INCREASING MAMMOGRAPHY SCREENING AMONG OLDER WOMEN

摘要：乳腺癌的发病率和死亡率在40岁以后迅速上升，60岁以上女性的发病率和死亡率增幅最大。然而，老年妇女接受筛查的可能性最小。拟议的研究将测试通过初级保健实践进行的项目的有效性，以增加65岁及以上的城乡妇女的乳房x光检查。该研究将采用随机设计，其中50个初级保健实践将随机分为干预组和对照组。干预实践将接受一个项目，以增加65岁及以上没有进行筛查的妇女的乳房x光检查，定义为在参加研究之前至少18个月没有进行乳房x光检查。研究的第一步将是确定医生和没有进行乳房x光检查的老年妇女进行乳房x光检查的潜在障碍。这些障碍将通过信息丰富和有说服力的信息加以解决，这些信息将分三个阶段，每隔四个月发布一次。第一阶段将确定初级保健医生对老年妇女乳房x光检查的关注，并测试低影响干预的有效性，该干预将解决医生筛查老年妇女的障碍，并为他们提供可用于解决患者担忧的信息。第二阶段将为老年妇女提供关于乳房x光检查的具体信息，并向她们强调医疗保险现在支付年度检查费用。第三阶段将测试一种易于学习的电话咨询方法的价值，这种方法可以在初级保健实践中实施。干预措施的有效性评估将通过乳房x光检查的医疗记录报告，以及对研究人群中妇女的测试前/测试后访谈来进行。这项研究将测试简单、廉价的教育干预在顺序设计中的价值，这将允许检查干预的每个阶段的相对有效性，作为增加老年妇女乳房x光检查的一种手段。

ABSTRACT=Both incidence and mortality from breast cancer increase rapidly after age 40, and the largest increase in both incidence and mortality occurs for women over 60. However, older women are least likely to be screened. The proposed study will test the efficacy of a program conducted through primary-care practices to increase mammography screening among urban and rural women age 65 and older. The study will employ a randomized design in which 50 primary-care practices will be randomized to intervention and control groups. The intervention practices will receive a program to increase screening mammography among women age 65 and older who are not current in their screening, defined as no mammogram for at least 18 months prior to being enrolled in the study. The initial step in the study will be to identify potential barriers to screening mammography for both physicians and older women who are not current in their screening. These barriers will be addressed through informative and persuasive messages that will be delivered in three phases, at four month intervals. The first phase will identify primary-care physicians concerns about mammography screening for older women, and test the efficacy of a low-impact intervention that will address physician barriers to screening older women, as well as providing them with information which they can use to address the concerns of their patients. The second phase will provide older women with information specific to their concerns about mammography screening, and highlight for them that Medicare now pays for annual screening. The third phase will test the value of an easily learned telephone counseling approach that can be implemented in a primary-care practice. Evaluation of the intervention's effectiveness will be through medical record reports of mammography screening, and pretest/posttest interviews with women in the study population. The study will test the value of simple, inexpensive educational interventions in a sequential design that will allow examination of the relative effectiveness of each stage of the intervention as a means of increasing mammography screening among older women.