Clinician Education and Workflow Tools to Improve Access to Recurrent and Metastatic Cervical Cancer Treatment

TL;DR

This study shows that combining clinician education with practical tools can improve access to cervical cancer treatment by reducing delays and enhancing care coordination.

Contribution

A multidisciplinary initiative combining education and workflow tools to improve cervical cancer care access is described and evaluated.

Findings

Clinicians showed increased knowledge and confidence after the program, with scores ranging from 3.7 to 4.0 out of 5.0.

Participants reported changes in practice, such as earlier specialist referrals and more frequent discussion of clinical trials.

Educational materials received 1,869 views and remained publicly accessible, indicating reach and ongoing utility.

Abstract

Background: Patients with recurrent or metastatic cervical cancer often face delays in treatment due to complex prior authorization (PA) processes and uneven access to specialty care. Educational interventions targeting clinicians and care teams may help streamline workflows and improve access to timely, evidence-based treatment.

Objective: To describe the design, implementation, and outcomes of a multidisciplinary quality-improvement initiative aimed at improving provider knowledge, administrative efficiency, and access to cervical cancer care.

Methods: The King County Medical Society (KCMS) launched the Cervical Cancer Education and Equity Initiative. The project combined clinician education with practical workflow tools, including a freely available Prior Authorization Toolkit. Activities included 21 short educational videos, a comprehensive slide-based educational module, monthly newsletters, social-media dissemination, and a centralized web hub integrating resources on immunotherapy, targeted therapy, and biomarker-driven care. Eighty-three clinicians completed the baseline survey (N=83), and 30 clinicians completed the follow-up survey, 30/83 (36.1%). Post-intervention surveys assessed clinician knowledge, confidence, and perceived impact on practice.

Results: Across knowledge/confidence items, 26/30 (86.7%) respondents completed each rating question; mean post-program scores ranged from 3.7 to 4.0 out of 5.0. For post-intervention practice change items, respondents reported earlier referral to specialists, 11/25 (44.0%); more frequent discussion of clinical trial options, 6/25 (24.0%); and increased attention to transportation, financial, or social-support barriers when planning care, 10/25 (40.0%). Respondents reported considering social determinants of health more often after the program, 17/25 (68.0%); 4/25 (16.0%) reported no change, and 4/25 (16.0%) indicated the item was not applicable to their role. A total of 1,869 views were recorded across 21 on-demand educational videos during the program period. All educational materials remained publicly accessible.

Conclusions: Targeted, workflow-aligned education paired with practical administrative tools may reduce barriers to cervical cancer treatment. This initiative demonstrates a replicable model for improving access to advanced oncology care through clinician education and systems-focused interventions.

Tables

Table 1. Educational outcomes and practice impact of the KCMS Cervical Cancer Education and Equity InitiativeData represent post-intervention, self-reported clinician survey responses collected anonymously via SurveyMonkey. Values are reported as n/N (%) unless otherwise noted; denominators vary by item due to incomplete responses. Mean change ratings are reported as the mean rating on a 5-point scale (1 = much less than before, 2 = a little less than before, 3 = no change, 4 = a little more than before, 5 = much more than before), with the corresponding sample size (n). For categorical change items, Increased combines response options 4–5 and Decreased reflects response option 2 (no respondents selected response option 1 for these items). Multi-select practice-change items allowed respondents to select more than one option; therefore, percentages may total >100%. “Not applicable” was included as a response option only for select items; where it was not offered, values are shown as 0/N (0.0%). Mean change ratings apply only to items assessed on the 5-point change scale; for items not assessed on that scale, the mean change rating column is populated as 0.0.KCMS = King County Medical Society; SDOH = social determinants of health

Outcome domain	Measure	N	Mean change rating (1–5)	Increased n/N (%)	No change n/N (%)	Decreased n/N (%)	More often n/N (%)	Selected n/N (%)	Not applicable n/N (%)
Clinician knowledge	Knowledge of current systemic treatment options	26	4.0	20/26 (76.9%)	6/26 (23.1%)	0/26 (0.0%)	0/26 (0.0%)	0/26 (0.0%)	0/26 (0.0%)
Clinician knowledge	Understanding of biomarker testing role	26	3.9	16/26 (61.5%)	10/26 (38.5%)	0/26 (0.0%)	0/26 (0.0%)	0/26 (0.0%)	0/26 (0.0%)
Clinical confidence	Confidence in referring to a specialist/higher-level center	26	3.9	16/26 (61.5%)	10/26 (38.5%)	0/26 (0.0%)	0/26 (0.0%)	0/26 (0.0%)	0/26 (0.0%)
Treatment navigation	Confidence in navigating prior authorization requirements	26	3.7	12/26 (46.2%)	14/26 (53.8%)	0/26 (0.0%)	0/26 (0.0%)	0/26 (0.0%)	0/26 (0.0%)
Referral awareness	Awareness of clinical trial options	25	3.8	14/25 (56.0%)	10/25 (40.0%)	1/25 (4.0%)	0/25 (0.0%)	0/25 (0.0%)	0/25 (0.0%)
Equity & SDOH	Consideration of SDOH when planning care	25	0.0	0/25 (0.0%)	4/25 (16.0%)	0/25 (0.0%)	17/25 (68.0%)	0/25 (0.0%)	4/25 (16.0%)
Care coordination	Practice change: Earlier specialist referral (multi-select)	25	0.0	0/25 (0.0%)	0/25 (0.0%)	0/25 (0.0%)	0/25 (0.0%)	11/25 (44.0%)	0/25 (0.0%)
Care coordination	Practice change: Greater attention to barriers (multi-select)	25	0.0	0/25 (0.0%)	0/25 (0.0%)	0/25 (0.0%)	0/25 (0.0%)	10/25 (40.0%)	0/25 (0.0%)

Full text

Introduction

Cervical cancer remains a major public health challenge worldwide, with substantial morbidity and mortality despite advances in prevention and treatment. Global surveillance data continue to demonstrate a high burden of disease and persistent disparities across regions and populations [1-3]. Patients with recurrent/metastatic cervical cancer represent the highest-acuity segment of the disease continuum and experience the poorest outcomes, underscoring the need for timely access to evidence-based systemic therapy and specialty care [4].

Systemic treatment options for recurrent/metastatic cervical cancer have expanded in recent years. Randomized clinical trials have established immunotherapy-based regimens as a standard component of first-line management for eligible patients, and additional agents have increased options for later lines of therapy [5-7]. As the therapeutic landscape evolves, guideline-concordant care increasingly depends on timely referral to appropriate specialists, completion of recommended diagnostic workup (including biomarker testing when indicated), and alignment of treatment selection with the most current evidence and guidelines [4-7].

However, delays in treatment initiation remain common, and administrative barriers are a well-documented contributor. Prior authorization processes can postpone therapy, increase clinician and staff workload, and disrupt care delivery in oncology settings [8-12]. Such delays are clinically meaningful, given evidence that longer time to treatment initiation is associated with worse outcomes across cancer settings [13]. Administrative burden may also exacerbate inequities when patients experience medical financial hardship or other social determinants of health (SDOH) that interfere with accessing specialty services, completing required testing, and navigating complex care pathways [14,15].

Clinicians and care teams therefore benefit from concise, practical resources that integrate current clinical guidance with operational tools to support efficient authorization, referral, and care coordination workflows [16]. The Cervical Cancer Education and Equity Initiative was developed to address these gaps by pairing evidence-based clinician education with actionable workflow resources, including a Prior Authorization Toolkit, to support clinician-reported confidence and perceived navigation of administrative processes related to timely and equitable care for patients with recurrent/metastatic cervical cancer.

Materials and methods

Study design and setting

The King County Medical Society (KCMS) conducted a regional educational quality-improvement initiative designed to support clinician-reported confidence and perceived navigation of evidence-based care for patients with recurrent/metastatic cervical cancer. The initiative ran from December 2024 through January 2026 and integrated clinician education, system-navigation resources, and broad digital dissemination to address clinical and administrative barriers to care, including prior authorization (PA) processes.

Intervention components

Educational content included a comprehensive slide-based module covering cervical cancer epidemiology, current treatment guidelines, biomarker and molecular testing, immunotherapy and targeted therapies, treatment sequencing, and PA workflows. This module served as the foundational source document for derivative educational materials, including downloadable clinical flyers and quick-reference tools. In addition, 21 short-form educational videos were produced and made publicly available via the KCMS website and the KCMS YouTube channel. Subject-matter experts reviewed all educational content for clinical accuracy and relevance.

Dissemination strategies included monthly electronic newsletters reaching more than 6,000 healthcare professionals, regular social media posts across multiple platforms, and a dedicated cervical cancer education page on the KCMS website housing all videos, downloadable materials, and toolkit components. All resources were freely accessible, with no registration required.

A downloadable Prior Authorization Toolkit was developed to support clinical teams in navigating oncology-related administrative requirements. The toolkit included step-by-step workflow guidance, documentation checklists, appeal templates, staff training resources, and printable clinic- and patient-facing materials. The toolkit was designed to promote standardized documentation practices and support perceived efficiency in administrative processes related to treatment initiation

Survey design and data collection

Program evaluation was conducted using baseline and follow-up surveys administered through SurveyMonkey. Survey items were developed by the authors for this program evaluation and had not been previously published, and were not formally validated. The instrument included items assessing respondent role and practice setting; awareness and use of KCMS educational resources; self-rated knowledge and confidence (5-point Likert-scale items); perceived program value; and self-reported perceived practice changes (select-all-that-apply and open-ended items). The complete survey instruments are provided in Appendix A and Appendix B; no external permissions were required.

The baseline survey was distributed via the KCMS newsletter and posted on the KCMS website. A total of 83 respondents completed the baseline survey (N=83). The follow-up survey was administered to baseline respondents and was open from December 1, 2025, through December 31, 2025. Of the 83 baseline respondents, 30 completed the follow-up survey (30/83 (36.1%); N=30). To reduce duplicate responses, SurveyMonkey settings restricted responses to one per device/browser.

Inclusion and exclusion criteria

Inclusion criteria were (1) self-identified healthcare professionals and/or members of clinical care teams and (2) voluntary completion of the baseline survey distributed through KCMS channels during the study period. For follow-up analyses, respondents were included if they completed both the baseline and follow-up surveys (30/83 (36.1%)).

Exclusion criteria were duplicate submissions when identifiable. Incomplete responses were excluded from analyses for the corresponding survey item; therefore, denominators vary by item and are reported for each outcome as n/N (%).

Outcomes

Primary outcomes included self-reported knowledge and confidence related to recurrent/metastatic cervical cancer care, including familiarity with biomarker-driven care; confidence in determining when referral to specialty or higher-level care may be indicated; confidence in navigating PA requirements; awareness of clinical trial options; and confidence supporting underserved populations and patients with limited English proficiency. Secondary outcomes included self-reported practice changes; perceived support in managing complex cases; emotional exhaustion related to managing recurrent/metastatic cervical cancer care; and helpfulness and satisfaction with specific KCMS resources (website materials, newsletters, videos, and the PA toolkit). Outcomes are reported as frequencies and percentages in the format n/N (%), with item-level denominators provided.

Data analysis

Survey responses were analyzed descriptively, consistent with the exploratory, perception-based aims of this quality-improvement initiative. Categorical responses are reported as frequencies and percentages (n/N (%)). Likert-scale ratings are summarized using means with the corresponding item denominator (n) reported. Open-ended responses were summarized descriptively.

