National Breast and Cervical Cancer Early Detection Program

Policy/Theory Exemplar
Contributor: Jacqueline Fawcett
August 23, 2018

Policy/Theory Exemplar (Conceptual Model of Nursing and Health Policy)

Year of implementation: 1990

The policy implementation pertains to the activities of nurses who work as case managers and nurses and others who work as patient navigators in cancer and cardiovascular screening programs offered by the Massachusetts Department of Public Health. One project designed to implement the policy was the Women’s Health Network, the other was the Care Coordination Program.

Policy summary

The National Breast and Cervical Cancer Early Detection Program was designed by the Center for Disease Control and Prevention (CDC) to provide free screening for low income women across the United States.

Nursing Perspective

The research was guided by the Conceptual Model of Nursing and Health Policy. See

  • Fawcett, J., & Russell, G. (2001). A conceptual model of nursing and health policy. Policy, Politics, and Nursing Practice, 2, 108-116
  • Russell, G.E., & Fawcett, J. (2005). The conceptual model for nursing and health policy revisited. Policy, Politics, and Nursing Practice, 6, 319-326.
Key Nurses and their roles 
  • The directors of the projects that were implemented in Massachusetts were Mary Lou Woodford, RN, Heather Nelson, PhD, and Anita Christie, RN.
  • Two projects (Women’s Health Network and Care Coordination Program) designed to evaluate the policy implementation were conducted by Russell Schutt (PhD, Sociology) and Jacqueline Fawcett, (PhD, Nursing).
    • See Fawcett, J., Schutt, R.K., Gall, G.B., Riley-Cruz, E., & Woodford, M.L. (2007). The work of nurse case managers in a cancer and cardiovascular disease risk screening program. Professional Case Management: The Leader in Evidence-Based Practice (formerly, Lippincott’s Case Management), 12, 93-105.
    • Schutt, R.K., Fawcett, J., Gall, G.B., Harrow, B., & Woodford, M.L. (2010). Case manager satisfaction in public health. Professional Case Management: The Leader in Evidence-Based Practice, 15,124-134.
    • Schutt, R.K., Siegfriedt, J., & Fawcett, J. (2017). Who cares? Case management and patient navigation in a public health program. International Journal of Care and Caring, 1, 367-387.

The findings of the Women’s Health Network (WHN) evaluation project conducted by Fawcett et al. (2007) and Schutt et al. (2010) revealed that the case managers provided excellent service to Massachusetts women in need of follow-up testing for breast and cervical cancer. Case manager practice activities encompassed client service activities (e.g., tracking test results, finding/connecting with clients, assessing client needs, and educating clients) and bureaucratic activities (e.g., documentation of services). Case managers reported a high level of commitment to delivering services, as well as satisfaction with their jobs and with their service delivery. Client satisfaction was high. Client service activity frequency was correlated with client caseload size, social barriers, overall workload, satisfaction with the way activities were carried out in the WHN, special training in WHN policies and procedures, and contracting organization service delivery arrangements. Bureaucratic activity frequency was correlated with caseload size, workload, months as a WHN case manager, system barriers, satisfaction with the way activities were carried out in the WHN, and special training.

The findings of the Care Coordination Program evaluation project conducted by Schutt et al. (2017) indicated that although patient navigators diversify the healthcare workforce and increase engagement with culturally diverse patients, their roles and orientation overlap with those of case managers. Schutt et al. (2017) concluded that there are multiple challenges in fostering patient engagement, needs for flexibility in case manager and patient navigator roles, and considerable potential for workforce expansion.