In 12 rural Wisconsin counties, the State is implementing screening mammography targeted at women over age 40 who have never have a mammogram. Six of these rural counties will be screened by Marshfield Clinic (6,400 women yearly) which expects to diagnose about 128 new cases of breast cancer yearly in these patients. In the current proposal, a 60-month research project will provide nursing interventions for women with newly diagnosed breast cancer to increase their access to national group breast cancer treatment protocols. The State screening program will provide rapid access to newly diagnosed breast cancer patients, allowing a timely staging workup and time to inform the women about treatment options (surgery, radiation, systemic therapy), and protocol treatment appropriate to her specific situation. Years 1-5, Diagnosis and Treatment Measures: In all 12 counties, selected diagnostic and treatment data will be abstracted on all women with breast cancer identified via the State screening process. This will provide """"""""baseline"""""""" data for the 6 counties which will later be intervened, and will provide concurrent control data for the 6 other counties which are not intervened. Years 2-5, Project Interventions: Six of the counties will receive nursing interventions, including: 1) community based seminars on breast cancer for local physicians, nurses, and medical personnel, 2) distribution of directories listing regional breast cancer diagnosis and treatment resources, 3) project tracking of the women's diagnostic workup in the rural community, 4) distribution of patient information packets describing diagnosis and treatment options, 5) assistance to the local physician in staging and determining protocol eligibility, 6) community nursing visits to explain protocols and obtain consent, 7) community-based consultation, 8) transportation and lodging if needed for the women to participate in protocol therapy. This research will use a non-randomized observational design with a 12 month baseline-measurement period, followed by a 48 month nursing- intervention period. The primary outcome measure will be the proportion of rural patients eligible for protocols who are enabled to enter these studies. Analyses will include intervened versus control counties, and intervened counties before and after interventions are applied. The primary hypothesis is that nursing interventions will increase rural patient protocol control.
