has the potential to save lives. For instance, the American Cancer Society reveals that the survival rate for localized breast cancer is 99%, and 28% for distant-stage cancer (Nicholas et al., 2020).

Furthermore, improvements in results have been noted as far as the strategies geared at enhancing access to early detection are concerned. Thus, interventions such as mobile health clinics and community-based screening campaigns have increased screening rates in low-resource environments. Schiffman et al. (2020) observed that increasing participation of lower-income and ethnic minority populations in cancer screenings reflects specialty deliberate outreach/educational activities. However, the collected information proves that enhancing the early detection programs can improve patient survival rates in the low-income census tracts diagnosed with cancer and tumor diagnosis at an earlier stage and effective treatment programs. Moreover, to eliminate cancer disparities and improve public health, one has to deal with the barriers to early detection with solutions tailored to individual clients (Nicholas et al., 2020).

Evidenced-Based Program Fitting the Needs of a Poor Community

The program currently in development is based on empirical knowledge and entails community cancer screening for low-income groups in the United States. In this regard, the intervention integrates the transportation of nomadic HCUs, CHW engagements, and health literacy education to mitigate barriers to early cancer detection (Tavakoli et al., 2020). Mobile health clinics will eliminate the need for the locals to travel far to access care since the necessary cancer screening procedures will be taken directly to underprivileged communities (Tavakoli et al., 2020). Taking advantage of their reliability within the community, CHWs will mobilize the neighbors to emphasize the importance of early detection of cancer by providing information regarding the generally available screening programs and booking appointments for individuals.

Moreover, these staff members will also assist the residents in getting health coverage if the latter has none, explain the options available for health coverage, and contact the nearest medical practitioners for further treatment to the residents as and when required. Lastly, informative forums and debates focused on health literacy will be conducted in community facilities and neighborhood administrative center to ensure the population does not only recognize the necessity of regular check-ups, as well as early signs of cancer, but also learn about how to overcome the barriers that one may face in the course of receiving the necessary medical treatment (Tavakoli et al., 2020). Using education, community-based programs, and improving access to health services, this stratagem interferes with the process, directly addressing the logistics and socioeconomic factors hindering low-income earners’ access to timely cancer tests. Also, m-Health services and community treatment increase early cancer detection and screening among vulnerable groups (Torabi et al., 2020).

Data Collection for Program Evaluation

The mixed approach of both primary and secondary research methods can be used to evaluate the effectiveness of the extensive community cancer screening project. Primary data collection is appropriate and selected because it involves directly asking the participants relevant questions in the form of questionnaires, medical assessments, and additional checks (Bukavina et al., 2020). Demographic data, health-related activities, testing history, and obstacles to receiving care will all be gathered through surveys. Mobile clinic health screenings will yield clinical data on the detection of cancer rates, diagnosing stages, and following referral rates. Participants’ adherence to suggested follow-up care and treatment outcomes will be monitored using follow-up evaluations (Kollman & Sobotka, 2018). Understanding the program’s direct influence on early cancer diagnosis and participant health outcomes requires access to this fundamental primary data.

Short and Long-Term Objectives for This Program Using the “SMART” Approach

The short-term objective is to raise the rates of cancer screening (mammograms, Pap smears, and colonoscopies procedures) by 25% in a year in well-defined communities with low incomes using the SMART approach (DeGroff et al., 2021). This goal is attainable, quantifiable, reasonable, and time-bound. Initial and follow-up data will be gathered via participant surveys and mobile health clinics so that success may be tracked. With mobile clinics, health literacy interventions for patients and the general public, and activities conducted by CHWs, this objective can be attained. The assessment of the advances will happen quarterly, while adjustments will also be made at the same intervals (DeGroff et al., 2021). The future goal hardly complements bigger healthy public goals of fighting early cancer detection in poorer regions with tremendous force in an aggressive form, and therefore, the elimination of prejudice and foundations were laid for sustainable success.

