REDUCING BARRIERS TO THE USE OF BREAST CANCER SCREENING

SUNYSB提交的拟议研究是一个更大的互动的一部分， 旨在增加未充分利用妇女的乳腺癌筛查的赠款 乳房X光检查 互动合作者包括福克斯大通癌症 中心，弗雷德哈钦森癌症研究中心，大学 马萨诸塞州和加州大学洛杉矶分校，所有成员， NCI乳腺癌筛查联盟 的总体目标 交互式应用程序是比较屏障的有效性- 具体电话咨询（BSTC）在美国的5个地区和 评估增加筛查干预措施的成本效益 在研究女性中。 SUNYSB项目将针对50-80岁的社区妇女， 通过电话调查确定为经常资源利用不足的国家 乳房X光检查 低收入、少数民族和老年妇女所占比例过高 在这些利用不足的人中。 女性样本将从四个 研究长岛的社区。 BSTC将是一种干预， 适用于所有联盟网站。 SUNYSB项目还将测试 个体化阶梯式继续医学教育干预 包括邮件、电话和办公室内的逐步升级 根据医生对国家卫生标准的遵守程度采取干预措施 乳腺癌筛查指南。 医生将被分为全， 部分遵守者或遵守较差者，根据对 研究社区的900多名初级保健医生。 诊室 干预措施旨在改善办公系统的使用， 发展临床乳房检查技能（使用MammaCare 方法）和沟通（使用标准化患者）。 ISCME 干预将仅限于使用不足的女医生， 被归类为部分或较差的遵守者。 这项研究涉及一个 析因设计，以测试BSTC和ISCME的相对效应， 单独和联合应用于增加常规乳腺X射线摄影的使用 将对1350名部分或较差依从医生的使用不足女性进行 随机分配到四个研究组。 另外600名使用不足的妇女， 完全依从的医生也将被随机分配到BSTC或 控制条件 干预前和干预后电话调查（使用 5个合作机构）将评估妇女的知识、信仰、 和实践。 研究的重点是如何 鼓励未充分使用者参加定期乳房检查。 的 研究结果应具有广泛的普适性，因为研究正在 在全国5个地方进行了一系列比较， 在不同的分娩环境和人群中。

The proposed research submitted by SUNYSB is part of a larger interactive grant aimed at increasing breast cancer screening among women who underuse mammography. The Interactive collaborators include the Fox Chase Cancer Center, Fred Hutchinson Cancer Research Center, University of Massachusetts and University of California at Los Angeles, all members of the NCI Breast Cancer Screening Consortium. The overall aims of the interactive application are to compare the effectiveness of Barrier- Specific Telephone Counseling (BSTC) in 5 regions of the U.S. and to assess the cost-effectiveness of the intervention in increasing screening among study women. The SUNYSB project will target community women aged 50-80 who are identified through telephone surveys as under-utilizers of regular mammography. Low-income, minority and elderly women are overrepresented among such under-utilizers. The samples of women will be drawn from four study communities on Long Island. BSTC will be an intervention that is common to all Consortium sites. The SUNYSB project will also test an individualized-stepped continuing medical education (ISCME) intervention involving progressive levels of mail, telephone and in-office interventions based on the physicians' level of compliance with national guidelines for breast screening. Physicians will be classified into full, partial, or poor-compliers based upon responses to baseline surveys of over 900 primary care physicians in the study communities. The in-office intervention is designed to improve the use of office systems and to develop skills in clinical breast examination (using the MammaCare approach) and communication (using standardized patients). The ISCME intervention will be limited to under-utilizer women's physicians who are classified as partial or poor compliers. The research involves a factorial design to test the relative effects of BSTC and of ISCME when applied alone and in combination on increasing regular mammography use 1350 underuser women with partial or poor complying physicians will be randomized to the four study arms. An additional 600 underuser women with full complying physicians will also be randomized to either a BSTC or control condition. Pre- and post-intervention telephone surveys (using core items adopted by the 5 collaborating institutions) will assess women's knowledge, beliefs and practices. The research focuses on the important question of how to motivate underusers to participate in regular breast screening. The results should have wide generalizability since the research is being conducted in 5 settings across the country with a range of comparisons across various delivery settings and populations.