Herman C J, Speroff T, Cebul R D
Department of Medicine, University Hospitals of Cleveland, Ohio.
Arch Intern Med. 1995 Apr 10;155(7):717-22.
To compare three approaches for improving compliance with breast cancer screening in older women.
Randomized controlled trial using three parallel group practices at a public hospital. Subjects included women aged 65 years and older (n = 803) who were seen by residents (n = 66) attending the ambulatory clinic from October 1, 1989, through March 31, 1990. All provider groups received intensive education in breast cancer screening. The control group received no further intervention. Staff in the second group offered education to patients at their visit. In addition, flowsheets were used in the "Prevention Team" group and staff had their tasks redefined to facilitate compliance.
Medical records were reviewed to determine documented offering/receipt of clinical breast examination and mammography. A subgroup of women without previous clinical breast examination (n = 540) and without previous mammography (n = 471) were analyzed to determine the effect of the intervention. During the intervention period, women without a previous clinical breast examination were offered an examination significantly more often in the Prevention Team group than in the control group, adjusting for age, race, and comorbidity and for physicians' gender and training level. The patients in the Prevention Team group were offered clinical breast examination (31.5%) more frequently than those in the patient education or control groups, but this was not significant after adjusting for the above covariates. Likewise, mammography was offered more frequently to patients in the Prevention Team and in the patient education group than to patients in the control group, after adjusting for the factors above using logistic regression.
The results provide support for patient education and organizational changes that involve nonphysician personnel to enhance breast cancer screening among older women, particularly those without previous screening.
比较三种提高老年女性乳腺癌筛查依从性的方法。
在一家公立医院采用三个平行组的实践进行随机对照试验。研究对象包括1989年10月1日至1990年3月31日在门诊就诊的65岁及以上女性（n = 803），由住院医师（n = 66）负责诊治。所有医疗服务组都接受了乳腺癌筛查的强化教育。对照组未接受进一步干预。第二组的工作人员在患者就诊时提供教育。此外，“预防团队”组使用了流程图，并且重新定义了工作人员的任务以促进依从性。
审查病历以确定记录的临床乳腺检查和乳房X线摄影的提供/接受情况。对一组既往未进行过临床乳腺检查（n = 540）且未进行过乳房X线摄影（n = 471）的女性亚组进行分析，以确定干预的效果。在干预期内，在调整年龄、种族、合并症以及医生性别和培训水平后，既往未进行过临床乳腺检查的女性在预防团队组中接受检查的频率明显高于对照组。预防团队组的患者接受临床乳腺检查的频率（31.5%）高于患者教育组或对照组，但在调整上述协变量后，差异无统计学意义。同样，在使用逻辑回归调整上述因素后，预防团队组和患者教育组的患者接受乳房X线摄影的频率高于对照组。
研究结果支持患者教育以及涉及非医师人员的组织变革，以提高老年女性尤其是既往未进行过筛查的女性的乳腺癌筛查率。
