Overcoming Cultural Barriers to Screening Access

TON - July 2017, Vol 10, No 4 - Conference Correspondent
Alice Goodman

Denver, CO—Sensitivity to cultural context is one of the keys to successful patient education and communication. An innovative program has met with success in encouraging women of Asian-Indio descent to participate in cancer screenings. This original program serves as a model for meeting the healthcare needs of culturally diverse groups that have historically shied away from cancer screening and other healthcare services.

“This program emphasizes that advanced nurse practitioners can take the initiative to be a vital link in the planning, development, implementation, and evaluation of cancer screening projects. We can impact disparities in cancer screening through leadership, education, and practice with targeted populations,” explained lead investigator Sharon K. Byrne, DrNP, APN, NP-C, AOCNP, CNE, Assistant Professor, School of Nursing, Health, and Exercise Science, The College of New Jersey, Ewing, and Advanced Nurse Practitioner, M.D. Anderson Cancer Center at Cooper, Camden, NJ.

“We can make a difference in delivering healthcare to communities that are underserved,” she emphasized.

Dr Byrne presented results of the project at the 42nd Annual Meeting of the Oncology Nursing Society.

Culturally competent education and care is a priority of the National Action Plan for Cancer Survivorship. Language and culture are important aspects of health communications that affect healthcare access and quality.

“Nurse-led programs are in a unique position to educate women and provide outreach services related to early detection of cancer. I was the lead advanced nurse practitioner for this program, which was started 10 years ago, and focuses on Asian-Indio [Indian and Pakistani] women providing both education and detection services,” she explained.

The ongoing project was initiated in 2007 with the goal of getting women from this ethnic group to participate in cancer screenings. A dedicated clinic was set up for monthly breast, cervical, and colorectal cancer screenings.

Dr Byrne and staff provided outreach education outside of the clinic to introduce the concept of early detection to this community.

“They had never heard of early detection of cancer,” she noted.

At the meeting, Dr Byrne presented interim results of the project. At first, only 2 or 3 women came to the clinic each month. As a result of outreach, the number of patients seen over time has reached 437, and the mean age is 47.5 years. The total number of clinic visits for screening is now “in the thousands,” she said.

Fourteen cancers have been identified over the course of screening, including 7 breast (3 ductal carcinoma in situ, 1 lobular carcinoma in situ, 1 stage I, and 2 stage II), 2 endometrial, and 5 cervical cancers.

“I think this is very alarming—that I could identify 14 cancers in this small group of women. Nonmalignant conditions are common in these women, many of whom don’t see a primary care provider,” Dr Byrne explained.

“I can make referrals and follow-up on them. They live in the Camden, NJ, area, which is a low socioeconomic area with free programs,” she continued.

Dr Byrne explained that many of these women do not drive, so they often come together in small groups. If a husband is present, he often tries to speak for them. The women are modest, and it was important that they could leave their saris on, adjusting them during mammography. Having a lay navigator who speaks Hindi was crucial to overcoming barriers that included their modesty, unfamiliarity with Western medicine, and lack of transportation.

Facilitators for Success

The project was made possible partly through a partnership with the National Indio Cooperative Enterprises, and their pledge to continue providing cancer education and outreach to the community, Dr Byrne explained.

“Establishing trust among the women in the Asian-Indio community was important, and, in order to do this, I had to go out to the community,” she said.

“Many of the women brought their significant others, who took over speaking for the women. I had to show cultural humility. These men were especially pleased that the women would see a female provider,” she continued.

A dedicated clinic location and consistent provider were components of success. The clinic is offered twice monthly, and provides on-site mammographies following each visit with a provider. The model is based on a case management approach with an outreach worker or lay navigator.

The clinic staff acknowledges and respects the women’s cultural beliefs, which helps them to feel understood. The clinicians also allow sufficient time for speaking, being heard, and having patients’ questions answered.

All of the women who participate in the clinic are uninsured. The staff connects them with charity care, Medicare, and Medicaid services.

The project was supported by grants from the Susan G. Komen Foundation, Avon Breast Health Foundation Outreach Program, New Jersey Cancer Education and Early Detection Program, as well as a Support of Scholarly Activities grant from The College of New Jersey.

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Last modified: August 7, 2017