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Shuldiner J, Shah N, Reis C, Chalmers I, Ivers N, Nathan P. Developing a Provincial Surveillance and Support System for Childhood Cancer Survivors: Multiphase User-Centered Design Study. JMIR Hum Factors 2022; 9:e37606. [PMID: 36099013 PMCID: PMC9516377 DOI: 10.2196/37606] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/27/2022] [Revised: 06/21/2022] [Accepted: 07/18/2022] [Indexed: 11/13/2022] Open
Abstract
Background Survivors of childhood cancer are at lifelong risk of morbidity (such as new cancers or heart failure) and premature mortality due to their cancer treatment. These are termed late effects. Therefore, they require lifelong, risk-tailored surveillance. However, most adult survivors of childhood cancer do not complete recommended surveillance tests such as mammograms or echocardiograms. Objective In partnership with survivors, family physicians, and health system partners, we are designing a provincial support system for high-priority tests informed by principles of implementation science, behavioral science, and design thinking. Methods Our multiphase process was structured as follows. Step 1 consisted of a qualitative study to explore intervention components essential to accessing surveillance tests. Step 2 comprised a workshop with childhood cancer survivors, family physicians, and health system stakeholders that used the Step 1 findings and “personas” (a series of fictional but data-informed characters) to develop and tailor the intervention for different survivor groups. Step 3 consisted of intervention prototype development, and Step 4 involved iterative user testing. Results The qualitative study of 30 survivors and 7 family physicians found a high desire for information on surveillance for late effects. Respondents indicated that the intervention should help patients book appointments when they are due in addition to providing personalized information. Insights from the workshop included the importance of partnering with both family physicians and survivorship clinics and providing emotional support for survivors who may experience distress upon learning of their risk for late effects. In our user-testing process, prototypes went through iterations that incorporated feedback from users regarding acceptability, usability, and functionality. We sought to address the needs of survivors and physicians while balancing the capacity and infrastructure available for a lifelong intervention via our health system partners. Conclusions In partnership with childhood cancer survivors, family physicians, and health system partners, we elucidated the barriers and enablers to accessing guideline-recommended surveillance tests and designed a multifaceted solution that will support survivors and their family physicians. The next step is to evaluate the intervention in a pragmatic randomized controlled trial.
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Affiliation(s)
- Jennifer Shuldiner
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | - Nida Shah
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada
| | - Catherine Reis
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada
| | | | - Noah Ivers
- Institute for Health System Solutions and Virtual Care, Women's College Hospital, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
| | - Paul Nathan
- Child Health Evaluative Sciences, The Hospital for Sick Children Research Institute, Toronto, ON, Canada.,Institute of Health Policy, Management and Evaluation, University of Toronto, Toronto, ON, Canada.,Division of Hematology/Oncology, The Hospital for Sick Children, Toronto, ON, Canada
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Oswal K, Kanodia R, Pradhan A, Nadkar U, Avhad M, Venkataramanan R, Sethuraman L, Caduff C, Purushotham A. Assessment of Knowledge and Screening in Oral, Breast, and Cervical Cancer in the Population of the Northeast Region of India. JCO Glob Oncol 2021; 6:601-609. [PMID: 32302235 PMCID: PMC7193798 DOI: 10.1200/jgo.19.00257] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023] Open
Abstract
PURPOSE The burden of cancer is increasing globally, with poor outcomes in terms of morbidity and mortality in patients, especially in low- and middle-income countries. Lack of awareness of the risk factors, symptoms, and signs of common cancers in addition to inadequate cancer prevention programs at the community level are a major hindrance to the early detection of cancer. METHODS A cross-sectional study was conducted in the North East Region (NER) of India, with a sample population of 1,400 participants from Assam (n = 1,000), Meghalaya (n = 200), and Nagaland (n = 200). The questionnaire developed for the study consisted of sociodemographic profile, knowledge about cancer (oral, breast, and cervical), its warning signs, risk factors, and attitude toward cancer screening. Statistical analysis was performed using STATA version 13.0. RESULTS Among all the participants, 59% had heard about oral cancer, 50% about breast cancer, and 31% about cervical cancer. A limited understanding of risk factors, symptoms, and signs was reported for oral cancer (45%), breast cancer (54%), and cervical cancer (63%). A total of 34% of participants were aware of cancer screening. Among those who were aware of cancer screening, only six people had undergone any form of cancer screening, and 71% cited media as the major source of information. CONCLUSION The level of cancer awareness is low in the NER. A multipronged approach is needed with assistance from government and nongovernment organizations for training, providing adequate human resources and equipment, and developing cancer screening infrastructure. This needs to be coupled with mass media communication and interpersonal communication through frontline health workers.
