LBA Category I: Community Outreach/Prevention

November 2023 Vol 14, No 11 —November 22, 2023

B1 Creation of an Ambulatory Safety Net to Increase Access to Cancer Screening

Paula Aguilera, RN, BSN; Ludmila Svoboda, RN, BSN, OCN, MA

Dana-Farber Cancer Institute, Boston, MA

Background: In collaboration with our colleagues at Lawrence General Hospital (LGH) and Holy Family Hospital (HFH) in the Merrimack Valley, the Cancer Care Equity Program (CCEP) has identified significant knowledge gaps among the local patient population regarding what cancer screening is and the importance of the associated screening tests.

Objective: The CCEP was awarded a grant by CRICO, the malpractice insurer for Harvard Medical Institutions, to implement an ambulatory safety net (ASN) that will reduce gaps in the timely diagnosis of cancer attributed to missed cancer screening opportunities, starting with colorectal cancer, and expanding to lung, breast, and prostate cancer.

Methods: During our landscape survey, we conducted on-site visits in the endoscopy suites at HFH and LGH. We evaluated cancellation data from both sites to compare anecdotal findings with patient data. The nurses provided insight regarding barriers that prevented patients from attending screening appointments. They emphasized the need for generalized education about cancer screening and the need for procedures, such as colonoscopies, mammograms, and low-dose chest computed tomography scans. Nurses often spend a substantial portion of their day educating patients. In addition, many endoscopy appointments need to be cancelled due to incomplete prep and other patient-facing issues such as unavailability of accompaniment and transportation. Our data show that cancellations for screening colonoscopies are occurring in all racial and ethnic groups, and lack of health literacy across groups leads to missed appointments or poor prep for the procedure.

Results: Refined and culturally tailored education is needed regarding cancer screening, its associated tests, and the potential positive impacts of early screening. Teaching material is at a reading level that is too advanced to understand, and not in the patient’s native language. The use of visual and auditory education can provide more concrete and culturally relevant examples and promote cancer screening. Our intervention will include one-on-one interactions with patients scheduled for cancer screenings, such as a colonoscopy, to educate them on why this appointment was made and assess barriers that may prevent them from attending their appointment. We will create educational videos that will be sent to patients incrementally in the weeks leading up to screening appointments, to reinforce the education provided over the phone. These videos can be downloaded and shared as a trusted educational source in the community.

Conclusions: This culturally inclusive educational intervention will provide targeted, effective, and long-lasting information that will help decrease disparities in morbidity and mortality for cancers in the Merrimack Valley. The ASN will allow us to gather data regarding demographics so we can refine our patient education. We will further explore barriers for patients and identify resources. We will track these survey data to be able to report back to key stakeholders involved in this project.


  1. AACR Cancer Disparities Progress Report 2022: Contents. American Association for Cancer Research. Accessed June 11, 2023.
  2. Cancer disparities. National Cancer Institute, National Institutes of Health. Reviewed March 28, 2022. Accessed June 11, 2023.
  3. Ma Z-Q, Richardson LC. Cancer screening prevalence and associated factors among US adults. Prev Chronic Dis. 2022;19:220063. Accessed June 11, 2023.
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Last modified: November 29, 2023

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