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

Authors

Laura A. Brady, SUNY University at BuffaloFollow
Laurene M. Tumiel-Berhalter, SUNY University at Buffalo; University at Buffalo Clinical and Translational Science InstituteFollow
Laura A. Schad, SUNY Upstate Medical UniversityFollow
Alexandrea Bentham, SUNY University at BuffaloFollow
Karen Vitale, University of Rochester Clinical and Translational Science InstituteFollow
Amanda Norton, A. Mandatory, Inc.Follow
Gary Noronha, University of Rochester School of Medicine and DentistryFollow
Carlos Swanger, University of Rochester School of Medicine and Dentistry; Rochester Regional HealthFollow
Christopher P. Morley, SUNY Upstate Medical UniversityFollow

Publication Date

10-18-2021

Keywords

cancer screening, quality improvement, breast cancer, cervical cancer, colorectal cancer, prevention

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.

Recommended Citation

Brady LA, Tumiel-Berhalter LM, Schad LA, Bentham A, Vitale K, Norton A, Noronha G, Swanger C, Morley CP. Increasing breast, cervical, and colorectal cancer screenings: a qualitative assessment of barriers and promoters in safety-net practices. J Patient Cent Res Rev. 2021;8:323-30. doi: 10.17294/2330-0698.1857