The cancer screening program is a nurse-led scheme that was launched to capture the cohort of patients who might be in a pre-clinical phase of any of the three high-priority cancers identified by the Ministry of Health and Prevention (MOHAP): colorectal, breast and cervical.
This program is embedded in the outpatient PowerForms as mandatory documentation for all (eligible) outpatient visits to primary health centers (PHCs) and facilities’ outpatient settings, in order to increase the uptake of and simplify access to information for nurses.
According to the UAE Vision 2021 national indicator and WHO, 2019 saw 29.28 cancer deaths per 100,000 population in the UAE1. Cancer is a life-threatening disease that can have a heavy financial burden on the individual and the system. It has been proven that certain cancers can be detected early and if the interventions are introduced at an earlier clinical stage, the disease prognosis and five-year survival rates can be improved.
To improve the early detection of cancer, MOHAP initiated a program to ensure that all patients who are visiting their PHCs or hospital outpatient clinics are being screened for three types of cancers: breast, cervical and colorectal. These three cancers contribute a heavy disease burden, they can be detected at an early phase by minimally invasive screening methods, and the disease prognosis can benefit from early detection.
Design & Development:
This program was designed based on well-defined, discrete rules that outline high-risk populations for each cancer. These rules are largely based on patient age and gender – the program is designed so that whenever a patient seeks care, the system determines that patient’s eligibility for screening for all three types of cancers. If the patient qualifies for screening, related orders are automatically generated after the patient’s approval. This protocol ensures that all patients identified as average risk by the system have orders to be screened in place before leaving MOHAP facilities.
The cancer screening workflow was designed to not only take into consideration the ease of documentation for nurses, but also provides robust clinical decision support for them. The complex algorithm of the workflow design ensures capturing of every patient who walks into PHCs and outpatient clinics in MOHAP facilities.
The design consists of smart templates that display the previous history of each cancer screening the patient underwent, the pending orders about each type of cancer screening, the date of the last test done, and the last screening performed, if any. These smart templates not only display important information but also provide decision support for the nurses on the eligibility of the patient to be screening in the current visit.
Once the patient is eligible and has agreed to any cancer screening, there are smart rules incorporated in the design that place auto orders for the respective cancer screening agreed for. The form also captures the reasons for refusal, to understand the apprehensions the population might have for getting screened. To provide important and relevant instructions to the patients, a patient instruction component is also embedded in the design.
Measuring the outcomes of this screening program was done following the general standard for evaluation of screening programs, which mainly considers uptake and coverage. The data analytics team developed three reports, one for each type of cancer screening and captured patients’ eligibility and documentation of screening consent.
Using these reports to monitor the proceedings of the introduced workflow on quarterly basis, the outcomes of this screening program across the year 2020 shows over-60% uptake of the screening by certain at-risk cohorts within our population.
This screening project was envisioned and aligned with the UAE 2021 vision of reducing the number of deaths from cancer. The idea is to capture the entire relevant cohort for the three most common types of cancers highlighted by MOHAP. Our project not only helped in the documentation and capturing of data, but also supported MOHAP in spreading awareness about the importance of cancer screening. The humanistic element of the project aim is what made working on this initiative meaningful and of high value.
Following implementation, we followed through screening program outcomes by reviewing overall documentation compliance, screenings being completed and have kept the MOHAP team up to date on the latest information to help keep that process working up to the best levels.
Wareed continues to support MOHAP innovatively in their journey towards world-class health care for all!
1. Number of Deaths from Cancer per 100,000 Population. [online] Available at: <https://www.vision2021.ae/en/national-agenda-2021/list/card/number-of-deaths-from-cancer-per-100-000-population>
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