DVD and telephone-based interventions effective to increase rates of cancer screening in rural areas

1. For female patients living in rural areas, an interactive DVD intervention and telephone-based patient navigation (PN) intervention increased rates being up-to-date with guideline-based breast, cervical, and colorectal cancer screening.

Evidence Rating Level: 1 (Excellent)

Individuals living in rural areas tend to have lower rates of screening as per guidelines, for breast, cervical, and colorectal cancer. Previous interventions have employed technological advancements and patient navigation tools to reach rural patients and promote screening for a single cancer. However, there are no known interventions that have been studied to promote screening for multiple types of cancer at once. Therefore, this current randomized controlled trial evaluated the effectiveness of various interventions at increasing women patients’ adherence to screening of breast, cervical, and colorectal cancer. The study compared a digital video disc (DVD) intervention, a DVD and telephoned patient navigation (PN) intervention, and usual care. The study population consisted of 963 female patients who were not up-to-date with at least 1 form of cancer screening. Participants were between 50 and 74 years, and came from rural Ohio and Indiana counties. For the DVD intervention, patients were mailed a DVD that allowed them to answer prompts and receive information based on their responses, educating patients on the advantages and barriers to screening. The DVD also provided information based on the patient’s age, family history, and thoughts about their own risk of cancer. The DVD/PN intervention added social workers who telephoned patients, an average of 3 times, to reiterate the DVD information, and provide counselling to explore how the patient’s barriers to screening could be overcome. Outcomes were evaluated 12 months, identifying which patients had completed screening for the 3 types of cancer, in accordance with guidelines. The results showed rates of 10%, 15%, and 30% for up-to-date screening of all cancers, for usual care, DVD, and DVD/PN interventions respectively. As well, the DVD participants had twice higher odds of being up-to-date with all screening compared to usual care (odds ratio 1.84, 95% CI 1.02-3.43, p = 0.048). The DVD/PN group had 3 times greater odds of being up-to-date with all screenings compared to the DVD group (OR 3.09, 95% CI 2.05-4.68, p < 0.001). Furthermore, the DVD/PN intervention had 4 times greater odds of patients being up-to-date for any one cancer compared to usual care (OR 4.01, 95% CI 2.60-6.28, p < 0.001), though this was not significant for the DVD intervention alone. Overall, this study showed that an interactive DVD intervention and a telephone patient navigation intervention were effective in improving cancer screening rates for female patients in rural areas.

Click to read the study in JAMA Network Open

Image: PD

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