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Randomized Controlled Trial
. 2017 Sep;7(3):547-556.
doi: 10.1007/s13142-017-0497-x.

Implementation and process evaluation of three interventions to promote screening mammograms delivered for 4 years in a large primary care population

Roger Luckmann  1 , Mary Jo White  2 , Mary E Costanza  3 , Christine F Frisard  2 , Caroline Cranos  3 , Susan Sama  4 , Robert Yood  5
Affiliations
Randomized Controlled Trial

Implementation and process evaluation of three interventions to promote screening mammograms delivered for 4 years in a large primary care population

Roger Luckmann et al. Transl Behav Med. 2017 Sep.

Abstract

The optimal form of outreach to promote repeated, on time screening mammograms in primary care has not been established. The purpose of this study is to assess the implementation process and process outcomes for three interventions for promoting biannual screening mammography in a randomized trial. In a large urban primary care practice over a 4-year period, we randomized women aged 40-85 and eligible for mammograms to three interventions: reminder letter only (LO), reminder letter + reminder call (RC), and reminder letter + counseling call (CC). We tracked information system development, staff training, patient and provider recruitment, reach, dose delivered and received, fidelity, and context measures. Ninety-three of 95 providers approved participation by 80% (23,999) of age-eligible patients, of whom only 207 (0.9%) opted not to receive any intervention. Of 9161 initial reminder letters mailed to women coming due or overdue for mammograms, 0.8% were undeliverable. Of women in the RC and CC arms unresponsive to the first reminder letter (n = 3982), 71.4% were called and reached, and of those, 49.1% scheduled a mammogram. Only 33.4% of women reached in the CC arm received full counseling, and women in the CC arm were less likely to schedule a mammogram than those in the RC arm. Implementing mail and telephone mammography reminders is feasible and acceptable in a large urban practice and reaches a majority of patients. Many schedule a mammogram when reached. A reminder letter followed by a simple reminder call if needed may be the optimal approach to promoting screening mammograms.

Keywords: Breast cancer; Mammogram; Reminder system; Screening; Telephone counseling.

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Conflict of interest statement

• The findings reported have not been previously published and this manuscript is not being simultaneously submitted elsewhere.

• The authors have full control of all primary data and agree to allow the journal to review their data if requested.

• There are no actual or potential conflicts of interest with the organization that sponsored the research.

• This work was supported by Grant R01CA132935 from the National Cancer Institute.

• All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

• Informed consent was obtained from all individual participants included in the study. The informed consent process was involved passive consent as stated in the manuscript.

• The study was approved by the Reliant Medical Group/Fallon Health Institutional Review Board (IRB).

Figures

Fig 1
Fig 1
Mammography reminder and counseling system (MRCS) cylinders represent databases. Arrows show direction of data flow
Fig 2
Fig 2
Women randomized, excluded, opted out, and sent reminders over 4 years by study arm. Wave 1 refers to the first reminder sent to any subject. Subsequent “waves” are repeat reminders for nonadherent women every 12 months until a mammogram is received and to women adherent women who are coming due for a second mammogram (i.e., 18 months since last mammogram)
Fig 3
Fig 3
First telephone call outcomes by intervention call arm and by age
Fig 4
Fig 4
Call outcomes for counseling call arm for those who accepted the call (N = 1326)
See this image and copyright information in PMC

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