Aboriginal or Torres Strait Islander communities

Case study: Updating cancer screening records

Case study detailing outcomes, feedback and challenges of a project to improve cervical, breast and bowel cancer screening rates at an Aboriginal Health Service.

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Background

A cervical screening nurse at an Aboriginal Health Service in regional Victoria was hired to work one day a week on improving cervical, breast and bowel cancer screening rates for six months.

A nurse consultant with expertise in working with under-screened communities, visited the Aboriginal Health Service to meet the Pap nurse and practice manager to discuss strategies that had previously worked well in Aboriginal Health Services, including:

using a consent form for all women who enter the clinic to seek permission to check their cervical and breast screening history (using the Victorian Cervical Cytology Register and the Victorian breast screening register) and using the information to update their records
using recall lists extracted by a data reporting program PenCAT, looking at never screened, under-screened and women without records, and followed up
holding a regular 6–8 week booking for a group of women (2+) at a local BreastScreen provider service and providing them with transport and morning tea on the day of screening.

The following is a list of outcomes, feedback and challenges from the project.

Important achievements

Over the six month period:

37 files were updated with missing cervical screening history provided by the Victorian Cervical Cytology Registry
72 recall letters sent to remind women to book a Pap test
54 reminder phone calls were made to women
44 women booked in for Pap tests (23 women actually screened)
8 women booked for a mammogram
data is now entered correctly for Pap tests – doctors now responsible for adding this to patient file where previously it was not entered
doctors now aware of protocol for prioritising patients for colonoscopy with a positive bowel cancer screening test
improved relationship with staff at designated colonoscopy provider – local doctors now feel comfortable to call and speak directly with specialists at the hospital around bowel cancer and colonoscopy.

What worked well?

Having one staff member work one day a week dedicated to cancer screening.
The community felt comfortable with the Pap nurse who already had an established rapport from previous work with the community.
Staff were familiar with the Pap nurse and were happy to refer patients and listen to advice on cancer screening.
Having two female GPs and a gynaecologist at the clinic. GPs could do Paps when Pap nurse was not available.
Good communication between all staff about the position – Pap nurse presented at the all-staff and clinical meetings about project, sent an all-staff email explaining position and informal conversations with staff about the role.
Nurse advocating for cancer screening with the doctors to keep it on the agenda.
Practice manager trained staff on how to correctly input data for Pap tests.
Consent form made electronic and linked to patient files.
Applying learnings from this project to other areas in the clinic i.e. asthma.

Sustainability after nurse’s role has finished

Existing positions in the clinic (e.g. nurse) to prioritise a phone call to women who are overdue for screening in addition to sending the standard reminder letter.
Regular item on bowel, cervical and breast screening in the Aboriginal Health Services’newsletter.
Add a cervical, breast and bowel cancer screening question to the annual health check.
Regular booking for a group (2+) for a breast screen every 6 weeks – designate a staff member to be responsible for organising the visit. Have a sign showing in reception for community to see when the next group booking is.
When staff are talking about cancer screening to patients, ensure they book patients for an appointment during this discussion.
Check which MBS items are available for cancer screening e.g. $40 available per patient that is 4 years overdue (note: this may not be relevant with the renewed National Cervical Screening Program).
Aboriginal Health Worker having access to sample kits to explain bowel cancer kit to all patients aged over 50.

Challenges of the project

Only having one day per week to work on the project. Although this was an enabler to the project more time would have allowed greater engagement with community (e.g. visit community groups and participate in events to capture opportunistic screening and/or for relationship building).
Monday is a hard day to work on the project as patients are more likely to decline a Pap test or not attend an appointment (even though logistically it was the best suited day for the clinic).
Staff change.