Certain cancer screening tests are effective in early detection, most notably, the tests used for breast, cervical, and colorectal cancers. These tests, all of which are endorsed by the U.S. Preventive Task Force for women over age 50, include mammography, clinical breast examination (CBE), Pap smear, and fecal occult blood test (FOBT). In spite of widespread endorsement, many women do not systematically receive these tests. This is especially true for certain subpopulations -- Hispanics, pooper women, and women without health insurance. For example, as recently as 1996, only 24 percent of Hispanic patients over age 50 in Los Angeles County reported receiving regular mammograms. This is a randomized trial involving a sample of primary care physicians drawn from 29 contiguous communities in Los Angeles. The trial has four specific aims: 1) develop, pretest, and implement a multifaceted physician intervention designed to increase physician use and referral rates for breast, cervical, and colorectal cancer screening for underscreened female patients, 2) identify and track for two years the screening rates of female patients over age 50 for mammography, CBE, Pap, and FOBT, 3) compare the intervention versus control to estimate the cost effectiveness ratio for the intervention relative to the control, and 4) evaluate the effectiveness of the proposed intervention in achieving its stated goals. The intervention to be tested is a CME workshop that incorporates cancer control content, communication skill training, and cultural competence training to increase patient adherence to screening; patient brochures for physicians practices; 3 post CME reminder/evaluations; and a 1 year and a 2 year post workshop patient chart audit feedback. The physician intervention will be evaluated using a randomized two-group design, while the patients' records and survey data will provide the behavioral data to assess patient adherence to screening for the three cancers. Although much is known about barriers to breast cancer screening relative to other cancers, we know far less about cultural and communication barriers to breast, cervical and colorectal cancer screening. We also need to learn about cultural and communication barriers that affect patients who otherwise have assess to care. This multifaceted physician intervention is highly exportable, especially to managed care settings. Since southern California is moving rapidly toward managed care predominance, this experiment has the potential to be highly marketable and influential with the majority of future providers who care about screening adherence.
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