Removing Barriers to Cancer Screening for High-Risk Patients
To help staff prepare for the Magnet site visit occurring March 26-29, each week BWH Bulletin will feature an example of a hospital initiative that demonstrates how the Brigham exemplifies the hallmarks of a Magnet institution. The following program reflects the hallmark of interprofessional collaboration.
While regular screening is a powerful tool for prevention and early diagnosis of colorectal cancer – the third-leading cause of cancer-related deaths among Americans – patients avoid having a colonoscopy for various reasons, often related to the complexity and inconvenience of preprocedure preparations.
Patients in our local community with limited English, poor health literacy, socioeconomic challenges, physical disabilities, cognitive impairment or behavioral health disorders are at greater risk of delaying or missing preventive screenings. Colonoscopies, specifically, have the added challenges of coordinated testing and stringent prep requirements. But thanks to a collaboration between BWHers in Primary Care Central Population Management (CPM) and Endoscopy nursing, fewer of these patients are falling through the cracks.
Staff in these areas work together to identify and support patients in this demographic with who need preventive cancer screening and may be at risk for being “lost to follow-up,” explained Sandy Cialfi, MBA, BSN, RN, CGRN, nurse director of Endoscopy.
“These patients are part of our community, and we have a responsibility to make sure they understand the importance of this screening and to do everything we can to help them access it,” Cialfi said.
The initiative, launched in 2015, yielded immediate results. Prior to the intervention, 62 percent of patients in this demographic completed colonoscopy screening over a three-month period. That rate rose to 70 percent over the next three months when the intervention was implemented. One year later, more than 80 percent of these high-risk patients underwent colonoscopies.
Using a registry tool in Epic, CPM staff identify at-risk patients and help coordinate any necessary services or support. This includes assistance with scheduling, one-on-one coaching to address health literary or language barriers, or transportation within the Boston area.
Travel home after the procedure can be a common challenge for patients in this population, explained Mary Merriam, RN, director of CPM program operations. Because colonoscopies are typically performed under sedation, patients must have an escort home, even if they take public transportation. CPM staff known as population health coordinators and patient navigators can fulfill this role for those at-risk patients who live in the local community; the team often helps patients who live outside the city connect with municipal and volunteer groups in their area that provide similar services.
Merriam noted that other patients may need help understanding certain requirements, such as how to measure the prep solution, or more targeted assistance with booking the appointment in coordination with work, school or child care schedules.
“We’re like shepherds. We can see when patients are coming in, help the care teams get ready and do all sorts of activities in the background to help both patients and providers be as prepared as possible,” Merriam said.
CPM staff closely partner with Endoscopy triage nurse Irina Filina, RN, CGRN, to review clinical concerns, questions or challenges, ultimately forming individualized care plans to ensure patients are scheduled for a colonoscopy, adequately prepped for the procedure and followed up with after the procedure.
Filina said this interdisciplinary collaboration has been crucial to the program’s success.
“Before this program was implemented, there were obstacles I couldn’t overcome on my own with some patients. These screenings are logistically challenging, and I was struggling,” she said. “The population health managers and patient navigators have been a tremendous help, whether it’s arranging transportation to get a patient here for their procedure or accompanying them to the pharmacy to pick up a medication. The bottom line is that by working together, we are saving more people’s lives.”
Merriam agreed: “Our staff are trained to do chart reviews and interview patients to screen for potential risks, but ultimately their background is not clinical. Irina helps us look at the more complex cases and takes care of some of barriers around reaching out to physicians or securing prescriptions. What makes this program so successful is that we work as partners.”
Visit BWHPikeNotes.org/magnet to learn more about the Brigham’s journey to Magnet designation. Resources include informational videos, frequently asked questions, a countdown to the site visit and instructions for accessing the body of evidence BWH submitted to the American Nurses Credentialing Center. The colorectal cancer screening initiative is featured in the Structural Empowerment (SE) 10EO section of the submission.