Organizational Culture and Readiness Assessment

Section A: Organizational Culture and Readiness Assessment 

The setting for my evidence-based practice project is a small community hospital that is part of a network of hospitals that expands between two states New York and Connecticut. The network of hospitals is called Nuvance Health, and it is a relatively new health care facility that is undergoing several changes. Nuvance Health is a merger between Healthquest and Western Connecticut Health Network. Dr. John Murphy, the Chief Executive Officer of Nuvance Health, says that the merger is very beneficial to them and the community. He says, “Coming together to become one health system gives us a tremendous opportunity to redefine how we provide care by improving on traditional healthcare experiences and elevating our ability to connect our communities with an expanded care network” (Nuvance Health, 2020, n.p). 

Nuvance Health was founded on four foundational values, which include the following. First, to be personal with their community, assessing and treating the psychosocial and physiological needs. Second, to embrace imagination, challenge the norms, never conform, and be curious about innovations. Third, to practice agility, by staying open-minded, embrace change, and overcome barriers. Lastly, to stay connected, by working together, sharing ideas, and overcoming barriers (Nuvance Health, 2020). The foundational values stated above form the basis of Nuvance’s organizational culture and values. Based on their culture and values, it is feasible that they would be open to change that would benefit the community. 

According to Denison Organizational Culture Model, the culture of an organization relates to performance measures, which are growth, quality, profitability, innovation, and customer and employee satisfaction (“Introduction to the Denison Model,” 2020). The Denison model has four components: mission, adaptability, involvement, and consistency. Each of these components helps answer key questions about the culture of an organization. For instance, the mission answers questions pertaining to an organization’s future prospects. Adaptability is used to assess how the organization is responding to the market or the environment in which it operates. Involvement is used to determine whether the employees are aligned with the organizational goals of the organization or not. And lastly, consistency is used to assess if the organization has values, systems, and processes in place to create leverage (“Introduction to the Denison Model,” 2020). Nuvance Health fulfills all the components of the Denison Model. Therefore, the organization is ready to accept change. 

Nuvance Health is a relatively new organization, and since it is still developing, the organization is likely to face a lot of challenges when implementing evidence-based practice. One of the challenges that this organization would be facing its time constraints. This organization is currently trying to integrate two different systems, and is assessing all levels and hospital administration, workflows, etc. to meet their values which can take time. Location is going to be another barrier because the organization is located in New York state. The ongoing COVID-19 pandemic in the state will pose a lot of challenges to this organization. There is also a financial barrier. Before the state of emergency that the state is currently in, the president of the hospital created four groups of employees to research ideas and implementation techniques to create change in the hospital; the change was to address our values and hit all the performance measures measured by the Denison Model. Therefore, if it were not for the ongoing Covid-19 pandemic, the implementation would have been successful. 

With my clinical experience, I would be able to assist the opening of this evidence-based practice program. About two years ago, the hospital president wanted to open a chemotherapy infusion center in her small community hospital, and I was recruited from a sister hospital to assist in the daily operations. Currently, I am the clinical coordinator of the chemotherapy infusion unit, and we have brought this unit to a successful stance. Since the unit was established, our patient satisfaction scores have been 100%. With this in mind, I am confident that we can organize an early screening clinic. 

In order for this program to work, there has to be community outreach advertising the clinic. The JBI Model of Evidence-based Healthcare would be a useful framework to use in the implementation of this project. The JBI grades of recommendation use a Feasibility, Appropriateness, Meaningfulness, and Effectiveness (FAME) scale (“JBI Approach To Evidence-Based Healthcare,” 2016). This scale was used to assess the proposal. 

There was a randomized controlled trial from 2015-2018, comparing the outreach and in-reach strategies done for colorectal cancer among Latinos in California. The strategies were one-on-one education, mailed outreach offering a fecal immune chemical test, and the promotion of colorectal screening. There were 671 patients whose intent was for screening. These patients had a median age of 59.9 years. In terms of gender, 48.9% of the patients were male, while 51.1% were female (Castañeda et al., 2020). Also, 86.3% of the patients spoke Spanish (Castañeda et al., 2020). As demonstrated by this randomized controlled trial, the controlled group was at high risk of not getting screenings, inreach strategy of one-on-one education nearly doubled, and outreach strategies offering the fecal immune chemical test alone and in combination with other strategies mentioned nearly tripled (Castañeda et al., 2020). This proved that conducting outreach programs in the community is efficient in getting patients that normally do not seek medical help from a doctor. It is also efficient in getting patents that abide by standards of general screening works. 

In Ontario, a tribal nation called First Nation has been confronted with increased cancer rates and low chances of survival. These indigenous people rarely participate in cancer screenings (Tobias et al., 2020). Health officials in Ontario created programs for breast, cervical, and colorectal screenings. This article reviewed how and what barriers affected the increase of screenings of the people of the First Nation. The findings of the research were that policymakers of Ontario have to work with the leaders of the First Nation to overcome barriers that impede the people from getting screened. Some of the barriers that impeded the delivery of health care include culture, accessibility, and the structure of the program (Tobias et al., 2020). We need to assess the barriers that impede members of our community to get cancer screenings and address them. 

Section B: Proposal/Problem Statement and Literature Review 

The PICOT question I developed is to answer the question: Will the increase in the number of screening tools reduce the mortality rate of cancer in the United States? There are health disparities in our society, and these disparities occur in regions that are categorized by ethnicity and race. However, it is important to note that cancer disparities can also occur due to age, gender, education, geographical location, and socioeconomic status (National Cancer Institute, 2019). I had personally witnessed these health disparities in my locality, especially when in the health care facility, where I started my nursing career. The facility is located in New York City. By increasing screenings, the mortality rate of cancer is highly likely to reduce. This means that a lot of lives will be saved. Here is the breakdown of the PICOT question: 

P: To reduce mortality rates due to cancer disparities of new cancer diagnosed patients 

I: To reduce cancer disparities by increasing the use of screening tools. 

C: Compare disparities between patients with proper screenings and those without. 

O: Outcomes will be to reduce health disparities with those with cancer, by using screening tools to diagnose a patient at Stage I and II, thus increasing survivorship 

T: Late-stage diagnosis will be decreased by 30% in five years 

To put this PICOT into practice and achieve its purpose, I proposed to open a monthly screening clinic that would assess patients and conduct. The tool that will be used to assess the patients is a questionnaire. Physicians and medical oncologists that are more familiar with the signs and symptoms of different cancers will create the questionnaire. The questionnaire will also be used in other screening measures, such as ultrasound, CT-scan, or blood test. The screenings will be cheap to ensure that the services are affordable to everyone. At the same time, financial issues, especially in this environment, can be added to limitations, especially if the hospital does not want to cover screenings for those that do not have insurance. With this program, we will serve the community and help reduce the incidence of a late-stage cancer diagnosis. Through this program, we will save a lot of lives. 

Section C: Solution Description 

In many communities, especially those who are economically disadvantaged, cancer is often diagnosed at late stages. This is one of the factors that significantly contribute to the low survival rates among these communities. The proposed solution to this health disparity is to create a monthly screening clinic. The clinic would be open to the community, where they can be assessed by physicians. The assessment would entail a specially developed questionnaire that would review all systems and detailed history, a physical, blood work, and other diagnostic screening tests if necessary. There would also be an educational session that could be customized to the needs of the patient. 

Increasing cancer screenings will highly likely save lives. Many studies document that increasing the number of cancer screenings will save lives. However, there are a few studies that disagree. For instance, there was a study that offered men and women a hypothetical screening test for breast and prostate cancer. Even though screening tests do not prevent or reduce the chance of cancer or extend life, over half of the people agreed to have the test for reassurances (Scherer et al., 2018). Scherer et al. (2018), wrote, “This research finds that a large proportion of the American public would like to receive cancer screening that does not prevent death from cancer or extend the length of life, a preference that is at odds with the primary purpose of screening, which is to prevent cancer deaths” (Scherer et al., 2018). If, as stated, the purpose of screening is to prevent cancer deaths, why wouldn’t the increase of cancer screenings of the population save lives? 

When cancer is diagnosed at an early stage, there is an increase in overall survival rates, which I can attest to as an oncology nurse treating cancer patients daily. I do think that we should not use the word cure and cancer together. This is because the word cure is a false reassurance as cancer can always come back. The best word to use is remission. A big component of this project is to educate the community. According to a study conducted by Calderón-Mora et al. (2019), education is very effective in promoting cancer screenings. In another study, Kanellakis and Lamote (2019) showed that annual low-dose computed tomography screening to detect lung cancer reduces mortality by 20% in the United States and 26% in the Netherlands and Belgium. Does that mean that every single patient should get scanned to check for lung nodules? No, this also took into account those patients that are predisposed to cancer due to age, symptoms, medical history, family history, smoking history, and performance status. 

I do not think this proposed intervention would be costly for the organization. This is because the program would be using one to two physicians and possibly two nurses once a month to operate the screening clinic. Patients would be referred to the lab or any diagnostic testing. Thus, all these tests can be done in the hospital as an outpatient; this will be done covered by the patient’s insurance. If the patient does not have insurance, there are social workers within the hospital and community clinics that help the uninsured to apply for Medicaid in the state of New York. 

The organization’s culture is one of advancement, improving care, and attending the needs of the community. This proposal falls in line with this culture because it focuses on the health of the community and overcoming barriers and disparities. Health disparities occur in parts of the population and are categorized by race and ethnicity. In addition, the disparities can also occur due to age, gender, education, socioeconomic status, and geographical locations (National Cancer Institute, 2019). 

The expected outcomes of this project are to reduce overall health disparities by increasing accessibility of doctors in the community as well as using cancer screening tools to increase overall survivorship by diagnosing cancer at an early stage. The goal is to decrease the diagnosis of late-stage cancers by at least 30%. There will be follow-ups for these patients. Quantitative data will be gathered and documented. By creating a database and tracking screening results, we should be able to confirm if our goal was achieved. There can also be barriers like patients not following up with screening tests, physicians, or not having an accurate history during the assessment process. To ensure this does not occur, the screening test will be ordered the same day, and the patient will be given an appointment for results before leaving the office. Also, by developing a detailed questionnaire of medical and family history, daily lifestyle, and demographics, we are going to be able to get more detailed information about the patient. 

If this proposal is implemented successfully, we will be providing patient-centered care and provide quality improvement. This will be monitored by quality surveys sent to patients after visits. It will increase professional expertise. The oncologist will also be educating interns, residents, nurses, and medical doctors that will participate in this screening day. Some of the areas that the oncologists will cover when educating other health care professionals include but are not limited to the signs and symptoms of cancer. The signs and symptoms of cancer often manifest itself differently in different organs or systems. If everyone in the team learns the signs and symptoms as well as the results that they should be alerted to and concerned about when doing the follow-ups, we will become efficient and successful in the care of our community. 

Section D: Change Model 

Several change models can be applied to the theoretical framework of the evidence-based practice project. The project I focused on was the monthly cancer screening clinic in which we tried to encourage the community to get screenings. This was done to ensure cancer is diagnosed at an early stage. The aim of the project was to increase the overall survival rate. The Health Belief Model is a behavioral change model that impacts public health and can be applied to the patient through their experience. When we talk about public health, the goal is to prevent diseases that can lead to deaths. The goals are also to promote quality of life and health, as well as to create changes at a community, societal and institutional level that can positively impact the environment of the population to increase healthy choices (The Transtheoretical Model (Stages of Change), 2019). 

The Health Belief Model was created to attempt to understand the reasoning of why people are not compliant with screenings and disease prevention recommendations. The model has also been used to explain patients’ responses to their disease, symptoms associated with the disease, and their management. This model is the basis of my evidence-based practice project. The model suggests that when a person feels threatened by disease or illness in conjunction with what they perceive as effective when is in relation to interventions and recommendation of the changed behavior will determine if the patient will adopt the change (The Transtheoretical Model (Stages of Change), 2019). There Health Belief model is composed of six elements, which are perceived susceptibility, perceived severity, perceived benefits, perceived barriers, then cue to action, and lastly, self-efficacy (The Transtheoretical Model (Stages of Change), 2019). 

