Davis Terry C, Arnold Connie L, Wolf Michael S, Bennett Charles L, Liu Dachao, Rademaker Alfred
Department of Medicine, Louisiana State University Health Sciences Center, Shreveport, Louisiana, USA.
J Community Support Oncol. 2015 Feb;13(2):47-54. doi: 10.12788/jcso.0108.
Breast and colon cancer screening in rural community clinics is underused.
To evaluate the effectiveness and cost-effectiveness of alternative interventions designed to promote simultaneous screening for breast and colon cancer in community clinics.
A 3-arm, quasi-experimental evaluation was conducted during May 2008-August 2011 in 8 federally qualified health clinics in predominately rural Louisiana. Baseline screening rates reported by the clinics was <10% for breast cancer (using mammography) and 1%-2% for colon cancer (using the fecal occult blood test [FOBT]). 744 women aged 50 years or older who were eligible for routine mammography and an FOBT were recruited. The combined screening efforts included: enhanced care; health literacy-informed education (education alone), or health literacy-informed education with nurse support (nurse support).
Postintervention screening rates for completing both tests were 28.1% with enhanced care, 23.7% with education alone, and 38.7% with nurse support. After adjusting for age, race, and literacy, patients who received nurse support were 2.21 times more likely to complete both screenings than were those who received the education alone (95% confidence interval [CI], 1.12-4.38; P = .023). The incremental cost per additional woman completing both screenings was $3,987 for education with nurse support over education alone, and $5,987 over enhanced care.
There were differences between the 3 arms in sociodemographic characteristics, literacy, and previous screening history. Not all variables that were significantly different between arms were adjusted for, therefore adjustments for key variables (age, race, literacy) were made in statistical analyses. Other limitations related generalizability of results.
Although joint breast and colon cancer screening rates were increased substantially over existing baseline rates in all 3 arms, the completion rate for both tests was modest. Nurse support and telephone follow-up were most effective. However, it is not likely to be cost effective or affordable in clinics with limited resources.
农村社区诊所的乳腺癌和结肠癌筛查未得到充分利用。
评估旨在促进社区诊所同时进行乳腺癌和结肠癌筛查的替代干预措施的有效性和成本效益。
2008年5月至2011年8月期间，在路易斯安那州主要为农村地区的8家联邦合格健康诊所进行了一项三臂准实验评估。诊所报告的基线筛查率为：乳腺癌（使用乳房X线摄影）低于10%，结肠癌（使用粪便潜血试验[FOBT]）为1%-2%。招募了744名年龄在50岁及以上、有资格进行常规乳房X线摄影和FOBT的女性。联合筛查措施包括：强化护理；基于健康素养的教育（仅教育），或基于健康素养的教育并辅以护士支持（护士支持）。
干预后两项检查均完成的筛查率为：强化护理组为28.1%，仅教育组为23.7%，护士支持组为38.7%。在调整年龄、种族和识字率后，接受护士支持的患者完成两项筛查的可能性是仅接受教育患者的2.21倍（95%置信区间[CI]，1.12-4.38；P = 0.023）。与仅教育相比，接受护士支持的教育每增加一名完成两项筛查的女性，增量成本为3987美元；与强化护理相比，增量成本为5987美元。
三组在社会人口学特征、识字率和既往筛查史方面存在差异。并非所有组间显著不同的变量都进行了调整，因此在统计分析中对关键变量（年龄、种族、识字率）进行了调整。其他局限性与结果的可推广性有关。
尽管在所有三组中，联合乳腺癌和结肠癌筛查率均比现有基线率大幅提高，但两项检查的完成率仍不高。护士支持和电话随访最为有效。然而，在资源有限的诊所，这可能不具有成本效益或难以承受。
