RAD-AID has partnered with ACR on many initiatives throughout its 13-year history, including support for RAD-AID’s annual global health radiology conference, collaborations in Haiti and Nepal, projects for radiology residents at RAD-AID’s international sites, and the recent collaborative distribution of ACR’s BI-RADS® Atlas to RAD-AID’s partner low-resource breast imaging centers in low- and middle-income countries.
When RAD-AID launched the Women’s Health Access Program in the U.S. in 2020, Ian A. Weissman, DO, FACR, chair of the ACR Commission on Patient- and Family-Centered Care (PFCC) Outreach Committee and president-elect of the Wisconsin Radiological Society, reached out to inquire about a potential collaboration between the two groups — as they share similar objectives of reducing healthcare disparities among people of color in the U.S.
Patient communication and navigation are essential factors in addressing morbidity and mortality from breast and cervical cancers. One of RAD-AID’s key strategies for capacity-building in underserved areas is to bridge patient navigation, education, and equipment resources. Navigation means directly helping patients to understand care options and find care providers to optimize access, follow-up, and care delivery. Navigation also addresses key social determinants of health, which are integral to health disparities. One way to improve patient access is to advance patient satisfaction and the diversity of providers.
Addressing Disparities
The RAD-AID USA Women’s Health Access Program, in partnership with Hologic, the Black Women’s Health Imperative, and the ACR PFCC Outreach Committee, seeks to combat existing health disparities. John R. Scheel, MD, MPH, PhD, a breast imaging radiologist at the University of Washington (UW) and director of the RAD-AID USA Women’s Health Access Program, leads this effort, along with Mary W. Wetherall, RN, director of nursing, and Olive Peart, MS, RT(R)(M), program manager of mammography technologists. The initiative will deliver multidisciplinary healthcare to underserved communities. Areas of focus include public outreach, nursing and community navigation, breast and cervical cancer screening, and other medical services for people of color, says Scheel. Sites will be located in cities such as Washington, D.C., Seattle, Denver, Phoenix, Chicago, Philadelphia, and New York, as well as more rural regions of Georgia and Alabama.
Partnerships among diverse individuals are necessary to eliminate health disparities, notes Scheel. “By including participants with different backgrounds, we’ll be able to identify gaps in our own knowledge and strategy,” he says. “One of the reasons I think we’ll be successful is that we’re involving patient populations, providers, nurses, RTs, and other patient- and back-facing staff across the continuum of care. We need everyone.”
This approach is one of the reasons the ACR PFCC Outreach Committee is excited about the collaboration. “Our committee members bring their areas of expertise and unique life experiences to this initiative,” says Weissman. “We aim to use our different talents to combat health disparities.”
Our committee members bring their areas of expertise and unique life experiences to this initiative. We aim to use our different talents to combat health disparities.
Creating Effective Communication
Patient communication is a central component of the project, says Scheel. “One of the big things we’re working on is developing communication, education, and results letters for mammography, as well as appointment reminders,” he says. For these communications to be successful in modifying health behavior, he says, they need to be culturally appropriate and written using words that people of all levels of education and fluency in English can understand. As was necessary for the UW project, outreach needs to incorporate diverse viewpoints and beliefs — as well as the misinformation that already exists in communities. “Many patients we’ve spoken to believe that if breast cancer doesn’t run in their family, they don’t need to worry about it — or they only need one mammogram over the course of their lifetime,” says Scheel. RAD-AID volunteer, Christine B. Ormsby, MD, leads the patient communication work group and is assisted by RAD-AID and PFCC Outreach Committee members.
“Outreach will also need to be educationally appropriate,” explains Weissman. “Most medical communication is written at a 12th-grade reading level, although it should be targeted more toward a third-grade level for increased comprehension. One of our goals will be figuring out how to clarify the language in the radiology reports to empower patients to more fully participate in their care.”
The ACR PFCC Outreach Committee will not only be working on communication, says Weissman. “A lot of the committee members actually reside in areas where RAD-AID International is setting up program sites,” he says, “so we’ll be on the ground working with the patients.”
Producing Results
Improving communication and access to underserved communities are only two of the initiative’s many goals. Ultimately, its overarching aim is to address health inequity by providing a model that can be used to address other health problems. “We want to serve as an example that promotes policy change,” says Scheel. “To really improve population health, we need to show a cost-effective solution such as ours exists.”
Weissman agrees. “Patients can only advocate for themselves so much,” he says. “Our goal is to remove the obstacles in their way toward the end result of improving their care. Systemic change is also key to improving outcomes and equity in healthcare. We’re confident the RAD-AID USA Women’s Health Access Program will be a part of that change by demonstrating tangible results in these underserved communities.”
Developing the Strategy
This program is founded on the premise that global health includes local community health. By addressing the upstream sources of health disparities, such as systemic racism and education, RAD-AID USA hopes to include people previously excluded from the healthcare system and, thus, improve population health. This means that RAD-AID’s work applies not just to the low- and middle-income countries, but also to communities in high-income countries that face critical barriers to health equity.
Early in Scheel’s career at UW and the Fred Hutchinson Cancer Research Center, he worked on the ¡Fortaleza Latina! program. This program used a multi-level intervention that included patient promoters/navigators at primary care centers and a mammography van to improve breast cancer screening rates in Seattle’s underserved Latinx population. When the van was sent out into the community, program leaders noticed many Latinx patients were reluctant to use these mammography services. He worked with a team to determine why the project was not as initially successful as they had hoped. They discovered many people in the community believed that because the mammography machines were mobile, they were not as high-quality as machines at a hospital. “We assumed addressing awareness, transportation, and cost would fix access issues and increase participation in screening,” explains Scheel. “However, we also needed to provide culturally-appropriate communication, specific to mobile mammovans, so the community understood that the screening exams and radiologists interpreting their exams were of the same quality as what they would receive at our fixed sites.”
Misinformation like this is just one reason that underserved populations experience deep inequities in healthcare. Black patients in particular experience higher death rates from breast and cervical cancers, despite having nearly identical incidence rates to White patients. These patients are often screened at lower-resourced and non-accredited facilities and experience longer intervals between mammograms — as well as between abnormal results and follow-ups.1 The collaboration between RAD-AID USA and the ACR aims to address these education and communication gaps.