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Affiliation(s)
- Kunal Oswal
- Tata Trusts Cancer Care Program, Mumbai, India
| | | | | | | | | | | | | | - Carlo Caduff
- Global Health and Social Medicine, King's College London, London, United Kingdom
| | - Arnie Purushotham
- Tata Trusts Cancer Care Program, Mumbai, India.,King's College London, London, United Kingdom
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3
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Jones T, Duquette D, Underhill M, Ming C, Mendelsohn-Victor KE, Anderson B, Milliron KJ, Copeland G, Janz NK, Northouse LL, Duffy SM, Merajver SD, Katapodi MC. Surveillance for cancer recurrence in long-term young breast cancer survivors randomly selected from a statewide cancer registry. Breast Cancer Res Treat 2018; 169:141-152. [PMID: 29353367 DOI: 10.1007/s10549-018-4674-5] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2017] [Accepted: 01/16/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE This study examined clinical breast exam (CBE) and mammography surveillance in long-term young breast cancer survivors (YBCS) and identified barriers and facilitators to cancer surveillance practices. METHODS Data collected with a self-administered survey from a statewide, randomly selected sample of YBCS diagnosed with invasive breast cancer or ductal carcinoma in situ younger than 45 years old, stratified by race (Black vs. White/Other). Multivariate logistic regression models identified predictors of annual CBEs and mammograms. RESULTS Among 859 YBCS (n = 340 Black; n = 519 White/Other; mean age = 51.0 ± 5.9; diagnosed 11.0 ± 4.0 years ago), the majority (> 85%) reported an annual CBE and a mammogram. Black YBCS in the study were more likely to report lower rates of annual mammography and more barriers accessing care compared to White/Other YBCS. Having a routine source of care, confidence to use healthcare services, perceived expectations from family members and healthcare providers to engage in cancer surveillance, and motivation to comply with these expectations were significant predictors of having annual CBEs and annual mammograms. Cost-related lack of access to care was a significant barrier to annual mammograms. CONCLUSIONS Routine source of post-treatment care facilitated breast cancer surveillance above national average rates. Persistent disparities regarding access to mammography surveillance were identified for Black YBCS, primarily due to lack of access to routine source of care and high out-of-pocket costs. IMPLICATIONS Public health action targeting cancer surveillance in YBCS should ensure routine source of post-treatment care and address cost-related barriers. Clinical Trials Registration Number: NCT01612338.
