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Utilizing Appointment Facilitation and Reminder Systems to Increase Screening Among Enrollees of the Wayne County BCCCP
The Wayne County BCCCP provides breast cancer screening, follow up and treatment at “no cost” to uninsured, low-income women 40 to 64 years of age in the metro Detroit area. Our population is diverse – 60% are African-American, 15% of Arabic descent and the remainder White (Hispanic and other). Each year nearly a third of our 7,000 program enrollees fail to follow through by scheduling and completing a screening appointment. Last year over 2,000 enrolled, eligible women missed an opportunity to be screened (and potentially treated) for early breast cancer.
To examine the current patterns of and barriers to BCCCP participation and compare the effectiveness and costs of mailed reminders and personal contact by telephone in promoting appointment scheduling and completion. We hypothesize that telephone-based, tailored strategies will be more effective than mailed reminders.
Our aims focus on promoting advancement along a screening pathway, consistent with the “stages of change” model.
1 Evaluate the impact of telephone outreach to promote the scheduling of screening appointments among BCCCP enrollees (contemplation to planning)
2. Evaluate the effectiveness of strategies intended to promote the completion of screening among women with scheduled appointments (planning to action).
3. Evaluate the effectiveness of strategies intended to promote rescheduling and completion of initially failed appointments (relapse prevention).
The Aim 1 design is observational. We will conduct interviews among a sample of 200 enrollees to examine perceived barriers to participation. All enrollees will be contacted by phone to offer assistance in scheduling appointments (n=1,600). Aim 2 is a randomized controlled trial designed to assess the effectiveness of telephone support as contrasted with a mailed postcard reminder as strategies to promote appointment keeping (n= 1,750 per arm). Aim 3 is also a randomized controlled trial, designed to assess the effectiveness of telephone support as contrasted with a mailed invitation as strategies to promote rescheduling of initially failed screening appointments (n=1400 per arm).
Potential Outcomes and Benefits of the Research:
A successful project will define and address remediable barriers to screening among BCCCP-eligible women who appear unable to take advantage of this no cost opportunity. Each year up to an additional 2,000 women could be screened. Furthermore, our results and strategies would generalize to other BCCCP’s in all 50 States.
Background: Uninsured, low-income women have limited access to breast cancer screening services. Since 1992, the CDC has offered a National Early Detection Breast and Cervical Cancer Program (BCCCP) which provides “free” breast cancer screening, follow up and treatment for eligible women. In metro Detroit this program is delivered by the Wayne County BCCCP. Following enrollment, women call the BCCCP to schedule an appointment. Last year our program enrolled over 7,000 women but fewer than 5,000 completed screening. Thus nearly 2,000 interested and eligible women missed an opportunity to be screened (and treated) for early breast cancer. Our program population is diverse-60% of enrollees are African-American, 15% Arabic and the remainder White (Hispanic and other).
Objectives/hypotheses: To better understand and address the barriers to BCCCP participation in our community.
Specific Aims: Women face barriers at each step in the BCCCP process from enrollment to appointment scheduling to appointment completion. Aim 1 is to see if telephone outreach to enrolled women can increase the number of scheduling screening appointments. Aim 2 is to determine if telephone support offered a few days before the scheduled appointment is more helpful than a simple mailed reminder in promoting appointment keeping. This call will address logistic and personal barriers. Aim 3 is to determine if telephone support is more effective than mailed reminders in promoting rescheduling of failed appointments.
Study Design: We will begin by calling enrolled women to help those without an appointment schedule one. We will interview 200 of these women to understand their barriers to BCCCP participation. Next we will divide women with scheduled appointments into 2 groups: one group will be sent a postcard reminder a few days before their scheduled appointment while the second will receive the postcard plus a phone call to offer additional assistance. Lastly, among all enrolled women who fail to keep a screening appointment, we will compare the effectiveness of mail and telephone contact as strategies to encourage rescheduling of appointments.
Potential Outcomes and Benefits of the Research: A successful project will define strategies that are effective in removing barriers to BCCCP participation. If effective, these strategies could increase by up to 2,000 the number of economically disadvantaged Wayne County women who would be screened by our BCCCP each year. Furthermore, our results and strategies generalize to BCCCP’s serving similar women in all 50 States.