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项目的一部分 Grant旨在增加未充分使用的女性的乳腺癌筛查 乳房X光检查。互动合作者包括福克斯·蔡斯癌症 加州大学弗雷德·哈钦森癌症研究中心 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。该计划的总体目标 互动应用是为了比较Barrier的有效性- 美国5个地区的特定电话咨询(BSTC) 评估增加筛查的干预措施的成本效益 在学习的女性中。 SUNYSB项目将以50-80岁的社区妇女为目标 通过电话调查确定为未充分利用常规 乳房X光检查。低收入、少数族裔和老年妇女的比例过高 在这些未充分利用的国家中。女性样本将从四个人中抽取 研究长岛上的社区。BSTC将是一项干预措施， 为所有联盟站点所共有。SUNYSB项目还将测试一个 个性化阶梯式继续医学教育干预 涉及邮件、电话和办公室的累进级别 基于医生对国家医疗服务的依从性水平的干预措施 乳房筛查指南。医生将被归类为完整的， 根据对基准调查的答复，部分或不符合要求 研究社区中有900多名初级保健医生。办公室里的 干预措施旨在改善办公系统的使用，并 培养临床乳房检查的技能(使用乳房护理 方法)和沟通(使用标准化患者)。国际教育、科学及文化研究中心 干预将仅限于未充分利用的女性医生，他们是 被归类为部分或差劲的遵从者。这项研究涉及一项 析因设计检验BSTC和ISCME的相对效应 单独和联合应用以增加定期乳房X光检查的使用 1350名部分或较差服从医生的未充分利用女性将 被随机分配到四个研究组。另有600名使用不足的女性 完全遵守规定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 和练习。这项研究集中在一个重要问题上：如何 鼓励未充分利用乳房的人定期进行乳房检查。这个 由于研究正在进行，因此结果应该具有广泛的推广性 在全国范围内的5个环境中进行了一系列比较 在不同的交付环境和人群中。

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.