Women’s Health Screening Event: Reducing Barriers to Provide Clinical Care
Katharine Conroy, BSPH; Amanda Recchini, RN, BSN; Gean Brown, MSN, RN, OCN
Middlesex Hospital Cancer Center
Background: Despite their varied etiologies, incidence rates, and mortality rates, breast and cervical cancer are both considerably more treatable when detected in their precancerous or early-stage phases. Nurse navigation, which is becoming an increasingly important subspecialty in oncology nursing, can serve to increase the efficacy of early-detection efforts, particularly for women with limited or no insurance coverage. Collaboration with trusted agencies such as the Connecticut Breast and Cervical Cancer Early Detection Program (CBCCEDP), which provides cost coverage for mammograms, Pap tests, and other examinations to those who qualify based on their insurance and income status, is also essential in reducing barriers to screening.
Methods, Intervention, and Analysis: The Middlesex Hospital Cancer Center (MHCC) designed and implemented the Women’s Health Screening Program, a 3-part event. In Part I, the gynecology nurse navigator and community outreach coordinator attended a local health conference with CBCCEDP representatives to educate and enroll women in CBCCEDP, as well as schedule them for a mammogram and/or Pap test 1 week later. All women were given an event-specific reminder card with their appointment information and other necessary details. During the interim week (Part II), the nurse navigator and outreach coordinator called all registrants to remind them of their appointments and ensure that they could be contacted. Transportation was arranged as needed. On the day of the screenings (Part III), women were met at the door and physically navigated through the exam process.
Results: All (100%) of the women registered for screening examinations at the health conference arrived for and completed their mammogram and/or Pap test 1 week later. A total of 10 women were provided with services, and the success of the event resulted from collaboration between 6 unique departments and physicians. On program evaluations, participants identified both the opportunity and the presence of a navigator as the greatest influences on their decision to be screened.
Discussion: The 100% rate of compliance with scheduled tests, combined with the navigation provided indicates that this model was effective in reducing significant barriers to care. Although none of the patients were found to have breast cancer or abnormal Pap test results through this event, 3 patients were diagnosed with dense breasts and 4 were referred for additional services, including colonoscopy, pelvic ultrasound, and genetic counseling. This reveals that the event had multifaceted benefits, as nongynecological findings were also able to be identified and addressed. Additionally, enrolling all participants in CBCCEDP ensures that a mechanism for future breast and cervical care is in place.
Towson University Cancer Wellness Program
Mary Sharon Curran, MS, RN
Towson University/Ulman Cancer Fund
Objectives: The participant shall be able to identify strategies for assisting young adult cancer patients/survivors in increasing their exercise; identify how exercise can benefit young adult survivors psychologically; and name entities in effective program collaboration.
Purpose: The Comprehensive Cancer Wellness Program is a joint initiative from the Towson University Wellness Center, Towson University Nursing Department, and the Ulman Cancer Fund (UCF) for Young Adults. This free, 8-week program is an outreach initiative aimed at improving the quality of life of young adult cancer patients/survivors (ages 18-40 years) in the Towson region who are undergoing active treatment for cancer, have had cancer in the recent past, or are living with significant long-term effects of cancer treatment as children or teens.
Method: Individually tailored exercise training and guidance is provided by Towson University Wellness Center staff 2 to 3 times per week in a fully equipped facility with state-of-the-art cardiovascular and strength-training equipment. Emotional support is provided by the UCF patient navigator, who also serves as a Towson University Nursing Department Clinical Associate Professor specializing in psychiatric and mental health nursing. Young adult cancer patients/survivors are referred from local cancer centers where UCF social workers and UCF nurse patient navigators are stationed. All participants must be cleared by their treating oncologist to participate in the program.
Results: Among cancer patients, the most commonly preferred feature was access to consultation with an exercise specialist who could take into account the patient’s previous exercise and cancer history, and their physical and emotional recovery goals. Medical oncologists were in favor of their younger patients increasing their posttreatment physical activity under appropriate supervision and noted the value of the real-world collegiate setting.
