Co-designing screening invitations with patients to reduce income-related disparities in cancer screening
Mental Health, Children and Community Care
St. Michael’s Hospital
St. Michael’s Hospital
SMH-16-012 TRANSFORMATION: This study’s aim was to transform how we reach out about cancer screening to our patients living with low income by co-designing a screening outreach strategy with our patients. Our patients told us that phone calls and group education were the most promising potential methods of outreach. ADOPTABILITY: Both the co-design approach that we took and the group education sessions that we are piloting can be adopted by other centres providing primary care in diverse settings across the province to reduce income-related disparities in cancer screening. OUTCOMES: Eight women attended our first pilot group education sessions, with 75% receiving at least one cancer screening test, and 100% agreeing or strongly agreeing that they learned something new and would make changes to help lower their risk of cancer.
SMH-16-012 In the St. Michael’s Hospital Academic Family Health Team, we had observed income gradients in cancer screening for our patients despite outreach. We hypothesized that our outreach strategies could be improved upon to be more compelling for our patients living with low income. We used AFP Innovation Funds to use co-design strategies to improve cancer screening uptake with patients living with low income. We conducted an exploratory, qualitative study in two phases: interviews and focus groups. For interviews, we recruited 25 patient participants who were or had been overdue for cancer screening and had been identified by their provider as potentially living with low income. For subsequent focus groups, we recruited 14 patient participants, 11 of whom had participated in Phase I interviews. To analyze written transcripts, we worked with qualitative research experts at our institution, drawing on best practices in Grounded Theory methodology. Emergent themes were expanded and clarified to better understand possible strategies to encourage screening uptake for patients living with low income. We found that patients believed that a warm and encouraging outreach approach would work best to increase cancer screening uptake. Phone calls and group education were specifically suggested as potentially promising methods. However, these views were not universal; for example, women were more likely to be in favour of group education. Our patients also countered our hypothesis that including an illustrated graphic in a reminder letter would improve screening uptake. As a result, we are now piloting a group education strategy, while still continuing to refine and explore other approaches, as we have learned from our patients that a multi-modal strategy will likely be best to maximize screening uptake.