It was a difficult process, but we have selected 4 finalists from among the peers you nominated for the Fifth Annual Oncology Nurse Excellence (ONE) Award of the Academy of [ Read More ]
August 2015 VOL 6 NO 4
Category VI: Community Outreach and Screening Programs
- G1. Practices and Perceived Barriers to Colorectal Cancer Screening by Nurses and Physicians Working in Primary Care Settings: Implications for Cancer Prevention and Nursing Education
- G2. Recognizing the Importance of a Diagnostic Breast Health Navigator
- G3. The Impact of Nurse Navigators in the Low-Dose Computed Tomography Lung Screening Program
Joshua Muliira, RN, BSN, MA, MSN, DNP; Melba D'Souza, RN, BSN, MSN, MPhil, PhD
Sultan Qaboos University, College of Nursing, Muscat, Oman
Background: Cancer is a leading cause of death worldwide and accounts for 7.6 million deaths annually. In the Middle East, an increase in cancer mortality of approximately 181% is expected during the next 15 years.
Objective: To explore the major barriers to colorectal cancer (CRC) screening in primary care settings of a developing country.
Methods: Self-administered questionnaires were used to collect data from 142 healthcare providers working in health centers. Descriptive statistics were used to analyze the major barriers, influencing factors, and differences between nurses’ and physicians’ perceptions.
Results: The participants were nurses (57.7%) and physicians (42.3%) with an average age of 32.5 years and clinical experience of 9.5 years. The majority (64.8%) of the participants reported that they rarely ordered, referred to, educated about, or recommended CRC screening for eligible patients. The factors perceived by nurses and physicians to have the most influence on their CRC screening practices were regular availability of patients who need CRC screening, continuing professional education about cancer prevention, availability of cancer specialists, and health facility policy about cancer screening. The only patient-related barrier to CRC screening rated as “major” by the majority (63.7%) of participants was patients’ lack of awareness about CRC tests. However, significant differences existed between nurses’ and physicians’ rating of patient-related barriers, such as fear of finding out about a cancer diagnosis (P ≥.05), belief that screening is not effective (P ≥.05), embarrassment or anxiety about screening tests (P ≥.03), and culture (P ≥.01). The reported major system barriers to CRC screening were lack of hospital policy or protocols, shortage of trained healthcare providers, availability of screening services, and waiting time for screening appointments.
Conclusion: These findings indicate a need to increase patient awareness, implement interventions to enhance healthcare providers’ practices, and implement an intervention to ameliorate patient and system barriers to CRC screening. Nurse educators, researchers, and nurse administrators have major roles to play in cancer prevention.
Michelle Weaver Knowles, RNC; Roni Nelsen, GN
Community Medical Center, Missoula, MT
Background: Nurse navigation plays a vital role in the diagnostic workup of breast health patients. Many healthcare providers recognize the important role of nurse navigators in breast cancer care, but what about patients who may not be diagnosed with breast cancer, but may be tagged as high risk, needing more frequent follow-up, or needing additional breast imaging modalities? This may include patients who have family members with genetic conditions, have a biopsy result with atypical ductal or lobular hyperplasia, or have no known genetic mutation but are at an increased risk based on their family history. The role of genetic education and testing has also been brought into the limelight recently. Nurses can assist in genetic education, testing, and referral to genetic counselors.
Objectives: To (1) assist diagnostic breast patients with education and follow-up, (2) assess patients meeting the criteria for genetic testing, (3) increase patient satisfaction, (4) increase retention to the facility, and (5) increase revenue.
Methods: Patients were followed by a nurse navigator and were educated. The navigators assessed their family history, assisted in genetic testing and referral to a genetic counselor, used an assessment with high-risk screening modalities, such as Tyrer-Cuzick, and provided referrals and resources as needed.
Results: Based on our experience, nurse navigators can assist busy primary care providers in education and the care of and referral for “previvors” of hereditary cancer conditions. Using risk assessment tools, such as Tyrer-Cuzick, can assist in identifying women who may not have a hereditary condition but who are possibly at high risk based on their family history. There are many benefits to having a breast health navigator follow patients through the diagnostic breast workup and follow-up. Patients will be better educated, placed in proper recall for follow-up, assessed/educated for hereditary cancer, and assessed with high-risk screening tools. This improves patient satisfaction, assists busy primary care providers with proper screening and follow-up, keeps referrals in the facility, and brings in revenue. In the case of hereditary cancers, more patients will be “previvors” versus patients with cancer. Diagnostic nurse navigation can also help facilitate scheduling annual health screening exams and referrals to promote healthy lifestyles. Patients feel less anxious and are happier, and it is a win for the facility with increasing patient satisfaction scores and increased retention and revenue.
Conclusion: Patients with the resource of a nurse navigator during a diagnostic breast workup will have greater satisfaction with care, compliance, and education, and will have more timely referrals.
Kristi M. Griffith, MSN, RN, CHPN; Susan W. Dahlin, BSN, RN, OCN; Nora J. Barrett, BSN, RN, OCN; Kristi L. Case, BS, CHW; Diana P. Conde; Stacey L. Webb, MPA-HCA, BSN, RN
Baylor Charles A. Sammons Cancer Center, Dallas, TX
Background: Since initiation of the helical low-dose computed tomography (LDCT) lung screening program in 2013, multiple barriers have been identified that potentially delay patient access to screening. Nurse navigators worked to remove these barriers to ensure timely access to screening. The issues identified included provider education, the referral process, financial considerations, follow-up protocols, and the streamlining of LDCT scheduling. One major obstacle to LDCT screening was scheduling the scan, with process delays up to 21 days after the order was received by the navigator. In the initial process, the navigator received the faxed order, confirmed eligibility, obtained date preferences, and coordinated unilaterally with the radiology department for scheduling. This cumbersome process required multiple steps to arrange, and resulted in delayed service and increased noncompliance because the sense of urgency decreased as time lapsed.
Objective: To decrease the time between receipt of the physician’s order for LDCT and the date of the actual screening.
Methods: To improve this process, a multidisciplinary team, including navigation, medical directors, radiologists, and billing specialists, collaborated in an effort to improve LDCT scheduling efficiency. In the new process (developed and approved in 2014), the navigator receives the physician’s order, confirms the patient’s eligibility for screening, and informs the patient of the out-of-pocket cost. Once confirmed, the efficient coordination for scheduling occurs via conference call. In this improved process, the navigator, patient, and radiology scheduler are directly connected via 3-way conferencing for prompt scheduling.
Results: Since the initial implementation and enactment of this enhanced scheduling process, more than 100 patients have received LDCT scans. In a preliminary analysis of the data, we found that the time between receipt of the LDCT order and actual scan was reduced by 4 days pre- versus postintervention (14.0 + 1.56 days vs 10 + 2.82 days, respectively).
Conclusion: This process improvement in efficiency is important, because it leads to earlier diagnosis and medical intervention if indicated. There is clear evidence that suggests early diagnosis and treatment yields better patient outcomes.
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