The Kennedy Health System Oncology Patient Navigation Program: A Collaborative Oncology Certified Nurse and Oncology Certified Social Worker Patient Navigation Team Model Louise M. Baca, RN, MSN; Eric Gonzalez, RN, [ Read More ]
October 2013 VOL 4, NO 5
Category V: Screening Programs for the Underserved
Trial of a Cervical/HPV Hispanic Screening
Robin Atkinson, RN, BSN, OCN, GYN, Oncology Nurse Navigator
Novant Health, Derrick L Davis Cancer Center
Background: Cervical cancer can be prevented with regular screening tests and follow-up. The 2 screening tests utilized are the Pap smear, which looks for cell changes on the cervix that might become cervical cancer if they are not treated appropriately, and the human papillomavirus (HPV) test, which screens for the virus that can cause these cell changes. Data from the Centers for Disease Control and Prevention 2004-2008 shows a higher incidence of HPV-related cervical cancer for the Hispanic population. A study of cervical cancer incidence and mortality in North Carolina also reflects this trend and revealed reasons for lack of screening as no insurance and low economic status. Our community data reflect this national and state trend with local Hispanic women citing uneasiness with the Pap examination process, especially if conducted by a male physician. Our cancer center outreach concern is the lack of available free cervical screening clinics for the underserved, uninsured group of Hispanic women. Objective: In our regional cancer center, the Hispanic population does not reflect the increased numbers of HPV cervical cancers seen in the state or national trend. We are missing this population. The objective was to implement a trial of free Pap screening to the population of Hispanic women who would otherwise not seek healthcare. A goal was to make the screening comfortable for the patient, easily accessible, and conducted within a reasonable time frame. Methods: A free community-based screening was offered to women of Hispanic decent over the age of 30 years in an accessible community Oncology Specialist Gynecological Clinic setting during evening hours. The women were recruited by a Hispanic patient advocate who worked in the local community cancer care facility. Recruitment was conducted in local churches, beauty shops, and wellness seminars that targeted the Hispanic population. The women signed up via phone or in person, and a letter was sent to the patient as a reminder before the event. The patient advocate called 1 to 2 days prior to the screening to confirm attendance. Clients were encouraged to obtain a babysitter if needed or bring someone with them to watch their children. Interpreters were used to help each individual woman complete the forms and make sure the personal information received upon registration was correct. Healthy snack bags were given to each participant since this was an evening screening. In each examination room we had a physician or midlevel RN and an interpreter. The staff volunteers consisted of: 2 Gyn oncology physicians (1 male and 1 female); 1 Gyn oncology nurse navigator; 1 Gyn oncology nurse practitioner; 2 Gyn oncology physician assistants; 5 Gyn oncology RNs; 1 Gyn oncology CNA; 2 Gyn oncology CMAs; 2 laboratory technicians to process the Pap smear and paperwork; 2 community volunteers from the local cancer care facility; and 8 interpreters. A Pap smear with thin Prep and HPV was used as the screening tool. Results: Thirty-eight women enrolled and 34 attended the evening clinic. There were 21 normal findings and 13 abnormal screenings.
The Table reflects the abnormal screenings and the follow-up. All results were reviewed by a Gyn oncologist, and recommendations for follow-up were given by the Gyn oncologist. Each abnormal result was called by the Gyn nurse navigator with the support of Hispanic patient advocate. Also, an education session by the Gyn nurse navigator and the Hispanic patient advocate was offered for all women with abnormal screenings to emphasize the importance of follow-up care. Twelve of thirteen (92%) participants attended the session. Personal diagnostic questions were answered privately with individuals to protect their health information. Conclusions: (1) The clinic was a success with attendance participation of 89% from those enrolled. This was due to our Hispanic patient advocate who worked individually with each attendee and conducted reminder calls and letters. (2) It was economically feasible with the cost of $58 for healthy snack bags. The volunteer time cost for those working in the evening clinic was 2 hours. (3) All positive screenings had a follow-up plan for patients that did not incur cost to them. (4) Patient satisfaction surveys are pending. The feedback will influence the next screening for this designated population.
Cancer Genetic Counseling and Testing: Genetic Counselors’ Perspectives on Patient Access, Resources, and Follow-Up Care
Mary Lou Woodford, RN, MBA, CCM; K. Habin; J. Boucher; M. Underhill; D. Lundquist; D. Guillaume
Background: The prominence of cancer genetics testing is outpacing current patient access, resources, and follow-up care by trained healthcare professionals, including oncology nurses. Significant concerns include the impact of predictive genetic testing on patient outcomes involving cancer surveillance, detection, and preventive care in the community (including those at a younger age). The purpose of this research was to describe genetic counselors’ perspectives on patient access, resources, and follow-up care related to cancer genetic counseling and genetic testing. The study aims were to: (1) Explore cancer genetic counselors’ experiences with patient access to predictive genetic testing, health information needs, and follow-up psychosocial support and counseling; (2) Describe strategies utilized by cancer genetic counselors to facilitate genetic counseling and testing for cancer predisposition syndromes, including experiences with the GIFFTS program; and (3) Identify needs for future research and community interventions to assist genetic counselors in providing cancer genetic counseling and testing within underserved, at-risk communities. Methods: A cross-sectional qualitative focus group method was used with clinical genetic counselors (CGCs). Eligible CGCs who participated in the study provided predictive genetic testing and counseling services within the past 5 years for identified at-risk patients for cancer susceptibility. A cross-sectional cohort of 3 focus groups included a total of 20 participants. Descriptive survey and qualitative content data were analyzed for common themes from focus group interview responses. Results: The results of qualitative responses revealed the following emerging themes: Navigating the System of Genetic Testing and Counseling, including subthemes of Access and Referrals, Barriers and Resources, Psychosocial Needs, and Patient/Provider Preparation. Navigating the System of Genetic Testing and Counseling was described by genetic counselor participants who identified referral, finances, knowledge, and preparation as key areas of need along with the impacts on high-risk patients (including the under- or uninsured) accessing follow-up preventive care. Conclusions: In summary, additional resources are necessary to address the needs of patients and providers, including the underinsured and uninsured, undergoing predictive cancer genetic testing and counseling as a result of a community. Genetics education and training are needed for all healthcare professionals, including oncology nurses, regarding care provision to a high-need and underresourced patient community. The study findings will be used in the development of patient-centered interventions aimed at reducing disparities in cancer genetics and preventive healthcare solutions.