Telephone care management to improve cancer screening among low-income women: a randomized, controlled trial

Abstract

Background: Minority and low-income women receive fewer cancer screenings than other women.

Objective: To evaluate the effect of a telephone support intervention to increase rates of breast, cervical, and colorectal cancer screening among minority and low-income women.

Design: Randomized, controlled trial conducted between November 2001 and April 2004.

Setting: 11 community and migrant health centers in New York City.

Patients: 1413 women who were overdue for cancer screening.

Intervention: Over 18 months, women assigned to the intervention group received an average of 4 calls from prevention care managers and women assigned to the control group received usual care. Follow-up data were available for 99% of women, and 91% of the intervention group received at least 1 call.

Measurements: Medical record documentation of mammography, Papanicolaou testing, and colorectal cancer screening according to U.S. Preventive Services Task Force recommendations.

Results: The proportion of women who had mammography increased from 0.58 to 0.68 with the intervention and decreased from 0.60 to 0.58 with usual care; the proportion who had Papanicolaou testing increased from 0.71 to 0.78 with the intervention and was unchanged with usual care; and the proportion who had colorectal screening increased from 0.39 to 0.63 with the intervention and from 0.39 to 0.50 with usual care. The difference in the change in screening rates between groups was 0.12 for mammography (95% CI, 0.06 to 0.19), 0.07 for Papanicolaou testing (CI, 0.01 to 0.12), and 0.13 for colorectal screening (CI, 0.07 to 0.19). The proportion of women who were up to date for 3 tests increased from 0.21 to 0.43 with the intervention.

Limitations: Participants were from 1 city and had access to a regular source of care. Medical records may not have captured all cancer screenings.

Conclusions: Telephone support can improve cancer screening rates among women who visit community and migrant health centers. The intervention seems to be well suited to health plans, large medical groups, and other organizations that seek to increase cancer screening rates and to address disparities in care.

Figure

Flow of study participants through recruitment, eligibility assessment, randomization, intervention, and outcome analysis. PCM = prevention care management.