Enhancing adherence following abnormal Pap smears among low-income minority women: a preventive telephone counseling strategy.
Enhancing adherence following abnormal Pap smears among low-income minority women: a preventive telephone counseling strategy.
复制标题
提高低收入少数族裔妇女子宫颈抹片检查异常后的依从性：预防性电话咨询策略。
DOI：
10.1093/jnci/89.10.703
复制
发表时间：
1997
期刊：
影响因子：
--
通讯作者：
Helm,CW
中科院分区：
文献类型：
--
作者：
Miller,SM;Siejak,KK;Schroeder,CM;Lerman,C;Hernandez,E;Helm,CW
背景：尽管近年来宫颈癌前病变的发病率不断增加，但及时的初始和长期随访护理可以有效减少不必要的发病率和死亡率。例如，如果早期发现，宫颈癌风险最高的人群（即社会经济地位较低的少数族裔女性）的 4 年生存率接近 95%。患有晚期疾病的女性前景较差（0%-39% 的生存率）。然而，高风险人群最不可能遵守推荐的诊断方案。 目的：我们测试了针对低收入内城区女性在子宫颈抹片检查结果异常后进行的简短电话咨询干预的有效性。这些妇女被告知进行初次和 6 个月重复随访诊断程序（即宫颈阴道镜检查）的重要性。方法：采用随机试验设计来比较电话咨询对这些妇女的影响，在预约 6 个月后重复阴道镜检查之前，有（n = 192）或没有（n = 203）加强咨询电话，并有电话预约确认/提醒电话（n = 192）。 216）并采取标准护理（即不进行电话联系）（n = 217）。电话咨询方案探讨并解决了依从性（即预约阴道镜检查）的三个心理障碍：1）编码/期望（例如，患者是否了解自己患宫颈癌的风险？）； 2）情感/情绪（例如，该妇女是否担心这种情况及其后果？）； 3) 自我监管/实用（例如，该妇女是否可能忘记医疗预约？）。使用逻辑回归分析干预组的效果以及对阴道镜检查依从性引起的心理障碍类型。结果：逻辑回归分析结果（以收到预约确认/提醒电话的女性作为对照组）显示，与电话确认相比，电话咨询对初次阴道镜检查的依从率显着更高（395 名女性中的 300 名 [76%] 与 216 名女性中的 147 名 [68%]；比值比 [OR] = 1.50；95% 置信区间 [CI] = 1.04-2.17）。此外，标准护理的依从率显着低于电话确认（217 名女性中的 109 名 [50%] 对比 216 名女性中的 147 名 [68%]；OR = 0.47；95% CI = 0.32-0.73）。关于 6 个月重复阴道镜检查预约的出席率，在初次就诊之前接受电话咨询（并建议进行后续阴道镜检查）的 80 名患者比接受电话确认的 47 名患者更有可能坚持（80 名女性中的 49 名 [61%] 与 47 名女性中的 17 名 [36.2%]；OR = 2.70；95% CI = 1.15-6.51）。电话确认组和标准护理组 (n = 30) 患者的 6 个月依从率较低，且无显着差异（47 名女性中的 17 名 [36.2%] 与 30 名女性中的 9 名 [30.0%]；OR = 1.08；95% CI = 0.40-2.89）。忘记医疗预约（OR = 0.31；95% CI = 0.19-0.51）和日程安排冲突（OR = 0.45；95% CI = 0.28-0.72）也与较低的依从率相关。结论：电话咨询的使用似乎是提高传统上服务不足的人群对后续宫颈诊断程序的初始和长期依从性的有效策略。对巴氏涂片检查结果呈阳性且具有特定心理障碍的患者可能需要更深入、更有针对性的咨询……
Background:Although the incidence of precancerous conditions of the cervix has recently been increasing, prompt initial and long-term follow-up care can effectively reduce unnecessary morbidity and mortality. For example, the 4-year survival rates among those individuals at greatest risk for cervical cancer (i.e., minority women of low socioeconomic status) approach 95% with early detection. Women who present with advanced disease have a much poorer outlook (0%-39% survival). Yet, high-risk individuals are least likely to adhere to recommended diagnostic regimens.Purpose:We tested the effectiveness of a brief telephone counseling intervention directed to low-income, inner-city women after they had received an abnormal Pap smear result. The women were counseled on the importance of having an initial and 6-month repeat follow-up diagnostic procedure (i.e., colposcopic examination of the cervix).Methods:A randomized trial design was used to compare the effects on these women of telephone counseling with (n = 192) or without (n = 203) a booster counseling telephone call prior to the appointment for a repeat colposcopy 6 months later, with a telephone appointment confirmation/reminder call (n = 216) and with standard care (i.e., no telephone contact) (n = 217). The telephone counseling protocol probed for and addressed three psychologic barriers to adherence (i.e., attendance at