Promoting Breast Cancer Screening in Non-adherent Women
Condition: Breast Cancer
MeSH terms: Breast Neoplasms
Study type: Observational

Summary: 
      This randomized study compares the effectiveness and cost-effectiveness of 3 proven methods
      of reaching out to women who are coming due for or who are overdue for a mammogram. The study
      originally embedded in a community healthcare plan and an associated community clinic, now
      accepts patients using the community clinic and 3 other health care plans. The study makes
      use of a complex computer driven reminder system.

      The study also will examine ways to improve the efficiency and sequencing of the
      interventions by identifying patient factors associated with intervention effectiveness.
    

Detailed description: 
      The randomized study compares three interventions. All eligible women are randomly assigned
      to 1 of 3 interventions. If they become 18 or more months from a prior mammogram, they will
      receive the intervention to which they were assigned.

      The 3 arms are

        1. RL ARM: (reminder letter) a control arm which consists of a reminder letter only that
           states when the last mammogram was, contains a standard recommendation from her primary
           care provider (PCP), and requests that the woman call a special number for help
           scheduling a mammogram.

        2. RC ARM: (reminder call) a reminder letter as above, followed, if no response, by a
           reminder call from a study scheduler who offers to help schedule a mammogram.

        3. ETTC ARM: (enhanced tailored telephone counseling call) a reminder letter as above,
           followed, if no response by a second letter, a mammography educational booklet and a
           second request to call a special number to schedule a mammogram. If no response, a study
           counselor/educator will call.

      A complex computer-based tracking system identifies women coming due for a mammogram or those
      overdue for a mammogram. The system interfaces with the clinic database systems and stores
      information re age, telephone number, address, prior screening dates, primary care provider
      name, scheduling dates, etc. The system can generate reminder letters as appropriate.

      The tracking system also interfaces with computer-assisted telephone script systems(CATI)
      which prompt the study scheduler or the study counselor to follow the protocol that is
      tailored to the individual patient.

      The CATI system captures data from all calls, including how ready a woman is to schedule, the
      answers to a brief socio-demographic survey and in the counselor call script barriers and
      misinformation about mammography.

      The computer system also interfaces with the radiology scheduling system so that study
      personnel can assist women in scheduling a mammogram during the phone call.

      The primary outcome is the number of women in each arm getting a mammogram. This data will
      come from the clinic data base and the healthcare plan billing system.

      Secondary outcomes include evaluation of the effect of booster or repeat interventions in
      women failing to respond to prior request for mammogram.
    

Intervention name(s): Reminder Letter; Reminder Call; Counselor Call
Intervention type(s): Behavioral; Behavioral; Behavioral
Intervention description(s): A letter sent to women reminding them that they are coming due or overdue for a mammogram. It contains a reminder that their doctor recommends mammography screening every 1-2 years; urges them to call a special number to a study scheduler to get assistance scheduling a mammogram and is signed electronically by their primary care provider. For women in the reminder letter only arm, who did not complete a mammogram within 12 months of the first reminder, a booster intervention (I.E. reminder letter) will be sent. The letter requests that a woman call in to schedule a mammogram, and reminds her that her PCP recommends she get one. Booster letters will be sent up to three times at annual intervals for those failing to get a mammogram; A reminder letter (as in the 1st group) is sent. If a woman does not call in to schedule a letter, 2 weeks later, a study scheduler will call her, remind her she is coming or is overdue, remind her that her PCP recommends screening every 1-2 years and offers to schedule a mammogram for her. For women in the reminder letter arm who did not complete a mammogram within 12 months of the first reminder, a booster intervention ( I.E.a reminder letter will be sent requesting that they call in to schedule a mammogram. The letter reminds her that her PCP recommends she get a mammogram. Those who do not respond within 7 days, will receive a scheduler call) will be repeated as necessary for up to 3 times.; Reminder letter s as above is sent. If subject does not call in to schedule within 2 weeks, second letter is sent with mammography educational booklet. Second letter reiterates reminder that PCP recommends screening. Has number to call to schedule. If subject does not schedule within 2 weeks, counselor will call. Protocol script includes tailored barriers counseling, correction of misinformation and motivational interviewing techniques. For those who did not complete a mammogram within 12 months of the first reminder, a booster intervention will be repeated annually for up to 3 times as necessary.Booster is reminder letter with pamphlet stressing the 4 reasons why women need regular mammograms.
Other intervention name(s): mammography reminder letter.; mammography phone call; educator call
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        Women aged 40 to 84 who have life expectancy of five years, have at least one breast, and
        who have been cared for by Fallon Community Health Plan and currently cared for by Reliant
        Medical Group (formerly called Fallon Clinic) PCP. Interventions directed at women who are
        at least 18 months from prior mammogram. Since July 2012, patients with a current Reliant
        Medical Group PCP who have been enrolled in Blue Cross/Bluse Shield, Harvard Pilgrim or
        Tufts health plans for 18 months may be eligible for enrollment.
      
Keywords: cost effectiveness; screening mammography; repeat mammography; telephone counseling; computerized reminders; compliance