The committee recommends that HRSA:
Use a standardized method to develop outcomes-based goals and objectives for appropriate planning and assessment.
Identify and evaluate the cost and effectiveness of steps to remove barriers to program implementation.
Train staff to identify specific barriers to implementation and develop strategies to overcome them.
The challenges of outreach and education even for the current RESEP program are substantial. If the RECA program is expanded as described in earlier chapters, the target audiences will be larger (for example, clinicians, health care organizations, special exposed populations, and the general public) than expected when the RESEP program was created. The barriers (knowledge deficits, interpersonal, personal factors, organizational, community factors, and public policy) to reaching program objectives are broader than originally understood and will be even more problematic if and when RECA expands nationally but they can be addressed with methods consistent with the health education research literature.
In particular, HRSA and its RESEP grantees or contractors should adopt and implement outcomes-based planning and implementation approaches. The following overarching specific changes are indicated. HRSA must:
Provide information about the existence and availability of RECA and RESEP.
Explain in clear and simple terms the likelihood of receiving compensation.
Put the low risks of radiogenic cancer in context to reassure exposed individuals.
Clearly explain the potential risks posed by medical testing and the relative lack of improvement in health outcomes gained by early detection of many RECA-compensable diseases.
Explain the proposed PC/AS method both to exposed individuals and to the clinicians who may be guiding their decision-making.
The committee recognizes the expanded nature of such an effort and offers its suggestions and recommendations in the hope that they will be helpful to future RECA and RESEP programs and populations.