Date of Degree


Document Type

Doctoral Project

Degree Name

Doctor of Nursing Practice (DNP)




Diana Beckmann-Mendez


Leticia Ybarra


Cervical and breast cancer screenings reduce the risk of morbidity and mortality for American women. In 2017, about 70% of U.S. women over the age of 21 obtained a Papanicolaou (Pap) test, which screens for cervical cancer. African American women have a cervical cancer screening rate of 74.6% and Hispanic women have a rate of 68.6%. The cervical cancer screening rates decrease to 51% for women who are uninsured (Centers for Disease Control and Prevention, 2017). In the United States, 50% of women older than 40 are current on their screening mammogram. African American women have a screening mammogram rate of 55% and Hispanic women have a rate of 46%. Women who are uninsured have a screening mammogram rate of 21% (American Cancer Society, 2017a).

This data suggests that underserved populations may not be appropriately screened, or followed up on in the instance of an abnormal finding, which causes delays in treatment. There are established standards of care that guide practice regarding how often women are screened, based on age and risk factors. Despite these set standards, delivery of care varies by provider, patient population, and facility location. A nurse-led wellness center in an urban south-central city in Texas was the site of this quality improvement project, aimed at improving the follow up process after cervical and breast cancer screening.

This project established a system for patient notification of test results and a referral process for ongoing care. Results indicated that the center was able to successfully implement this process by establishing a workflow that included the creation of an algorithm, a reference binder, and a checklist for staff to follow. Preliminary results indicate that 100% of patients have been notified of test results.