title: What women want: patient recommendations for improving access to breast and cervical cancer screening and follow-up.
abstract: BACKGROUND
  The patient voice remains underrepresented in clinical and public health interventions. To inform interventions that strive to improve access to breast and cervical cancer screening and follow-up among low-income populations, we explored recommendations from low-income women pursuing health care in the safety net.
  
  
  METHODS
  Semi-structured interviews were conducted among women receiving follow-up care for an abnormal breast or cervical cancer screening result or a positive cancer diagnosis in federally qualified health centers, free clinics, or an academic cancer center in the Chicago metropolitan area.
  
  
  RESULTS
  Of the 138 women interviewed in the parent study, 52 women provided recommendations for improving access to screening and follow-up care. Most were between 41 and 65 years old (62%) and African American (60%) or White (25%). Recommendations included strengthening community-based health education with more urgent messaging, strategic partnerships, and active learning experiences to increase patient engagement, which women regarded as a key driver of access. Women also suggested increasing access by way of changes to health care delivery systems and policy, including more direct patient-provider and patient-clinic communications, addressing delays caused by high patient volume, combining preventive services, expanding insurance coverage, and adjusting screening guidelines.
  
  
  CONCLUSIONS
  This exploratory study demonstrates important insights from the patient lens that may help to increase the acceptability and efficacy of community and clinical interventions aimed at improving access to breast and cervical cancer screening and follow-up. Further research is needed to identify appropriate integration of patient input into interventions, practice, and policy change.
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
authors.forename: Daiva M
authors.initials: DM
authors.lastname: Ragas
authors.affiliation: Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois.
authors.forename: Narissa J
authors.initials: NJ
authors.lastname: Nonzee
authors.affiliation: Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois.
authors.forename: Laura S
authors.initials: LS
authors.lastname: Tom
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
authors.forename: Ava M
authors.initials: AM
authors.lastname: Phisuthikul
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois.
authors.forename: Thanh Ha
authors.initials: TH
authors.lastname: Luu
authors.affiliation: Rush Institute for Healthy Aging, Rush University Medical Center, Chicago, Illinois.
authors.forename: XinQi
authors.initials: X
authors.lastname: Dong
authors.affiliation: Department of Obstetrics and Gynecology, Northwestern University, Chicago, Illinois; Institute for Public Health and Medicine, Northwestern University, Chicago, Illinois; Robert H. Lurie Comprehensive Cancer Center, Northwestern University, Chicago, Illinois; Department of Preventive Medicine, Northwestern University, Chicago, Illinois. Electronic address: m-simon2@northwestern.edu.
authors.forename: Melissa A
authors.initials: MA
authors.lastname: Simon
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D002641:Chicago; D003256:Community Participation; D003266:Continuity of Patient Care; D055088:Early Detection of Cancer; D005260:Female; D006266:Health Education; D007722:Health Knowledge, Attitudes, Practice; D006297:Health Services Accessibility; D006301:Health Services Needs and Demand; D006801:Humans; D007407:Interviews as Topic; D008327:Mammography; D008403:Mass Screening; D008875:Middle Aged; D011203:Poverty; D036301:Qualitative Research; D012307:Risk Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears