Improving Cancer Screening Rates in Rural Women Veterans Through Clinician-Driven Outreach in the BOOST Program

Women Veterans and rural Veterans face barriers to routine cancer screenings. A clinician-driven outreach program called the Boost Team was developed to provide care coordination and counseling for women Veterans. This secondary data analysis aims to understand how clinician-driven care-coordination and counseling impact breast and cervical screening completion.

Retrospective chart review was conducted on a random selection of 115 charts of Veterans who had previously been contacted via telephone by the Boost outreach Nurse Practitioner (NP), and a subset of 55 charts in which breast or cervical cancer screening was addressed were identified for a subset analysis. Data were collected on this subset of Veterans who received any kind of Boost intervention (e.g., education, new screening orders placed, help coordinating screening exams) related to breast and/or cervical cancer screening. The number of mammograms and Pap smears that were completed in the 12-month period following the outreach intervention was also tracked.

A total of 55 out of 115 (48%) randomly sampled charts involved an intervention related to breast and/or cervical cancer screening. Of the 55 cases studied, before the Boost intervention, 64% were due for breast cancer screening (n = 35) and 49% (n = 27) of the cohort were due for cervical cancer screening. After the intervention, 32% (n = 18) were due for breast cancer screening and 29% (n = 16) were due for cervical cancer screening. The study sample was mostly comprised of rural or highly rural Veterans. Of those due for breast cancer screening, 83% (n = 29) received counselling regarding screening, and 59% (n = 17) of counselled patients went on to complete mammography. Of those due for cervical cancer screening, 81% (n = 22) requested counselling, and 50% (n = 11) completed the screening. Of the Veterans due for either screening who did not have questions or request counseling, none completed the screening.

This analysis highlights the potentially positive impact clinician-driven outreach to provide health education and care coordination can have on improving breast and cervical cancer screening rates among rural women Veterans. By using Veteran-centered communication strategies and providing expert-level care coordination to overcome system-level barriers, the Boost NP supported the completion rates of breast and cervical cancer screening. Among patients due for screening, a significant number of patients had questions, demonstrating a need for counseling by a clinician. Future research should compare telephonic outreach to other methods of outreach and education such as invitations to group visits or flyers/mailers/text message campaigns and explore how to engage harder-to-reach populations, especially rural Veterans, while strengthening trust in VHA care utilization.