Conclusions: The program offers examples of how medical centers, academic institutions, and nonprofit organizations can effectively collaborate to develop and implement a wellness program for young adults in their 20s and 30s who are surviving cancer. Exercise is not only safe after cancer, but it can also improve physical functioning and psychological adaptation. The advice of medical oncologists to “get more exercise” can best be followed by young adult survivors when they have a safe, structured option that allows for professional guidance in a real-life setting.
Research Implications: Further research is needed to determine if this model can be effectively utilized in other urban academic settings. In addition, longer-term outcomes such as frequency and intensity of weekly exercise, general psychological well-being, and remediation of treatment side effects 1 year after program completion should be explored.
Clinical Implications: The program model demonstrates how oncologists can easily and effectively help young adult cancer patients transition into survivorship, and how exercise can be integrated into survivorship planning.
Role of Clinical Navigation in a Colonoscopy Screening Program
Patricia Hegedus, RN, OCN, MBA; Noel Kinard, LMSW; Sharon Bartelt, RN, MSN, MBA, CPHQ, CSSBB, OCN; Kirsten Beeker, RN, BSN, OCN, CBCN
Gibbs Cancer Center & Research Institute, Spartanburg Regional Healthcare System
Background: Spartanburg Regional Healthcare System Gibbs Cancer Center & Research Institute (GCC&RI) is a nationally recognized cancer treatment and research facility located in Spartanburg, SC. To reduce colorectal cancer (CRC), there is a great need in South Carolina and throughout the United States to increase colonoscopy screening services.
Objectives: The Betty Ann Moore Colorectal Cancer Screening Program (BAM) has focused on increasing the number of people screened for CRC since 2007. The program began with seed funding from the children of Betty Ann Moore. Her children wanted to remove the financial barrier for residents in the upstate South Carolina community who would otherwise be unable to receive a screening colonoscopy. Clinical navigation services have played an integral role in the success of the program.
Method: The Gastrointestinal (GI) Clinical Navigator screens the patient for eligibility, facilitates physician referral, provides patient education, and monitors program outcomes. The GI Clinical Navigator facilitates the referrals throughout the care continuum, screening through treatment and survivorship. Navigation services played a key role in the development of the financial and clinical requirements to qualify to receive the screening colonoscopy. This process continues to be utilized today. In fall 2010, GCC&RI’s involvement in the statewide screening effort, the South Carolina Colon Cancer Prevention Network (SCCCPN), enabled us to utilize BAM funds to provide both diagnostic and screening colonoscopies.
Results: BAM has provided 174 colonoscopies: 93 were screening colonoscopies and 81 were diagnostic colonoscopies. Three patients have been diagnosed with CRC under BAM’s diagnostic colonoscopy services. These patients were able to avoid the delay in diagnosis, thereby improving their chances of a cure. A total of 114 (66%) patients had polyps removed. Of the 114 patients, 63 (55%) were adenomatous precancerous polyps.
Conclusion: The challenge to increase CRC screening in the upstate community has been achieved through our collaborative efforts and support from our statewide partners, including the SCCCPN. Our continued partnership will inevitably ensure earlier CRC detection and prevention for upstate South Carolina residents. BAM continues to be supported by individual donations and fundraising events. The contribution of the Clinical Navigator in program facilitation and patient coordination is undeniable and has led to the success of the program. BAM continues to provide CRC screening to the underinsured in Spartanburg and surrounding counties in upstate South Carolina, making it a unique program in the state.
Women’s Health Cancer Screening–An Initiative Reaching Uninsured Women in the Communities North of Pittsburgh, Pennsylvania
Kathleen Bryte, MSN, RN, OCN; Elizabeth Shumaker, MSN, RN, OCN
Background: To prevent or detect cancer at an early stage, the American Cancer Society recommends that healthy women should have yearly clinical breast examinations and mammograms starting at age 40 years and Papanicolaou (Pap) tests every 3 years starting at age 21 years. Community leaders in the North Hills of Pittsburgh completed a needs assessment that revealed a privation of cancer screening services for uninsured women living in our community; they sought programs that could address this need.
Objectives: The primary intention of the Women’s Health Cancer Screening (WHCS) is to provide breast and gynecologic cancer screenings and healthy lifestyle education free of charge for women who would otherwise not have these basic medical services.