Perceived susceptibility refers to a person’s perception of the risk of getting an illness. Perceived severity is the person’s feelings about how serious getting the illness will be. Perceived benefits are the perception of how effective an action taken by the person to reduce the illness. Perceived barriers talk about how the persons feel about obstacles that impede making the medical recommendations. Cue to action is what stimulates the person to make the decision to follow the medical recommendations. Lastly, self-efficacy refers to the person’s confidence in how they will follow the recommendations and change their behavior successfully (The Transtheoretical Model (Stages of Change), 2019). 

There was a study done to understand what prevented Turkish women from getting early screening tests for gynecological cancer. The researchers identified a problem of late-stage gynecological cancer diagnosis in their population. Thus, they used the Health belief model to evaluate the subjects’ beliefs of Pap smear testing, which is the screening tool for this type of cancer. They studied 620 women, the youngest 19 years old and oldest 59 years old. From their study, the researchers found that 90.32% of the women were married, 45.32% had graduated primary school, 58.23% were housewives, and 49.3% had a Pap smear at least once before (Cangol, Sogut, Berberoglu and Dolu, 2020). When looking at environmental factors, socioeconomic status, and educational levels, they concluded that women’s perception and understanding of the purpose of Pap smears were low. This directly affected the rate of women getting screened. Women of lower educational levels and lower incomes were less likely to get early screening tests (Cangol, Sogut, Berberoglu, and Dolu, 2020). 

There was another study that looked at what factors cause the delay of Iranian women seeking treatment for breast cancer. The researchers noted that a delay in treatment decreased survival rates. They studied160 cases, and they looked at demographical factors, knowledge, and attitudes. They used the Health belief model phases to construct their data collection tool. They concluded that the delay of women seeking treatment had to do with their health beliefs and knowledge about breast cancer (Khanjani et al., 2018). 

In creating the conceptual model of my project using the Health Belief Model, I have to analyze my community’s perceived susceptibility; does education, age, gender, socioeconomic status affect their susceptibility? If we can understand which factor affects their perception of disease, we can target that group and create change in the community through education. The same factors would explain the perceived severity, benefits, and barriers. Based on this research, if we understand the behaviors in relation to perceived susceptibility, severity and benefits of why people feel and behave in certain ways with their health management, we can create an educational program included in the monthly screening clinics that target the perceived barriers, create a cue to action and help maintain a self-efficacy. 

Section E: Implementation Plan 

The setting of the evidence-based project is to have a monthly cancer screening day in which we first use a questionnaire to provide a detailed history and physical, routine blood work, and a personalized education plan. At this point, there is no need for informed consent because there is no invasive procedure being done. Once there is a cancer diagnosis, depending on cancer, the physician might order genetic testing. This would require obtaining consent from the patient. The consent form will be provided by the company performing genetic testing. The information collected during these screenings would be used to determine the effectiveness of the program. Due to these, there might be a need for consent, especially if you want to use data collected (Clayton, 2020). Consent forms have to be approved by a policy committee. This can cause interruption on the timeline because these policy committees sometimes take months or even a year to review policies and consents. When reviewing the consent form with the participants, it is our duty to ensure that the participant reads and understands the consent. However, we might face some barriers when it comes to ensuring all patients read and understand the consent forms. In order to avoid this, we would have to provide concise information that is not full of medical jargon and allowing them to read the consent on their own without our presence (Douglas, McGorray, and Ewell, 2020). Teach back method can be used to prove to understand. 

Due to the ongoing coronavirus pandemic, it is difficult to create a timeline to implement this project. The current hospital where this program is going to be implemented has lost more than $500,000 a week due to the coronavirus pandemic. Therefore, the management has really been trying to be fiscally conservative. We are now halfway into the year, and I do not think that this project will occur this year. Thus, considering all these factors, this project may be implemented in May 2021. I think this project would take about 3-4 months to design and promote, thus starting the new year we would take on this new project. Because this program is only once a month, we would have to proceed with the program for a year to see the effectiveness of this program. 

