PATHFINDERS--ACCESS AND EARLY CANCER DETECTION FOR THE UNDERSERVED

Northern California Cancer Center, Fremont CA

Investigators

Linked publications & trials

Abstract

Strategies to improve survival from breast and cervical cancer have not successfully addressed the needs of low-income and ethnically diverse women. The goal of this project is to improve initial breast and cervical cancer screening and maintenance of interval screening under conditions of shifting access to medical care in low-income, multi-ethnic sample of women in Alameda County, California. The specific aims of this study are: 1) in a randomized controlled trial, to develop and test the impact of a phased, access-oriented intervention, individually tailored in both content and intensity, "managed outreach"; 2) to evaluate the cost- effectiveness of the intervention; 3) to prospectively assess the association between cost of outreach and women's characteristics (including insurance status, positive/negative perceptions toward screening); 4) to identify and measure positive/negative perceptions in an under-served, multi-ethnic population. The proposed intervention, informed by a conceptual framework anchored in the Trans-theoretical Model and Precede-Proceed, is designed to achieve maximum impact at a minimum cost in an effort to make the intervention affordable to agencies serve low- income communities. A cohort of 1,500 ethnically diverse women, ages 45- 74, will be recruited from low-income census tracts, randomized to intervention of control group, and followed over 3 years. Throughout the intervention, women will be linked with resources from provider systems and insurance plans. The phases have been designed such that a costly, but effective, lay health work component is combined with less expensive but complementary activities. Computer-generated tailored letters, along with audio tapes for women of low literacy, will be sent every 6 months throughout the intervention based on data from follow-up surveys, insurance plans, and providers. Phase I combines letters and telephone counseling by Lay Wealth Workers (LHWs), or in-person support if needed. In Phase II, to reduce the cost and intensity of the intervention yet still make language-appropriate information and support available, LHWs will be phased out and women will be encouraged to use a multi-lingual telephone help-line for screening and access assistance. For the final 6 months of the intervention, the help-line will be phased out and women will be referred to existing community resources. We expect that this phased intervention will result in significant improvements in consumer skills and maintenance screening. The innovations of this study are to provide women tailored outreach at the lowest possible cost, and to associate outreach cost with individual pros/cons for screening.