2018?Central East Regional Cancer Program funded project
Cancer Screening Noncompliance Survey
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Cancer Screening is promoted in many ways in Ontario
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Cancer Care Ontario does mail out reminders and advertising.
Health Care Providers address it in medical appointments.
Clinics do phonecall/email/text/mail-out reminders.
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Despite all this education and promotion, cancer screening rates seldom, if ever, reach 100 percent.
We felt it important to ask patients themselves for reasons that they don?t get screened. Central East Regional Cancer Program funded a pilot project to do a phone survey of patients who were overdue for screening.
Phone Survey for Overdue Cancer Screening
We generated lists of patients who are overdue for either Cervical, Breast or Colorectal Cancer Screening. Our data query focused on patients who at one point had been screened but had become overdue since their last screening. The Cervical and Colorectal lists were verified against our physicians CCO SAR reports and the Breast list was verified by Central East Regional Cancer Program through the OBSP database.
We had a registered nurse go through the lists and make the calls. She made two attempts at each phone number to reach the patient. After consulting with some patients and staff, a? standardized greeting and question was decided on and presented to each patient.
??????????? ?Hello, This is <Name> calling from the Kawartha North Family Health Team. Do you have a few moments to answer some questions about cancer screening? We would like to find out reasons that people do not get screened. Our records show that you are overdue for <TYPE of SCREENING>.? Could you tell us why??
At this point the patient?s response was recorded into one of six catagories:
1-Does not believe in the science
2-Busy but want to get screened
3-Too busy to get screened
4-Unaware was overdue
5-Do not need to get screened, I am healthy
6-Test is uncomfortable or icky
We called 321 patients (136 calls did not connect after two tries)
Combined Results (without did not connect)
PDSA Cycle:
Confidence: We had expected around a 80% response rate. This is based on hundreds of calls using our robocaller technology. We experienced a 60% rate when we started our breast cancer screening calls. I expect that this may be due to the time of day that the calls were made. Our robocaller reminder calls are done between 4pm and 6pm during weekdays. The Nurse made the calls between 9am and 4pm weekdays. I think more people are at home during the 4pm-6pm period hence the difference in rates.
We adjusted by adding 2nd round of calling for breast cancer screening to increase the number of responses received.
Results and interpretation:
The vast majority of responders indicated their wish to be screened even though they have been too busy prior. This indicates that screening is inconvenient and hard to incorporate into their regular routines.
The next group were people who thought the test was uncomfortable or icky. Of this group they found mammograms the least icky and pap smears the most icky.
The smallest group discounted the need for screening due to doubting the science or believing themselves healthy.
How to make screening more convenient? FOBT Kits can be mailed and the introduction of the new ?pen? system will make the collection of samples easier as well as less icky. Mammograms and Pap clinics could be offered in the evenings and weekends. Any increase in the convenience of getting screened will have a direct impact on screening rates.
Project Lead: Cameron Berry CHIM
??????????????Quality Improvement Decision Support Specialist
March 26, 2019 ????????????????????????? Kawartha North Family Health Team