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Affiliation(s)
- Tarsha Jones
- Florida Atlantic University Christine E. Lynn College of Nursing, 777 Glades Road, Boca Raton, FL, 33431, USA
| | - Debra Duquette
- Feinberg School of Medicine, Northwestern University, Arkes Family Pavilion Suite 600, 676 N Saint Clair, Chicago, IL, 60611, USA
| | - Meghan Underhill
- The Phyllis F. Cantor Center for Research in Nursing & Patient Care Services, Dana-Farber Cancer Institute, Harvard Medical School, 450 Brookline Avenue, Boston, MA, 02215, USA
| | - Chang Ming
- Nursing Science, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland
| | | | - Beth Anderson
- Michigan Department of Health and Human Services, 333 S. Grand Ave., P.O. Box 30195, Lansing, MI, 48909, USA
| | - Kara J Milliron
- University of Michigan Comprehensive Cancer Center, 1500 East Medical Center Drive, Ann Arbor, MI, 48109, USA
| | - Glenn Copeland
- Michigan Cancer Surveillance Program, 333 S. Grand Ave., P.O. Box 30195, Lansing, MI, 48909, USA
| | - Nancy K Janz
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA
| | - Laurel L Northouse
- University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI, 48109, USA
| | - Sonia M Duffy
- Ohio State University College of Nursing, 1585 Neil Ave, Columbus, OH, 43210, USA
| | - Sofia D Merajver
- School of Public Health, University of Michigan, 1415 Washington Heights, Ann Arbor, MI, 48109, USA.,School of Medicine, University of Michigan, 1500 E Medical Center Dr, Ann Arbor, MI, 48109, USA
| | - Maria C Katapodi
- Nursing Science, Faculty of Medicine, University of Basel, Bernoullistrasse 28, 4056, Basel, Switzerland. .,University of Michigan School of Nursing, 400 North Ingalls Building, Ann Arbor, MI, 48109, USA.
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4
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Gray BM, Vandergrift JL, Lipner RS. Association between the American Board of Internal Medicine's General Internist's Maintenance of Certification Requirement and Mammography Screening for Medicare Beneficiaries. Womens Health Issues 2018; 28:35-41. [DOI: 10.1016/j.whi.2017.10.003] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2017] [Revised: 09/27/2017] [Accepted: 10/04/2017] [Indexed: 10/18/2022]
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Sheffet AM, Ridlen S, Louria DB. Baseline Behavioral Assessment for the New Jersey Health Wellness Promotion Act. Am J Health Promot 2016; 20:401-10. [PMID: 16871820 DOI: 10.4278/0890-1171-20.6.401] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE To determine baseline use rates for health-promoting behaviors of the recently adopted New Jersey Health Wellness Promotion Act and to examine the effects of demographic and socioeconomic factors on the use of preventive services included in the Act. DESIGN A random telephone survey of 3094 households was conducted using questions from the Behavioral Risk Factor Surveillance System supplemented by questions related to provisions of the Act. SETTING All New Jersey households. SUBJECTS State representative adult sample of 1246 subjects. MEASURES Rates for getting timely screening tests, for obtaining influenza immunizations, and engaging in selected health-promoting behaviors. RESULTS Rates for receiving recommended screening tests ranged from 0.88 for blood pressure testing to 0.29 for osteoporosis screening. According to bivariate analysis, having insurance was the most consistent determinant associated with receiving preventive services but was associated only with sigmoidoscopy, mammography, and Pap smear testing in the multivariate modeling. Reminders were significantly associated with respective screening tests. Age was positively associated with receiving the majority of tests. Gender ethnicity, education, and income affected receipt sporadically. Half the respondents were overweight and a quarter were current smokers. CONCLUSIONS Receipt of appropriate screening tests and adoption of health-promoting behaviors fell short of desired goals. Having health insurance increased receipt rates, but was not enough to achieve usage goals. Procedure-specific reminders may improve usage rates.