The long-term objective is to decrease the cancer mortality rate by 15 percent in five years. This shall be done with a continued focus on high screening standards and offering all the requisite care to diagnosed persons, including speedy treatment and follow-up care (Reidhead, 2021). Death rates will be calculated using information from health departments and local cancer registries. Baseline rates will be established at the program beginning, and annual evaluations will be carried out to monitor program progress. This difficult but attainable goal helps national public health campaigns aimed at reducing health disparities (Reidhead, 2021). The program’s goal is to guarantee appropriate care, earlier diagnosis, and finally, better health status of such groups of people with a focus on long-lasting therapies.

Stakeholders to Be Involved in This Program Planning

While planning and implementing a cancer screening program in low-income settings, the crucial element to observe is stakeholder involvement. Such stakeholders include physicians and nurses, communities, regional governmental organizations, patients and their families, and financing institutions. They are useful, especially in achieving the program goals and the community’s needs (Adamu et al., 2021). Healthcare professionals give information and referrals for screening procedures, further examination, and treatment. Education and outreach are employed to develop rapport and ensure participants’ engagement by community organizations. Public health activities receive backing from local governmental organizations that provide data, resources, and guidance concerning regulatory frameworks. Additionally, patients and families offer significant input to ascertain that the scheme is patient-centered and devoid of barriers. The funding needed to attain sustainability is obtained by funding organizations (O’Donovan et al., 2019).

Program Planning Model Selected for the Program

The approach used is the RE-AIM (Reach, Effectiveness, Adoption, Implementation, Maintenance) model created by Curley, which encompasses the success and geographical spread of the program under execution among the targeted communities. Incorporating the RE-AIM framework’s Reach dimension, the program will focus on directing its promotional strategies targeting the target population alongside community agencies such as senior centers and religious institutions (Kong et al., 2020). Its success will be assessed by the decline in the number of patients diagnosed in the terminal stages of the disease in the future and the increase in screening usage in the near future according to the SMART goals (Effectiveness). To increase adoption, partnerships with Federally Qualified Health Centers (FQHCs) will be employed so that screening services can easily blend with the existing healthcare facilities (Kong et al., 2020).

Cultural and Ethical Considerations in Relation to the Program Design

Cultural and ethical factors should be taken into consideration while designing a cancer screening program for low-income Americans to ensure its efficiency and embrace by society. Cultural understanding is crucial because most people from these communities are ethnically, culturally, and spiritually different from the dominant medical norm, which means that they have different perceptions of the health-illness process. Cultivating trust and increasing people’s participation in programs will improve reception by acknowledging and valuing such cultural differences. Noteworthy, the lack of trust in several areas of healthcare mostly stems from previous prejudice or unfavorable incidents (Ghose et al., 2019). To eliminate such an approach, people in the community need to get involved in marketing the program and ensuring that all relevant information is conveyed to non-specialists by physicians. Therefore, for community healthcare providers to politely and efficiently communicate with people and, at the same time, understand the impact of a certain language alongside conforming to the basic etiquette, as well as the belief systems regarding health, certain cultural training must be taken into account (Ghose et al., 2019).

Ethical issues are considered to be important in relation to the program being designed. The top ethical standard is the patient’s consent to participate in the study. Patients and/or the legal representative of the participants have the right to be informed of the purpose of the screenings, advantages and disadvantages, if there are any, and their right to turn down any screening with no explanation needed or consequences ensuing (Kutikov et al., 2020). For users with different demands, it also entails offering information in several languages and formats that are easier to understand. Security and secrecy must always be sacrosymmetric, especially when dealing with sensitive health information. People need to understand that their data is safeguarded strictly and would only be applied to enhance the participant’s health profile (Kutikov et al., 2020).

Another cardinal principle of ethics worth considering is equity. The program should allow the members of the targeted population to avail equal chances of being screened regardless of their financial status. Managing practical issues like child care, travel, and scheduling appointments may fall under this category (Marron et al., 2021). To lower financial barriers, free or inexpensive screenings must be made available, especially for people without insurance or with insufficient coverage.

