Journal
Improving cervical cancer screening rates at a Federally Qualified Health Center
ABSTRACT Background: Cervical cancer is the fourth most common cancer in women. Early detection with screening methods can help to prevent mortality. Local Problem: Cervical cancer screening is below national standards at a Midwest Federally Qualified Health Center and may compromise future funding. A manual chart review of cervical cancer screening was compared with an electronic health record–generated report and found results from outside facilities accounted for 27% of the metric's underperformance. This quality improvement project aimed to improve the Uniform Data System performance for cervical cancer screening at a specific health center from 46.3% to 79.2% by July 2024. Methods: Implementation, guided by the Improvement Model and Lewin's Change Theory, included (1) analysis of cervical cancer screening underperformance, (2) sharing data with key stakeholders, and (3) creating tip sheets for chart reconciliation. Interventions: Interventions consisted of (1) auditing and reconciling charts from Epic's generated reports, (2) modifying the frequency of or discontinuing Pap smears, (3) updating surgical history to reflect hysterectomy type, and (4) sending scheduling outreach messages. Results: As of March 2024, cervical cancer screening 2023 percentages increased by ≥9% for each quarter and by 8.7% for year-to-date at the Midwest health center. The quality metric's quarter 1 and 2, 2024 data increased by 4% and 3% as of July 2024. Conclusions: Although the target goal was not reached in the designated time frame, the percentage increase proves that implementation of a chart reconciliation workflow can improve rates for cervical cancer screening at a Federally Qualified Health Center.
Implementing a standardized protocol to improve cervical cancer screening rates in primary care
ABSTRACT Background: Routine cervical cancer screening for women aged 21–65 is a recommended standard practice. Early identification and treatment of cervical cancer improves patient outcomes. Local Problem: Cervical cancer screening rates at the primary care project site were 51%, well below the national benchmark of 87%. The purpose of this quality improvement project was to increase cervical cancer screening rates by implementing a standardized eligibility assessment protocol. Methods: This initiative took place at an outpatient family practice site over 7.5 months and included 2,018 eligible patients. Interventions: Evidence-based interventions included a standardized process change that shifted eligibility assessment from an opportunistic screening by providers to a proactive screening by clinical staff. Using a system reminder prompt, clinical staff began assessing all eligible patients during rooming and proactively scheduling future Pap appointments in office or placing OBGYN referrals, per patient preference. Results: A statistically significant increase in cervical cancer screening rates occurred, 33% (p < .001). The rate of scheduled Pap appointments increased by 124% (p < .001), the rate of OBGYN referrals increased by 300% (p < .001), and the rate of completed Pap tests in office increased by 280% (p < .001). Conclusion: The results suggest that implementing a proactive, standardized screening process can increase cervical cancer screening rates in primary care.
Women's perceptions and preferences for cervical cancer screening in light of updated guidelines
ABSTRACT Background: Updated risk-based guidelines for cervical cancer screening (CCS) allow for individualized screening that minimizes unnecessary testing. However, these guidelines are complex and may not be easily understandable to patients. Purpose: To describe women's perceptions and preferences about CCS in light of recent guideline changes. Methodology: This qualitative study conducted in February 2020 used online, text-based focus groups with a sample of US women (n = 49) ages 27–45. After participants completed a short demographic survey, an experienced moderator used a semistructured guide to solicit participants' perceptions of routine gynecologic care and CCS. We summarized survey data using descriptive statistics. Two authors analyzed transcripts using conventional content analysis and met with other team members to resolve discrepancies and determine final themes. Results: Most participants were non-Hispanic White (65%), had health insurance (90%), and reported having a routine gynecologic examination in the past year (70%). We identified four common themes: (1) low perceived risk of human papillomavirus (HPV) coupled with low knowledge about HPV as a causative factor for cervical cancer, (2) confusion about—and mistrust of—recent individual risk-based guidelines that determine the indicated timing and type of CCS test (Pap or HPV testing), (3) mixed opinions about performing a self-swab for HPV testing, and (4) conflicting perceptions of trust toward providers and the health care industry. Conclusions: Findings highlight women's uncertainty and hesitancy about updated CCS guidelines. Implications: Provider–patient communication strategies should consider women's gaps in knowledge about HPV, include the rationale for guidelines and types of tests, and build trust between patients and providers.
