DIRECT CLINICIAN CONTACT TO IMPROVE CERVICAL CANCER SCREENING PARTICIPATION IN VETERANS

Cervical cancer is caused by high risk types of human papilloma virus (hrHPV), persistent hrHPV infections may result in precancerous cervical lesions. Undetected lesions may slowly progress to invasive cervical cancer. Routine cervical cancer screenings (CCS) via papanicolau testing is recommended every 3 years for women aged 21-65, with an increased interval to every 5 years with hrHPV cotesting. Active duty service members experience a) increased rates of HPV infections and cervical dysplasias, b) increased incidence of cervical cancer, and c) decreased CCS rates. The purpose of this doctoral project was to increase CCS participation rates in veteran patients aged 21-65 by providing 1:1 patient education on cervical cancer and the utilization of an evidence-based tool to collect patient perceived barriers to completing CCS. This quality improvement project was conducted at a level 1a Veterans Health Administration facility in southern California; the goals were to increase CCS rates by at least 10% from a baseline of 65.91% by 2023 calendar year end and to also determine primary patient perception barriers to CCS for dissemination to the women's health leadership team. A total of 1,159 women were eligible for CCS; 453 patients ranging from the ages of 21 to 65 years were categorized as overdue based on clinical reminder status. Of those, 39 contacts were attempted and 37 were provided CCS education. Of the 37 successful contacts, 6 patients completed their overdue screening within the implementation window. The CCS completion rate increased from 65.91% to 74.9% post intervention. 12 of the 37 veterans also consented to participate in a modified CPC-28 questionnaire to gather patient-reported barriers to timely CCS completion. Reported barriers included an absence of trust in the organization and patient lack of knowledge surrounding CCS guidelines. Results of the voluntary survey were shared with facility providers and leadership as potential seed for future care delivery improvement endeavors.