To achieve the goal of reducing breast cancer morbidity and mortality, it
is imperative that symptomatic women adhere to recommendations for
definitive diagnostic procedures as a prerequisite to appropriate
treatment. Failure to obtain appropriate diagnostic services can have
serious psychological sequelae, grave implications for morbidity and
mortality, and significant cost implications for the health care system.
In the period between detection and diagnosis, women report considerable
distress, anxiety, and decrease in well-being which can negatively impact
adherence. Lack of adherence is particularly likely to occur in low-
income, indigent populations which must negotiate complex overburdened
health systems to receive care. Interventions targeting these symptomatic
women to reduce psychosocial distress and enhance adherence to diagnostic
follow-up procedures are urgently needed. However, in the continuum from
detection through diagnosis, treatment and rehabilitation, least attention
has focused on intervening to ensure timely effective diagnosis once an
abnormality has been identified.
The proposed study will fill this critical gap in breast cancer control
research. We will test a telephone counseling intervention delivered by
a team of profession and lay counselors, targeting low-income, multi-
ethnic women who present with an abnormality in the breast that may be
suspicious for breast cancer. Using a randomized design, we will evaluate
the effectiveness of the intervention in increasing patient adherence to
physician recommendations for follow-up of the problem and on decreasing
psychosocial distress and improving quality of life.
Specifically, the study will seek to accomplish the following: (1)
Identify all women newly presenting with a breast abnormality suspicious
for cancer at the two largest County hospitals in Los Angeles. (2) Select
a random sample of 1000 women from this population. (3) Randomize this
sample to an intervention or usual care control condition. (4) Deliver
interactive telephone counseling to all intervention subjects, including
a counseling session from a profession counselor and four follow-up
supportive calls from a lay peer counselor. Control group subjects will
have no contact with the study staff (usual care). (5) Conduct a 12-month
telephone follow-up interview to evaluate the effectiveness of the
intervention in reducing psychological distress and enhancing quality of
life, and to obtain self-reports of adherence to follow-up
recommendations. (6) Conduct a retrospective chart audit for all women in
the study 12 months after the intervention to obtain an independent
measure of adherence to follow-up recommendations. (7) Describe patterns
of adherence in this low-income population. (8) Profile these women with
respect to psychological distress and quality of life, and study the
relationship of these variables to adherence behavior.
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