A number of resources will be used in this project. Some of the resources that will be used in this project include human resources, management, financial resources, social work, hospital lab, and those managing diagnostic testing. Human resources and management need to be involved in determining the staff that is going to be part of this project and have the necessary credentials. It would be ideal for staffing the project with healthcare workers that are already part of the system. I do understand that, currently, we are short on nurses and physicians. Therefore, whoever is chosen has to go through an interview process to determine their capabilities to support the project. The hospital’s financial analyst needs to be involved as we would be using part of the money that is donated to our oncology unit to run this monthly screening day. The budget would provide money for printed materials, which include education. Social work also needs to be involved, as we might find grounds for social work referrals. Those that manage the hospital lab and the diagnostics testing should also be involved as they will have an increase in volume. To be successful in this project, it is going to take an interdisciplinary approach. 

As mentioned before, a detailed history and physical questionnaire would be used to screen the patients. This includes the family and social history of the patients. The physicians will use the information provided to determine what labs and diagnostic testing should be ordered if any. These tests would have to go through medical insurance. If there is no insurance, the hospital has resources for financial assistance for patients. After this is done, it is important to follow up with the patients to determine if there were any early detection, and this quantitative data will be used to measure the success of the program. 

While I described the process of delivery of this project, there is going to be ongoing training. The lead physician of this program will be an oncologist because of his knowledge of the subject. There was a resident program that started less than a year ago, and this will be a perfect opportunity to teach and educate residents in oncology. From my experience working in a prior hospital with a resident program, first-year and second-year residents do not feel comfortable with oncology patients and, at times, do not understand how to treat. For example, an oncology patient that comes into the hospital for pain and their home medication is fentanyl patch, OxyContin IR, Oxycotin extended released, and possibly a benzodiazepine. In the emergency department or on the floor received 0.5mg to 1mg of morphine IVP. The patients’ medication tolerance is much higher than that, so this would not help control the patients’ pain. I have witnessed this many times, and to detect changes, an oncologist will be needed. So by starting their exposure and education at the beginning, they will be better prepared to treat oncology patients. This will start by following the oncologist during his office hours and see the interaction with patients also including oncology into their curriculum and lectures they are already receiving. A study that researched the incorporation of interprofessional education between health professionals they felt more comfortable. They appreciated that they had the opportunity to speak to cancer physicians by increasing their knowledge and confidence in discussing oncology matters (Navarro and Sehgal, 2016). 

The data collection will be documented in an excel spreadsheet using identifiers because we will have to be able to go back to the data to follow up as certain testing might take over a month to receive. Data collected would be medical record number, number of follow-ups and consultations, medical history, and social number. There will also have to be a separate data collection on the monthly expenditures of supplies, educational, and promotional material. The purpose of this evidence-based project is to help the community. However, I have to realize that it is also a business, and the hospital cannot incur losses, especially in these hard times. The data will be examined by management, the financial and fiscal auditors, and myself, but they will determine the functionality of the program at the end. In Europe, they have a cancer registry, which is basically a database that helps in the evaluation of cancer screening programs and its effectiveness and the occurrence of cancer in an area (Anttila et al., 2015). This program can be the first step to creating a registry that would identify risk factors along with occurrences within the community and help the implementation of interventions that would reduce that incidence. 

As discussed in previous topics, the barriers can range from financial, when the financial resources available are diminished. It can be a lack of promotional when the program is not being effectively promoted in the community. The cost of the personnel will be already covered because the physician and nurses would be supplied by the hospital. There would be costs related to printed material in which the institution has a print shop that they use in which the materials will be done at a discounted price. This program will be an extension of our chemotherapy infusion program. Therefore, some of the materials needed, such as paper, pens, etc. will come out of their budget and supplies. There are no travel costs because they will be done in the hospital. The hospital has a medical record system, so there would not computer-related costs. 

Another barrier or benefit that I might not have discussed before is the managerial turnover that is currently occurring due to the merging of two health systems, as I previously discussed. There was a research that discussed managerial turnover and how it affected an organization, and it concluded that it was of benefit. The organization did fiscally better compared to those without a turnover (Connolly, 2018). From what I am currently experiencing in the institution, the changes that are being made by the top of this new health system has been a positive change and slowly improving the procedures of the old system. Considering all these factors and after the evidence-based program is implemented for a year, we would have analyzed the data to determine we would maintain the program, extend it, or discontinue it. 

