Black women experience significant disparities and inequities in the healthcare system when facing breast cancer. Black women die from breast cancer at a rate 41% higher than non-Hispanic white women and are twice as likely to be diagnosed with an aggressive, hard to treat type of cancer called triple-negative breast cancer.
“One big factor affecting these disparities are barriers in our healthcare system that limit access or diminish the experience in care,” says Paula Houston, Ed.D, chief equity officer of UW Medicine’s healthcare equity program and a breast cancer survivor herself. “These issues within our healthcare systems result in decreased regular screening or poorer quality screenings for Black women.”
To help change this, UW Medicine has embarked on a pilot project to improve screening rates for breast cancer for Black patients, thanks to a generous philanthropic donation. The project is part of a new donor-funded series of Patients Are First Innovation Pilots (PAFIP) and supports UW Medicine’s goal to address challenges in improving the delivery of care, clinical outcomes and the patient care experience.
“This is precisely the type of impactful initiative that PAFIP was created to help foster. Supporting innovative, patient-centered solutions to disparities in care delivery is a priority for us,” says Lisa Brandenburg, president, UW Medicine Hospitals and Clinics.
The first, and perhaps most important, part of this project is directly working with Black women to help design UW Medicine’s outreach to better facilitate breast cancer screenings.
“We aren’t just going to impose our ideas and solutions. Instead, we’re going to the community and asking, ‘What are the barriers that you experience ? How can we design our services and outreach programs to meet your needs?’” explains Vicky Fang, MD, leader of the pilot project and medical director of UW Medicine primary care and population health.
Fang and team are working with Bridgette Hempstead, founder of Cierra Sisters, an organization that advocates for and supports Black women living with breast cancer. Hempstead will lead detailed interviews with Black women to better understand their needs and the barriers they face.
Some barriers are known — access to online scheduling may be limited, screening locations aren’t always convenient and mid-day weekday appointments are not easy for working patients, for example.
Collaboration and partnerships are essential to success. The project spans many areas of UW Medicine, including Primary Care staff, breast cancer specialists, the Office of Healthcare Equity, the UW Department of Human Centered Design & Engineering, the Division of General Internal Medicine and the Division of Hematology and Oncology.
Currently, patients are given a phone number to call to set up an appointment, but this initiative aims to more proactively engage patients to get breast cancer screening.
One outcome of the pilot, which concludes in May, is the development of a prototype for a web-based tool or app that will help health navigators reach out to Black patients. Instead of receiving a bulk mailing to encourage setting up an appointment, for example, the tool would offer a way to interact with patients to walk through scheduling, mammogram information and more.
Alongside this pilot is an initiative to increase access to screening right now with the Mammogram Van — a mobile screening “clinic” — that visits several areas in and around Seattle, including Federal Way, Kent/Des Moines, Highpoint, Rainier Beach and at Harborview Medical Center. Primary Care staff at the UW Neighborhood Federal Way and Kent/Des Moines Clinics are receiving training and access to directly schedule patients for the Mammogram Van so patients leave the clinic with an appointment time in hand.
“I look at things differently when I walk into a healthcare or social services provider and think about the person who isn’t educated [about breast cancer], who doesn’t have a support system, who is worried about money because they don’t have insurance,” says Houston. “What’s that service provider doing to make sure this person is going to have a good experience and is going to have the same opportunity or outcome as someone else who has more privilege or more resources?”
These questions are being actively pursued by Houston and colleagues at UW Medicine to make sure that access to quality healthcare is a high priority, making it clear that the screening pilot project and Mammogram Van are part of a bigger, ongoing effort at UW Medicine to ensure the care we offer is equitable, respectful and compassionate.