Methods: WHCS is an initiative led by the University of Pittsburgh Medical Center Passavant that not only offers a one-time physical examination and testing on the day of the screening, but more importantly provides women with no-cost, long-term access to these potentially lifesaving procedures by introducing them to the Pennsylvania Healthy Woman Program (HWP). Informational flyers announcing the WHCS were given to the local food banks and other community centers for distribution. In addition to their 20- to 30-minute visit with a gynecologic specialist where they received thorough breast and pelvic examinations and personalized discussions about appropriate health issues, the women also received other health screenings, education about cancer prevention and healthy lifestyle choices, and the opportunity to learn about and complete the forms for enrollment in the HWP. Biopsies were done that day for identified lesions, and transvaginal ultrasounds (TVUS) performed when pelvic masses were detected. All of the women also met with medical financial counselors, who helped them discern appropriate avenues for health insurance coverage. A letter containing copies of all test results, any recommendations for follow-up, and a reminder about getting their mammogram through the Pennsylvania HWP was sent to each woman.
Results: Two WHCSs have been held on Saturdays, with 27 and 29 participants, respectively. Between the 56 participants, abnormal findings and procedures on the day of their screening included 5 pelvic masses/TVUS, 4 breast masses, 3 cervical biopsies, 2 positive HPV results, and 1 positive Pap test. All women who met the criteria received a voucher to have a free mammogram.
Conclusions: Each woman who attended the WHCS was given the cancer screenings and healthy lifestyle education personalized according to their age, identified issues, and the recommended, evidence-based preventive guidelines. The administration of the hospital deemed the WHCSs to be a successful endeavor that fulfilled the expectations described in the community needs assessment and plans to continue the program at least annually.
Support Your Girls: They’ll Thank You Later
Donna Moore Wilson, BSN, RN, CBCN; Judy Heilman, MBA
Bon Secours Richmond Health System
Background: Research has proven that the earlier breast cancer is found, the higher the probability of cure. According to the American Cancer Society (http://www.cancer.org/cancer/breastcancer/index) breast cancer found during screening examinations tends to be smaller and confined to the breast. Providing breast education and dispelling myths increases the likelihood that women will perform breast self-examinations and obtain yearly screening mammograms.
Methods: For the past 4 years, Bon Secours Cancer Institute has hosted “Support Your Girls” seminars at local country club and hotel banquet rooms, inviting women to a ladies’ night out and providing dinner, education, photo booths, prizes, scheduling for screening mammograms, bra fittings, and the opportunity to purchase bras from local merchants, Dillard’s and Nordstrom. Staff and community partners provided booths with education and community resources prior to the event. Nutrition education was provided by Whole Foods and Fresh Market. Women are invited via television, radio, and newspaper ads, and the Internet. Advanced registration was required, with a limit of 175 attendees. For the past 2 years, the events have filled to capacity, with women being placed on waiting lists. Upon their arrival to the event, women were given gift bags and a bingo card filled with the names of the vendors providing education and services. Women were required to visit each booth to have their bingo cards signed. The completed bingo cards were collected, and a winner was drawn at the end of the evening. The winner received a pink Coach pocketbook. During the dinner, speakers provided education on a variety of subjects, such as integrative medicine, breast reconstruction, breast radiology, navigation, breast surgery, and how to be fitted for the perfect bra. Community partners provided additional giveaways including a hotel weekend package for 2, gift certificates for facials, dinner out at restaurants, gift baskets, and massages.
Results: The annual events have become increasingly popular with the community. This event provides Bon Secours Cancer Institute the opportunity to provide education and updates on breast health from experts including fellowship trained breast surgeons. Attendees were given information on complete breast diagnosis and treatment under 1 roof. For 2014 events, 23 screening mammograms were scheduled; of those, 27% had never been treated by a Bon Secours provider, 33% were over the age of 40 and never had a mammogram, and 22.4% were women under the age of 40 who came to be educated on breast health and awareness.
Conclusion: The events provided an opportunity for the women in the community to be educated on breast health in an informal relaxed setting. The relaxed atmosphere provides a trusting safe environment where women feel comfortable asking questions and learning about the importance of breast health.