Funding the Selected Program

Both public and private sources are enlisted to fund the cancer screening program so that as many people as possible can participate. The process involves applying for funding from federal and state organizations involved in health, such as the CDC and the NIH, to support efforts to improve cancer outcomes and decrease health disparities. Other funding sources are grants and contributions from private foundations and non-healthcare nonprofit organizations like the Cancer Society and the Robert Wood Johnson Foundation (Perkins et al., 2020). Also, collaborations with businesses and organizations in the vicinity for sponsorships and in-kind will also be sought.

Incorporating the local community into the fundraising campaigns and social fundraising events is possible if they aim only to generate money and increase awareness. The initiative seeks to lay down a good economic foundation for the program in the area through the development of sound partnerships as well as diversification of financing sources. This will ensure the sustainability of the program and further ensure practical help has been imparted to low-income groups (David et al., 2020).

Marketing Strategies for This Program

Strategies in the marketing communication of the cancer screening program in economically disadvantaged populations need to include elements that assure the targeted populations, educate them about the program, and encourage them to participate in the program. As such, this will include partnering and collaborating with well-respected leaders and influential members of the community. Word-of-mouth marketing is also a useful strategy, where program promoters can become ambassadors, involving the participation of healthcare providers, spiritual leaders, and other members of the community (Perkins et al., 2020). Such partnerships ensure significant support for the project and guarantee clarification of misinformation and concerns linked to cancer screenings. They can greatly contribute to increasing the popularity of programs within the community and engage people in the programs.

Another necessity is targeted communication that is adjusted in regard to cultural differences. As such, the marketing materials must be provided in all the languages prevailing in the area to create equal opportunities for the population of the given neighborhood. These sources should offer information to explain why people need cancer screenings, address myths and misconceptions about them, and guide patients to establish programs and acquire the screenings. Additionally, one can also effectively target or communicate with a large number of people through available media, like neighborhood radio stations, public announcements, social networking sites on the World Wide Web, and posters mounted in the neighboring shops and community centers.

Promoting a LIB and planning opportunities such as a specific day for events in neighboring areas that can directly affect the inhabitants and extending the invitation for a screening or an educational session is another good marketing strategy for this program. It is possible to organize educational seminars for clients at senior centers, community centers, and religious organizations, directly reaching out to the people. Mobile health clinics can be developed in convenient community locations to provide on-site testing and scrutinize prompt access to several physicians for consultation or any problem. Engaging with local events, such as healthcare fairs and festivals, can help gain attention and facilitate the direct selling of the worth of the particular initiative of using technology in delivering healthcare services.

References

Adamu, D., Robertson, N. M., Weller, D., & Campbell, C. (2021). Role of community-based resources in cervical cancer screening uptake in low- and middle-income countries: a scoping review protocol. Journal of Global Health Reports. https://doi.org/10.29392/001c.18246

Bukavina, L., Prunty, M., Mishra, K., Sun, H., Sheyn, D., Conroy, B., Mahran, A., MacLennan, G., Schumacher, F., Ponsky, L., & Markt, S. (2020). Gender disparities in bladder cancer-specific survival in high poverty areas utilizing the Ohio Cancer Incidence Surveillance System (OCISS). Urology. https://doi.org/10.1016/j.urology.2020.07.013

CDC. (2024, April 8). About the National Breast and Cervical Cancer Early Detection Program. National Breast and Cervical Cancer Early Detection Program. https://www.cdc.gov/breast-cervical-cancer-screening/about/index.html

Chu, S., & Majumdar, A. (2022). Opportunities and challenges for a sustainable energy future. Nature, 488(7411), 294–303. https://doi.org/10.1038/nature11475

DeGroff, A., Miller, J., Sharma, K., Sun, J., Helsel, W., Kammerer, W., Rockwell, T., Sheu, A., Melillo, S., Uhd, J., Kenney, K., Wong, F., Saraiya, M., & Richardson, L. C. (2021). COVID-19 impact on screening test volume through the National Breast and Cervical Cancer Early Detection Program, January–June 2020, in the United States. Preventive Medicine, 151, 106559. https://doi.org/10.1016/j.ypmed.2021.106559

