Taking action

The ‘Importance of Primary Care in Cancer Screening’ video shares North Coast practices experiences of what worked for them when they sought to improve cancer screening rates:

The information below is a great summary of what we have learnt from the Women’s Cancer Screening Collaborative about how practices can improve their patients screening rates.

If you would like to improve cancer screening rates in your practice, a good first step is to engage and motivate your practice team.

Ideas for engaging the team:

Motivate the team by showing the video above which shares North Coast practice’s experiences of what worked for them to improve screening rates.

As a team, review local screening rates and why screening is important (visit the ‘cancer screening’ section of ncphn.org.au/wcsc for more information).

Hold a staff meeting to ‘brainstorm’ ideas about what changes they would like to see, who will be responsible for what and how you will track change.

Put up posters in the lunch room to share information about what the practice is doing to improve screening rates.

Use data to understand how well your practice is performing in cancer screening and to identify which of your patients are never screened or under-screened.  (Practices often find that when they look at their data their screening rates are not quite as good as they had anticipated).

How to use data to identify screening rates and under-screened patients?

• Use CAT4 to establish your screening rates and which patients are under-screened using easy to follow CAT4 recipes (contact your Practice Support Officer if you want help with installing or using CAT4)
• If CAT4 cannot give you accurate data because of how your practice has managed breast screen results in the past, you can access a list of your patients who have had a mammogram at BreastScreen using the BreastScreen Data Request Form
• Your practice may decide that it will take too long to go back and code all your patients breast screen results in a way that allows CAT4 or your practice software to produce a list of who is or isn’t screened.  That’s ok, the best thing to do is to set up a better system moving forward (see ‘systemise’)

• Patients can be up to 60% more likely to screen when reminded by their General Practice in addition to screening registries.
• The NSW Pap Register gets around 200 ‘return to senders’ everyday.

How to effectively remind your patients to screen?

Check out the video above to hear practices talking about finding a reminder system that suited them.

Ask patients what kind of reminders would work best for them e.g. letter, phone call, text message.

Introduce a systematic way to send out reminders using an approach that works for your patients and your practice.

Monitor how your system has worked and adjust over time if needed.

Developing a systematic approach to managing your recall and reminders is the foundation to being able to improve screening rates long term and monitor progress.

NCPHN can provide your practice with excellent ‘Recall and Reminder Guides’ from Train IT Medical, contact Meg Baker or your Practice Support Officer for your guide.

There are always simple things that can be done to be more patient centered.  Patient centered approaches may be especially important when trying to engage women who have never screened or are very under-screened.

Ideas for improved patient centredness

• Ensure your practice meets health literacy standards
• Run a simple survey with women to ask them what gets in the way of them screening, this will give you valuable information to inform your service delivery
• Look at your data to see if particular groups of women are under-screened, and ask these women what would help them to screen
• Understand what resources and organisations already exist that can help you communicate and engage with patients at risk of under-screening  (e.g. BreastScreen resources, ACON LGBQTI screening resources, ‘Being a Healthy Woman‘  information and counselling tools for women with intellectual disabilities)

HealthPathways puts all the management and localised referral information a clinician needs at their finger tips.

On 1 December 2017 the renewed National Cervical Screening Program will be implemented. Cervical cancer is one of the most preventable cancers. The new Cervical Screening Test is expected to protect up to 30% more women.

HealthPathways has developed the Cervical Screening Pathway as part of a nationwide collaboration of HealthPathways teams, Family Planning NSW and input from the Cancer Council, Wiki Cancer and NPS MedicineWise.

The pathway guides clinicians through the new routine screening recommendations, as well as the additional screening requirements for certain women e.g. those with symptoms, those who began sexual activity at a young age, immune deficient women etc. It provides links to numerous resources for GPs, self-directed learning modules and patient information. It also introduces and provides information on self-collected samples for under screened women. 

In addition to the Cervical Screening pathway, localised management and referral information is available for:

• Lymphoedema
• Lymphoedema Therapy
• Breast Screening
• Breast Pain (Mastalgia)
• New Breast Lump
• Nipple Discharge
• Breast Cancer – Established
• Breast Cancer Follow-up
• Familial Breast or Ovarian Cancer Syndromes
• Familial Cancer Syndromes
• Familial Colorectal or Endometrial Cancer Syndromes
• Ovarian Cyst
• Ovarian Cancer – Established
  Ovarian Cancer Follow-up
• Ovarian Cancer Diagnosis
  Endometrial Cancer
• Cancer Care Psychosocial Support

Access these HealthPathways by visiting:

manc.healthpathways.org.au 

Username: manchealth

Password: conn3ct3d

Simply type the name of the HealthPathway you want into the ‘search’ function.

Breast Care Nurses and Breast and Gynaecology Cancer Nurse Specialists have advanced training in the provision of  physical, psychological and emotional support to people diagnosed with breast and gynaecological cancer.

They can also provide advice and support to general practice in relation to the care of patients.

Key points:

• From the time of diagnosis and throughout treatment, support is available for free, in the private or public health system.
• Support is available from Day 1 and for as long as it is needed.
• Nurses provide support for all stages of breast cancer – from  early through to metastatic.

You can find contact details for nurses in your area via the Breast Care Nursing HealthPathway

Username: manchealth

Password: conn3ct3d

What can you do to reduce health literacy as a barrier for your patients?

Access:

Enable access to screening messages:

• Provide information in a variety of formats e.g. print, video, email, text message
• Distribute messages in a variety of ways e.g. social media, newspapers, radio, local newsletters.
• Think about how, where, when, and to whom you are providing information.

Understand:

Make information clear and easy to understand:

• Use the Health Literacy Checklist to check the readability of any patient information you give out.
• Test your use of jargon when talking to patients about cancer
• Make recall and reminder letters and text messages easy to read. Here’s an example
• Use the Teach-Back method to confirm understanding of what you have discussed.

 Appraise

Help people understand how and why the information applies to them:

• Target messages for certain groups e.g. Indigenous women or women at increased risk. This can address cultural beliefs, differences in cancer risk and informed decisions.
• Tailor messages to an individual. This takes into account personal barriers, family history and genetics.

Act

When people can access, understand and appraise information, they are more likely to take action. This means using available screening services or having conversations about cancer screening.

• Support informed decision making and provide decision aids.
• Ensure people understand and act on follow-up care. Teach-Back can be used to support this.

For more information, or to book a health literacy training for your practice, visit the Health Literacy Northern NSW website