Mass Matters: Increasing Mammography Rates to Underserved Women

Breast cancer is the most frequently diagnosed cancer among women in Indiana and the United States (Indiana Cancer Organization, 2019). An estimated 268,000 new cases of invasive breast cancer were diagnosed and 41,760 women died due to breast cancer in 2019 (ACS, 2019). Substantial breast cancer-related morbidity and mortality disparities persist among the underserved. Disparities in breast cancer outcomes are due to lower mammography screening rates, lack of timely follow-up of abnormal results, and lack of timely treatment initiation among women with breast cancer (Highfield et al., 2015). The purpose of this evidence-based practice project was to address low mammography rates to the underserved population by implementation of an intervention to increase breast cancer screening at a site dedicated to assist the economically challenged by sending an informational letter and text message reminder for one’s scheduled mammogram appointment. The Iowa Model of Evidence-Based Practice to Promote Quality Care was selected as a guideline to facilitate evidence into best practice to an underserved population serviced by several community health clinics in Northwest Indiana. Each participant received a mailed informational letter regarding the benefits of breast cancer screening and what a mammogram is. At the patient’s free will, she scheduled an appointment for a mammogram. Based on the date the mammogram scheduled, the participant received a text message reminder before the set appointment. Each appointment scheduled was detailed within the clinic’s EMR. The EMR was reviewed weekly of each appointment kept, rescheduled, cancelled, or no-show and documented within an Excel Spreadsheet. This data was categorized according to ethnic background, age, and insurance status to detail the crude rates of mammography. Data was analyzed utilizing the Chi square test of independence. Demographic information was calculated by descriptive statistics. A text message reminder was a statistically significant intervention to promote mammogram appointment adherence. Application of findings will be discussed

Mass Matters: Increasing Mammography Rates to Underserved Women

Breast cancer is the most frequently diagnosed cancer among women in Indiana and the United States (Indiana Cancer Organization, 2019). An estimated 268,000 new cases of invasive breast cancer were diagnosed and 41,760 women died due to breast cancer in 2019 (ACS, 2019). Substantial breast cancer-related morbidity and mortality disparities persist among the underserved. Disparities in breast cancer outcomes are due to lower mammography screening rates, lack of timely follow-up of abnormal results, and lack of timely treatment initiation among women with breast cancer (Highfield et al., 2015). The purpose of this evidence-based practice project was to address low mammography rates to the underserved population by implementation of an intervention to increase breast cancer screening at a site dedicated to assist the economically challenged by sending an informational letter and text message reminder for one’s scheduled mammogram appointment. The Iowa Model of Evidence-Based Practice to Promote Quality Care was selected as a guideline to facilitate evidence into best practice to an underserved population serviced by several community health clinics in Northwest Indiana. Each participant received a mailed informational letter regarding the benefits of breast cancer screening and what a mammogram is. At the patient’s free will, she scheduled an appointment for a mammogram. Based on the date the mammogram scheduled, the participant received a text message reminder before the set appointment. Each appointment scheduled was detailed within the clinic’s EMR. The EMR was reviewed weekly of each appointment kept, rescheduled, cancelled, or no-show and documented within an Excel Spreadsheet. This data was categorized according to ethnic background, age, and insurance status to detail the crude rates of mammography. Data was analyzed utilizing the Chi square test of independence. Demographic information was calculated by descriptive statistics. A text message reminder was a statistically significant intervention to promote mammogram appointment adherence. Application of findings will be discussed

Reducing the No-show Rate of Breast Cancer Screenings: A Quality Improvement Project

Clinical nurse leaders (CNLs) are change agents who “improve quality, cost, or efficiency of healthcare delivery” (Noles, Barber, James, & Wingo, 2019, p. 307). The CNL of a breast cancer clinic recognized the significant impact the high no-show rate of breast cancer screening appointments had on patient outcomes and staff productivity. After conducting a microsystem assessment, the CNL organized a meeting with key stakeholders to identify potential interventions to address this issue. Concerns regarding the efficiency and effectiveness of the current telephone reminder system were raised, indicating an area for improvement. The CNL facilitated the team in researching evidence-based practices to identify a better method to remind patients of their appointments. After conducting the literature review, a text-based reminder system proved to be the most effective, efficient, and economical (Vidal, Garcia, Benito, Binefa, & Moreno, 2014). The aim of this quality improvement project is to reduce the breast cancer screening no-show rate by 2% to enhance the quality of life of patients, decreasing cancer mortality through early detection of breast cancer. During this time, the Covid-19 pandemic hit, preventing the progression and changing the scope of the project where implementation and evaluation of the intervention could not be accomplished. However, the CNL continued communicating and collaborating with staff members remotely to develop a detailed plan with the hopes of the team utilizing components that will work for them. The CNL was driven by professional values and core competencies to engage staff, cultivating an environment that supports change