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Affiliation(s)
- Amiram M Sheffet
- Department of Preventive Medicine and Community Health, UMDNJ-New Jersey Medical School, Newark, New Jersey 07101, USA
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6
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Slater JS, Parks MJ, Malone ME, Henly GA, Nelson CL. Coupling Financial Incentives With Direct Mail in Population-Based Practice. HEALTH EDUCATION & BEHAVIOR 2016; 44:165-174. [DOI: 10.1177/1090198116646714] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Financial incentives are being used increasingly to encourage a wide array of health behaviors because of their well-established efficacy. However, little is known about how to translate incentive-based strategies to public health practice geared toward improving population-level health, and a dearth of research exists on how individuals respond to incentives through public health communication strategies such as direct mail. This study reports results of a population-based randomized controlled trial testing a direct mail, incentive-based intervention for promoting mammography uptake. The study population was composed of a random sample of Minnesota women enrolled in Medicare fee-for-service and overdue for breast cancer screening. Participants ( N = 18,939) were randomized into three groups: (1) Direct Mail only, (2) Direct Mail plus Incentive, and (3) Control. Both direct mail groups received two mailers with a message about the importance of mammography; however, Mail plus Incentive mailers also offered a $25 incentive for getting a mammogram. Logistic regression analyses measured intervention effects. Results showed the odds for receiving mammography were significantly higher for the Direct Mail plus Incentive group compared with both Direct Mail only and Control groups. The use of incentives also proved to be cost-effective. Additionally, the Direct Mail only group was more likely to receive mammography than the Control group. Findings offer experimental evidence on how the population-based strategy of direct mail coupled with a financial incentive can encourage healthy behavior, as well as how incentive-based programs can be translated into health promotion practice aimed at achieving population-level impact.
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DiGuiseppi CG, Thoreson SR, Clark L, Goss CW, Marosits MJ, Currie DW, Lezotte DC. Church-based social marketing to motivate older adults to take balance classes for fall prevention: cluster randomized controlled trial. Prev Med 2014; 67:75-81. [PMID: 25025522 DOI: 10.1016/j.ypmed.2014.07.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2014] [Revised: 07/02/2014] [Accepted: 07/05/2014] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Determine whether a church-based social marketing program increases older adults' participation in balance classes for fall prevention. METHODS In 2009-10, 51 churches (7101 total members aged ≥ 60) in Colorado, U.S.A. were randomized to receive no intervention or a social marketing program. The program highlighted benefits of class participation (staying independent, building relationships), reduced potential barriers (providing convenient, subsidized classes), and communicated marketing messages through church leaders, trained "messengers," printed materials and church-based communication channels. Between-group differences in balance class enrollment and marketing message recall among congregants were compared using Wilcoxon Two-Sample Test and regression models. RESULTS Compared to 25 control churches, 26 churches receiving the social marketing program had a higher median proportion (9.8% vs. 0.3%; p<0.001) and mean number (7.0 vs. 0.5; IRR=11.2 [95%CI: 7.5, 16.8]) of older adult congregants who joined balance classes. Intervention church members were also more likely to recall information about preventing falls with balance classes (AOR=6.2; 95% CI: 2.6, 14.8) and availability of classes locally (AOR=7.7; 95% CI: 2.6, 22.9). CONCLUSIONS Church-based social marketing effectively disseminated messages about preventing falls through balance classes and, by emphasizing benefits and reducing barriers and costs of participation, successfully motivated older adults to enroll in the classes.
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Affiliation(s)
- Carolyn G DiGuiseppi
- Colorado Injury Control Research Center, Department of Epidemiology, Colorado School of Public Health, Campus Box B119, 13001 E 17th Place, Aurora, CO 80045, USA.
