# Within-Person Changes in Cancer Screening and Patient–Provider Communication Before and During COVID-19 in Kansas and Western Missouri

## TL;DR

The study found that during the pandemic, people in Kansas and Missouri shifted to digital health information and communication, and delayed some cancer screenings like mammograms and colonoscopies.

## Contribution

The study quantifies within-person changes in health communication and cancer screening timing before and during the pandemic in a specific geographic region.

## Key findings

- Health information sources shifted from print to digital (internet, email) during the pandemic.
- Screening timing changed significantly for mammograms, colonoscopies, and stool tests, but not for Pap tests.
- Patient–provider communication increased via EHR, email, text, and video during the pandemic.

## Abstract

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.