Efficacy of implementing a BRCA screening protocol in primary care
ABSTRACT Breast cancer is the second leading cause of cancer death for women, whereas ovarian cancer is the deadliest gynecological cancer. Breast cancer gene 1 (BRCA1) and breast cancer gene 2 (BRCA2) mutations can increase the risk of developing breast and ovarian cancer. Screening can assist in prevention and early detection. This study aimed to increase provider knowledge of BRCA mutations, the use of BRCA screening tools, and genetic referrals. An Institutional Review Board–approved study was implemented for providers for training on BRCA1 and BRCA2 mutations and the importance of screening and referral for those at risk. Measures included provider confidence and knowledge after training as well as number of patient referrals. A standardized webinar was required with further education provided in multiple modalities. The number of BRCA screenings and referrals for genetic screening was monitored through the electronic health record (EHR). Eight providers including five nurse practitioners and three medical doctors participated in the complete project. As a result, 56 patients were BRCA screened, and four referrals were made to receive genetic counseling. Education enhanced knowledge, increased screening tool use, and resulted in improvement in genetic referrals through the EHR.
Psychosexual responses to BRCA gene mutations in women of childbearing age
Improving human papilloma virus vaccination rates among adolescents
ABSTRACT Background: The human papilloma virus (HPV) is the leading cause of cervical cancer worldwide and is responsible for genital warts and five other types of cancers. The HPV vaccine was introduced in 2006 and demonstrated to be safe and more effective than expected, yet adolescent rates of immunization in the United States remain low. Local problem: Adolescent HPV vaccine rates were below the national average, and effective vaccine recommendation strategies were not used at an urban pediatric primary care office in southern Florida. Methods: The percentage of HPV vaccine rates in this primary care office were measured among adolescents ages 13–17 years using data obtained from Florida's state vaccine registry before implementation of the intervention, after the intervention, and monthly over a 90-day period. Interventions: Interventions aimed to improve vaccine rates included implementing an HPV protocol consisting of education on providing a strong bundled recommendation, appointing a vaccine champion, implementing standing vaccine orders, and educational materials. Results: The vaccine rates among adolescents increased by 11% for the initial dose, 7% for the second dose, and 6% for the vaccine completion rate. Chi-square test demonstrated statistical significance, for the initial vaccine. Conclusion: A nurse practitioner–led application of an evidenced-based HPV vaccine protocol positively affected the care of adolescents in this primary care setting.
Knowledge, attitudes, and practices related to human papillomavirus vaccination among college students in a state university: Implications for nurse practitioners
ABSTRACT Background: Human papillomavirus (HPV) is the most common sexually transmitted infection in the United States and disproportionately affects adolescents and young adults. Although a safe and efficacious vaccine is available, many college students are unimmunized against HPV. Most students presenting to college health centers are within the age range for catch-up immunization, giving nurse practitioners (NPs) in this setting an opportunity to increase vaccination rates. More information is needed about college students' HPV knowledge, attitudes, and vaccination uptake so that NPs can make effective vaccine recommendations to this population. Purpose: To examine (a) Knowledge and attitudes about HPV and its vaccine; (b) HPV immunization practices; and (c) factors associated with HPV knowledge, attitudes, and vaccination among college students in a US university. Methods: This cross-sectional quantitative study collected data from participants in a state university student health center. Data collected included knowledge, attitudes, and practices about HPV and its vaccine from 627 students. Results: Participants had a moderately low HPV knowledge but positive attitudes toward HPV and its vaccine. Participants with a higher level of HPV knowledge were US born, health-related majors, married or divorced, and had positive attitudes. Higher HPV knowledge, vaccine uptake, and a family history of cervical cancer were associated with positive attitudes. Predictors for vaccine uptake include being a health-related major and positive vaccine attitudes. Implications for practice: The results of this study help NPs, registered nurses, and other health care providers make effective HPV vaccine recommendations to college students. Students with positive HPV attitudes can serve as peer educators to increase HPV vaccination awareness in this population.
Ovid Technologies (Wolters Kluwer Health)
2327-6924
