Monday, October 24, 10:30
a.m.-noon
"Mammoday"—A Breast Cancer Screening Program for Older
Women: Intervention Opportunities for the Cancer Registrar
Authors
R.
Williams1; C.L. Spencer1.
1Howard University Cancer Center,
Washington, DC.
Background
Howard University Cancer Center, Delmarva
Foundation, NCI's Cancer Information Service and Men Against
Breast Cancer formed a partnership to offer Mammodays. The
primary purpose of the project is offer free mammography
screening to women who receive Medicare with the intent of
promoting the habit of obtaining annual mammograms.
Additionally, the project explores the knowledge and utilization
of Medicare mammography benefits among African American women in
the District of Columbia.
Methods
The objectives of the Mammodays project are to 1).
Provide mammograms for at least 60 Medicare recipients annually,
2). Assess the knowledge and usage levels of Medicare
mammography benefits of African American women age 50 and older
living the District of Columbia 3). Determine barriers to
utilizing Medicare benefits among African American women; and
4). Determine the best channels for reaching the target
population. Participants were identified through churches, CDC
breast and cervical program, community based organizations and
local media promotions. Women attending Mammodays received a
free clinical breast exam and mammogram. Prior to getting
screened participants were asked to complete a short
questionnaire regarding their knowledge and usage of Medicare
mammography benefits and barriers to use.
Results
To date five Mammodays have been held. One hundred two
women have been screen and four have been diagnosed with breast
cancer. A total of 50 surveys have been completed. Based upon
completed surveys the majority of women were not aware of the
Medicare mammography benefit. Among those aware of the benefit
the majority had not utilized the benefit for screening.
Discussion
Information collected from the Mammodays project to
date indicates a need to increase public education to promote
Medicare mammography benefits. Programs specifically aimed at
African American women in urban areas are needed. Collecting
more information to understand barriers to utilizing Medicare
mammography benefits among women who are aware is an important
next step for this project.
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Improving Cancer Screening Among Low-Income Women: A
Randomized Controlled Trial
Authors
A.N. Cassells1; A.J. Dietrich2; C.M.
Robinson2; J.N. Tobin1; M. Greene2; M. Beach3; C. Sox2; R.
Younge4; K. DuHamel5.
1Clinical Directors Network, Inc., New
York, NY;
2Dartmouth Medical School, Hanover, NH;
3Norris Cotton
Cancer Center/Dartmouth Hitchcock Medical Center, Lebanon, NH;
4Fordham Family Practice, Bronx, NY;
5Mount Sinai School of
Medicine, New York, NY.
Background
Low-income women receive fewer indicated cancer
screening tests than those with higher incomes. This project was
aimed at evaluating the impact of an intervention to increase
breast, cervical and colorectal cancer screening.
Methods
Design: Randomized controlled trial with patients as
the unit of randomization and analysis on an intent-to-treat
basis. Setting: 11 Community/Migrant Health Centers (C/MHCs) in
New York City that are part of a Practice-Based Research
Network. Patients: 1413 eligible and consenting women recruited
during primary care visits. Intervention: Patients assigned to
the intervention received a series of support calls from
Prevention Care Managers (PCMs). The calls assessed patient
barriers to screening, provided any needed education, and
assisted with access to services. Main and Secondary Outcome
Measures: Mammography and Pap test within the past 18 months;
colorectal cancer screening by one of several methods at
intervals suggested by the United States Preventive Services
Task Force; number of screening services up-to-date.
Results
Between baseline and follow-up, all three services
increased significantly more for the intervention group compared
with the usual care group. For the intervention group,
mammography was 0.1 higher (a 17% increase), Pap was 0.07 higher
(a 10% increase) and colorectal cancer screening was 0.24 higher
(greater than a 60% increase). The proportion of patients up to
date for all three services increased by 0.22 (a 120% increase).
Of those assigned to the intervention, 9% were never
successfully contacted. The mean number of calls completed per
patient was 4.
