Mammography Reminders for Encouraging Women to Undergo Regular Mammography Screenings for Breast Cancer
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Study type: Observational

Summary: 
      RATIONALE: Mammography reminders may encourage women to undergo regular mammography
      screenings for breast cancer.

      PURPOSE: This randomized clinical trial is studying three different mammography reminder
      interventions to compare how well they work in encouraging women to undergo regular
      mammography screenings for breast cancer.
    

Detailed description: 
      OBJECTIVES:

        -  Compare the effectiveness of mammography reminder interventions using usual care
           reminder vs enhanced automated phone reminder vs enhanced letter reminder in increasing
           the proportion of women who undergo annual mammograms as recommended by medical
           organizations.

        -  Compare the impact of alternative delivery channels (mail vs automated phone reminders)
           and enhanced messages in facilitating maintenance of mammography in these participants.

        -  Determine the incremental benefit of adding a consequence elaboration component to
           barriers-specific telephone counseling in encouraging these participants to regain
           adherence to mammography.

        -  Determine the minimum intervention needed for change to ensure annual mammography and
           maintenance in participants.

      OUTLINE: This is a randomized, controlled study. Participants are randomized to 1 of 3 arms.

        -  Arm I: Participants receive a usual care mammography reminder by telephone annually for
           4 years.

        -  Arm II: Participants receive an enhanced automated phone mammography reminder annually
           for 4 years.

        -  Arm III: Participants receive an enhanced letter mammography reminder annually for 4
           years.

      Insurance claims reports and patients' self reports as to whether or not they subsequently
      underwent mammography are examined. Patients who do not undergo mammography within 6 months
      after receiving a reminder are further randomized to 1 of 4 arms.

        -  Arm I: Participants receive no further reminders until the next annual reminder.

        -  Arm II: Participants receive an enhanced Barriers-Specific Counseling Call
           (BarriConCall) annually for 4 years that focuses on positive consequences of undergoing
           mammography.

        -  Arm III: Participants receive an enhanced BarriConCall annually for 4 years that focuses
           on negative consequences of not undergoing mammography.

        -  Arm IV: Participants receive a standard barrier call (BarriCall) annually for 4 years.

      PROJECTED ACCRUAL: A total of 4,040 participants (1,000 for usual care mammography reminder;
      1,520 for enhanced automated phone mammography reminder; and 1,520 for enhanced letter
      mammography reminder) will be accrued for this study.
    

Intervention name(s): Mammography appointment reminders; telephone counseling
Intervention type(s): Behavioral
Intervention description(s): Women randomly assigned to UCR, EAPR, ELR; repeated 4 times at yearly intervals. Using claims data, supplemented by self-report, verified if women had recent mammograms. Women who remained non-adherent after reminders received Barriers-Specific Telephone Counseling Call, or an enhanced call including focus on either positive or negative consequences of getting/not getting mammograms. Prior to calls, women in each of the three phone counseling groups received priming letters to prime them to process information in the call. Priming letters should prepare women to process information from subsequent counseling calls more deeply by focusing on the positive or negative consequences of getting/not getting mammograms or on identifying and overcoming their own barriers to being screened.
Other intervention name(s): Usual Care Reminder(UCR); Enhanced Automated Phone Reminder (EAPR); Enhanced Letter Reminder (ELR); Priming Letter (PL); BarriCall; BarriConCall+; BarriConCall-
Observational model: Cohort
Time perspective: Prospective
Sampling method: Probability Sample
Study population: 
        Women members of The North Carolina Teachers' and State Employees' Comprehensive Major
        Medical Plan (SHP) who are age 40-75. They must be enrolled with the SHP for at least 24
        months, not covered by COBRA or Medicare primary. Based on claims data, women will have had
        their last mammogram 6-8 months ago.
      
Keywords: breast cancer screening; mammography adherence; non-adherent