Breaking Barriers: Providing Skin Cancer Education to the Homeless and Uninsured

Jaclyn Altshuler; Luke Wallis; Alexis Tracy; Margaret Brown; Faryal Siddiqui; Michelle A. Nguyen MD; John Browning MD

Jaclyn Altshuler University of Texas Health Science Center at San Antonio School of Medicine
Luke Wallis University of Texas Health Science Center at San Antonio School of Medicine
Alexis Tracy University of Texas Health Science Center at San Antonio School of Medicine
Margaret Brown University of Texas Health Science Center at San Antonio School of Medicine
Faryal Siddiqui University of Texas Health Science Center at San Antonio School of Medicine
Michelle A. Nguyen MD University of Texas Health Science Center at San Antonio School of Medicine
John Browning MD University of Texas Health Science Center at San Antonio School of Medicine

Abstract

Background: One in five Americans will develop skin cancer with an even higher rate presumed for the homeless and uninsured patient population. Travis Park Dermatology Clinic (TPDC) is a medical student-run free clinic in San Antonio, Texas that serves the homeless and uninsured patient population.

Objective: The purpose of this study was to investigate the level of knowledge regarding basal cell carcinoma (BCC) and skin cancer prevention in the TPDC patient population and to determine if education can improve patient knowledge, with the hope of preventing future cases of skin cancer.

Methods: Patients at TPDC were surveyed to assess demographics, including age, ethnicity, sun protection behaviors, sun exposure, and occupation. They also completed a â€œpre-educationâ€ quiz to assess their baseline knowledge of BCC. Students then educated patients on identifying BCC and preventative measures and also supplied them with appropriate sunscreen. Afterwards, patients completed the â€œpost-educationâ€ quiz, identical to the â€œpre-educationâ€ quiz for purposes of assessing the efficacy of this educational project.

Results: Fifty-seven of these patients (80%) had never heard of BCC. The average time spent outdoors was 2.93 hours per day; however the majority of patients (57%) reported not using any sunscreen. The average pre-education quiz score was 60.1% and the average post-education quiz score was 70.5% showing an increase of 10.4% (p<0.05).

Conclusion: The results indicate that the TPDC patient populationâ€™s knowledge of BCC and sun protection increased during the course of the project. Â Data indicate a need for the continuation of education regarding BCC and its prevention in the homeless and uninsured population of San Antonio.

Author Biographies

Jaclyn Altshuler, University of Texas Health Science Center at San Antonio School of Medicine

Jaclyn Altshuler is a medical student at the University of Texas Health Science Center at San Antonio. She hasÂ been involved in community service projects benefitting the medicallyÂ underserved population in San Antonio.

Luke Wallis, University of Texas Health Science Center at San Antonio School of Medicine

Luke Wallis is a member of the University of Texas Health Science Center at San Antonio Class of 2018. He graduated with honors from Texas A&M University with a B.S. in Biological Sciences. He currently serves as a clinic coordinator at the Student Run Free Clinic for Dermatology. Luke also enjoys mentoring undergraduate students interested in medicine and is a team leader for the global health elective, for which he traveled to Panama last year.

References

Robinson, JK. Sun exposure, sun protection, and vitamin D. JAMA; 2005:294(12):1541-43.

Collins, S, Doty, M, Robertson, R, and Garber, T. Help on the Horizon: How the Recession Has Left Millions of Workers without Health Insurance, and How Health Reform Will Bring Reliefâ€“Findings from The Commonwealth Fund Biennial Health Insurance Survey of 2010. 2015. Available at: http://www.commonwealthfund.org/publications/fund-reports/2011/mar/help-on-the-horizon. Published 2015. Accessed March 5, 2015.

Majerol, M, Newkirk, V, Garfield, R. The Uninsured: A Primer, Key Facts about Americans without Health Insurance. 1st ed. Washington: Kaiser Family Foundation; 2015:1-17. Available at: http://files.kff.org/attachment/the-uninsured-a-primer-key-facts-about-health-insurance-and-the-uninsured-in-america-primer. Published 2015. Accessed March 18, 2015.

Texmed.org. The Uninsured in Texas. 2015. Available at: http://www.texmed.org/Uninsured_in_Texas/#who. Published 2015. Accessed March 18, 2015.

Chau S, Chin M, Chang J, Leucha A, Cheng E, Schlesinger J, et al. Cancer Risk Behaviors and Screening Rates Among Homeless Adults in Los Angeles County. Cancer Epidemiol Biomarkers Prev.; 2002:11(5):431.

Wilde M, Jones B, Lewis BK, Hull CM. Skin cancer screening in the homeless population. Dermatol Online J; 2013:19(1):14.

Tung R, Vidimos A. Nonmelanoma Skin Cancer. 2009. Available at: http://www.clevelandclinicmeded.com/medicalpubs/diseasemanagement/dermatology/nonmelanoma-skin-cancer/. Published 2009. Accessed March 8, 2015

Chung, S. Basal Cell Carcinoma. Archives of Plastic Surgery; 2012:39(2):166â€“170.

Casson PR, Robins P. Malignant tumors of the skin. In: McCarthy JG, ed. Plastic surgery: Tumors Of The Head, Neck, and Skin. 1st ed. Philadelphia: WB Saunders Co.; 1990:3619â€“3623

The American Academy of Dermatology. How to Select a Sunscreen. 2015. Available at: https://www.aad.org/dermatology-a-to-z/health-and-beauty/general-skin-care/sun-protection/sunscreen-labels/how-to-select-a-sunscreen. Accessed February 12, 2015.

The American Academy of Dermatology. Sunscreen FAQs. 2015. Available at: https://www.aad.org/media-resources/stats-and-facts/prevention-and-care/sunscreen-faqs. Accessed February 12, 2015

Skin Cancer Foundation. Skin Types and At-Risk Groups. 2015. http://www.skincancer.org/prevention/are-you-at-risk/skin-types-and-at-risk-groups. Accessed March 2, 2015.