||7R01CA074322-05 Interpret this number
||Community Trial to Increase Cancer Screening Adherence
DESCRIPTION: Certain cancer screening tests are effective in early
detection, most notably, the tests used for breast, cervical, and colorectal
cancers. These tests, all of which are endorsed by the U.S. Preventive Task
Force for women over age 50, include mammography, clinical breast
examination (CBE), Pap smear, and fecal occult blood test (FOBT). In spite
of widespread endorsement, many women do not systematically receive these
tests. This is especially true for certain subpopulations -- Hispanics,
pooper women, and women without health insurance. For example, as recently
as 1996, only 24 percent of Hispanic patients over age 50 in Los Angeles
County reported receiving regular mammograms.
This is a randomized trial involving a sample of primary care physicians
drawn from 29 contiguous communities in Los Angeles. The trial has four
specific aims: 1) develop, pretest, and implement a multifaceted physician
intervention designed to increase physician use and referral rates for
breast, cervical, and colorectal cancer screening for underscreened female
patients, 2) identify and track for two years the screening rates of female
patients over age 50 for mammography, CBE, Pap, and FOBT, 3) compare the
intervention versus control to estimate the cost effectiveness ratio for the
intervention relative to the control, and 4) evaluate the effectiveness of
the proposed intervention in achieving its stated goals. The intervention
to be tested is a CME workshop that incorporates cancer control content,
communication skill training, and cultural competence training to increase
patient adherence to screening; patient brochures for physicians practices;
3 post CME reminder/evaluations; and a 1 year and a 2 year post workshop
patient chart audit feedback. The physician intervention will be evaluated
using a randomized two-group design, while the patients' records and survey
data will provide the behavioral data to assess patient adherence to
screening for the three cancers.
Although much is known about barriers to breast cancer screening relative to
other cancers, we know far less about cultural and communication barriers to
breast, cervical and colorectal cancer screening. We also need to learn
about cultural and communication barriers that affect patients who otherwise
have assess to care.
This multifaceted physician intervention is highly exportable, especially to
managed care settings. Since southern California is moving rapidly toward
managed care predominance, this experiment has the potential to be highly
marketable and influential with the majority of future providers who care
about screening adherence.
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