Improving Screening Uptake among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia
Abstract
:1. Introduction
2. Materials and Methods
2.1. Study Participants
2.2. Interventions
- The educational brochure was sent to each study participant by mail, typically within a week of randomization.
- A half-hour tailored telephone counseling session was conducted by a member of the study outreach team, in which the importance of breast cancer screening was emphasized, the woman’s “readiness for change” to engage in appropriate screening was evaluated [21], financial and physical barriers to screening were assessed, and recommendations for positive actions were developed and communicated. Additionally, each breast cancer survivor was urged to encourage her female FDRs to “talk with your doctor about… having regular breast screening tests…”. A written version of the telephone counseling script was subsequently mailed to the survivor, along with a separate note encouraging breast cancer screening.
- For study participants able and willing to identify a primary care provider, that PCP was mailed a packet containing the following: (1) a cover letter describing the study and notifying the PCP that a named study participant (who currently was not adherent to breast cancer screening recommendations) was a member of his/her practice; (2) a letter of support―signed by the presidents of the Georgia Chapter of the American College of Physicians, the Georgia Academy of Family Physicians, and the Georgia Chapter of the American College of Obstetrics and Gynecology, as well as by the medical director of the Cancer Coalition of South Georgia―that encouraged the PCP to note their patient’s elevated risk status in her medical record and engage in appropriate screening and follow-up; and (3) a “pink reminder form” with the study participant’s name and screening status for inclusion in her medical record.
2.3. Statistical Analyses
3. Results
3.1. Study Enrollment and Retention
3.2. Intervention Impact
4. Discussion
4.1. Appraisal of Findings
4.2. Study Limitations
5. Implications for Improving Adherence to Breast Cancer Screening
Recommendations
6. Conclusions
Author Contributions
Funding
Acknowledgments
Conflicts of Interest
Note
References
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Characteristics | Level | Intervention Group | |||
---|---|---|---|---|---|
Sample Totals a | Low-Intensity a N = 45 | High-Intensity a N = 50 | p-Value * | ||
Age | ≤45 years | 19 (20.0) | 10 (22.2) | 9 (18.0) | 0.673 |
46−55 years | 51 (53.7) | 22 (48.9) | 29 (58.0) | ||
≥56 years | 25 (26.7) | 13 (28.9) | 12 (24.0) | ||
Race/ethnicity | White | 33 (35.1) | 16 (35.6) | 17 (34.7) | 0.022 |
Black | 49 (52.1) | 19 (42.2) | 30 (61.2) | ||
Other | 12 (12.8) | 10 (22.2) | 2 (4.1) | ||
Marital status | Married/partnership | 49 (52.1) | 22 (48.9) | 27 (55.1) | 0.547 |
Other | 45 (47.9) | 23 (51.1) | 22 (44.9) | ||
Education level (highest grade completed) | College or post-grad | 45 (48.4) | 23 (52.3) | 22 (44.9) | 0.477 |
Other | 48 (51.6) | 21 (47.7) | 27 (55.1) | ||
Employment status | Working (FT/PT) | 55 (59.1) | 29 (65.9) | 26 (53.1) | 0.208 |
Other | 38 (40.9) | 15 (34.1) | 23 (46.9) | ||
Annual family income | <$50,000 | 43 (45.7) | 18 (40.0) | 25 (51.0) | 0.110 |
≥$50,000 | 36 (38.3) | 22 (48.9) | 14 (28.6) | ||
Refused/DK | 15 (16.0) | 5 (11.1) | 10 (20.4) | ||
Health insurance status b | Private | 54 (59.3) | 28 (65.1) | 26 (54.2) | 0.537 |
Public | 16 (17.6) | 7 (16.3) | 9 (18.8) | ||
Uninsured | 21 (23.1) | 8 (18.6) | 13 (27.0) | ||
SEER Summary Stage c | In Situ | 22 (23.1) | 11 (24.4) | 11 (22.0) | 0.874 |
Localized | 47 (49.5) | 21 (46.7) | 26 (52.0) | ||
Regional | 26 (27.4) | 13 (28.9) | 13 (26.0) | ||
Year of Diagnosis | 2000−2002 | 28 (29.5) | 11 (24.4) | 17 (34.0) | 0.486 |
2003−2006 | 38 (40.0) | 18 (40.0) | 20 (40.0) | ||
2007−2009 | 29 (30.5) | 16 (35.6) | 13 (26.0) |
Intervention Group | |||||
---|---|---|---|---|---|
Characteristics | Level | Sample Totals a | Low-Intensity a N = 48 | High-Intensity a N = 35 | p-Value * |
Age | ≤45 years | 52 (62.7) | 31 (64.6) | 21 (60.0) | 0.646 |
46−55 years | 13 (15.6) | 6 (12.5) | 7 (20.0) | ||
≥56 years | 18 (21.7) | 11 (22.9) | 7 (20.0) | ||
Race/ethnicity | White | 39 (47.5) | 22 (45.8) | 17 (50.0) | 0.330 |
Black | 40 (48.8) | 23 (47.9) | 17 (50.0) | ||
Other | 3 (3.7) | 3 (6.3) | 0 (0.0) | ||
Marital status | Married/partnership | 32 (39.5) | 20 (41.7) | 12 (36.4) | 0.631 |
Other | 49 (60.5) | 28 (58.3) | 21 (63.6) | ||
Education level (highest grade completed) | College or post-grad | 41 (50.0) | 23 (47.9) | 18 (47.1) | 0.939 |
Other | 41 (50.0) | 25 (52.1) | 16 (52.9) | ||
Employment status | Working (FT/PT) | 53 (66.3) | 29 (61.7) | 24 (72.7) | 0.305 |
Other | 27 (33.7) | 18 (38.3) | 9 (27.3) | ||
Annual family income | <$50,000 | 36 (43.9) | 21 (43.8) | 15 (44.1) | 0.289 |
≥$50,000 | 39 (47.6) | 21 (43.8) | 18 (53.0) | ||
Refused/DK | 7 (8.5) | 6 (12.4) | 1 (2.9) | ||
Health insurance status b | Private | 47 (57.3) | 27 (57.4) | 20 (57.1) | 0.614 |
Public | 15 (18.3) | 10 (21.3) | 5 (14.3) | ||
Uninsured | 20 (24.4) | 10 (21.3) | 10 (28.6) |
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Lipscomb, J.; Escoffery, C.; Gillespie, T.W.; Henley, S.J.; Smith, R.A.; Chociemski, T.; Almon, L.; Jiang, R.; Sheng, X.; Goodman, M.; et al. Improving Screening Uptake among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia. Int. J. Environ. Res. Public Health 2020, 17, 977. https://doi.org/10.3390/ijerph17030977
Lipscomb J, Escoffery C, Gillespie TW, Henley SJ, Smith RA, Chociemski T, Almon L, Jiang R, Sheng X, Goodman M, et al. Improving Screening Uptake among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia. International Journal of Environmental Research and Public Health. 2020; 17(3):977. https://doi.org/10.3390/ijerph17030977
Chicago/Turabian StyleLipscomb, Joseph, Cam Escoffery, Theresa W. Gillespie, S. Jane Henley, Robert A. Smith, Toni Chociemski, Lyn Almon, Renjian Jiang, Xi Sheng, Michael Goodman, and et al. 2020. "Improving Screening Uptake among Breast Cancer Survivors and Their First-Degree Relatives at Elevated Risk to Breast Cancer: Results and Implications of a Randomized Study in the State of Georgia" International Journal of Environmental Research and Public Health 17, no. 3: 977. https://doi.org/10.3390/ijerph17030977