Abstract
Background: Individuals with severe mental illness (SMI) have significantly lower rates of cancer screening, leading to increased poor health outcomes, including death. Some of the contributing factors contributing to low screening rates include stigma as well as the lack of access to primary care services.2 As a result, there is a need to look at new systems to support this population in order to deliver more equitable care.3Currently, Ontario Health offers cancer screening programs to individuals. However, individuals with SMI have disproportionately had lower adoption of these programs compared to the general population.4 In some cases, screening rates can be 30% lower than the general population.5,6 In order to address this gap, one of the ways is to deliver cancer screening in inpatient mental health settings, where this population often receive care. This work focuses on recommendations for delivering women health and other related cancer screening to individuals with SMI in inpatient mental health settings.
Approach: A number of quality improvement initiatives were conducted to explore ways of working with community partners to deliver women's health cancer screening to individuals with SMI while receiving care in inpatient settings. Using a co-design approach, models of care were developed which included building dedicated processes for referral, follow-up care and education materials. These models of care were piloted in a mental health hospital in Toronto, Ontario and the evaluations informed the recommendations that are outlined here.
Results: A number of recommendations were identified from the QI initiatives. For example, patient and family education continues to be a significant gap and there needs to be facilitation of dedicated patient education sessions that is trauma-informed and considerate of their concerns. In addition, there is a need to develop dedicated workflows that provide patients and support persons a comfortable space to receive the screening (e.g., a larger screening room, more time per appointment). Subsequently, due to the lack of primary care for this population, there is a need to develop dedicated processes for follow-up care, should there be a need. By engaging with clinicians and patient and family specialists, it can help inform the development of meaningful processes, supports and partnerships for supporting cancer screening in this population.
Implications: To our knowledge, this is one of the first initiatives focused on improving the delivery of cancer screening to this population. These findings can be used by health care administrators and clinicians as a starting point to adapt and develop similar initiatives to increase screening rates for individuals in their own patient population. Future work should focus on evaluating and scale-up the impact of these initiatives in other areas.
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