Development, Implementation and Evaluation of a Screening Mammography Program

Breast cancer is a major public health concern in the United States and remains a priority for national women’s health centers, primary care practices and cancer control organizations such as the American Cancer Society (ACS). The cancer care continuum includes the spectrum of prevention/risk reduction, early detection, treatment, and living with the diagnosis. Currently there are no proven primary prevention options for women at average risk of developing breast cancer; therefore, secondary prevention interventions such as screening mammography and clinical breast examination (CBE) are required to reduce morbidity and mortality. This manuscript describes a Doctor of Nursing Practice (DNP) led quality improvement project aimed at increasing mammography screening completion rates in one community health center within a reputable safety-net community health network with access to a mobile mammography van. The intent of this project was to discover the barriers that patients view in complying with their breast cancer screening recommendation, the workflow of the health centers with the best practice, and the creation of a mammography toolkit to provide consistency in processes amongst multiple sites. Although there were challenges in reaching a significant amount of patients to unveil all the possible barriers, overall implementation of this quality improvement project resulted in a well appreciated mammography toolkit, which will be available to all primary care health centers and included in the orientation of medical evaluation workers and health workers as it relates to patients obtaining proper breast health. Keywords: screening mammography, telephone reminder calls, toolkit, DN

The Effect of Patient Reminders on Osteoporosis Screenings

Osteoporosis is characterized by reduction of bone mass and compromised bone strength, resulting in an increased fracture risk. Since a reduction of bone mass has been shown to be predictive of future fracture risk, prevention strategies target screening those patients at risk for decreased bone mass by using bone mineral density (BMD) dual energy x-ray absorptiometry (DXA) scans. Current national guidelines recommend that all women 65 years and older undergo BMD testing using central DXA every two years. Despite these recommendations, women age 65 years and older still do not participate in this screening. Greater rates of osteoporosis screening could be achieved by identifying an efficient, effective way for healthcare providers and patients to schedule DXA scans. The purpose of this EBP project was to determine if a mailed patient reminder would increases BMD screening rates in women at risk for osteoporosis, as compared to the previous practice of provider recommendation during a scheduled visit. The Stetler Model was used to guide the EBP project, and Kotter and Cohen’s eight steps for successful change provided support for the behavioral change. The population of focus consisted of female Medicare recipient’s age 65 years and older who were active patients within a Midwestern community care clinic in the fall of 2013. Overall, the mailed reminder for osteoporosis screening demonstrated effectiveness in improving BMD screening rates. At the end of the 12-week project, the percentage of female Medicare recipients who were up to date in their BMD screening increased from 17.07% to 31.40%. Those participating in BMD screening during the 12-intervention intervention period ranged in age from 65 to 98. Of the 47 female patients who were not up to date and had a DXA scan as a result of the intervention, a significantly larger percentage were patients of the physician (87.23%) versus patients of the NP (12.77%) who focused on women\u27s wellness during routine office visits (χ² = 9.824, p = .002)

Factors Associated With Patient Portal Utilization, Preventive Services Utilization, and Health Promoting Behaviors Among Adults in the United States

Background: Nearly 60% of adults in the United States are estimated to have one or more chronic conditions, necessitating strategies to improve the health status of persons with chronic disease. Given that health information technology (HIT) is considered highly valuable for superior disease management, it is imperative to examine how HIT use can improve health behaviors, which can in turn improve health status. This study aimed to examine if there was an association between patient portal utilization and the use of preventive services & health-promoting behaviors. Also, this study examined the influence of self-efficacy on preventive health behaviors among adults in the United States. Methods: This study analyzed secondary data from the nationally representative Health Information National Trends Survey 5 combined dataset from 2017 to 2020. Data analysis was restricted to respondents who had used their patient portals in the past year and the sample size was 14,103. Binomial & multinomial logistic regression models were conducted for this study. Results: Patient portal utilization was significantly associated with preventive health behaviors such as pap smear testing, mammogram screening, non-smoking, levels of participation in physical activities, and muscle-strengthening activities. Self-efficacy was significantly associated with mammogram screening and the levels of participation in physical and muscle-strengthening activities. Conclusion: The study provides information that suggests that stakeholders need to encourage the population to use their patient portals. Also, optimizing the patient portals for not just clinical care but preventive care may reduce the incidence and cost of chronic diseases

