title: Cancer screening and prevention in rural Wisconsin: the Greater Marshfield Experience.
abstract: BACKGROUND
  Providing medical services to rural residents results in unique challenges to providers and patients. Cancer screening (CS) and early detection services (EDS) are frequently underutilized with rural residents often presenting with advanced cancer at diagnosis. A comprehensive approach to determine barriers and overcome them constitutes "The Greater Marshfield Experience."
  
  
  METHODS
  Focus groups with rural residents determined the greatest barriers to receipt of CS and EDS were distance, cost, time from work and self-reliant behavior. Directives to address these concerns were to keep information simple and provide services at the workplace. In response, Marshfield Clinic and its research division developed a collaborative research partnership with public health agencies (PHA), federally funded government programs and volunteer agencies.
  
  
  RESULTS
  In-house activities to remove barriers for providing CS and EDS included the development of a separate screening unit for these activities. Reminder systems were employed to notify patients of the need and availability of preventative services. Co-payments for health screening services were eliminated from the clinic owned health plan. Area residents near poverty level were encouraged to enroll in federally subsidized health plans that promoted and paid for CS and EDS. Federally funded cancer screening studies were implemented that funded breast and cervical cancer screening and evaluated the benefits of screening for prostate, lung, colorectal and ovarian cancers (PLCO). Outreach activities included developing partnerships with local PHA and minority groups and providing mobile screening services to remote areas.
  
  
  CONCLUSIONS
  Concentrated, collaborative efforts to develop in-house systems and outreach activities resulted in delivery of CS and EDS in remote areas.
authors.affiliation: Marshfield Clinic/Marshfield Medical Research and Education Foundation, USA.
authors.forename: D J
authors.initials: DJ
authors.lastname: Reding
authors.forename: K A
authors.initials: KA
authors.lastname: Lappe
authors.forename: M
authors.initials: M
authors.lastname: Krueger
authors.forename: B L
authors.initials: BL
authors.lastname: Kolehouse
authors.forename: D
authors.initials: D
authors.lastname: Steneil
authors.forename: R A
authors.initials: RA
authors.lastname: Leer
mesh_terms: D000328:Adult; D000368:Aged; D016001:Confidence Intervals; D019033:Delivery of Health Care, Integrated; D005260:Female; D017144:Focus Groups; D006297:Health Services Accessibility; D006801:Humans; D008297:Male; D008403:Mass Screening / Q000458:organization & administration* / Q000706:statistics & numerical data; D008875:Middle Aged; D009369:Neoplasms / Q000517:prevention & control*; D016017:Odds Ratio; D011203:Poverty; D017010:Reminder Systems; D012423:Rural Health; D012424:Rural Population; D014922:Wisconsin