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 US Preventive Task Force for women over age 50, include mammography, clinical breast exam (CBE), pap smear, and fecal occult blood test (FOBT). In spite of widespread endorsement by credible sources, many women do not systematically receive these tests, especially if they are older women and Hispanic older women. As recently as 1996 in a Los Angeles County study, 58 percent of women aged 60-64, and only 25 percent of those who were Hispanic, reported adherence with mammography screening. In 1997, in a different Los Angeles study, only 32 percent of female patients aged 60-80 were adherent with annual FOBT. Hispanic patients reported a 23 percent adherence rate. Since older women are especially at risk for cancer with increasing age, these screening rates are unnecessarily low. The overall goal of this study is to increase the screening adherence of 60-80 year old women, especially Hispanic women. The investigators propose a randomized trial involving a sample of primary care physicians drawn from 23 contiguous communities in Los Angeles County. The research design incorporates a physician intervention that teaches physician communication and caring skills. These skills have been identified as the most significant predictors of mammography, CBE and FOBT adherence in previous studies conducted by the team. The primary physician outcome measure will be changes in the reported utilization of these skills, combined in the Physician Behavior Checklist (PBC) measure that will be validated in this study. The PBC assesses the effectiveness of the physician in facilitating adherence. Long term objectives include: 1) develop, pre-test and implement a physician intervention designed to increase physician use of PBC skills, 2) determine the screening rates of female patients ages 60-80 and assess how these rates change as a function of the intervention, 3) compare the intervention versus control group to estimate the cost effectiveness ratio of the intervention relative to the control group, and 4) evaluate the effectiveness of the proposed intervention. Few physician and patient communication and relationship skills have been directly linked to patient outcomes such as cancer screening adherence. A brief validated patient measure (for use across medical settings in English and Spanish) such as the PBC will be an important contribution to public health policy. Finally, the physician intervention that is proposed for testing is efficient, feasible, and exportable.