Ghose, S., Radhakrishnan, V., & Bhattacharya, S. (2019). Ethics of cancer care: Beyond biology and medicine. Ecancermedicalscience, 13. https://doi.org/10.3332/ecancer.2019.911

Heard, C. (2018). Utilizing community promotoras to increase cervical cancer screening in Hispanic women. Nursing & Healthcare International Journal, 2(2). https://doi.org/10.23880/nhij-16000141

Insel, T., Cuthbert, B., Garvey, M., Heinssen, R., Pine, D. S., Quinn, K., Sanislow, C., & Wang, P. (2020). Research Domain Criteria (RDoC): Toward a new classification framework for research on mental disorders. American Journal of Psychiatry, 167(7), 748–751. https://doi.org/10.1176/appi.ajp.2010.09091379

Kollman, J., & Sobotka, H. L. (2018). Poverty and Cancer Disparities in Ohio. Preventing Chronic Disease, 15. https://doi.org/10.5888/pcd15.180332

Kong, S.-C., Lai, M., & Sun, D. (2020). Teacher development in computational thinking: Design and learning outcomes of programming concepts, practices and pedagogy. Computers & Education, 151, 103872. https://doi.org/10.1016/j.compedu.2020.103872

Kutikov, A., Weinberg, D. S., Edelman, M. J., Horwitz, E. M., Uzzo, R. G., & Fisher, R. I. (2020). A war on two fronts: Cancer care in the time of COVID-19. Annals of Internal Medicine. https://doi.org/10.7326/m20-1133

Marron, J. M., Charlot, M., Gaddy, J., & Rosenberg, A. R. (2021). The ethical imperative of equity in oncology: Lessons learned from 2020 and a path forward. American Society of Clinical Oncology Educational Book, 41, e13–e19. https://doi.org/10.1200/edbk_100029

Matsuoka, J., & Hori, M. (2019). Incidence rates of esophageal cancer in the world from the cancer incidence in five continents XI. Japanese Journal of Clinical Oncology, 49(8), 1–2. https://doi.org/10.1093/jjco/hyz114

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O’Donovan, J., O’Donovan, C., & Nagraj, S. (2019). The role of community health workers in cervical cancer screening in low-income and middle-income countries: A systematic scoping review of the literature. BMJ Global Health, 4(3), e001452. https://doi.org/10.1136/bmjgh-2019-001452

Perkins, R. B., Guido, R. S., Castle, P. E., Chelmow, D., Einstein, M. H., Garcia, F., Huh, W. K., Kim, J. J., Moscicki, A.-B., Nayar, R., Saraiya, M., Sawaya, G. F., Wentzensen, N., & Schiffman, M. (2020). 2019 ASCCP risk-based management consensus guidelines for abnormal cervical cancer screening tests and cancer precursors. Journal of Lower Genital Tract Disease, 24(2), 102–131. https://doi.org/10.1097/lgt.0000000000000525

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In a 7- to 10-page proposal (not including title page and references), address the following:

Briefly identify your selected chronic health issue and population.
Describe the geographic region and important characteristics of this population.

Describe the patterns of the disease in your selected population using the epidemiologic characteristics of person, place, and time.
Identify one health outcome you would like to improve for the population.
Briefly summarize current evidence that supports the importance of improving this health outcome.
Briefly describe the evidence-based program you are developing, and why this approach will best fit the needs of your population.
Explain what data you would need to collect, and how you would obtain and analyze it. You may choose to collect primary data or use secondary data. Justify your choice.
Using the “SMART” method, write short- and long-term objectives for the program.
Identify the stakeholders who should be involved in program planning.
Identify which program planning model (see Curley, Chapter 7) you selected for your program. Justify your selection of the model. Based on the model, explain how you would plan, implement, and evaluate the program.
Explain any relevant cultural or ethical considerations related to your program design.
Explain how you would fund the program.
Describe strategies that would be appropriate for marketing the program.