Discussion
PCMs can improve cancer screening up-to-date status
for women who visit C/MHCs. Next steps are to enhance the
intervention to provide outreach to women who seldom visit C/MHCs
for primary care and to disseminate the intervention to settings
where it can be sustained such as managed care organizations,
health plans and large medical groups
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A Controlled Trial of Three Interventions To Increase
Colorectal Cancer Screening in African Americans
Authors
D.S. Blumenthal1; S. Smith1.
1Morehouse School of Medicine, Atlanta, GA.
Background
Colorectal cancer is the second deadliest among
cancers and disproportionately affects African-Americans. We
tested three different interventions to increase screening for
colorectal cancer among African Americans: (1) a one-on-one
counseling intervention; (2) a small group educational
intervention; (3) a "financial incentives" intervention in which
the participants' out-of-pocket cost for screening was
reimbursed. The counseling and educational interventions
incorporated elements of the Health Belief Model and Social
Learning Theory. The three intervention cohorts were compared
with a "control" cohort that did not receive an intervention.
Methods
We recruited 245 African American participants over age
50 in metropolitan Atlanta and randomized them to one of the
four cohorts. Pre-and post-intervention questionnaires were
administered to determine knowledge, attitudes and behaviors (KAB)
related to screening and to measure psychosocial parameters
(self-esteem, perceived stress & social support) at baseline and
post intervention. Screening outcomes were assessed three months
after the intervention.
Results
Participants in the one-on-one counseling intervention
showed a 70% improvement in KAB on the post-intervention
questionnaires as compared to the pre-intervention
questionnaire. Participants in the small group education
intervention showed a 40% improvement. Neither the financial
incentives cohort nor the control cohort showed any change. At
30 days post-intervention, the one-on-one counselling cohort had
the highest screening rate -- double the rate in the control
cohort.
Discussion
One-on-one counselling appears to be the most
effective approach but also the most expensive. Small group
education offers a cost-effective alternative. Our experience
with financial incentives demonstrates that financial barriers
are important but are not the only barrier to screening. If
preliminary results are borne out, the study will offer
relatively simple models useful in increasing screening rates
among African Americans.
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The Great Game Plan: Telehealth in
Action
Authors
C. Rice1; J. Molley-Strudwick1; W.H.
Fite1.
1Orlando Veterans Healthcare Center, Orlando, FL.
Background
Lifestyle modification by persons with
pre-diabetes metabolic syndrome, including normalization of
weight and a regular exercise regimen can result in striking
reductions in incidence of diabetes as well as prevalence,
morbidity, and mortality of renal and cardiovascular disease.
Preventive health programs provide an effective and economical
means to positively affect changes in the health status of
veterans at risk for diabetes, renal, and cardiovascular
morbidities, and other chronic disease processes. Nursing
leaders and clinicians should investigate and implement telehealth programs as components of preventive health
initiatives.
Methods
Individuals determined to have pre-diabetes and
metabolic syndrome received a standardized educational
regimen, a scale, sphygmomanometer, and the Health Buddy®.
Each day it provided brief educational messages and asked
patients questions concerning their well being. At periodic
intervals, it requested patients to enter their home weight
and blood pressure measurements. These data were uploaded to
the monitoring facility without patient intervention. Risk
stratification algorithms within the monitoring software
identified patients at increased risk. These patients received
telephone calls or home visits for encouragement and
additional education. Clinical outcome measures for this
preliminary assessment included reduction of weight, abdominal
girth, and body mass index (BMI).
Results
Results from the first 24 enrollees following 90 days
of program participation revealed statistically significant
reductions in weight ( = 10.8 lbs, =9.3, p<.001), BMI ( =1.59,
=1.39, p<.001); and abdominal girth ( =3.6in, =3.2, p=.01).
Discussion
The impressive positive results evidenced in this
preliminary analysis demonstrate the effectiveness of telehealth interventions in the management of pre-diabetes
metabolic syndrome.
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