Focus Area: Screening Policies, Procedures, and Practices within Health Facilities
Breast Cancer Screening Change Package
The screening policies, procedures, and practices within health facilities focus area includes tools and resources to assess the status of cancer screening, make cancer screening a priority, reduce structural barriers, and use data to identify patients due for screening and opportunities to improve cancer screening rates within a clinical setting or system.
- Change concepts are “general notions that are useful for developing more specific strategies for changing a process.”1
- Change ideas are evidence-based or practice-based “actionable, specific ideas or strategies.”1
- Each change idea is linked to tools and resources that can be used or adapted to improve cancer screening.
Notes
- Tools and resources with a symbol may contain some information that does not reflect the current US Preventive Services Task Force (USPSTF) recommendations for breast cancer screening.
- Tools and resources with a symbol are patient resources.
See a list of acronyms used in this change package.
Change Concepts Menu
- Make cancer screening a priority.
- Implement population management strategies for all eligible patients.
- Establish standard operating procedures for screening.
- Use risk assessment tools and follow-up.
- Practice patient education, communication, and shared decision making.
- Implement patient and provider reminder systems.
- Reduce structural barriers in the health care setting.
Change Concept: Make cancer screening a priority.
Tools and Resources, by Change Idea
Assess primary care clinics’ readiness to implement existing evidence-based interventions (EBIs) to increase cancer screening.
Use a whole office approach by delegating screening tasks across the health care facility team.
- Jackson A, Chan K, 2019 — Increasing Breast Cancer Screening Rates in Difficult-to-Engage Patients [PDF-185KB] [journal supplement]
Make cancer screening a quality improvement measure at the system level.
- HRSA — UDS Clinical Quality Measures 2022 [PDF-2.9MB], page 2–3
- Jackson A, Chan K, 2019 — Increasing Breast Cancer Screening Rates in Difficult-to-Engage Patients [PDF-185KB] [journal supplement]
- The Primary Care Coalition of Montgomery County — Breast Healthcare Improvement in the Safety-Net: Change Package Rapid Innovation to Improve Outcomes [PDF-2.9MB], pages 12–15
Optimize billing practices by using existing codes to capture all billable services.
Change Concept: Implement population management strategies for all eligible patients.
Tools and Resources, by Change Idea
Benchmark or compare health care facility screening prevalence to state and national prevalence.
- ACS — Cancer Facts and Figures for African American/Black People 2022–2024 [PDF-8.5MB]
- ACS — Cancer Prevention and Early Detection Facts and Figures 2022 [PDF-2.8MB], (tables and figures only) pages 32–33
- CDC — United States Cancer Statistics: Data Visualizations Tool (see Screening and Risk Factors tab)
- NACHC — Value Transformation Framework: Cancer Screening [PDF-447KB], page 5
Use community assessment data to identify barriers to and resources for screening.
- BMC and AVON Foundation for Women — The Boston Medical Center Patient Navigation Toolkit 1st edition [PDF-807KB], pages 10–19
- Evidence-Based Cancer Control Programs (EBCCP) — Friend to Friend, see Program Materials: Training Manual, page 3-1
- Kobetz E, Menard J, Barton B, Pierre L, Diem J, Auguste PD, 2009 — Patnè en Aksyon: Addressing Cancer Disparities in Little Haiti Through Research and Social Action, see Rapid Assessment Survey Questions [full text available]
Use EHR tools to calculate and analyze cancer screening rates.
Analyze data by patient sub-populations to determine if screening disparities exist.
- CDC — United States Cancer Statistics (USCS): Data Visualizations Tool
- NIH, NCI, and CDC — State Cancer Profiles Interactive Maps
Change Concept: Establish standard operating procedures for screening.
Tools and Resources, by Change Idea
Implement standing orders for screening.
Use implementation guides and quality improvement tools to create workflows and address workflow barriers.
- Jackson A, Chan K, 2019 — Increasing Breast Cancer Screening Rates in Difficult-to-Engage Patients [PDF-185KB], page 5 [journal supplement]
- Smalls TE, Heiney SP, Baliko B, Tavokoli AS, 2019 — Mammography Adherence: Creation of a Process Change Plan to Increase Usage Rates [full text available for purchase]
Change Concept: Use risk assessment tools and follow-up.
Tools and Resources, by Change Idea
Use a family history algorithm to assess a patient’s risk of developing cancer to help determine eligibility for screening at an earlier age.
Use a risk calculator to determine a patient’s eligibility for screening at an earlier age.
Change Concept: Practice patient education, communication, and shared decision making.
Tools and Resources, by Change Idea
Use tools and resources to facilitate shared decision making regarding screening.