Section F: Evaluation of Process 

In my evidence-based project, I am creating a monthly cancer screening day. With this project, it is the goal to prove that early cancer screenings lead to early diagnosis. This, in turn, increases the rate of survival. The data collection would provide quantitative and qualitative data. Upon the first interaction with the patient, we would collect a detailed social and family history. This will give us the basis of predisposing and precipitating factors leading to cancer. Then, we will continue to follow the patient through all the screening tests performed and tally, which screening tests were done and record the results. Next, we will assess how many patients were diagnosed with early to late-stage cancer. All this information is very important to access all contributing factors and to determine if the program is successful. We will also access which patients were diagnosed with any other disease like hypertension, diabetes, etc. as a result of all the different tests being done. 

If we see about ten to twelve members of the community monthly, that will equate to 120 to 150 people a year. The total number a day is ten because this would be a consultation. To have a thorough visit with the oncologist, we need to allow at least one hour per person, given that the oncologist will be working for 12 hours a day. If about 10 to 20 percent of those screened have a positive screening, the program will be considered to be successful. If the number increases to 30 or 40 percent, it will mean that there is a problem in the community. This because that would mean that 3 to 4 out 10 to 12 are diagnosed with cancer, which is a very high ratio when looking at local communities. As we are using the information and data of patients for research purposes for surveillance and testing, we need to ensure that the rules placed by regulatory agencies are followed. This includes providing informed consent, causing no harm, and contributing to the general knowledge among our peers in healthcare (Lee, 2019). 

The research will have validity and reliability because it is going to be based on factual numbers as we are following all the patients. As a result, the results will show some consistency and the instruments used to measure the results accurately. The project is applicable to our goals as an organization. After the implementation of this program for a year, we can determine if the outcomes reached the purpose intended. As the PICOT was stated in previous sections, it is the goal to reduce the cancer mortality rate by 30%, and assessing the increase of survivorship by five years. After following all the patients through their screenings, lab work, follow-ups, and obtaining the results, we can tally all the patients and which had a positive screening. It is important to record what other new diagnoses resulted from this program like hypertension, diabetes, etc. It is imperative also to analyze the cost of the strategies for implementation of the project, the costs of running the screening that has to be included in a budget, as well as the revenue incurred by the hospital due to the referrals, lab testing, and diagnostic testing. This will help decide if the program is cost-effective (Cidav et al., 2020). If the project is successful and it runs for at least three years, we would follow up with those patients that were diagnosed with cancer and assess survivorship, and this could be done by phone calls, which would be a cost-effective during this part of the implementation (Skolarus et al., 2012). 

The implications of this project for my practice and future research include: to serve the community and to increase the health of our community by actively intervening in the lives of patients by seeing a physician, social work, and nutritionist (if applicable). With the COVID-19 pandemic, the results showed that those with co-morbidities are impacted with a higher death rate. Bringing those in the community for these cancer screenings is not only going to assist us for that purpose, but also with all the information we will gather we can diagnose those co-morbidities at an early time to get it under control. If we have a second wave of the COVID-19 infection, we can see trends and compare them. This project is to improve the overall health of the community, and it can be referred to as public health. 

References 

Anttila, A., Lönnberg, S., Ponti, A., Suonio, E., Villain, P., Coebergh, J., and von Karsa, L., 2015. Towards the better implementation of cancer screening in Europe through improved monitoring and evaluation and greater engagement of cancer registries. European Journal of Cancer, 51 (9); 241-251. 

Calderón-Mora, J., Byrd, T., Alomari, A., Salaiz, R., Dwivedi, A., Mallawaarachchi, I., and Shokar, N., 2019. Group Versus Individual Culturally Tailored and Theory-Based Education to Promote Cervical Cancer Screening Among the Underserved Hispanics: A Cluster Randomized Trial. American Journal of Health Promotion, 34 (1); 15-24. 

Cangol, E., Sogut, S., Berberoglu, U., and Dolu, I., 2020. Evaluation of Women Having Pap Smear Test by Health Belief Model Scale. International Journal of Caring Sciences, 13 (1); 333-342. 

