DVD, Counseling Boost Cancer Screening Among Rural Women
A low-cost intervention that involved mailing patients an educational, personally tailored DVD along with follow-up telephone counseling significantly improved rates of recommended cancer screenings among women living in rural areas, where uptake of such screenings is often suboptimal.
Women who received the DVD along with counseling from patient navigators were almost six times more likely to undergo guideline-recommended breast, cervical, and colorectal cancer screening in comparison with patients who received usual care.
“Our findings demonstrate that interventions delivered remotely to rural women can simultaneously improve screening rates for breast, cervical, and colorectal cancer,” report the authors of a study published on April 28 in JAMA Network Open.
Rates of routine cancer screenings are lower among women in rural areas. Barriers include having worse access to care and having less knowledge about screening recommendations. Lower screening rates can lead to later-stage diagnoses and worse patient outcomes. Recent data indicate, for instance, that cancer mortality rates are higher in rural areas than in urban areas.
Efforts to improve screenings often focus on one type of cancer, such as breast, cervical, or colorectal cancer. Victoria L. Champion, PhD, RN, of the School of Nursing, Indiana University, Indianapolis, and colleagues investigated the potential benefits of an intervention to improve screening for all three types of cancer simultaneously.
For the study, Champion and colleagues recruited 963 women from rural Indiana and Ohio who were not up to date on recommended cancer screenings. The women were between the ages of 50 and 74 (mean age, 58.6 years); almost all (97%) were White.
Participants completed a baseline survey that assessed their beliefs, knowledge, and self-reported adherence to cervical, breast, and colorectal cancer screening. The authors randomly assigned participants to one of three interventions between November 2016 and July 2019.
One group was mailed an educational interactive DVD that contained messages tailored to each woman’s survey responses; this group also received a telephone follow-up within 4 weeks from patient navigators. The second group received the educational DVD without telephone follow-up. The third group received only usual care, which varied by location but at best involved a reminder to schedule a cancer screening.
The interactive DVD was designed to assess patients’ health beliefs and address common issues, including perceptions about the risk of developing the targeted cancers, as well as barriers, benefits, and self-efficacy in obtaining recommended screenings. The follow-up calls were provided as necessary; patients received a mean of three content calls (range, 1 to 14 calls) per woman. The patient navigators provided further counseling to help women overcome the barriers associated with screenings.
At 12-month follow-up, the unadjusted rate of screenings for all three types of cancer was 10% in the usual-care group, 15% in the DVD group, and 30% in the DVD plus patient navigation group (omnibus P < .001). The unadjusted 12-month rate of being up to date with screening for any of the three types of cancer was 25% for usual care, 29% for DVD alone, and 49% for both interventions (omnibus P < .001).
After multivariate adjustment, those who received the DVD/patient navigator intervention were nearly six times more likely to obtain all needed screenings compared with those who received only usual care (odds ratio [OR], 5.69; P < .001).
Those who received only the DVD were almost two times more likely to undergo the recommended cancer screenings (OR, 1.84; P = .048). Women in the double intervention group were three times more likely to obtain all needed screenings compared with those in the DVD group (OR, 3.09; P < .001).
The authors also found that participants who were aged 65 years or older were only half as likely to be up to date on screenings for all cancers (OR, 0.53; P = .03).
With previous studies showing similar results, the current study adds to a growing body of evidence of the benefits of such interventions. However, with DVD technology becoming obsolete, the authors note the need to translate the DVD intervention to an online tool.
Overall, “this study supports the one-stop-shop approach as advocated by other researchers who also found that a screening intervention could simultaneously improve the uptake of more than 1 cancer screening test,” the authors say. “The potential for increasing multiple screening behaviors at one time is especially relevant for rural communities where health care may be hampered by remote living conditions that limit access to preventive services.”
And with the general costs of cancer treatment in the US running an average of about $150,000 per patient, the relatively low cost of this intervention, even with patient navigators, could yield significant savings.
“The additional costs required for the addition of patient navigators to improve screening may result in cost savings by avoiding cancer deaths or treatment at more advanced stages,” Champion and colleagues write.
The study was supported by grants from the National Cancer Institute and the National Institute of Nursing Research.
JAMA Netw Open. Published April 28, 2023. Full text
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