The literature has emphasized that increased awareness of the public of the significance of disease prevention through avoidance of risk and early intervention and detection of cancer by screening tests is important. It has been demonstrated that patients rely on their physicians to inform them of their need for cancer screening tests and early detection. Physician reminders improve the physician's ability to remember to perform screening tests when age specific categories are determined. The goal of this study is to determine if reminders given to the patient at the onset of their appointment makes a difference in performance of screening tests for early detection. Screening tests will be performed on the basis of the American Cancer Society and the American College of Obstetrics and Gynecology's recommendations in the following categories: physician breast exam, mammography, pap smear, pelvic exam, rectal exam, stool occult blood, and sigmoidoscopy. Two primary care outpatient clinics will be used -- Medical Group Practice and Family Practice. The practice subjects will be physicians in training, namely housestaff from the following programs: primary care Medicine, Internal Medicine, combined Medicine/Pediatrics and Family Practice. A stratified random sample containing all of the residents in the program will be assigned to a study and a control condition. In the study condition, residents as well as patients will have age specific reminders of what screening exams should be performed. In the control condition only residents will be reminded to perform the age specific screening exams. The hypothesis under study for each of the categories above is that the performance of screening exams will increase as a result of patients being aware of what should be performed for their age group. The hypotheses will be tested using categorical data modeling that fits linear models to functions of response frequencies. Main effects and interaction effects will be analyzed to determine the complexity of the performance of screening exams. A follow-up analysis will be performed to determine the long-term effects of the initial patient intervention.
