helping women stay up-to-date with cancer screening by using a prevention care manager or usual care

Conditions: Breast Cancer; Cervical Cancer; Colorectal Cancer

Summary: rationale: women may stay up-to-date with cancer screening if a health professional helps them overcome barriers to screening, including helping them to schedule cancer screening appointments. purpose: this randomized clinical trial is studying the use of health professional-tailored telephone support compared with usual care from their personal doctor to help women overcome barriers to screening for colorectal, cervical, and breast cancer.

objectives: primary * develop and evaluate an enhanced telephone support intervention (prevention care manager \[pcm\]) to promote colorectal, cervical, and breast cancer screening more widely among women enrolled in a medicaid managed care organization (mmco). * explore the impact of patient, community/migrant health center (c/mhc), and mmco characteristics on cancer screening status and the impact of the intervention. * evaluate the impact of the enhanced pcm intervention upon colorectal, breast, and cervical cancer screening rates. secondary * compare the status of women who are up-to-date (utd) on crc screening versus the utd status of cervical cancer and breast cancer screening. outline: this is a randomized, controlled study. the study is conducted in 2 parts. * part 1 (barrier interview and pilot testing): patients are stratified according to primary language and whether or not they have had an outpatient visit in the past year. * barrier interview: patients undergo a 15-30 minute interview to determine barriers they face preventing them from receiving recommended cancer screenings and healthcare, as well as facilitators which have encouraged them to be screened. * pilot testing: patients from the barrier interviews and other eligible medicaid managed care organization (mmco) patients receive scripted telephone calls from a prevention care manager to assist them in getting up-to-date on their cancer screening tests over 3 months. * part 2 (randomized control trial): patients are stratified according to treatment center (community/migrant health center vs diagnostic and treatment center) and age. patient are randomized to 1 of 2 intervention arms. * arm i (prevention care manager): patients are stratified according to the number of tests for which they are up-to-date at baseline. patients receive reminder letters encouraging them to contact their primary care provider for colorectal, breast, and cervical cancer screening and 3 to 4 telephone support calls to help them become up to date for colorectal, breast, and cervical cancer screening. * arm ii (usual care): patients receive usual care according to their primary care physician. in both arms, patients are followed for 18 months. projected accrual: a total of 2,600 patients will be accrued for this study.

Eligibility criteria:
disease characteristics: * enrolled in a participating medicaid managed care organization (mmco) as a medicaid patient for ≥ 12 months * not up-to-date (utd) for colorectal cancer screening * utd status defined by any of the following: * home fecal occult blood test within the past 12 months * flexible sigmoidoscopy within the past 5 years * double-contrast barium enema within the past 5 years * colonoscopy within the past 10 years * registered to receive primary care from a participating community/migrant health center, diagnostic and treatment center, or other participating practice in new york city * must have a telephone available * no mmco claim for any of the following: * colorectal, breast, or cervical cancer * colon polyp removal * total colectomy patient characteristics: * female * able to use telephone * no plans to move for ≥ 1 year prior concurrent therapy: * see disease characteristics

Keywords: colon cancer rectal cancer breast cancer cervical cancer