Castañeda, S., Bharti, B., Rojas, M., Mercado, S., Bearse, A., & Camacho, J. et al. (2020). Outreach and Inreach Strategies for Colorectal Cancer Screening Among Latinos at a Federally Qualified Health Center: A Randomized Controlled Trial, 2015–2018. The American Journal Of Public Health, 110 (4); 587-594. doi: 10.2105/ajph.2019.305524 

Cidav, Z., Mandell, D., Pyne, J., Beidas, R., Curran, G., and Marcus, S., 2020. A pragmatic method for costing implementation strategies using time-driven activity-based costing. Implementation Science, 15 (1); 1-15. 

Clayton, E., 2020. What Should We Be Asking of Informed Consent? The Journal of Law, Medicine & Ethics, 48 (1); 185-187. 

Connolly, J., 2018. Can Managerial Turnover Be a Good Thing? The Impact of City Manager Change on Local Fiscal Outcomes. Public Administration Review, 78 (3); 338-349. 

Douglas, B., McGorray, E., and Ewell, P., 2020. Some researchers wear yellow pants, but even fewer participants read consent forms: Exploring and improving consent form reading in human subjects research—psychological Methods. 

JBI Approach to Evidence-Based Healthcare. (2016). Retrieved May 9, 2020, from https://joannabriggs.org/jbi-approach.html#tabbed-nav=JBI-approach 

Introduction to the Denison Model. (2020). Retrieved May 12, 2020, from https://www.denisonconsulting.com/wp-content/uploads/2019/08/introduction-to-the-denison-model.pdf 

Kanellakis, N., and Lamote, K., 2019. Management of incidental nodules in lung cancer screening: ready for prime-time? Breathe, 15 (4); 346-349. 

Khanjani, N., Rastad, H., Saber, M., Khandani, B., and Tavakkoli, L., 2018. Causes of Delay in Seeking Treatment in Iranian Patients with Breast Cancer Based on the Health Belief Model (HBM). International Journal of Cancer Management, 11 (6); 1-10. 

Lee, L., 2019. Public Health Data Collection and Implementation of the Revised Common Rule. The Journal of Law, Medicine & Ethics, 47 (2); 232-237. 

National Cancer Institute. (2019). Cancer Disparities. [Online] Available at: https://www.cancer.gov/about-cancer/understanding/disparities [Accessed May 9, 2020]. 

Navarro, D., and Sehgal, I., 2016. Use of SkypeTM sessions with top cancer trial physicians to bring Interprofessional Education (IPE) into a didactic oncology course. Currents in Pharmacy Teaching and Learning, 8 (3); 346-352. 

Nuvance Health. (2019). Welcome to Nuvance Health: new brand identity revealed. [Online]. Retrieved June 17, 2020, from https://www.healthquest.org/medical-practice/news/welcome-to-nuvance-health-new-brand-identity-revea-698.aspx 

Scherer, L., Valentine, K., Patel, N., Baker, S., and Fagerlin, A., 2018. Supplemental Material for A Bias for Action in Cancer Screening? Journal of Experimental Psychology: Applied, 25 (2); 149-161. 

Skolarus, T., Holmes-Rovner, M., Hawley, S., Dunn, R., Barr, K., Willard, N., Wei, J., Piette, J. and An, L., 2012. Monitoring Quality of Life among Prostate Cancer Survivors: The Feasibility of Automated Telephone Assessment. Urology, 80 (5); 1021-1026. 

Sphweb.bumc.bu.edu. 2019. The Transtheoretical Model (Stages of Change). [Online] Available at: http://sphweb.bumc.bu.edu/otlt/MPH Modules/SB/BehavioralChangeTheories/BehavioralChangeTheories6.html [Accessed 27 May 2020]. 

Tobias, J., Tinmouth, J., Senese, L., Jumah, N., Llovet, D., & Kewayosh, A. et al. (2020). Health Policy as a Barrier to First Nations Peoples’ Access to Cancer Screening. Healthcare Policy | Politiques De Santé, 15 (3), 28-46. doi:10.12927/hcpol.2020.26132 

Zomahoun, H., Massougbodji, J., Bussières, A., Thomas, A., Kairy, D., Uwizeye, C., Rheault, N., Charif, A., Diendéré, E., Langlois, L., Tchoubi, S., Gaye, S. and Légaré, F., 2020. Improving the usefulness of evidence concerning the effectiveness of implementation strategies for knowledge products in primary healthcare: protocol for a series of systematic reviews. Systematic Reviews, 9 (1); 1-10. 

