An Intervention for Moving Long Overdue Women To Get a Mammogram

• Published in: Cancer research (Chicago, Ill.) Vol. 69; no. 24_Supplement; p. 6076
• Main Authors: Costanza, M., Luckmann, R., White, M., Rosal, M., LaPelle, N., Cranos, C.
• Format: Journal Article
• Language: English
• Published: 15.12.2009
• ISSN: 0008-5472; 1538-7445
• DOI: 10.1158/0008-5472.SABCS-09-6076

Abstract Background: While there is substantial evidence that mammography screening decreases breast cancer mortality, as many 15 million American women are overdue for a biennial mammogram. This pilot study addressed the usefulness of a computer-assisted telephone counseling program in motivating reluctant or resistant women to get a mammogram.Methods: 127 women, aged 45-79, enrolled in primary care practices and without a documented mammogram for >=27 months were identified, approved by providers and eligible for study. All women had adequate health insurance and all had received a screening recommendation from their provider. The intervention included a mailed educational booklet followed by tailored counseling call, motivational interviewing and facilitated short-interval test scheduling. Using a computer-assisted telephone counseling program, the counselor identified the subject's stage of readiness to get a mammogram, reviewed the booklet in detail, clarified any misinformation and discussed specific barriers. At the conclusion of counseling, the counselor used motivational interviewing techniques to reconcile subjects' stated values with their stage of readiness. Outcome measures included stage change and completed mammograms within 12 months of the call as documented in the claims data.Results: Of the 127 eligible women, 45 (35%) agreed to counseling. 11% of these women had never had a mammogram, 7% had not had one in 48-59 months; 62% had not had one in>=60 months. At the start of the call, 11% had decided not to get mammograms, 16% were undecided about whether to get one, 44% were planning to get one but had no specific appointment and 4% had a mammogram appointment. Of these 45 women, 73% moved 1 or more stages closer to getting a mammogram. Of 13 women initially not planning to get a mammogram, 3 scheduled a mammogram and 3 stated an intention to get one. 75 % of women who scheduled a mammogram with the counselor went on to complete the test. 58% of the 45 counseled women actually got a mammogram. Of the 82 eligible women who refused to be in the study or did not respond to the telephone calls, only 21% got a mammogram. (57.8% vs. 21.3%, p<.001)Conclusions: It is possible to reach mammogram-reluctant women and to move them to complete a mammogram. Many of the counseled women were not against having mammograms but had no definite plans to get one. Women who schedule a mammogram are likely to keep the appointment. Given the low rate of mammography in those refusing to participate or not answering our calls, we suspect this group held a large number of mammogram-resistant women.For these women, additional interventions, such a monetary enhancement might prove useful. A prospective controlled trial to evaluate this intervention is currently underway. Supportedby NIH R21-100286 Citation Information: Cancer Res 2009;69(24 Suppl):Abstract nr 6076.