INCREASING CANCER SCREENING AMONG UNDERSERVED WOMEN

这项研究建议使用两种方法来增加乳房和子宫颈 以贫困、老年为主的妇女的癌症筛查率 和/或40岁及以上的美洲原住民：1)促进癌症 在一家大型县级医院对因某些原因就诊的妇女进行筛查 除癌症筛查外(“inReach”)；以及2)鼓励和 动员社区内生活在低收入家庭的妇女 待筛选的高层建筑(“外展”)。基于形成性研究和 第一年进行的试点研究，以医院为基础的干预 将制定和实施战略，提高贫困人口和贫困人口的比例 被提供、接受并完成乳房和乳房的美洲土著妇女 宫颈癌筛查。常规筛查命令的效力， 独立的筛查诊所，从Primar以外的诊所招聘 护理，并提供立即(而不是预定的)筛查 学习。综合医院的1,500名妇女 人口外加250名额外的美洲原住民妇女将被随机分配到 乳腺癌和宫颈癌筛查干预措施(基于 形成性研究)或常规护理(对照)。成本效益将是 将对评估和医院工作人员进行培训，以帮助维持这一活动。 外联部分将使用社区组织和侦察 向贫困和老年妇女推广乳腺癌筛查的方法 住在低收入的高楼大厦里。42栋高层建筑将被 随机分为治疗条件或对照条件。在治疗中 条件，高层的社会工作者和同龄人领导将 鼓励他们的客户和邻居在每年12周期间接受筛查 竞选活动。筛查率将通过自我报告进行评估，以待确认 通过明尼苏达州公共服务部为所有人维护的数据库 为医疗补助患者提供付费程序。美国癌症协会将 在干预的前两年提供协助，并接管这项活动 在本研究的外展部分的最后阶段。

This study proposes to use two approaches to increase breast and cervical cancer screening rates among women who are predominantly indigent, elderly and/or Native American 40 years of age and older by: 1)promotion of cancer screening within a major county hospital to women who present for reasons other than cancer screening ("inreach"); and 2) encouragement and mobilization of women from within the community who live in low income high-rises to be screened ("outreach"). Based on formative research and pilot studies conducted in the first year, the hospital-based intervention will develop and implement strategies to improve the proportion of poor and Native American women who are offered, accept, and complete breast and cervical cancer screening. The efficacy of standing orders for screening, a freestanding screening clinic, recruitment from clinics other than primar care, and the offer of immediate (rather than scheduled) screening will be studied. One thousand five hundred women from the general hospital population plus 250 additional Native American women will be randomized to either a breast and cervical cancer screening intervention (based on the formative research) or usual care (control). Cost-effectiveness will be assessed and hospital staff will be trained to help sustain the activity. The outreach component will use a commumity organization and reconnaissance approach to promote breast cancer screening to poor and elderly women who live in low income high-rises. Forty-two high-rise buildings will be randomized to be either treatment or control conditions. In the treatment condition, social workers and peer leaders from the high-rises will encourage their clients and neighbors to be screened during annual 12 week campaigns. Screening rates will be assessed by self-report to be confirmed by a database the Minnesota Department of Human Services maintains for all paid procedures for Medicaid patients. The American Cancer Society will assist during the first two intervention years and take over the campaign during the last phase of the outreach component of this study.