| | - Sallie R Thoreson
- Colorado Department of Public Health and Environment, 4300 Cherry Creek Dr S, Denver, CO 80246, USA
| | - Lauren Clark
- College of Nursing, University of Utah, 10S 2000 E, Salt Lake City, UT 84112, USA
| | - Cynthia W Goss
- Colorado Injury Control Research Center, Department of Epidemiology, Colorado School of Public Health, Campus Box B119, 13001 E 17th Place, Aurora, CO 80045, USA
| | - Mark J Marosits
- Worldways Social Marketing, 240 Thames St., Suite 200, Newport, RI 02840, USA
| | - Dustin W Currie
- Colorado Injury Control Research Center, Department of Epidemiology, Colorado School of Public Health, Campus Box B119, 13001 E 17th Place, Aurora, CO 80045, USA
| | - Dennis C Lezotte
- Department of Biostatistics and Bioinformatics, Colorado School of Public Health, Campus Box B119, 13001 E 17th Place, Aurora, CO 80045, USA
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Katapodi MC, Northouse LL, Schafenacker AM, Duquette D, Duffy SA, Ronis DL, Anderson B, Janz NK, McLosky J, Milliron KJ, Merajver SD, Duong LM, Copeland G. Using a state cancer registry to recruit young breast cancer survivors and high-risk relatives: protocol of a randomized trial testing the efficacy of a targeted versus a tailored intervention to increase breast cancer screening. BMC Cancer 2013; 13:97. [PMID: 23448100 PMCID: PMC3599993 DOI: 10.1186/1471-2407-13-97] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/17/2012] [Accepted: 02/21/2013] [Indexed: 11/10/2022] Open
Abstract
Background The Michigan Prevention Research Center, the University of Michigan Schools of Nursing, Public Health, and Medicine, and the Michigan Department of Community Health propose a multidisciplinary academic-clinical practice three-year project to increase breast cancer screening among young breast cancer survivors and their cancer-free female relatives at greatest risk for breast cancer. Methods/design The study has three specific aims: 1) Identify and survey 3,000 young breast cancer survivors (diagnosed at 20–45 years old) regarding their breast cancer screening utilization. 2) Identify and survey survivors’ high-risk relatives regarding their breast cancer screening utilization. 3) Test two versions (Targeted vs. Enhanced Tailored) of an intervention to increase breast cancer screening among survivors and relatives. Following approval by human subjects review boards, 3,000 young breast cancer survivors will be identified through the Michigan Cancer Registry and mailed an invitation letter and a baseline survey. The baseline survey will obtain information on the survivors’: a) current breast cancer screening status and use of genetic counseling; b) perceived barriers and facilitators to screening; c) family health history. Based on the family history information provided by survivors, we will identify up to two high-risk relatives per survivor. Young breast cancer survivors will be mailed consent forms and baseline surveys to distribute to their selected high-risk relatives. Relatives’ baseline survey will obtain information on their: a) current breast cancer screening status and use of genetic counseling; and b) perceived barriers and facilitators to screening. Young breast cancer survivors and high-risk relatives will be randomized as a family unit to receive two versions of an intervention aiming to increase breast cancer screening and use of cancer genetic services. A follow-up survey will be mailed 9 months after the intervention to survivors and high-risk relatives to evaluate the efficacy of each intervention version on: a) use of breast cancer screening and genetic counseling; b) perceived barriers and facilitators to screening; c) self-efficacy in utilizing cancer genetic and screening services; d) family support related to screening; e) knowledge of breast cancer genetics; and f) satisfaction with the intervention. Discussion The study will enhance efforts of the state of Michigan surrounding cancer prevention, control, and public health genomics. Trial registration NCT01612338
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Affiliation(s)
- Maria C Katapodi
- University of Michigan School of Nursing, 400 N, Ingalls Building, Room 2158, Ann Arbor, MI 48109, USA.
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Clark L, Thoreson S, Goss CW, Zimmer LM, Marosits M, DiGuiseppi C. Understanding Fall Meaning and Context in Marketing Balance Classes to Older Adults. J Appl Gerontol 2011; 32:96-119. [DOI: 10.1177/0733464811399896] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
This study explored older, community-dwelling adults’ attitudes and values about proposed church-delivered balance classes for fall prevention. Community observation, group interviews with stakeholders, key informant interviews, and focus groups with church members ≥60 years of age were analyzed in two ways: first for inductive themes expressing community sentiment about fall prevention for older adults, then for content useful in creating locally tailored social marketing messages. Four themes expressed perceptions of fall-prevention programming: de-emphasizing fall risk and emphasizing strength and independence, moving older adults out of their “comfort zones” to join classes, identifying relationships to support fall-prevention activities, and considering gender-based differences in approaches to fall prevention. A content analysis of the same dataset yielded information about preferred places in the community, promotion through churches, a tolerable price, and the balance class product itself. The qualitative results will inform the social marketing program to increase intervention delivery success.
