Telephone Intervention Increases Cancer Screening Rates in Women

QUEBEC CITY — A series of telephone calls can significantly improve cancer screening rates among low-income women, a randomized controlled trial suggests.

Not all practices have the resources to implement such an intervention, Allen J. Dietrich, M.D., said at the annual meeting of the North American Primary Care Research Group. But the model is compatible with telephone support systems available in many health care groups.

He presented a study in which 1,390 women aged 50–69 years were recruited from 11 community and migrant health centers in New York City that are part of a practice-based research network. Most women were overdue for two or all three of the following cancer screenings: Pap, mammography, and colorectal.

Patients were randomized to usual care or to an intervention that included a series of telephone calls to assess patient barriers to screening, provide any needed education, and assist with access to services.

Many of the women were foreign born, and Spanish was the primary language for 445 (64%) of the 696 women in the intervention group. An average of four 15-minute telephone calls were made to the women by master's degree students, who followed a bilingual script. Education materials and clinician recommendation letters were mailed also.

An analysis showed that 37% of patients received education alone, 9% education plus an appointment reminder, 7% education plus access assistance, 2% access assistance alone, and 18% received a phone call but did not receive any of the three types of support.

Despite a large media campaign on colon cancer led by television anchor Katie Couric at the time of the study, the largest barriers were to colorectal screening, said Dr. Dietrich, associate director for population science at the Norris Cotton Cancer Center in Lebanon and Dartmouth Medical School, Hanover, both in N.H. Women had no information, disinformation, or had not received a clinical recommendation for this particular service.

When the subject of home fecal occult blood testing was broached, the response from many of the women was, “You want me to do what?” The response became so common that staff referred to it by initials alone.

Between baseline and follow-up at 18 months, all three screening services increased significantly more for the intervention group, compared with the usual care group.

Colorectal cancer screening increased the most, with more than a 60% increase observed for the intervention group.

There was a 17% increase in mammography and a 10% increase in Pap testing.

In the usual care group, mammography and Pap testing rates remained about the same as at baseline and colorectal screenings increase slightly.

The next step for the researchers is to replicate the findings in Medicare or managed care organizations in New York City. They plan to use billing data rather than chart records to identify women in need and perhaps to combine the telephone interventions with existing outreach efforts such as child immunization reminders.

“This is centralized telephone resources as an intervention, but clearly there are other things that are needed to address these health care disparities,” Dr. Dietrich said. “This isn't the answer to everything anymore than office systems are the answer to everything. We need more intervention research that increases the options to address prevention care services and their disparities in primary care.”