appointment for colposcopy examination): 1) encoding/expectancy (e.g., did the patient understand her risk of developing cervical cancer?); 2) affective/emotional (e.g., was the woman worried about the condition and its consequences?); and 3) self-regulatory/practical (e.g., was the woman likely to forget medical appointments?). Logistic regression was used to analyze the effects of the intervention group and the type of psychologic barriers elicited on colposcopy adherence.Results:The results of logistic regression analysis (using those who received an appointment confirmation/ reminder telephone call as the comparison group) revealed that telephone counseling produced significantly higher adherence rates to the initial colposcopy visit compared with telephone confirmation (300 [76%] of 395 women versus 147 [68%] of 216; odds ratio [OR] = 1.50; 95% confidence interval [CI] = 1.04-2.17). Additionally, standard care resulted in significantly lower adherence rates than did telephone confirmation (109 [50%] of 217 women versus 147 [68%] of 216; OR = 0.47; 95% CI = 0.32-0.73). Regarding attendance at the 6-month repeat colposcopy appointments, the 80 patients who had received telephone counseling prior to the initial visit (and were recommended for follow-up colposcopy) were significantly more likely to adhere than were the 47 patients who had received telephone confirmation (49 [61%] of 80 women versus 17 [36.2%] of 47; OR = 2.70; 95% CI = 1.15-6.51). The 6-month adherence rates for patients in the telephone confirmation group and the standard care group (n = 30) were low and did not differ significantly (17 [36.2%] of 47 women versus nine [30.0%] of 30; OR = 1.08; 95% CI = 0.40-2.89). Forgetting medical appointments (OR = 0.31; 95% CI = 0.19-0.51) and having scheduling conflicts (OR = 0.45; 95% CI = 0.28-0.72) were also associated with lower rates of adherence.Conclusion:The use of telephone counseling appears to be an effective strategy for enhancing initial and long-term adherence to a follow-up cervical diagnostic procedure in a traditionally underserved population. Patients who respond to a positive Pap test result with a particular profile of psychologic barriers may require more intensive and targeted counseling …
登录
查看更多内容
电话咨询提高了低收入少数族裔女性对阴道镜检查的依从性。
DOI：
10.1200/jco.1992.10.2.330
发表时间：
1992
期刊：
Journal of clinical oncology : official journal of the American Society of Clinical Oncology
影响因子：
--
作者：
Lerman,C;Hanjani,P;Caputo,C;Miller,S;Delmoor,E;Nolte,S;Engstrom,P
通讯作者：
Engstrom,P
女性对阴道镜检查的信息需求。
DOI：
10.1111/j.1547-5069.1990.tb00164.x
发表时间：
1990
期刊：
Image--the journal of nursing scholarship
影响因子：
--
作者：
A. Barsevick;D. Lauver
通讯作者：
D. Lauver
宫颈上皮内瘤变（不典型增生和原位癌）和早期浸润性宫颈癌
DOI：
10.3322/canjclin.39.3.157
发表时间：
1989
期刊：
CA: A Cancer Journal for Clinicians
影响因子：
--
作者：
J. Nelson;H. Averette;R. Richart
通讯作者：
R. Richart
DOI：
10.1093/jnci/85.13.1074
发表时间：
1993-07-07
期刊：
JOURNAL OF THE NATIONAL CANCER INSTITUTE
影响因子：
--
作者：
LERMAN, C;DALY, M;ENGSTROM, P
通讯作者：
ENGSTROM, P
和田拓郎等人：癌症研究。
DOI：
--
发表时间：
--
期刊：
影响因子：
--
作者：
通讯作者：
--