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Affiliation(s)
| | - Sallie Thoreson
- Colorado Department of Public Health & Environment, Denver, CO, USA
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10
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Abstract
For cancer screening programmes to bring about reductions in mortality, a substantial proportion of the population must participate. Programmes with low uptake can be ineffective and can promote inequalities in health-service provision. Strategies to promote uptake are multifaceted, reflecting differences in the cancers targeted, invitees, health-service contexts, and the tests themselves. Accordingly, there is no universal approach. Strategies should accommodate the many factors that can influence uptake and should incorporate the need to promote informed choice. Screening has the potential to cause harm, and there is an ethical imperative to seek out strategies that provide balanced information on cancer screening. Further research is needed to assess newer approaches to promoting uptake, such as IT-based programmes, and to identify strategies that are balanced, self-sustaining, and affordable.
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Abstract
Electronic communication promises to revolutionise the delivery of health care. In the first of two articles considering the potential for email consultations, Car and Sheikh summarise the evidence about their use for preventive health care, health education, and managing non-urgent conditions
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Affiliation(s)
- Josip Car
- Department of Primary Care and Social Medicine, Imperial College London, London W6 8RP
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Chirikos TN, Christman LK, Hunter S, Roetzheim RG. Cost-effectiveness of an intervention to increase cancer screening in primary care settings. Prev Med 2004; 39:230-8. [PMID: 15226030 DOI: 10.1016/j.ypmed.2004.03.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND The main goal was to conduct a cost-effectiveness analysis of an intervention designed to increase cancer screening rates in primary care settings serving disadvantaged populations. The Cancer Screening Office Systems intervention reminded clinicians whether screening mammography, Pap smears, and/or fecal occult blood tests were up-to-date in eligible patients and then established a division of office responsibilities to ensure that tests were ordered and completed. METHODS The cost-effectiveness analysis was predicated on data generated from a cluster-randomized controlled trial of Cancer Screening Office Systems conducted at eight clinics participating in a county-funded health insurance plan in Florida. Cost numerators were computed from estimated time inputs of both clinical personnel and patients valued at nationally representative wages as well as expenses for Cancer Screening Office Systems-related materials and overhead. Effectiveness denominators were constructed from net changes in screening rates observed experimentally over a 12-month follow-up. Two types of incremental cost-effectiveness ratios were computed: the cost per extra screening test by type and the cost per life-year saved without and with Cancer Screening Office Systems. RESULTS Cancer Screening Office Systems produced statistically significant increases in screening rates, and these gains more than outweighed the costs of the intervention viewed from either payer or societal perspectives. CONCLUSIONS Cancer Screening Office Systems are a cost-effective means of addressing cancer-related health disparities.
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Affiliation(s)
- Thomas N Chirikos
- H. Lee Moffitt Cancer Center and Research Institute, University of South Florida, Cancer Prevention and Control, Tampa, FL 33612, USA.
