Promoting Breast Cancer Screening in Non-Adherent Women

促进非依从性女性的乳腺癌筛查

基本信息

批准号：
7654081
负责人：
MARY E COSTANZA
金额：
$ 71.2万
依托单位：
UNIV OF MASSACHUSETTS MED SCH WORCESTER
依托单位国家：
美国
项目类别：
财政年份：
2009
资助国家：
美国
起止时间：
2009-03-27 至 2014-01-31
项目状态：
已结题

来源：
https://reporter.nih.gov/project-details/7654081
关键词：
Address Adherence Adopted Adoption Affect Age Behavioral Breast Breast Cancer Detection Caring Censuses Commit Community Health Planning Counseling Data Decision Making Drops Education Effectiveness Effectiveness of Interventions Enrollment Evaluation Guidelines Health Health Planning Healthcare High Prevalence Income Insurance Intervention Letters Long-Term Effects Mails Mammography Managed Care Modeling Motivation Outcome Pamphlets Patients Population Protocols documentation Randomized Research Risk Role Schedule Screening procedure Source Staging Subgroup System Telephone Testing Time Triage Uncertainty Upper arm Woman aged base compare effectiveness computerized cost cost effective cost effectiveness health care delivery health care service organization improved information organization malignant breast neoplasm member mortality motivational enhancement therapy outreach outreach program programs public health relevance response successful intervention treatment as usual

项目摘要

DESCRIPTION (provided by applicant): In the U.S. about 23 million women aged 50-74 are overdue for recommended biennial screening mammography. Repeated annual screening is considered optimal by some experts and even more women would be overdue by this standard. The reduction in breast cancer mortality expected from screening mammography requires repeated mammogram use, so women who do not have a mammogram every 1-2 years are at risk for developing advanced stage or incurable breast cancers. NHIS 2005 data show a significant drop in mammograms gotten in the prior 24 months. Between 2000 and 2005, rates dropped for women aged 50-64 from 78.6 to 71.8% and for those >65, from 68 to 63.8%. Those most affected had higher incomes, private insurance and a usual source of care. Despite strong evidence that mail and telephone outreach to women can increase mammography rates, few health care delivery organizations have adopted comprehensive outreach programs, especially ones including a telephone component. Reasons for this include: 1) uncertainty about the optimum outreach strategy and long-term effectiveness; 2) absence of feasible, replicable models for use in large organizations; and 3) cost and cost-effectiveness data to guide the decisions on implementation. To address these concerns this study aims to identify the most effective and cost effective of the outreach strategies that studies have been shown to be effective or promising. We propose to randomize all women age 51-84 enrolled in a large group model HMO (n=23,000) to 1 of 3 intervention arms. We will continue to enroll new HMO members and to deliver the interventions over a 4-year period to assess long-term outcomes. The interventions are: 1) a reminder letter only (RL) (usual care for this HMO); 2) a reminder letter followed by a reminder phone call to nonresponders (RL-RC) that includes an opportunity to schedule a mammogram; and 3) a reminder letter followed by an enhanced, tailored telephone counseling (ETTC) to nonresponders (RL-ETTC) that includes motivational interviewing, barrier-specific counseling, and an opportunity to schedule a mammogram. Our aims are to: 1) compare the effectiveness of the 3 interventions in increasing adherence to screening mammography guidelines (mammogram every 1-2 years) each year for 4 years; 2) Identify ways to improve the efficiency and sequencing of the interventions by identifying patient factors and intervention mechanisms associated with increased intervention effectiveness; and 3) to determine the incremental cost per unit increase in on-time mammography utilization of the 2 telephone counseling arms compared to the mailed reminder only intervention. We hypothesize that ETTC intervention will be associated with a higher prevalence of mammography within 24 months than the brief telephone reminder intervention, and both telephone interventions will be more effective than the mailed reminder alone for each for the 4 intervention years and that the effectiveness of the intensive telephone intervention will increase each year due to the cumulative effect of the education and motivation it provides. PUBLIC HEALTH RELEVANCE: Research has shown that mailing reminders and calling women who are due for a screening mammogram can increase the chances that these women will get a mammogram. Research is needed to identify the most effective and cost-effective type of telephone intervention before widespread adoption of reminder and counseling systems can occur. We propose to compare a low intensity and a high intensity reminder/counseling protocol to a mailed reminder alone in a large closed panel HMO. The HMO is committed to incorporating the most study's successful interventions.

描述（由申请人提供）：在美国，大约2300万50-74岁的女性对于建议进行双年生乳房X线摄影而过期。重复的年度筛查被一些专家认为是最佳的，而这一标准将逾期。乳房X线摄影的乳腺癌死亡率降低需要反复使用乳房X线照片，因此每1 - 2年没有乳房X光检查的女性有发展晚期阶段或无法治愈的乳腺癌的风险。 NHIS 2005数据显示，在前24个月内，乳房X线照片显着下降。在2000年至2005年之间，50-64岁的女性从78.6％下降至71.8％，而> 65岁的女性从68％下降到63.8％。受影响最大的人的收入更高，私人保险和通常的护理来源。尽管有强有力的证据表明邮件和电话宣传妇女可以提高乳房X线摄影率，但很少有医疗保健提供组织采用了全面的外展计划，尤其是包括电话组件在内的计划。原因包括：1）关于最佳外展策略和长期有效性的不确定性； 2）没有可行的可复制模型用于大型组织； 3）成本和成本效益数据，以指导实施决策。为了解决这些关注，本研究旨在确定研究表明有效或有前途的研究策略中最有效和最具成本效益。我们建议将所有51-84岁的女性随机分配，该妇女参加了大型HMO（n = 23,000）至3个干预组中的1个。我们将继续招募新的HMO成员，并在4年期间提供干预措施以评估长期成果。干预措施是：1）仅提醒字母（RL）（对此HMO的通常护理）； 2）提醒信，然后是致电非反应者（RL-RC）的提醒电话，其中包括安排乳房X光检查的机会； 3）提醒信，然后是提醒，量身定制的电话咨询（ETTC）给非反应者（RL-ETTC），其中包括激励性访谈，特定于障碍的咨询以及安排乳房X光检查的机会。我们的目的是：1）比较三种干预措施在增加乳房X线摄影指南（每年1 - 2年）持续4年中筛查乳房X线摄影指南（乳房X线照片）的有效性； 2）通过确定与干预效率提高相关的患者因素和干预机制来确定提高干预措施效率和测序的方法； 3）与仅邮寄的提醒干预措施相比，要确定2个电话咨询臂的按时乳房X线摄影利用率增加的每单位成本增加。我们假设ETTC干预措施将在24个月内与短暂的电话提醒干预相比，乳房X线摄影的患病率更高，并且两种电话干预措施在4个干预年份中的每一年都将比单独的邮寄提醒更有效，并且由于教育和动机的累积影响，每年的强化电话干预的有效性将增加。公共卫生相关性：研究表明，邮寄提醒和打电话给应进行筛查乳房X线照片的女性可以增加这些女性获得乳房X线照片的机会。需要进行研究以确定最有效，最具成本效益的电话干预类型，然后再进行提醒和咨询系统的广泛采用。我们建议将低强度和高强度提醒/咨询方案与仅在大型封闭面板HMO中的邮寄提醒进行比较。 HMO致力于纳入最多的研究的成功干预措施。