Efficacy of patient letter reminders on cervical cancer screening

Abstract

OBJECTIVE:To perform a meta-analysis on existing randomized controlled trials to investigate the efficacy of patient letter reminders on increasing cervical cancer screening using Pap smears. METHODS:A search was conducted for all relevant published and unpublished studies between the years 1966 and 2000. Eligibility criteria included randomized controlled studies that examined populations due for Pap smear screening. The intervention studied was in the form of a reminder letter. The Mantel-Haenszel method was used to measure the summary effect of the intervention. A test for homogeneity using the Mantel-Haenszel method was performed. RESULTS:Ten articles fulfilled the inclusion criteria, including one unpublished study. The test for homogeneity showed evidence of heterogeneity ( 2 = 31, 9 df, P < .001). An analysis for causes of heterogeneity was pursued. Division into subpopulations based on socioeconomic status resolved the heterogeneity ( 2 = 5.2, 8 df, P = .75). The studies evaluating those in lower socioeconomic groups had a smaller response (odds ratio [OR], 1.16; 95% confidence interval [CI ], 0.99 to 1.35) than those studies using mixed populations (OR, 2.02; 95% CI, 1.79 to 2.28). The pooled odds ratio showed that patients who received the intervention were significantly more likely to return for screening than those who did not (OR, 1.64; 95% CI, 1.49 to 1.80). E arly detection of cervical cancer through screening can lower mortality by 20% ± 60%. 1 Despite public health education on the benefits of screening for cervical cancer, the overall percentage of women who had a recent Pap test according to the Centers for Disease Control and Prevention's National Health Interview Survey between 1987 and 1992 remained at 67%. 2 Certain subpopulations have been found to lag behind the general population in cervical cancer screening rates. Those less likely to be screened include the elderly, women living in rural areas, non±English-speaking Hispanics, those below the poverty index, and women with less than a high school education. 3 Interventions to improve Pap smear screening have had mixed results, with some studies finding significant improvement in screening while others only a modest benefit, if any. We are aware of only one other metaanalysis specifically dealing with patient reminders for cervical cancer screening. 4 This meta-analysis, which pooled 6 studies, found that women had a higher likelihood of obtaining a Pap smear if they received reminders. But there was marked heterogeneity in the pooled studies so that the significance of the results was unclear. The authors did not pursue an examination for sources of heterogeneity. We found 2 additional metaanalyses of letter reminder interventions. A metaanalysis on reminders promoting mammography found an improvement in mammography completion rates using a letter intervention (OR, 1.48; P < .001). 5 However, this study also had evidence of heterogeneity that could not be explained. A meta-analysis of computer-based reminder systems using physician and ...

Tailored interventions to promote mammography screening: A meta-analytic review

“…The very small aggregate effect size is similar to effect sizes found from meta-analyses of patient letter reminders for cervical cancer screening (OR = 1.64; Tseng et al, 2001) and of tailored self-help materials promoting smoking cessation (OR = 1.42; Lancaster and Stead, 2006). The small size may be due to an increase in mammography rates in the general population (Legler, 2002).…”

Inadequate Systems to Support Breast and Cervical Cancer Screening in Primary Care Practice

“…Patient reminders have been shown to be effective in increasing breast and cervical cancer screening rates. [29][30][31][32] Reported NCQA recognition as a PCMH also was associated with increased use of comparative performance reports and automated reports to alert providers of patients due for cancer screening outside the context of the clinical visit. Theoretical and empirical evidence supports the efficacy of physician audits and feedback in improving cancer screening.…”

Randomized, Controlled Trial of a Multimodal Intervention to Improve Cancer Screening Rates in a Safety-Net Primary Care Practice

“…[10][11][12] By contrast, electronic physician reminders have little effect on screening rates, and solitary, lower-cost interventions (mailed patient reminders, automated phone calls) increase screening rates, but only modestly. 6,[13][14][15][16][17] However, several low-cost interventions might be combined to improve effect sizes. Stone et al reviewed interventions to improve preventive healthcare services and showed an additive effect of combined interventions.…”