Enhanced Intervention for Mammogram-Resistant Women

对乳房 X 光检查耐药女性的加强干预

• 批准号: 6751237
• 负责人: MARY E COSTANZA
• 金额: $ 15.9万
• 依托单位: UNIV OF MASSACHUSETTS MED SCH WORCESTER
• 依托单位国家: 美国
• 财政年份: 2003
• 资助国家: 美国
• 起止时间: 2003-06-01 至 2006-05-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6751237
• 关键词: anxiety; behavior therapy; behavioral /social science research tag; belief; breast neoplasms; cancer risk; clinical research; counseling; decision making; fear; female; health behavior; human subject; interview; mammography; motivation; neoplasm /cancer education; technology /technique development; women' s health

DESCRIPTION (provided by applicant): This is an exploratory behavioral research project, which focuses on the development of an effective outreach intervention for mammogram-resistant women. In our previous cancer control work, we identified a group of women who were not up to date with mammogram screening recommendations. This group was identified by their intentions: not planning to get a mammogram. The importance of this finding is twofold. 1) This is a mammoqram-resistant group. These women have not responded to a public health climate of mammography recommendations, a strong reminder system (annual written reminders from their managed care organization and quarterly reports of their overdue status to their primary care physicians), or tailored telephone counseling. 2) These women are an at risk population. They are at risk for the development of advanced breast cancer, which is more lethal than cancers discovered by screening. At least 15 percent of women may be mammogram resistant. Because tailored telephone counseling is a cost-effective intervention and is easily integrated into health care systems, we wanted to explore whether enhancing the intervention would make it effective with mammogram-resistant women. In order to develop a meaningful improvement in tailored telephone counseling, we need to know more about this group. Our study begins with in-depth qualitative research, designed to understand the reluctance, psychosocial characteristics and global feelings/beliefs about breast cancer and breast cancer screening. We will then develop an enhanced telephone-based counseling intervention. New strategies include: motivational interviewing, a technique developed to motivate classically resistant patients (alcoholics and tobacco/drug addicts); multiple calls; supplementary materials; and an effort to improve access and physician recommendation. This will be pre-tested on mammogram-resistant women and adjusted following evaluation of their responses and input. The enhanced intervention will then be pilot tested on 50 mammogram-resistant women and evaluated for its success in moving them towards mammography. Outcome measures include rate of mammography utilization by radiology billing records and by self-report. Secondary measures include changes in stage and other variables. The project is grounded in two strong behavioral theories: The Precaution Adoption Process Model of Weinstein and the Cognitive-Social Information Processing (C-SHIP) Model of Miller and Shoda. This study should increase scientific knowledge about an at-risk population and the limits of telephone based counseling. If successful, the enhanced intervention would be tested in a randomized controlled trial and could be modified to include groups resistant to other screenings (e.g. pap smear or colon cancer screening). If not successful, one could avoid using telephone-counseling strategies in this resistant group. Alternative avenues of communication and motivation would need to be developed.

描述（由申请人提供）：这是一个探索性行为研究项目，该项目的重点是开发为抗乳房X线照片的妇女进行有效的外展干预措施。在我们以前的癌症控制工作中，我们确定了一群没有乳房X光检查建议的女性。这组是通过他们的意图确定的：不打算获得乳房X线照片。这一发现的重要性是双重的。 1）这是一个耐乳房的群体。这些妇女尚未回应乳房X线摄影建议的公共卫生氛围，强大的提醒系统（来自托管护理组织的年度书面提醒以及对初级保健医生的逾期报告）或量身定制的电话咨询。 2）这些妇女处于危险中。它们有发展晚期乳腺癌的风险，这比筛查发现的癌症更具致命性。至少有15％的女性可以抗乳房X线照片。由于量身定制的电话咨询是一种具有成本效益的干预措施，并且很容易纳入医疗保健系统，因此我们想探索加强干预措施是否会使对抗乳房X线照片的妇女有效。为了在量身定制的电话咨询方面发展有意义的改进，我们需要更多地了解该组。我们的研究始于深入的定性研究，旨在了解对乳腺癌和乳腺癌筛查的不情愿，社会心理特征和全球感受/信念。然后，我们将开发一种基于电话的咨询干预措施。新的策略包括：动机访谈，这是一种旨在激励经典的患者（酗酒者和烟草/吸毒者）开发的技术；多个呼叫；补充材料；并努力改善访问和医师的建议。这将在对乳房X线照片的妇女中进行预测，并在评估其反应和输入后进行了调整。然后，将对50名抗乳房X线照片的女性进行试验测试，并评估其将其转向乳房X线摄影。结果指标包括放射学计费记录和自我报告的乳房X线摄影利用率。次要措施包括阶段和其他变量的变化。 该项目以两种强大的行为理论为基础：温斯坦的预防措施采用过程模型以及米勒（Miller）和史迪（Shoda）的认知社会信息处理（C-SHIP）模型。这项研究应增加有关高危人群和基于电话咨询的局限性的科学知识。如果成功，将在一项随机对照试验中测试增强的干预措施，并可以修改以包括对其他筛查具有抵抗力的组（例如PAP涂片或结肠癌筛查）。如果不成功，可以避免在此抵抗组中使用电话会议策略。需要开发沟通和动力的替代途径。