The use of behavioural sciences in targeted health messages to improve the participation in cervical and breast screening programmes

The aim of this thesis was to examine the effects of behaviourally informed interventions deployed in text message reminders and invitation letters on the participation in cervical and breast cancer screening. Cancer screening saves lives through detecting cancer or precancerous changes early, when medical intervention is more likely to reduce morbidity and mortality. A key factor in the success of any screening programme is public participation. Although some individuals may object to cancer screening, evidence suggests that public support for cancer screening provision in the UK is above 90%. Yet despite this, participation rates across all three cancer screening programmes (breast, cervical and colorectal) remain lower than expected given reported intentions. This thesis explores the role of decision making – both reflective and automatic in the context of cancer screening behaviour and highlights the potential for the application of behavioural economic theory and behavioural science to inform intervention design aimed at increasing cancer screening uptake. Through the application of frameworks informed by behaviour change theory, three randomised controlled trials were designed to test the impact of behavioural interventions on participation rates in regional cervical and breast cancer screening programmes within the London area. The intervention design of each trial focused on the message content within either text message reminders or invitation letters. The first randomised controlled trial (RCT) tested different behaviourally-informed invitation letters in cervical screening and found that a shortened letter that contained a loss framed message has a small but significant positive impact on cervical screening rates. The second RCT tested different text message reminder content against a no-text message control and found that text message reminders can improve participation in cervical cancer screening. However, the content of such text message reminders further affects screening participation behaviour. The final RCT tested the effect different behaviour message content in text message reminders for timed appointments in the breast screening programme. No significant difference in breast screening participation was noticed as a result of the message content within text message reminders. However, due to logistical barriers encountered during the trial, which included a reconfiguration of regional screening services, this study had to be closed early, prior to the sample size being reached and was therefore underpowered. This research highlights the importance of the message content within health communications in cancer screening to improve participation rates. Exploratory subgroup analyses within these trials, indicates that different subgroups of women with common characteristics such as age, level of deprivation or previous exposure to cancer screening affected which message content was most effective and improving cancer screening participation.Open Acces

Breast and Cervical Cancer Screening in African American Women After Multiple Interventions

Approved May 2017 by the faculty of UMKC in partial fulfillment of the requirements for the degree of Doctor of Nursing PracticeAfrican American women are consistently diagnosed at later stages of breast and cervical cancer than Caucasian women, leading to increased morbidity and mortality rates. Although the mammogram and Papanikolaou (Pap) smear are the two most effective screening tests for these cancers, African American women have suboptimal rates of participation in these tests. The purpose of this doctor of nursing practice project was to determine if multi-component interventions increase breast and cervical cancer screening rates among African American women at a primary care clinic in an urban community. This quasi-experimental study included 15 African American women aged 40 and older at a primary care clinic in an urban community. The evidence based interventions included patient education, follow-up reminder phone calls, and informational patient handouts. The primary outcome for this project was the receipt of a screening mammogram and Pap smear. The secondary outcome for this project was change in patient intention to obtain breast and cervical cancer screening utilizing pre-and post questionnaires developed from the Theory of Planned Behavior. This project resulted in three women overdue for breast cancer screening obtaining recommended mammograms, and zero women overdue for cervical cancer screening obtaining a Pap smear. There was no significant change in intention to obtain breast and cervical cancer screening. The goal of this project was to increase participation in both breast and cervical cancer screening in African American women, ultimately leading to reduced morbidity and mortality

Computer-generated reminders delivered on paper to healthcare professionals: effects on professional practice and healthcare outcomes.