Appendices 

Appendix A: Conceptual Model 

CONCEPTUAL MODEL BASED ON THE HEALTH BELIEF MODEL 

Modifying Factors 

Likelihood of Action 

Individual Perceptions 

Cues to Action 

Educational program – informational interviews with nurses on signs and symptoms to report 

Review history of diagnosis and symptoms 

Advertising in local community centers, churches, and hospital 

Attending the cancer screening and future routine screenings 

Perceived benefits of screening- perceived barriers to screening equals attendance of screening 

Perceived threat of cancer 

Age, sex, ethnicity, personality, socioeconomic status, knowledge, predisposition to cancer and self-efficacy 

Perceived susceptibility to cancer and perceived severity of cancer 

Appendix B: Handouts –History and Physical 

Appendix C: Project Budget 

Appendix D: Project Timeline 

Appendix E: Questionnaire 

Part A: How effective do you believe the following screening procedures are effective in reducing the mortality of cancer? 

Part B: Please complete the following table based on your recommendations on the frequency of screening. 

Appendix F: Resource List 

Appendix G: Consent Form 

INFORMED CONSENT FORM 

PROJECT TITLE : MONTHLY CANCER-SCREENING PROGRAM AT NUVANCE HEALTH 

Principal Investigator 

Claudia Rodriguez 

What you should know about this research study: 

We give you this informed consent document to outline the purpose of this study, the risks involved in this study, and the benefits of this study. So that you may read about the purpose, risks, and benefits of this research study. 

Participating in this study is purely voluntary, and you have the right to change your mind later. 

Please review this consent form carefully. Contact the principal investigator or other staff for more clarification. 

Your participation is voluntary. 

PURPOSE 

The purpose of the study is to increase cancer screenings at Nuvance Health to reduce the mortality of cancer. Cancer is a serious health and is often diagnosed at late stages. You are being asked to participate in this study to facilitate the process of early detection of cancer. This will help in early diagnosis and treatment, which will, in turn, help reduce the mortality of cancer. Before you sign this form, please seek more clarification regarding any aspect of this study. You may take as much time as necessary to think it over. 

PROCEDURES AND DURATION 

If you decide to participate in this study, you are asked to provide some samples and undergo some tests or screenings during your visit. This will be done with the help of a health care professional. The health care professional will take some tests. You will receive the results of the test by phone or mail in less than a week. The results will be explained to you. The profession will make follow-ups. If you test positive, you will be asked to come back to the facility for follow-up testing. If any abnormality is detected, we will provide some treatments using your insurance. 

RISKS AND DISCOMFORTS 

Undergoing cancer screening can cause worry or concern. For this reason, counseling will be provided. We will provide you with appropriate follow-up testing and discuss ways to take care of yourself and avoid cancer. 

BENEFITS AND/OR COMPENSATION 

You will know whether you have cancer or not. This will help in early diagnosis and treatment. You will undergo follow-up testing if you have a positive result. 

There is no cost to you for participation in this study. There is no compensation for this study. 

CONFIDENTIALITY 

The information you will provide will be kept safe and secure; it will be identified only by a code and date of collection. Any data stored on computers will have a security code. Only the research team and your provider will have access to your name and the study results. 

VOLUNTARY PARTICIPATION 

Participation in this study is voluntary. You have the right to terminate your participation in the investigation without your prior request. 

AUTHORIZATION 

You are making a decision whether or not to participate in this study. Your signature indicates that you have read and understood the information provided above, have had all your questions answered, and have decided to participate. 

Name of Research Participant (please print) Date 

Signature of Staff Obtaining Consent Date 

(Optional) 

FUTURE CONTACT 

Do you agree to be contacted in the future regarding participation in future research related to cervical cancer screening and treatment? 

Yes Signature Phone number 

No Signature Phone number 

YOU WILL BE GIVEN A COPY OF THIS CONSENT FORM TO KEEP. 

If you have any questions concerning this study or consent form beyond those answered by the investigator, please feel free to contact us through: 

Phone: 

Mail: