Reducing Barriers to Use of Breast Cancer Screening
 |
Dorothy
S. Lane, M.D., M.P.H., principal investigator
Stony Brook University, N.Y. |
Dr. Dorothy Lane, of Stony Brook University, investigated
whether a telephone counseling intervention aimed at women who are known
to underuse breast cancer screening can with, or without, an accompanying
educational intervention for their physicians, increase use of breast
cancer screening.
She found that women who had a previous mammogram at the start of the
study and who subsequently received telephone counseling were more likely
to become regular mammography users than women who did not receive counseling.
In addition, the findings suggested that the educational intervention
for physicians is associated with initiation of mammography use among
women who have never had a mammography. More research with larger samples
is needed to confirm this finding.
The study found that women who had a previous mammogram at the start
of the study and who received telephone counseling were 40 percent more
likely than women who did not receive counseling to become regular mammography
users by the end of the study. Greater reductions in perceived barriers
to mammography were associated with receiving telephone counseling. Telephone
counseling did not appear to be effective among women who never had a
mammogram. However, data suggested that physicians continuing medical
education (CME) intervention has potential for initiating mammography
use among women who never had a previous mammogram (described later).
Further study with larger samples is needed to confirm this finding.
In a first step of the study, Dr. Lane and colleagues surveyed more than
8,900 Long Island women, ages 50-80, by telephone about their use of breast
cancer screening, and over 540 doctors by questionnaire. The researchers
identified over 3,400 women who had not received mammograms in the past
two years and the past two years prior to that. Forty-five percent of
women in the 65 years-of-age and older age group were found to underuse
mammography, and 34 percent of women in the 50 to 64 years-of-age group
to underuse it.
The chief reasons given for not getting mammograms were procrastination
and not believing a mammography was needed — the latter reason given
more frequently by women in the older age group. The researchers found
that over 80 percent of the women who were underusers of mammography had
less than a college degree, the majority (58 percent) had family incomes
of under $35,000, and most were homemakers or retired.
During the intervention phase of the study, the effectiveness of telephone
counseling and physician education were tested. An annual mailing alerted
women that they would be called by the Early Detection Guidelines Education
(EDGE) Project and encouraged them to go for mammography. Three annual
mailings were conducted during this intervention period and included educational
materials and incentives to promote screening.
A three-month period elapsed following each educational mailing before
initiating telephone counseling of women who did not return the response
sheet, in order to allow them time to obtain a mammogram if they were
prompted by the mailings. In the intervention group, 1,165 underuser women
reported that 597 mammograms were obtained during the first year of the
intervention, and 615 mammograms were obtained during the second year
of intervention, for a total of 1,195 mammograms.
A quality control evaluation was also conducted of a sample of 117 counseling
calls for the telephone counseling intervention. Seventy-one percent of
women who were contacted reported that the calls were "entirely reassuring,"
and 71 percent of the women said the calls were "entirely helpful."
In addition, 65 percent of the women said that they felt "entirely
encouraged" by the EDGE counselor to have mammogram in the future.
Among women who mentioned a barrier to mammography, 64 percent reported
that after discussing it with the EDGE telephone counselor, the barrier
would not keep them from getting a mammogram in the future.
Ninety-three physicians obtained the in-office continuing medical education
(CME) intervention which included three modules: (1) office systems, (2)
behavioral counseling, and (3) revisiting physical examination of the
breast. The in-office intervention also included an optional follow-up
visit with the office staff and a subsequent visit by a standardized patient.
As an adjunct to the educator office visit, the researchers developed
a workbook that can also be used as a freestanding self-instructional
continuing medical education (CME) activity. The workbook was mailed to
those physicians in the intervention group who did not receive an in-office
visit. Physicians' anonymous evaluations of the in-office intervention
were very positive.
The researchers found that self-reported overall breast cancer screening
educational need scores improved for a greater proportion of physicians
in the intervention group, especially among those who received the in-office
CME intervention, compared to physicians who did not receive the intervention.
Educational need with regard to clinical breast examinations also declined
while use of provider reminder systems, preparedness to counsel women
about clinical breast exams, and recognition of age as an important risk
factor for breast cancer improved in more intervention physicians than
control physicians. Findings from the study were reported in1999 to 2002.
Published reports
Funding / Timeline
|
