Phone Support Increases Screening Rates Among Low-Income Women
A strategy for promoting cancer screening among low-income women through telephone calls offering encouragement and logistical support has been effective in New York City, and some Medicaid Managed Care Centers are planning to test the approach this summer.
The strategy uses trained counselors to contact by telephone women who are overdue to be screened for breast, cervical, or colon cancer. Women in underserved communities have low screening rates, and screening is one way to prevent deaths from these cancers.
In a randomized clinical trial to test the intervention, researchers found that women who received the telephone support - four phone calls on average - had higher screening rates than women who received the standard care of a phone call and a pamphlet.
The most dramatic result was a nearly 25-percentage point increase in colon cancer screening among the intervention group during the 18-month trial, the researchers report in the April 18 Annals of Internal Medicine.
"We were able to improve rates of cancer screening among women served by community health centers through a practical and reproducible intervention," says lead researcher Dr. Allen Dietrich of the Norris Cotton Cancer Center at the Dartmouth-Hitchcock Medical Center.
Telephone support is an idea that can easily be adopted around the country, he adds, and many organizations are now running telephone disease-management programs.
One such organization is Medicaid. In the next phase of the NCI-funded project, Dr. Dietrich will test the intervention at Medicaid Managed Care Centers.
According to the plan, staffers at the care centers will use billing records to identify women who are behind on their screening and who should be contacted by telephone. The programs will be guided by lessons learned from the trial in New York City.
The trial involved 1,400 women who were recruited from 11 community clinics or migrant health centers. About 60 percent of the women spoke Spanish, and of the participants who reported their race, 38 percent said they were African American.
In the trial, screening rates in the intervention group rose 7 percentage points for Pap tests (from 71 percent to 78 percent); 10 points for mammography (from 58 percent to 68 percent); and 24 points for colon cancer screening (from 39 percent to 63 percent).
The rates for Pap tests and mammography at the 11 clinics were "quite good" before the trial started, notes Dr. Dietrich, adding, "We were gratified that a modest intervention could improve the rates."
The large increase for colon cancer testing is important, he says, because screening for this cancer has lagged behind that of cervical and breast cancer.
The rise in colon cancer screening alone might be worth the cost of the intervention, says Dr. Mary Barton of the Agency for Healthcare Research and Quality, who wrote an accompanying editorial.
She points out that the intervention, in addition to being multilingual and culturally appropriate, encouraged women to raise the issue of screening with their doctors rather than wait for the doctors to raise it.
Women who could not easily communicate with their doctors were given brightly colored cards listing the tests for which they were overdue that could be shared with their doctors at the next visit.
"The health coaches were saying to the women, 'You bring it up,'" says Dr. Barton. "This is one of the most interesting and potentially most effective aspects of the intervention."
By Edward R. Winstead