- GW Cancer Center — Guide for Patient Navigators: A Supplement to the Oncology Patient Navigator Training: The Fundamentals [PDF-2.7MB], pages 83–88
- Kunneman M, Montori VM, Castaneda-Guarderas A, Hess EP, 2016 — What Is Shared Decision Making? (and What It Is Not)
- Weill Cornell Medicine — Breast Screening Decisions
Use patient education materials and small media such as videos and printed materials.
- ASCO — Mammogram
- CDC — African American Women and Mass Media campaign posters
- CDC — Breast Cancer: Things You Should Know [PDF-335KB] [patient information sheet]; also available in Spanish [PDF-280KB]
- Jackson A, Chan K, 2019 — Increasing Breast Cancer Screening Rates in Difficult-to-Engage Patients [PDF-185KB]
- NCI — Understanding Breast Changes: A Health Guide for Women [information booklet]; also available in Spanish
- WPSI — Well-Woman Chart [English and Spanish]
Use communication tools and strategies to improve patient-centered communication.
- GW Cancer Center — Health Equity Toolbox: Resources to Foster Cultural Sensitivity and Equitable Care for All [PDF-386KB]
- GW Cancer Center — Practice Patient-Centered Care Posters
- Jackson A, Chan K, 2019 — Increasing Breast Cancer Screening Rates in Difficult-to-Engage Patients [PDF-185KB] [journal supplement]
Personalize messaging to increase screening among patients.
- GW Cancer Center — Practice Patient-Centered Care Posters
Provide educational and instructional materials to patients on screening procedures.
- ACS — Tips for Getting a Mammogram [English and Spanish]
- CDC — What Is a Mammogram? [English and Spanish]
Change Concept: Implement patient and provider reminder systems.
Tools and Resources, by Change Idea
Use multi-modal screening reminders, such as mail, phone, or text messages, for patients.
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country [PDF-4.2MB], pages 15 and 21–24
Use electronic reminders, such as prompts in the EHR, for providers and staff.
Use physical reminders, such as stickers or cards, for providers and staff.
Change Concept: Reduce structural barriers in the health care setting.
Tools and Resources, by Change Idea
Identify health-related social needs.
- Activate Care — CMS releases standardized screening tool for health-related social needs [tool and article]
Offer non-traditional facility hours.
Offer screening in non-clinical or alternative settings such as mobile vans or community centers.
- Mobile Healthcare Association — Special Interest Group – Mobile Mammography
Use telehealth for screening consultations and follow-up of results.
- President’s Cancer Panel — Closing Gaps in Cancer Screening: Connecting People, Communities, and Systems to Improve Equity and Access [PDF-14MB], pages 3 and 17–19
Use patient navigation to improve completion of screening.
- BMC and AVON Foundation for Women — The Boston Medical Center Patient Navigation Toolkit 1st edition [PDF-807KB]
- Evidence-Based Cancer Control Programs (EBCCP) — Kukui Ahi (Light the Way): Patient Navigation – Addressing Barriers Worksheet; Implementation Guide
- GW Cancer Center — Guide for Patient Navigators: A Supplement to the Oncology Patient Navigator Training: The Fundamentals [PDF-2.7MB]
- GW Cancer Center — Together, Equitable, Accessible, Meaningful (TEAM) Training [CEU course, free, registration required]
- NIHB — Health Systems Improvement Toolkit: A Guide to Cancer Screenings in Indian Country [PDF-4.2MB], pages 25–26
- Smalls TE, Heiney SP, Baliko B, Tavokoli AS, 2019 — Mammography Adherence: Creation of a Process Change Plan to Increase Usage Rates [full text available for purchase]
Ensure information or interpretation services are available in the patient’s primary language.
- Juckett G, Unger K, 2014 — Appropriate Use of Medical Interpreters
Streamline administrative procedures, such as simplifying patient paperwork, reducing the number of required visits, and offering flexibility for late arrivals.
- The Community Guide — Cancer Screening: Reducing Structural Barriers for Clients – Breast Cancer
Conduct an environmental scan and organizational assessment of cancer screening capacity.
- BMC and AVON Foundation for Women — The Boston Medical Center Patient Navigation Toolkit 1st edition [PDF-807KB], pages 5–19
- Evidence-Based Cancer Control Programs (EBCCP) — Kukui Ahi (Light the Way): Patient Navigation – Facility Tour Worksheet
Reference
1Centers for Disease Control and Prevention. Tobacco Cessation Change Package. Atlanta, GA: Centers for Disease Control and Prevention, U.S. Department of Health and Human Services; 2019.