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13
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Roetzheim RG, Christman LK, Jacobsen PB, Cantor AB, Schroeder J, Abdulla R, Hunter S, Chirikos TN, Krischer JP. A randomized controlled trial to increase cancer screening among attendees of community health centers. Ann Fam Med 2004; 2:294-300. [PMID: 15335126 PMCID: PMC1466693 DOI: 10.1370/afm.101] [Citation(s) in RCA: 61] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND We assessed the efficacy of the Cancer Screening Office Systems (Cancer SOS), an intervention designed to increase cancer screening in primary care settings serving disadvantaged populations. METHODS Eight primary care clinics participating in a county-funded health insurance plan in Hillsborough County, Fla, agreed to take part in a cluster-randomized experimental trial. The Cancer SOS had 2 components: a cancer-screening checklist with chart stickers that indicated whether specific cancer-screening tests were due, ordered, or completed; and a division of office responsibilities to achieve high screening rates. Established patients were eligible if they were between the ages of 50 and 75 years and had no contraindication for screening. Data abstracted from charts of independent samples collected at baseline (n = 1,196) and at a 12-month follow-up (n = 1,237) was used to assess whether the patient was up-to-date on one or more of the following cancer-screening tests: mammogram, Papanicolaou (Pap) smear, or fecal occult blood testing (FOBT). RESULTS In multivariate analysis that controlled for baseline screening rates, secular trends, and other patient and clinic characteristics, the intervention increased the odds of mammograms (odds ratio [OR] = 1.62, 95% confidence interval [CI], 1.07-9.78, P = .023) and fecal occult blood tests (OR = 2.5, 95% CI, 1.65-4.0, P <.0001) with a trend toward greater use of Pap smears (OR = 1.57, 95% CI, 0.92-2.64, P = .096). CONCLUSIONS The Cancer SOS intervention significantly increased rates of cancer screening among primary care clinics serving disadvantaged populations. The Cancer SOS intervention is one option for providers or policy makers who wish to address cancer related health disparities.
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Affiliation(s)
- Richard G Roetzheim
- Department of Family Medicine, University of South Florida, Tampa, Fla 33612, USA.
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Lynch FL, Whitlock EP, Valanis BG, Smith SK. Cost-effectiveness of a tailored intervention to increase screening in HMO women overdue for Pap test and mammography services. Prev Med 2004; 38:403-11. [PMID: 15020173 DOI: 10.1016/j.ypmed.2003.11.024] [Citation(s) in RCA: 17] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Research has established the societal cost-effectiveness of providing breast and cervical cancer screening to women. Less is known about the cost of motivating women significantly overdue for services to receive screening. METHODS In this intent-to-treat study, a total of 254 women, aged 52-69, who were overdue for both Pap test and mammography, were randomized to two groups, a tailored, motivational outreach or usual care. For effectiveness, we calculated the percent of women who received both services within 14 months of randomization. We used a comprehensive cost model to estimate total cost, per-participant cost, and the incremental cost-effectiveness of delivering the outreach intervention from the health plan perspective. We also conducted sensitivity analyses around two key parameters, target population size and level of effectiveness. RESULTS Compared with usual care, outreach (P = 0.006) screened significantly more women. The intervention cost US dollars 167.62 (2000 U.S. dollars) for each woman randomized to outreach, and incremental cost-effectiveness of outreach over usual care was US dollars 818 per additional woman screened. Sensitivity analyses estimated incremental cost-effectiveness between Us dollars 19 and US dollars 90 per additional woman screened. CONCLUSIONS Larger health plans can likely increase Pap test and mammography services in this population for a relatively low cost using this outreach intervention.
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Affiliation(s)
- Frances L Lynch
- Center for Health Research, Kaiser Permanente Northwest, Portland, OR 97227, USA.
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15
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Abstract
Perhaps the most common and familiar way that the results of medical research and epidemiologic investigations are summarized is in a table of counts. Numbers of subjects with and without the outcome of interest are listed for each treatment or risk factor group. By using the study sample data thus tabulated, investigators quantify the association between treatment or risk factor and outcome. Three simple statistical calculations are used for this purpose: difference in proportions, relative risk, and odds ratio. The appropriate use of these statistics to estimate the association between treatment or risk factor and outcome in the relevant population depends on the design of the research. Herein, the enumeration of proportions, odds ratios, and risks and the relationships between them are demonstrated, along with guidelines for use and interpretation of these statistics appropriate to the type of study that gives rise to the data.
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Affiliation(s)
- Christopher L Sistrom
- Departments of Radiology and Biostatistics, University of Florida College of Medicine, PO Box 100374, Gainesville, FL 32610, USA.
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