Background:

Primary care providers (PCPs) address many issues, including cancer prevention and screening, within the limited time available during appointments. Across the San Diego VA Healthcare System, rates of individuals who are up to date with cancer screenings are below the national VA rates. With PCPs being the first line of defense against screening for cancer, it is essential to address this gap in healthcare. This quality improvement project aimed to increase the percentage of up-to-date cancer screenings across multiple cancers (breast, colorectal, cervical, prostate, and lung) among patients at the VA La Jolla Primary Care clinic.

Methods:

We standardized workflow by incorporating cancer screening into the primary care note template to prompt the primary care provider to screen for breast cancer, colorectal cancer, prostate cancer, cervical cancer, and lung cancer. A customized after visit summary (AVS) that included cancer screening was created as part of this project and was given to the patient. The primary outcome was the proportion of cancer screenings completed between October 2023 and March 2024. We analyzed the trend of up-to-date cancer screenings across our patient panel from December 2023 to March 2024.

Results:

Through October 2023 to March 2024, 28 patients were found to be eligible and due for age-appropriate cancer screening, and 43 cancer screening tests were ordered. As of March 2024, 27 of these 43 (63%) tests were completed. Among the study sample, 5/5 (100%) of mammograms were completed, 5/9 (56%) of fecal immunochemical tests were completed, 1/8 (13%) of colonoscopies were completed, 14/16 (88%) of PSA labs were completed, 1/1 (100%) of Pap smears were completed, and 1/4 (25%) of low-dose CTs were completed. From December 2023 to March 2024, screening uptake improved in the three cancer types recorded on the Almanac database. Colorectal cancer screening increased from 48.6% to 50.2%, breast cancer screening increased from 70.4% to 76%, and cervical cancer screening increased from 69.8% to 72.6%.

Conclusions:

Incorporation of cancer screening into the AVS creates a tool that is patient-centered, and this tool has been distributed across the primary care clinic. However, further efforts are needed to increase completion of screening tests. The addition of an automated reminder for lung cancer screening is in progress, and future projects could study the effects of this reminder on screening rates. Completion of cancer screening requires steps outside of the primary care visit, such as scheduling with other departments, and may need to involve further interventions, such as sending a reminder to the patient if a test is not completed within a specific period of time.