Ethics and consent

This project involved human participants (clinicians) through a voluntary, anonymous program-evaluation survey administered via SurveyMonkey and distributed through KCMS channels. No patient data, live human tissue, or identifiable private information were collected or reported. Completion of the survey constituted implied informed consent. KCMS determined that this activity constituted an anonymous clinician-focused program evaluation/quality improvement project and that formal institutional review board (IRB) review was not required; therefore, IRB approval was not applicable.

Results

Eighty-three clinicians completed the baseline survey (N=83). Respondents were primarily MD/DO 37/83 (44.58%), followed by physician assistant (PA) 17/83 (20.48%) and nurse practitioner (NP) 14/83 (16.87%); smaller proportions included registered nurse (RN) 3/83 (3.61%) and clinical nurse specialist (CNS) 2/83 (2.41%). An additional 10/83 (12.05%) selected “Other,” which included medical assistants and other office staff.

Clinicians represented a broad range of specialties, including internal medicine 18/83 (21.69%), family medicine 12/83 (14.46%), gynecologic oncology 9/83 (10.84%), obstetrics/gynecology (OB/GYN) 7/83 (8.43%), and medical oncology 2/83 (2.41%). “Other” specialty was selected by 35/83 (42.17%) and included write-in specialties such as radiology, orthopedics, emergency medicine, general surgery, anesthesia, and pathology.

Across baseline items assessing barriers to evidence-based care, respondents prioritized administrative/payer constraints, workload limitations, and equity-linked access challenges. For systemic barriers, prior authorization/insurance delays and denials were rated as most important (mean importance score 4.50; higher scores indicate greater importance), followed by insurance denial of treatment options (4.00) and patient financial constraints (3.50). Professional barriers were led by burnout/high work demands (4.25), with lack of time for professional development and geographic barriers rated similarly (3.67 each). Patient-related barriers were dominated by health disparities in underserved populations (5.25) and cultural/language barriers (4.67), followed by patient non-adherence (3.75) and limited culturally relevant education resources (3.67). Baseline confidence in providing effective care was moderate for patients with limited English proficiency (LEP) (mean 3.25/5; n=83) and underserved/marginalized patients (mean 3.00/5; n=83). Respondents also identified barriers to accessing advanced treatment options for underserved patients, including clinical trials.

Preferred educational formats favored practical, guideline-based resources; clinical guidelines were selected most frequently. These findings informed the development of the intervention materials, including a slide-based clinician education module and short-form videos addressing guideline-based management, biomarker testing, treatment sequencing, and clinical trial awareness, as well as a Prior Authorization Toolkit with workflow guidance, documentation checklists, and appeal templates designed to reduce administrative delays.

Post-intervention survey responses are summarized in Table 1. Respondents reported increased knowledge of current systemic treatment options for recurrent/metastatic cervical cancer, 20/26 (76.9%) (mean 4.0/5; n=26), and increased understanding of biomarker testing in treatment selection, 16/26 (61.5%) (mean 3.9/5; n=26). Increased confidence in determining when a patient should be referred to a specialist or higher-level center was reported by 16/26 (61.5%) (mean 3.9/5; n=26), and increased confidence in navigating prior authorization requirements was reported by 12/26 (46.2%) (mean 3.7/5; n=26). Awareness of clinical trial options increased for 14/25 (56.0%), was unchanged for 10/25 (40.0%), and decreased for 1/25 (4.0%).

Respondents reported considering social determinants of health more often when planning care for recurrent/metastatic cervical cancer, 17/25 (68.0%). Reported practice changes included earlier referral to gynecologic or medical oncology specialists, 11/25 (44.0%), and increased attention to transportation, financial, or social-support barriers when planning care, 10/25 (40.0%).

Engagement metrics included 1,869 total views across selected educational videos during the program period. Resource formats were rated as moderately to very helpful (mean helpfulness ratings 3.2-3.7 out of 5; n=22), and educational materials remained publicly available on the KCMS website.

