Implementing a team-based care model to increase cervical cancer screening uptake in low-resource primary care settings

Abstract

Cervical cancer is almost entirely preventable with tools like screening. Yet, its burden remains high, particularly among populations with limited medical access. Rural and federally qualified health centers (“low-resource primary care settings”) are major cervical cancer screening providers for populations with limited medical access; however, their screening uptake has been persistently low. Reducing the burden of this preventable cancer will require increasing cervical cancer screening uptake in low-resource primary care settings. A team-based care model—two or more health professionals collaborating dynamically, interdependently, and adaptively to provide health services—may offer an innovative way to increase screening uptake.

Low-resource primary care settings rely heavily on interprofessional collaboration, especially with medical assistants (MAs) and nurses, due to primary care provider (PCP) shortage. MAs often serve as the link between clinics and their patients and are considered the “invisible glue” holding clinics together. However, existing evidence-based strategies (EBS) for increasing cervical cancer screening (e.g., training) do not explicitly engage these interprofessional team members who are predominant and essential in low-resource primary care settings. Thus, research is needed to select and adapt existing cervical cancer screening EBS that primarily target overburdened PCPs by including the roles and responsibilities of other team members. Shifting to a team-based care model would align existing EBS with the realities of working in low-resource primary care settings and reduce the cervical cancer burden for all populations, which is the National Cancer Institute’s scientific priority.

The objective of the proposed convergent parallel mixed-method study is to select and adapt existing EBS into a team-based care model and pilot it to increase cervical cancer screening uptake in low-resource primary care settings. Our central hypothesis is that a team-based care model is feasible and acceptable and will increase cervical cancer screening uptake. The specific aims are to: 1) Identify barriers and facilitators of interprofessional collaboration for cervical cancer screening in low-resource primary care settings to inform the EBS adaptation; 2) Use principles of participatory research to select and adapt cervical cancer screening EBS (designed for PCPs) into a team-based care model to increase cervical cancer screening uptake; and 3) Pilot test the adapted team-based care model to increase cervical cancer screening uptake in low-resource primary care settings.

This study will yield a team-based care model tailored to increase screening uptake in low-resource primary care settings, ultimately reducing cervical cancer burden. Through this work, I will obtain training in 1) team-based care models, 2) participatory research, and 3) practice-based research. I have assembled an interdisciplinary mentorship team with expertise in these areas, cervical cancer prevention and control, and implementation science, to ensure the successful completion of this Career Development Award, which will transform me into an independent clinical scientist who implements high-quality cancer prevention and control programs in low-resource primary care settings throughout my career.