Clinical practice does not always reflect best practice and evidence, partly because of unconscious acts of omission, information overload, or inaccessible information. Reminders may help clinicians overcome these problems by prompting them to recall information that they already know or would be expected to know and by providing information or guidance in a more accessible and relevant format, at a particularly appropriate time. This is an update of a previously published review. To evaluate the effects of reminders automatically generated through a computerized system (computer-generated) and delivered on paper to healthcare professionals on quality of care (outcomes related to healthcare professionals' practice) and patient outcomes (outcomes related to patients' health condition). We searched CENTRAL, MEDLINE, Embase, six other databases and two trials registers up to 21 September 2016 together with reference checking, citation searching and contact with study authors to identify additional studies. We included individual- or cluster-randomized and non-randomized trials that evaluated the impact of computer-generated reminders delivered on paper to healthcare professionals, alone (single-component intervention) or in addition to one or more co-interventions (multi-component intervention), compared with usual care or the co-intervention(s) without the reminder component. Review authors working in pairs independently screened studies for eligibility and abstracted data. For each study, we extracted the primary outcome when it was defined or calculated the median effect size across all reported outcomes. We then calculated the median improvement and interquartile range (IQR) across included studies using the primary outcome or median outcome as representative outcome. We assessed the certainty of the evidence according to the GRADE approach. We identified 35 studies (30 randomized trials and five non-randomized trials) and analyzed 34 studies (40 comparisons). Twenty-nine studies took place in the USA and six studies took place in Canada, France, Israel, and Kenya. All studies except two took place in outpatient care. Reminders were aimed at enhancing compliance with preventive guidelines (e.g. cancer screening tests, vaccination) in half the studies and at enhancing compliance with disease management guidelines for acute or chronic conditions (e.g. annual follow-ups, laboratory tests, medication adjustment, counseling) in the other half.Computer-generated reminders delivered on paper to healthcare professionals, alone or in addition to co-intervention(s), probably improves quality of care slightly compared with usual care or the co-intervention(s) without the reminder component (median improvement 6.8% (IQR: 3.8% to 17.5%); 34 studies (40 comparisons); moderate-certainty evidence).Computer-generated reminders delivered on paper to healthcare professionals alone (single-component intervention) probably improves quality of care compared with usual care (median improvement 11.0% (IQR 5.4% to 20.0%); 27 studies (27 comparisons); moderate-certainty evidence). Adding computer-generated reminders delivered on paper to healthcare professionals to one or more co-interventions (multi-component intervention) probably improves quality of care slightly compared with the co-intervention(s) without the reminder component (median improvement 4.0% (IQR 3.0% to 6.0%); 11 studies (13 comparisons); moderate-certainty evidence).We are uncertain whether reminders, alone or in addition to co-intervention(s), improve patient outcomes as the certainty of the evidence is very low (n = 6 studies (seven comparisons)). None of the included studies reported outcomes related to harms or adverse effects of the intervention. There is moderate-certainty evidence that computer-generated reminders delivered on paper to healthcare professionals probably slightly improves quality of care, in terms of compliance with preventive guidelines and compliance with disease management guidelines. It is uncertain whether reminders improve patient outcomes because the certainty of the evidence is very low. The heterogeneity of the reminder interventions included in this review also suggests that reminders can probably improve quality of care in various settings under various conditions

Screening mammography beliefs and recommendations: a web-based survey of primary care physicians

<p>Abstract</p> <p>Background</p> <p>The appropriateness and cost-effectiveness of screening mammography (SM) for women younger than 50 and older than 74 years is debated in the clinical research community, among health care providers, and by the American public. This study explored primary care physicians' (PCPs) perceptions of the influence of clinical practice guidelines for SM; the recommendations for SM in response to hypothetical case scenarios; and the factors associated with perceived SM effectiveness and recommendations in the US from June to December 2009 before the United States Preventive Services Task Force (USPSTF) recently revised guidelines.</p> <p>Methods</p> <p>A nationally representative sample of 11,922 PCPs was surveyed using a web-based questionnaire. The response rate was 5.7% (684); (41%) 271 family physicians (FP), (36%) 232 general internal medicine physicians (IM), (23%) 150 obstetrician-gynaecologists (OBG), and (0.2%) 31 others. Cross-sectional analysis examined PCPs perceived effectiveness of SM, and recommendation for SM in response to hypothetical case scenarios. PCPs responses were measured using 4-5 point adjectival scales. Differences in perceived effectiveness and recommendations for SM were examined after adjusting for PCPs specialty, race/ethnicity, and the US region.</p> <p>Results</p> <p>Compared to IM and FP, OBG considered SM more effective in reducing breast cancer mortality among women aged 40-49 years (<it>p </it>= 0.003). Physicians consistently recommended mammography to women aged 50-69 years with no differences by specialty (<it>p </it>= 0.11). However, 94% of OBG "always recommended" SM to younger and 86% of older women compared to 81% and 67% for IM and 84% and 59% for FP respectively (<it>p = </it>< .001). In ordinal regression analysis, OBG specialty was a significant predictor for perceived higher SM effectiveness and recommendations for younger and older women. In evaluating hypothetical scenarios, overall PCPs would recommend SM for the 80 year woman with CHF with a significant variation by specialty (38% of OBG, 18% of FP, 17% of IM; <it>p </it>= < .001).</p> <p>Conclusions</p> <p>A majority of physicians, especially OBG, favour aggressive breast cancer screening for women from 40 through 79 years of age, including women with short life expectancy. Policy interventions should focus on educating providers to provide tailored recommendations for mammography based on individualized cancer risk, health status, and preferences.</p