Discussion

This regional quality-improvement initiative evaluated a clinician-focused education program paired with workflow tools intended to support clinician awareness, confidence, and perceived navigation of administrative and care-coordination processes related to recurrent or metastatic cervical cancer. Post-intervention survey responses indicated increased self-reported knowledge of systemic treatment options (mean change 4.0/5; increased 20/26 (76.9%)) and increased understanding of biomarker testing in treatment selection (mean change 3.9/5; increased 16/26 (61.5%)). Respondents also reported increased confidence in navigating prior authorization requirements (mean change 3.7/5; increased 12/26 (46.2%)) and increased confidence in determining when referral to a specialist or higher-level center was indicated (mean change 3.9/5; increased 16/26 (61.5%)). These findings reflect clinician-reported perceptions across domains relevant to guideline-concordant care in recurrent/metastatic cervical cancer, including biomarker-informed treatment selection, immunotherapy and targeted therapy use in appropriate patients, and timely referral to specialty care [4-7].

A pragmatic feature of the initiative was the availability of asynchronous educational content and downloadable tools through a centralized website hub. Participants rated KCMS resources as moderately to very helpful, with mean helpfulness ratings ranging from 3.2 to 3.7 out of 5 across formats (n=22). Video engagement during the program period totaled 1,869 views for the videos included in this analysis, indicating utilization of the educational assets, not necessarily educational effectiveness. The program’s emphasis on workflow tools is consistent with published literature describing prior authorization as a major source of administrative burden in oncology practice, including increased staff time, delays in care delivery, and disruption of clinical workflows [8-12].

Equity-related outcomes were also reported. Respondents indicated considering social determinants of health more often when planning care for recurrent/metastatic cervical cancer (17/25 (68.0%)); 4/25 (16.0%) reported no change, and 4/25 (16.0%) indicated the item was not applicable to their role. In addition, 10/25 (40.0%) reported paying more attention to transportation, financial, or social-support barriers when making treatment plans (multi-select item). These perception-based findings align with existing evidence that financial hardship and broader social determinants are associated with disparities in access to cancer care and outcomes [14,15]. Delays in treatment initiation are clinically meaningful, and observational evidence has demonstrated an association between longer time to initial cancer treatment and worse outcomes across cancer populations, underscoring the importance of reducing administrative barriers and improving care navigation [13]. Although delays in treatment initiation are known to be clinically meaningful, this initiative did not assess objective treatment timelines.

This initiative has limitations. Outcomes were based on voluntary, self-reported survey responses and did not include objective operational endpoints (e.g., prior authorization turnaround time, time to treatment initiation, or referral completion). Engagement metrics reflect resource utilization rather than individual-level learning outcomes. In addition, post-intervention responses were collected from a limited sample, and survey participation may reflect selection bias toward clinicians most interested in cervical cancer education or systems-navigation tools.

Despite these limitations, the initiative demonstrates the feasibility of disseminating clinician education alongside practical workflow resources in a real-world professional society setting. Continued public availability of materials may support ongoing utilization beyond the project period. Future evaluation could incorporate objective measures of access and timeliness (e.g., prior authorization turnaround time, referral completion, and time to treatment initiation) to assess whether clinician-reported perceptions correspond to measurable changes in care delivery [8-13].

Conclusions

A clinician-centered educational program paired with practical workflow tools was followed by self-reported increases in clinician knowledge, confidence, and perceived care-navigation behaviors related to recurrent or metastatic cervical cancer. Post-intervention respondents reported perceived increases in knowledge of systemic treatment options, understanding of biomarker testing in treatment selection, confidence in determining when referral to specialty or higher-level care may be indicated, and confidence in navigating prior authorization requirements.

Freely accessible digital resources, including short educational videos, downloadable materials, and a Prior Authorization Toolkit, may represent a feasible approach for supporting clinician awareness of guideline-concordant oncology care and administrative processes. Professional medical societies may be well-positioned to disseminate timely clinical education and workflow tools through existing communication channels (e.g., newsletters and web hubs). Continued public availability of these resources may facilitate ongoing utilization beyond the intervention period and inform future adaptation, pending evaluation using objective outcome measures.