Abstract B79: Addressing patient barriers to cancer screening in safety net clinics
Authors: Morton Rentonia , Cotter Megan , Riehman Kara , Liang Lily Shuting , Kegler Michelle , Phillips Emily , Beasley Derrick , Hermstad April , Martinez Jeremy 
Published: May 2016

Abstract
Background: Medically underserved, uninsured patients experience individual and structural barriers to screening for breast and colon cancer, contributing to ongoing cancer health disparities. Community-based safety net clinics serving this patient population use a variety of policy and system-level strategies that can reduce patient barriers. A qualitative study conducted by The American Cancer Society (Society) and the Emory Prevention Research Center (EPRC) on safety net clinics highlights key patient barriers and strategies employed to overcome these barriers to increase cancer screening in this population.
Methods: Society evaluators conducted site visits to nine safety net clinics receiving grant funds from the Society to increase breast and colon cancer screening among underserved populations in 2013. The evaluation assessed the implementation process of client and provider-directed intervention strategies. Evaluation staff conducted 52 in-depth interviews with 3-10 staff at each clinic. Interviews were digitally recorded and transcribed verbatim. Transcriptions were coded and analyzed by a team of researchers from both organizations using the Consolidated Framework for Implementation Research (CFIR) constructs to assess factors associated with effective implementation.
Results: A majority of interviewees (67%-100%, mean 87%) in all 9 sites talked about patient needs and barriers and ways to address them. Patient barriers identified included low English proficiency, presenting challenges in communicating with providers; low health literacy; additional challenges to preparing for colonoscopies; limited transportation to services; lack of insurance/underinsurance; fear of cancer and co-morbidities that add to the complexity of the screening process. At the system level, structural barriers included perceived complexity of the healthcare system; requirement of multiple clinic visits to different locations to receive education and screening; and inconsistent messages received from providers at different facilities.
While sites employed a variety of strategies to address patient barriers, almost all sites stressed that they are patient-centered and that the clinic staff prioritized improving patients' experience and meeting their needs. Some mentioned the importance of patient activation, ensuring the patients had all necessary information and were fully engaged in decisions about the screening process. One such respondent commented, “If we empower the patients with knowledge and give them the information up front and establish that accountability, then we'll see a reduction in lost patients.” Besides providing interpretation, transportation assistance, and assistance in getting insurance or other access to screening services, many sites utilized patient navigators to conduct education and patient reminders to promote cancer screening. Some sites implemented system-level changes to streamline the workflow of clinical processes to reduce the steps required of patients when accessing screening services. Respondents felt that system-level changes increased the likelihood of sustainable improvement in patient experiences, completion of screening, and the quality of preparation for screening.
Conclusion: This presentation will describe in detail the strategies employed by safety net clinics and discuss potential approaches to strengthen safety nets' capacity in addressing patient barriers, which has great potential to further reduce cancer health disparities experienced by underserved and uninsured populations.
Citation Format: Rentonia Morton, Megan Cotter, Kara Riehman, Lily Shuting Liang, Michelle Kegler, Emily Phillips, Derrick Beasley, April Hermstad, Jeremy Martinez. Addressing patient barriers to cancer screening in safety net clinics. [abstract]. In: Proceedings of the Eighth AACR Conference on The Science of Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; Nov 13-16, 2015; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2016;25(3 Suppl):Abstract nr B79.