Qualitative evaluation of the assessment of cancer screening and follow-up (ACIC-Ca) tool: Findings from cancer collaborative participants in the pursuit of quality improvement

PURPOSE This study examines an adaptation of a survey measurement tool (Assessment of Cancer Screening and Follow-Up (ACIC-Ca)) and its implementation by health disparities collaborative teams. METHODS Qualitative data from 43 staff members in 9 US health centers were collected through in-depth interviews, focus-group discussions, and direct observation of teams completing the tool. The appropriateness, relevance, and utility of the tool were evaluated by thematic analysis using NVivoŽ software. Variables were coded according to pre-determined outcome measures relative to the tool: 1) process of completion; 2) ease of completion; 3) comprehension; 4) scoring; and 5) component applicability. RESULTS Respondents found that completing the tool was an informative, albeit lengthy process; which provided a helpful format for communication and clarification. 76% of the respondents considered the tool moderate to easy to complete. 14 tool sub-components contained unclear language, however, there were no suggestions to remove or add components. Much attention was focused on each sub-component's score. Many barriers contributed to the inability to maximize the use of the ACIC-Ca, namely: time, lack of trained staff in the Chronic Care Model, and missing or under-utilized Plan-Do-Study-Act tools. CONCLUSION The components in the ACIC-Ca are relevant to cancer screening, and appropriate to include in the tool. The ACIC-Ca provides benchmarks describing quality cancer screening and follow-up that helped gauge progress. Although the tool facilitated identifying areas of weaker performance, more emphasis was placed on ranking scores than discussions focused on improvement of care processes. Utility might increase if explicitly linked to action planning.