Breast Cancer Outreach Among Primary Care Patients

Study Overview
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Brief Summary
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This project aims to evaluate different approaches to increase breast cancer screening among primary care patients at Penn Medicine through a centralized screening outreach program. In a pragmatic trial, the investigators will evaluate different approaches to increase completion of screening among eligible patients, including ordering mammograms in bulk prior to outreach, sending personalized text reminders, and endorsing of the communication by the primary care provider.

Detailed Description
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While mammograms are recommended by guidelines for early detection of breast cancer, mammogram rates are significantly lower now than they were prior to the initial COVID-19 pandemic surge in early 2020. In this project, the investigators will evaluate different ways of reaching out to eligible patients to encourage them to participate in breast cancer screening. Through letters, texting, and the electronic health record portal (MyPennMedicine (MPM)), the investigators will compare mammogram bulk orders, text messaging, and primary care provider endorsement to traditional outreach messaging with the goal of increasing breast cancer screening uptake.

Official Title
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Breast Cancer Outreach Among Primary Care Patients

Conditions
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Breast Cancer

Intervention / Treatment
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* Behavioral: Bulk Order
* Behavioral: Texting
* Behavioral: Clinician Endorsement
* Behavioral: No Bulk Order
* Behavioral: Standard Endorsement


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Women ages 40-74 Followed by Primary Care with a Penn Medicine PCP listed and at least one visit in the last 2 years Health Maintenance due (default biannual screening starting at age 50 or edit modifier based on input by clinician) Exclusion Criteria: Currently scheduled for a mammogram History of bilateral mastectomy

Ages Eligible for Study
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Minimum Age: 40 Years
Maximum Age: 74 Years

Sexes Eligible for Study
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Female

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Screening
Allocation: Randomized
Intervention Model: Factorial Assignment
Masking: Double


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: No Order<br> | Behavioral: No Bulk Order<br>* The outreach will ask patients to contact their PCP's office in order to have a mammogram order placed on their behalf.<br>|
| Experimental: No Order + Text (NO+T)<br> | Behavioral: Texting<br>* In addition to outreach, patients will receive text messaging with information regarding the importance of screening, how to schedule a mammogram, and locations available for mammography.<br>Behavioral: No Bulk Order<br>* The outreach will ask patients to contact their PCP's office in order to have a mammogram order placed on their behalf.<br>|
| Experimental: Bulk Order (BO)<br> | Behavioral: Bulk Order<br>* A mammogram order will be placed using bulk order technology in the EHR in advance of outreach for all patients.<br>|
| Experimental: Bulk Order + Text (BO+T)<br> | Behavioral: Bulk Order<br>* A mammogram order will be placed using bulk order technology in the EHR in advance of outreach for all patients.<br>Behavioral: Texting<br>* In addition to outreach, patients will receive text messaging with information regarding the importance of screening, how to schedule a mammogram, and locations available for mammography.<br>|
| Experimental: Clinician Endorsement (CE)<br> | Behavioral: Clinician Endorsement<br>* Outreach informing patients that they are overdue for a mammogram will be signed by the patient's primary care provider.<br>|
| Experimental: Clinician Endorsement + Text (CE+T)<br> | Behavioral: Texting<br>* In addition to outreach, patients will receive text messaging with information regarding the importance of screening, how to schedule a mammogram, and locations available for mammography.<br>Behavioral: Clinician Endorsement<br>* Outreach informing patients that they are overdue for a mammogram will be signed by the patient's primary care provider.<br>|
| Experimental: Standard Messaging (SM)<br> | Behavioral: Standard Endorsement<br>* Patient's will receive outreach from the practice informing them that they are overdue for a mammogram.<br>|
| Experimental: Standard Messaging (SM+T)<br> | Behavioral: Texting<br>* In addition to outreach, patients will receive text messaging with information regarding the importance of screening, how to schedule a mammogram, and locations available for mammography.<br>Behavioral: Standard Endorsement<br>* Patient's will receive outreach from the practice informing them that they are overdue for a mammogram.<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mammogram Completion in 3 months | Percent of patients that complete a mammogram | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Mammogram Completion in 6 months | Percent of patients that complete a mammogram | 6 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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Mammography, Preventive Screening, Population Health