Chollette Veronica Y, Altman Blair H, McGee-Avila Jennifer K, Grenen Emily M, Jacobsen Paul B, Kobrin Sarah
Division of Cancer Control and Population Sciences, National Cancer Institute, Rockville, MD, USA.
ICF Next, Rockville, MD, USA.
Public Health Rep. 2025 Jul 8:333549251316190. doi: 10.1177/00333549251316190.
Supporting medically underserved and socially disadvantaged populations, particularly in relation to cervical cancer, requires identifying coordination gaps. However, approaches to address the cervical cancer screening process between cancer centers and safety-net settings of care (hereinafter, safety-net settings) are poorly understood. We describe interactions and identify opportunities to guide cancer centers that aim to strengthen cervical cancer prevention, screening, and treatment for patients referred to them from safety-net settings.
We administered a 15-item online survey from January 12 through February 9, 2022, to National Cancer Institute (NCI) cancer centers; the intended audience was associate directors of community outreach and engagement and/or associate directors of population sciences. Of 64 eligible cancer centers, 47 (73.4%) completed the survey; however, 7 cancer centers were excluded from analysis because they reported not having a formal arrangement with safety-net settings. We developed survey items in consultation with subject matter experts and conducted pilot testing before administration to sites.
The most common forms of partnership between NCI cancer centers and safety-net settings were referrals and consultations (34 of 40; 85.0%). We identified multilevel barriers affecting coordination and follow-up of abnormal cervical cancer screening test results. Communication between safety-net settings and cancer center staff was the most reported systems-level challenge to care coordination (35 of 40; 87.2%). Collection and synthesis of patient data presented the primary systems-level challenge to following up to abnormal cancer screening (34 of 40; 85.0%).
Collaborations between cancer centers and safety-net settings are common but limited by challenges in care delivery and coordination. Our findings underscore the importance of identifying intervention points to optimize the management of cervical cancer care for patients in safety-net settings.
为医疗服务不足和社会弱势群体提供支持，尤其是在宫颈癌方面，需要找出协调差距。然而，对于癌症中心与安全网医疗机构（以下简称安全网机构）之间宫颈癌筛查流程的处理方法，我们了解甚少。我们描述了两者之间的互动，并确定了一些机会，以指导那些旨在加强为从安全网机构转诊而来的患者进行宫颈癌预防、筛查和治疗的癌症中心。
2022年1月12日至2月9日，我们对美国国立癌症研究所（NCI）的癌症中心进行了一项包含15个项目的在线调查；目标受众是社区外展与参与副主任和/或人口科学副主任。在64个符合条件的癌症中心中，47个（73.4%）完成了调查；然而，有7个癌症中心被排除在分析之外，因为它们报告称与安全网机构没有正式安排。我们在与主题专家协商后制定了调查项目，并在向各机构发放之前进行了预测试。
NCI癌症中心与安全网机构之间最常见的合作形式是转诊和咨询（40个中有34个；85.0%）。我们确定了影响宫颈癌筛查异常检测结果协调和后续跟进的多层次障碍。安全网机构与癌症中心工作人员之间的沟通是护理协调方面最常被提及的系统层面挑战（40个中有35个；87.2%）。患者数据的收集与整合是对异常癌症筛查进行后续跟进的主要系统层面挑战（40个中有34个；85.0%）。
癌症中心与安全网机构之间的合作很常见，但受到护理提供和协调方面挑战的限制。我们的研究结果强调了确定干预点以优化安全网机构中宫颈癌患者护理管理的重要性。
