INTEGRATING AND PRIORITIZING CANCER PREVENTION IN MEDICAL PRACTICE

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Prevention and early detection services often stumble over one another because there are multiple systems and sts of recommendations for delivering them. Consequently, systems designed to increase adherence to recommended for delivering them. Consequently, systems designed to increase adherence to recommended services often encourage over-use of some resources among some individuals while still leaving a substantial group of underserved persons. This project focuses on the benefit of a system for identifying high priority cancer prevention and early detection needs, integrating them into a single intervention, and delivering that intervention as a means of improving the delivery of services to the underserved. The intervention uses motivational interviewing and a personal models approach to encourage selective delivery of as many needed services as possible. The project focuses on women who fall into the mammography an pap smear safety nets (excessive interval since last tested) and women who smoke. The three intervention groups are methods for improving delivery of existing services to women in greatest need of them. We will also compare the delivery of unnecessary cancer control services in the groups compared to usual care, and assess the impact of the interventions on patient satisfaction with KP and cost to the system. The study has a 2X2 factorial design featuring the effects of a system Out- reach (mail-phone), system In-reach (clinic based intervention at th time of primary cre service), and combined In-reach and Out-reach. Each of the three interventions will be compared to usual care with respect to the proportion of high priority needs that are met during a follow-up interval, and athe proportion of unnecessary services delivered.