Bramalea CHC utilized an innovative youth poster competition to help raise the level of cancer awareness and screening education among the families it serves.
By Jason Rehel, story producer and editor, AOHC
Cancer screening rates in Ontario aren’t as high as they should be, and nowhere near provincial benchmarks. Health Quality Ontario (HQO) suggested as much in its April 2016 report, “Income and Health”. The report linked low income levels to lower rates of colorectal, breast, and cervical cancer screening, and included some startling statistics about disparities:
• Just over half (54.3%) of women living in the poorest urban neighbourhoods have had cervical cancer screening in the last three years, compared with two-thirds (66.7%) of women living in the wealthiest urban neighbourhoods.
• Nearly half (49.7%) of people living in the poorest urban neighbourhoods are overdue for colorectal cancer screening, compared with just over one-third (34.9%) of people living in the wealthiest urban neighbourhoods.
Being a newcomer to Canada can also mean you’re much less likely to receive preventive screening. For cervical cancer, Cancer Care Ontario (CCO) notes that “women with low income and education, who are older, who speak a foreign language or who are not Canadian-born are less likely to be screened.” In fact, CCO points out that “newcomers and immigrants often experience challenges [just] finding information about cancer screening.”
The provincial government tried using financial incentives for physicians to boost cancer screening rates in Ontario. But those efforts have mainly failed, owing to what Canadian health policy analyst Steven Lewis says is an over-emphasis on “extrinsic motivations” (money) and not enough attention to “intrinsic motivations” (the desire to do a good job, help people). Examining “the more durable and powerful” intrinsic motivations of both providers and patients, Lewis argues, is what allows us to get to the root causes of low screening rates, and thereby know what we might do to help nudge people towards getting screened.
“Appropriate screening should be baked into the performance expectations of organizations and individuals, and no extra pay or funding should be required,” Lewis says.
Without using financial incentives, and with doctors who are paid using a salary model, Ontario’s Community Health Centres are seizing opportunities to increase screening rates with a robust health equity approach that is “baked into performance expectations.” In the process, they’re achieving higher cancer screening rates than provincial averages. To better understand some of the ways that Ontario’s 74 Community Health Centres break down barriers that keep people from getting screened for cancer, here are six case studies from across the province:
TAIBU CHC: TRANSFORMING CANCER SCREENING THROUGH AN EQUITY LENS
Located in Scarborough, TAIBU Community Health Centre recognizes the prevalence of anti-black racism, including its impact on how the community they serve accesses services. “We plan and develop programs and services with a specialized focus on how we can address the needs and barriers faced by this community,” says Liben Gebremikael, Executive Director of TAIBU CHC.
What that means:
- TAIBU’s staff start by understanding and then responding to cultural factors that affect screening rates: For example, its call-back program ensures providers do not call Muslim clients during Ramadan.
- Town halls deepen understanding of factors affecting screening, and awareness programs highlight that the black population served by the centre is disproportionately affected by cancer.
CSC TÉMISKAMING: SUSTAINING A CULTURE OF QUALITY IMPROVEMENT
“Examining things on a quarterly basis wasn’t good enough for us. So day-to-day attention to screening is now part of every encounter, even prescription renewals,” says Roxanne Rodgers, a Registered Nurse at the Larder Lake location of Centre de santé communautaire Témiskaming in northeastern Ontario. “Our [Electronic Medical Records] EMR dashboard is simplified so that all the indicators are in one spot, so that we can quickly see when a person is due for screening. Then we can prepare and offer a requisition right on the spot.”
What that means:
- Using an in-house designed dashboard tool, clinicians at the centre’s five sites can compare how others are doing, which helps to foster healthy competition and collaboration.
- A volunteer driving initiative gets people without transportation to appointments, a key factor for a centre that serves mainly a rural and semi-rural population.
WELLFORT COMMUNITY HEALTH SERVICES: A UNIQUE AWARENESS APPROACH
“At WellFort, we continue to achieve our cancer prevention goals by living our values of being responsive to our community needs, and striving to be creative leaders on health equity in Peel,” says Mayo Hawco, Executive Director of WellFort.
What that means:
- Clients have access to cancer screening education and awareness materials in languages they’re comfortable with, and delivered in a culturally-appropriate manner. For example, youth from the community were involved in a cancer awareness poster competition to broaden the reach of prevention messages and help tailor them to the community.
- BIRT (an internationally recognized data analytics tool developed by AOHC and its members) is used to coordinate client appointments to take advantage of prevention opportunities for those due for screening.
SEAWAY VALLEY CHC: FROM EDUCATION TO PREVENTION
“People in the area we serve need a high level of education and support on how important cancer screening is to an overall prevention approach. Once people are educated, they become active partners in their own health,” says Debbie St. John-de Wit. “So our investment in education and explaining the ‘why’ of screening serves a purpose for years ahead.”
What that means:
- Nurses lead the way to ensure prevention awareness is part of every encounter. Education is tailored to priority populations, such as seniors and the LGBTQ+ community, to ensure the right approach for people facing health equity barriers.
- Clinical and data management staff have taken steps to ensure staff utilize the Electronic Medical Records (EMR) in consistent ways, to ensure quarterly reports on cancer screening are as accurate as possible for nurses, who then can take a systematic approach to outreach.
CSC HAMILTON/NIAGARA: FOSTERING RELATIONSHIPS THAT PROMOTE PREVENTION
“Relationships – both between the clients and their family members and their physician, and between interprofessional team members themselves – are at the core of how we keep our cancer screening rates high,” says Marcel Castonguay, Executive Director of the Centre de santé communautaire Hamilton/Niagara.
What that means:
- French-speaking physicians develop strong relationships with the Francophone population they serve, partly by ensuring annual exams serve as important points for education of clients and their families, many of whom are also caregivers.
- Clinical and non-clinical team members collaboratively address barriers that clients face, through informal huddles and case conferencing where necessary to ensure no social determinant is left untouched if someone isn’t getting preventive care.
Of course, the examples above are only part of the story of how AOHC members are working to boost their cancer screening rates. Next month, at AOHC's annual Shift the Conversation Conference, the West End Quality Improvement (WEQI) collective, a group of seven GTA CHCs working collaboratively on cancer screening rates, will present the results of their initiative, and the process and tools that got them there. The session (C7) takes place at 3:30 p.m. on June 7. For details of that session and others, click here.