An RCT to Increase Breast and Colorectal Cancer Screening

Champion, Victoria L.; Christy, Shannon M.; Rakowski, William; Lairson, David R.; Monahan, Patrick O.; Gathirua-Mwangi, Wambui G.; Stump, Timothy E.; Biederman, Erika; Kettler, Carla; Rawl, Susan M.

doi:10.1016/j.amepre.2020.03.008

Cited by 16 publications

(21 citation statements)

References 30 publications

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“…Both involved a tailored DVD, with one also including PN, which allowed for assessment and an individualized approach to resolving individual barriers to screening. Results demonstrated that women receiving the tailored DVD followed by telephone based PN were over five times more likely to become UTD with mammography screening compared to women randomized to UC, consistent with other studies that have tested some combination of tailored messaging and PN [ 19 , 20 ]. For example, a meta-analysis found that interventions led by PNs significantly increased mammography, almost twofold over UC [ 36 ].…”

Section: Discussionsupporting

confidence: 84%

“…Participants used a DVD remote control to answer questions presented on menus within the DVD, and a tailored algorithm provided appropriate messages based on individual inputted responses. Content for interactive messages within the DVD were supported by a theoretical framework and were revised from an extensive message library used in prior research [ 15 , 16 , 17 , 18 , 19 , 20 ]. Tailored messages were delivered based on each user’s cancer screening history; knowledge of and risk factors for breast cancer; perceived benefits and barriers to breast cancer screening; and self-efficacy to obtain breast cancer screening.…”

Section: Methodsmentioning

confidence: 99%

“…Interventions to increase population-based mammography screening have been developed and tested for over two decades and include technology-based interventions supported by tailored messaging [ 12 , 13 , 14 , 15 , 16 , 17 , 18 , 19 , 20 ]. Additionally, patient navigation (PN) has been shown to increase women’s motivation and self-efficacy to complete mammography screening by reducing and/or removing barriers to screening [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

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The Effect of Two Interventions to Increase Breast Cancer Screening in Rural Women

Champion

Monahan

Stump

et al. 2022

Cancers

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Guideline-based mammography screening is essential to lowering breast cancer mortality, yet women residing in rural areas have lower rates of up to date (UTD) breast cancer screening compared to women in urban areas. We tested the comparative effectiveness of a tailored DVD, and the DVD plus patient navigation (PN) intervention vs. Usual Care (UC) for increasing the percentage of rural women (aged 50 to 74) UTD for breast cancer screening, as part of a larger study. Four hundred and two women who were not UTD for breast cancer screening, eligible, and between the ages of 50 to 74 were recruited from rural counties in Indiana and Ohio. Consented women were randomly assigned to one of three groups after baseline assessment of sociodemographic variables, health status, beliefs related to cancer screening tests, and history of receipt of guideline-based screening. The mean age of participants was 58.2 years with 97% reporting White race. After adjusting for covariates, 54% of women in the combined intervention (DVD + PN) had a mammogram within the 12-month window, over 5 times the rate of becoming UTD compared to UC (OR = 5.11; 95% CI = 2.57, 10.860; p < 0.001). Interactions of the intervention with other variables were not significant. Significant predictors of being UTD included: being in contemplation stage (intending to have a mammogram in the next 6 months), being UTD with other cancer screenings, having more disposable income and receiving a reminder for breast screening. Women who lived in areas with greater Area Deprivation Index scores (a measure of poverty) were less likely to become UTD with breast cancer screening. For rural women who were not UTD with mammography screening, the addition of PN to a tailored DVD significantly improved the uptake of mammography. Attention should be paid to certain groups of women most at risk for not receiving UTD breast screening to improve breast cancer outcomes in rural women.

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Section: Discussionsupporting

confidence: 84%

Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The Effect of Two Interventions to Increase Breast Cancer Screening in Rural Women

Champion

Monahan

Stump

et al. 2022

Cancers

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“…Two trials, deemed to have significant clinical variability for having exclusively enrolled only either sexes, were not included in the final meta-analysis (Champion et al, 2020;Hong and Kam, 2014). The effect estimates of the remaining four studies are summarized in Figure 4.…”

Section: Resultsmentioning

confidence: 99%

“…Adjusted odds ratio (95% CI) Variables adjusted for Champion, et al (2020) Stool-based screening:1.52 (0.85-2.73) Colonoscopy: 4.59 (2.24-9.42) Mammography medical record indicator; health site; age; race; education; income; marital status; BMI; whether depression limits patient's activities; family history of 1 or more blood relatives with colon cancer ; family history of 1 or more blood relatives with breast cancer; perceived risk of breast cancer; doctor's recommendation for mammography; number of past-year primary care visits, excluding eye care and dentistry; number of self-reported health problems; baseline stage of readiness; and scale scores measuring knowledge, susceptibility, benefits, fear, fatalism, self-efficacy, and barriers Cohen-Cline, et al (2014) 1.32 (1.14-1.52) Age, sex, and prior CRC screening among males, younger age groups, and lower educational level (Selva et al, 2019;Deding et al, 2017). This may account for the disproportionately higher uptake in an all-female population enrolled in one of the studies (Champion et al, 2020). In this systematic review, a posthoc analysis of studies which used unadjusted models showed high heterogeneity (I 2 =97%) suggesting that population demographics may indeed be contributing to the variability in between studies.…”

