Implementation of Education-Based Reminders to Improve Cervical and Breast Cancer Screening Rates

BACKGROUND: Increased cervical and breast cancer screening is associated with reduced morbidity and mortality. Despite clear recommendations, cervical and breast cancer screening rates remain decreased at the national, statewide, and local levels.

LOCAL PROBLEM: The project setting was a rural, outpatient community clinic that provides primary care services to uninsured populations. The project site reported less than optimal cervical and breast cancer screening rates. The purpose of this project was to send education-based appointment reminders in the patient’s preferred language. The project aimed to increase cervical cancer screening rates in women ages 21-65 to 65% and breast cancer screening rates in women ages 40-74 to 50% within 3 months of project implementation.

METHODS: The Evidence Based Practice Improvement (EBPI) model was used to guide the project. Plan, Do, Study, Act (PDSA) cycles were used to test the practice change before full implementation. Cervical and breast cancer screening rates were measured throughout the project. The number of reminders sent to patients due for screening, and whether it was sent in the patient’s preferred language, was also measured.

INTERVENTIONS: Phone prompts included a brief message with educational content on the screening type due and an opportunity to schedule an appointment. Mail prompts also contained educational content with an appointment reminder. All appointment reminders were made or sent in the patient’s preferred language.

RESULTS: 100% of patients due for cervical and/or breast cancer screening received a reminder in their preferred language. Cervical cancer screening rates increased 11.3%, from 53% to 59%. Breast cancer screening rates increased 20%, from 40% to 48%.

CONCLUSIONS: Implementation of education-based appointment reminders resulted in a clinically significant increase in cervical and breast cancer screening rates, increasing access to patient education and cancer screening services. Given the success and sustainability of this project, future efforts include spreading the practice change to add similar reminders to improve other cancer screening rates and access for the clinic population.