(0211) Developing a Pilot Curriculum for Head and Neck Cancer Screening in Tennessee Correctional Facilities

Introduction: The US has approximately 2.1 million incarcerated individuals who are at high risk for head and neck cancer (HNC) due to a multi-fold increase in tobacco and alcohol use compared to the general population. The purpose of this research is to identify barriers for the incarcerated population and pathways for timely HNC care.

Methods: This is an ongoing, qualitative study that began in December 2021. We interviewed stakeholders within the Tennessee Department of Correction (TDOC) system, including leadership of the Department of Corrections, facility administrators, correctional managed care directors, and providers. We performed site visits to Tennessee prisons. Using this data, we generated a value stream map based on the following key findings: in-network otolaryngologic care is not available to prisoners; midlevel providers are the primary gatekeepers to subspecialty services, and out-of-network referral to otolaryngology is dependent upon recognition of suspicious lesions.

Results: Based on these findings, we conducted 2 interventions. First, we conducted a pilot study with TDOC providers. We developed a 1 hour in-person curriculum to teach head and neck anatomy and diagnostic findings, and assessed subjective and objective competencies before and after completion of the curriculum. We had 27 participants in total, all of whom were advanced practice practitioners. Participants reported subjective improvements in the following categories: examination and history skills, appropriate imaging, and referral indications. Second, we worked with TDOC to alter nursing protocols so worrisome HNC symptoms (persistent otalgia, hemoptysis, dysphagia, dysphonia, etc) were more appropriately triaged to next echelon care. Data collection on the results of this intervention are ongoing.

Conclusions: This study identified barriers to care for prisoners within TDOC as it relates to HNC. The current TDOC infrastructure provides a meaningful pathway for early detection of head and neck malignancies in a high-risk and historically underserved population of US citizens.