Section: Studymentioning

confidence: 99%

Mobile health interventions for improving colorectal cancer screening rates: A systematic review and meta-analysis

Elepaño

Fusingan

Yasay

et al. 2021

Asian Pac J Cancer Prev

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Objective: The aim of this systematic review and meta-analysis was to determine the efficacy of different mHealth interventions in increasing colorectal cancer (CRC) screening rates. Methods: A literature search for eligible studies was done in ClinicalTrials.gov, PubMed, and Scopus in October 2020. Included studies were randomized controlled trials done on adults due for CRC screening, who received either an mHealth intervention to promote screening or usual care. The primary outcome from these studies was completion of CRC screening. Two reviewers independently worked on selecting studies, collecting data, and determining risk of bias. Adjusted odds ratios (AOR) for CRC screening rates were summarized into a Forest plot. Results: A total of ten trials from three continents were included in the qualitative analysis. Risk of bias is low in terms of randomization, but high in terms of participant blinding, due to the nature of the interventions. Meta-analysis of four trials showed low clinical and statistical heterogeneity (I 2 =0%). Overall, the use of mHealth interventions is associated with higher CRC screening uptake when compared to usual care (AOR 1.33; 95% CI, 1.20-1.46). This effect was seen across different types of mHealth interventions, which included automated and non-automated telephone education and text-message reminders. Conclusion: This study showed that mHealth is associated with increased CRC screening participation regardless of the type of intervention used.

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Comparative Effectiveness of 2 Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening Among Women in the Rural US

et al. 2023

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ImportanceWomen living in rural areas have lower rates of breast, cervical, and colorectal cancer screening compared with women living in urban settings.ObjectiveTo assess the comparative effectiveness of (1) a mailed, tailored digital video disc (DVD) intervention; (2) a DVD intervention plus telephonic patient navigation (DVD/PN); and (3) usual care with simultaneously increased adherence to any breast, cervical, and colorectal cancer screening that was not up to date at baseline and to assess cost-effectiveness.Design, Setting, and ParticipantsThis randomized clinical trial recruited and followed up women from rural Indiana and Ohio (community based) who were not up to date on any or all recommended cancer screenings. Participants were randomly assigned between November 28, 2016, and July 1, 2019, to 1 of 3 study groups (DVD, DVD/PN, or usual care). Statistical analyses were completed between August and December 2021 and between March and September 2022.InterventionThe DVD interactively assessed and provided messages for health beliefs, including risk of developing the targeted cancers and barriers, benefits, and self-efficacy for obtaining the needed screenings. Patient navigators counseled women on barriers to obtaining screenings. The intervention simultaneously supported obtaining screening for all or any tests outside of guidelines at baseline.Main Outcomes and MeasuresReceipt of any or all needed cancer screenings from baseline through 12 months, including breast, cervical, and colorectal cancer, and cost-effectiveness of the intervention. Binary logistic regression was used to compare the randomized groups on being up to date for all and any screenings at 12 months.ResultsThe sample included 963 women aged 50 to 74 years (mean [SD] age, 58.6 [6.3] years). The DVD group had nearly twice the odds of those in the usual care group of obtaining all needed screenings (odds ratio [OR], 1.84; 95% CI, 1.02-3.43; P = .048), and the odds were nearly 6 times greater for DVD/PN vs usual care (OR, 5.69; 95% CI, 3.24-10.5; P &lt; .001). The DVD/PN intervention (but not DVD alone) was significantly more effective than usual care (OR, 4.01; 95% CI, 2.60-6.28; P &lt; .001) for promoting at least 1 (ie, any) of the needed screenings at 12 months. Cost-effectiveness per woman who was up to date was $14 462 in the DVD group and $10 638 in the DVD/PN group.Conclusions and RelevanceIn this randomized clinical trial of rural women who were not up to date with at least 1 of the recommended cancer screenings (breast, cervical, or colorectal), an intervention designed to simultaneously increase adherence to any or all of the 3 cancer screening tests was more effective than usual care, available at relatively modest costs, and able to be remotely delivered, demonstrating great potential for implementing an evidence-based intervention in remote areas of the midwestern US.Trial RegistrationClinicalTrials.gov Identifier: NCT02795104

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An RCT to Increase Breast and Colorectal Cancer Screening

Cited by 16 publications

References 30 publications

The Effect of Two Interventions to Increase Breast Cancer Screening in Rural Women

The Effect of Two Interventions to Increase Breast Cancer Screening in Rural Women

Mobile health interventions for improving colorectal cancer screening rates: A systematic review and meta-analysis

Comparative Effectiveness of 2 Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening Among Women in the Rural US

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