"This study represents a promising step toward addressing the clear-cut disparity in cancer screening rates and death rates for certain low-income and minority groups," said lead author Dr. Allen Dietrich, a family physician and professor of community and family medicine at Dartmouth Medical School. "Our team found that telephone support can increase the historically low cancer screening rates for minority women. We are hopeful that this model can be transferred to other populations who could benefit from this type of outreach."
This randomized, controlled trial enrolled 1413 women ages 50 to 69 who were patients of 11 community health centers in New York City, and whose records indicated they were overdue for cancer screening. These women were randomly assigned to receive either telephone calls from prevention care managers or to simply continue with the centers' usual care. Eighteen months later, the researchers found that screening rates increased 12% for mammographies, 7% for Papanicolaou tests and 13% for colorectal screenings when they compared the rates for women who received the phone calls to those that had not.
"What makes this study so exciting is that we reached a population that has always had access problems and we showed that with the right care, attention and support, we were able to substantially reduce their barriers to cancer screening," said study co-author Dr. Jonathan Tobin, head of the Clinical Directors Network in New York City. "We've identified a methodology that we believe is both low cost and highly effective and we believe it will enable patients to remain up-to-date in their early detection services."
Women who were assigned to the intervention group received an average of four telephone support calls from a bilingual prevention care manager. These managers were trained to provide information on screenings and to respond to a number of common barriers that each patient could face that could delay their screenings. Barriers mentioned in the study include a lack of information on how to ask for a screening or schedule it, and many patients said they had trouble communicating with their physician. Care managers scheduled appointments, sent information cards to each patient to help communications efforts with their physician on their next visit, and provided directions to screening facilities.
"Since sixty percent of the patients were Spanish speaking and several are recent immigrants the to U.S., the ability for them to speak with someone who could communicate across cultural boundaries and help navigate the system was especially important," noted Dietrich, who is also associate director for population sciences at Norris Cotton Cancer Center at Dartmouth-Hitchcock Medical Center in Lebanon, NH.
Dietrich and his research team will begin a larger study through Medicare managed care organizations in May 2006. "We hope the next study proves that this model can be sustained over time using existing medical infrastructure without support from research grants," said Dietrich.
These findings could have several implications in the medical community, according to the authors. In addition to potentially saving lives through earlier detection and addressing health care disparities in the US, other preventive services such as smoking cessation could be incorporated into telephone support to increase the value of this outreach, they write.