Facilitating colorectal cancer screening access through systems analysis: A case study of the Northwest Territories

Regions: Inuvialuit Settlement Region, Gwich'in Settlement Area, Sahtu Settlement Area, Dehcho Region, North Slave Region, South Slave Region

Tags: health, health care evaluation, cancer, cancer screening

Principal Investigator: Champion, Caitlin E (1)
Licence Number: 15747
Organization: University of Ottawa
Licensed Year(s): 2015
Issued: Aug 26, 2015
Project Team: Dr Gonzalo Alvarez (Research Co-supervisor, University of Ottawa), Dr Ewan Affleck (Local Supervisor, Yellowknife Health and Social Services)

Objective(s): To determine how current health care processes and system-level factors within the Northwest Territories health care system are influencing patient access to colorectal cancer screening.

Project Description: The objective of this research project is to determine how current health care processes and system-level factors within the Northwest Territories (NWT) health care system are influencing patient access to colorectal cancer screening.

Specific objectives are to:
1) conceptualize colorectal cancer screening to identify and describe the health care processes (health system agents, interactions, information problems) and system-level factors (system context and system behaviours) impacting care access;
2) construct an exploratory process model representing the care processes and system-level factors influencing colorectal cancer screening access in the NWT; and,
3) translate the exploratory process model into preliminary parameters to inform a quantitative system dynamics model.

A qualitative case study of colorectal cancer screening within the NWT will be undertaken with colonoscopy services provided by the Stanton Territorial Health Authority forming the case study boundaries. Patient-level data from medical records and community-level data from semi-structured interviews with health care providers will be used to describe colorectal cancer screening in the NWT health care system.

Data collection and analysis will be conducted in two phases; the first phase of data collection and analysis will be conducted on medical records of patients undergoing screening and diagnostic colonoscopy for colorectal cancer screening at the Stanton Territorial Hospital in 2012, the first full year screening guidelines were in place, with purposeful sampling of Inuit, Dene, Metis and non-indigenous patients from each of the six referring health and social services authorities. Consultation letters and colonoscopy procedure reports from patient medical records will be analyzed following qualitative content analysis methods.

The results from the medical records analysis will inform a second phase of data collection consisting of 1-1.5 hour recorded phone or in-person semi-structured interviews with health care providers from each of the referring health and social services authorities, as well as specialist care providers at Stanton Territorial Hospital who are involved in colorectal cancer screening. Health care providers will be recruited via email recruitment notice with follow-up phone call from the research team. Verbatim interview transcripts will be analyzed following qualitative content analysis methods.

Results from both phases of data collection and analysis will be used to develop an exploratory process model depicting the health care processes and system-level factors influencing colorectal cancer screening within the NWT health care system. Data collection and analysis will be managed using NVivo software, and data will be stored on an encrypted USB. Validation of the exploratory process model will be conducted via participant review with individual study participants. Preliminary quantitative parameters of health care processes and system-level factors will be identified from the exploratory process model in the final stage of data analysis.

Local health care providers will be approached for participation in semi-structured interviews regarding accessibility of colorectal cancer screening services within the NWT. Benefits include increased health care provider knowledge of colorectal cancer screening guidelines and available services within the territory to refer patients to appropriate services. Potential long terms benefits include restructuring of health care services, particularly colonoscopy services, tailored to patient needs across the territory.

Health care providers participating in interviews will be provided a preliminary final report for review and feedback prior to completion of the project. Once final results of the data analysis and participant review are complete, the study will be compiled into a Masters Thesis and made publicly available through the University of Ottawa.

Study results will also be shared with administrative and clinical stakeholders across the NWT through communication and meetings with the Joint Senior Management Council, senior administration within the Stanton Territorial Health Authority and Beaufort-Delta Health and Social Services Authority, the Medical Directors forum, and the Nursing Leadership forum. At the study conclusion results will be shared with administrators and physicians within the Stanton Territorial Health Authority and Beaufort Delta Health and Social Services authority through knowledge dissemination workshops.

The fieldwork for this study will be conducted from September 1, 2015 to December 31, 2015.