Increasing Breast, Cervical, and Colorectal Cancer Screenings: A Qualitative Assessment of Barriers and Promoters in Safety-Net Practices

Authors

Laura A. Brady, Department of Family Medicine, State University of New York (SUNY) University at Buffalo, Buffalo, NY.
Laurene M. Tumiel-Berhalter, Department of Family Medicine, State University of New York (SUNY) University at Buffalo, Buffalo, NY.
Laura A. Schad, Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY.
Alexandrea Bentham, Department of Family Medicine, State University of New York (SUNY) University at Buffalo, Buffalo, NY.
Karen Vitale, University of Rochester Clinical and Translational Science Institute, Rochester NY.
Amanda Norton, A. Mandatory, Inc. (consulting for SUNY Upstate Medical University), Groton, NY.
Gary Noronha, Center for Primary Care, Department of Medicine, University of Rochester School of Medicine and Dentistry, Rochester, NY.
Carlos Swanger, Rochester Regional HealthFollow
Christopher P. Morley, Department of Public Health and Preventive Medicine, SUNY Upstate Medical University, Syracuse, NY.

Document Type

Article

Publication Title

Journal of Patient-Centered Research and Reviews

Abstract

Purpose: Breast, cervical, and colorectal cancer screening rates are suboptimal in underserved populations. A 7-year quality improvement (QI) project implemented academic detailing and practice facilitation in safety-net primary care practices to increase cancer screening rates. This manuscript assesses barriers and promoters. Methods: Primary care practices providing care to underserved patients were recruited in New York cities Buffalo, Rochester, and Syracuse. Enrollment totaled 31 practices, with 12 practices participating throughout. Annually, each practice received 6 months of practice facilitation support for development and implementation of evidence-based interventions to increase screening rates for the three cancer types. At the end of each practice facilitation period, focus groups and key informant interviews were conducted with participating personnel. Content analysis was performed annually to identify barriers and promoters. A comprehensive final analysis was performed at project end. Results: Barriers included system-level (inconsistent communication with specialists, electronic health record system transitions, ownership changes) and practice-level challenges (staff turnover, inconsistent data entry, QI fatigue) that compound patient-level challenges of transportation, cost, and health literacy. Cyclical barriers like staff turnover returned despite attempts to resolve them, while successful implementation was promoted by reducing patients' structural barriers, adapting interventions to existing practice priorities, and enacting officewide policies. During the QI project, practices became aware of the impact of social determinants of health on patients' screening decisions. Conclusions: The project's longitudinal design enabled identification of key barriers that reduced accuracy of practices' screening rates and increased risk of patients falling through the cracks. Identified promoters can help sustain interventions to increase screenings.

First Page

323

Last Page

330

DOI

10.17294/2330-0698.1857

Volume

8

Issue

4

Publication Date

10-18-2021

PubMed ID

34722800

Recommended Citation

Brady, L. A., Tumiel-Berhalter, L. M., Schad, L. A., Bentham, A., Vitale, K., Norton, A., Noronha, G., Swanger, C., & Morley, C. P. (2021). Increasing Breast, Cervical, and Colorectal Cancer Screenings: A Qualitative Assessment of Barriers and Promoters in Safety-Net Practices. Journal of Patient-Centered Research and Reviews, 8 (4), 323-330. https://doi.org/10.17294/2330-0698.1857