Physicians' recommendations for mammography: do tailored messages make a difference? A randomized trial of the impact of risk assessment and feedback on participation in mammography screening. A randomized controlled trial to motivate worksite fecal occult blood testing. A randomized trial of breast cancer risk counseling: the impact on self-reported mammography use. Patient Satisfaction with Health Care Decisions Effect of interventions on stage of mammography adoption Cost-effectiveness comparison of five interventions to increase mammography screening. Effects of individualized breast cancer risk counseling: a randomized trial. Do tailored behavior change messages enhance the effectiveness of health risk appraisal? Results from a randomized trial. Controlled trial of pretest education approaches to enhance informed decision-making for BRCA1 gene testing. Adherence by African American men to prostate cancer education and early detection Strategies to Increase Mammography Utilization BRCA1 testing in families with hereditary breast-ovarian cancer. A prospective study of patient decision making and outcomes. The short-term impact of tailored mammography decision-making interventions. Does the frame affect the picture? A study into how attitudes to screening for cancer are affected by the way benefits are expressed Tailored risk notification for women with a family history of breast cancer.
OBJECTIVES Message tailoring , based on individual needs and circumstances , is commonly used to enhance face-to-face patient counseling . Only recently has individual tailoring become feasible for printed messages . This study sought to determine whether printed tailored recommendations addressing women 's specific screening and risk status and perceptions about breast cancer and mammography are more effective than st and ardized printed recommendations . METHODS Computer-assisted telephone interviews were conducted with 435 women , aged 40 to 65 years , who had visited family practice groups within the previous 2 years . Subjects were r and omly allocated to receive individually tailored or st and ardized mammography recommendation letters mailed from physicians to patients ' homes . Follow-up interviews were conducted 8 months later . RESULTS Tailored letter recipients were more likely to remember and to have read more of their letters than st and ardized version recipients . After controlling for baseline status , tailored letter receipt was associated with more favorable follow-up mammography status for women with incomes below $ 26,000 and for Black women . CONCLUSIONS Tailored messages are a more effective medium for physicians ' mammography recommendations ; tailoring may be especially important for women of low socioeconomic status BACKGROUND Although rates of mammography screening among women in the general population have been increasing they still fall short of national goals . This study evaluated the effects on rates of participation in mammography screening of obtaining risk factor information and providing general or personalized risk information through direct mailed correspondence . METHODS Women enrollees in a health maintenance organization ( N = 2,076 ) , age 50 and above , were r and omized to one of the following four groups : ( a ) no risk factor question naire + generic invitation , ( b ) no risk factor question naire + general risk invitation , ( c ) risk factor question naire + general risk invitation , and ( d ) risk factor question naire + personal risk invitation . Computerized visit records were monitored for 12 months following a mailed invitation to assess whether a mammogram had been obtained . RESULTS Overall participation was 37.5 % and the rate of participation did not differ significantly across groups ( P = 0.26 ) . Participation was related to age ( P < 0.02 ) , with rates highest for women ages 60 - 69 years ( 42.7 % ) compared with those for women ages 50 - 59 ( 35.5 % ) and those age 70 + ( 33.7 % ) . Among women with a family history of breast cancer , the personalized risk invitation was associated with significantly higher participation compared with general risk invitation ( 66.7 versus 42.9 % , respectively ; P < 0.003 ) . CONCLUSIONS Women with a family history of breast cancer are more likely to obtain a mammogram if that fact is reinforced as a risk factor . Research on environmental barriers to mammography screening may suggest alternative strategies for increasing participation Colorectal cancer is second only to lung cancer as a cause of cancer death in the United States . Studies have shown that fecal occult blood ( FOB ) tests are effective in detecting colorectal cancer in its early stages . To increase the participation in the FOB test among the working population , a r and omized controlled trial was conducted . A total 278 federal employees 40 years or older in Washington State were r and omly divided into a intervention group which received a Colorectal Cancer Risk Appraisal and a control group which received a simple information letter . After three months a follow-up question naire was sent to all participants to measure the effectiveness of the intervention . As a result of the study , the intervention group had a 4.3 % higher compliance rate with the FOB test during the three month follow-up period ( p = .10 ) . The largest effect of the intervention was on the employees ' intention to get a FOB test within the next year ( 62.6 % in the intervention group vs. 36.2 % in the control group , OR = 3.18 , p less than .001 ) OBJECTIVES We evaluated the impact of individualized breast cancer risk counseling on mammography use among women at risk for breast cancer . METHODS Participants ( n = 508 ) were r and omized to the breast cancer risk counseling intervention or a general health education control intervention  , and 85 % completed follow-up . RESULTS In multivariate modeling , a significant group-by-education interaction demonstrated that among less-educated participants , breast cancer risk counseling led to reduced mammography use . There was no intervention effect among the more-educated participants . CONCLUSIONS These results suggest that st and ard breast cancer risk counseling could have an adverse impact on the health behaviors of less-educated women Patient satisfaction measures have previously addressed satisfaction with medical care , satisfaction with providers , and satisfaction with outcomes , but not satisfaction with the health care decision itself . As patients become more involved in health care decisions , it is important to underst and specific dynamics of the decision itself The  Satisfaction with Decision ( SWD ) scale  measures satisfaction with health care decisions . It was developed in the context of postmenopausal hormone-replacement therapy decisions The six-item scale has excellent reliability ( Cronbach 's alpha = 0.86 ) . Discriminant validity , tested by performing principal- components analysis of items pooled from the SWD scale and two conceptually related measures , was good . Correlation of the  SWD scale  with measures of satisfaction with other aspects of the decision-making process showed the  SWD scale  was correlated most highly ( 0.64 ) with " decisional confidence , " and least with " desire to participate in health care de cisions " and " satisfaction with provider " The  SWD  scale predicts decision certainty in this study . Use in an independent study showed that the  SWD scale  was correlated with the likelihood of patients ' intentions to get a flu shot . Further investigation in relation to other health decisions will establish the utility of the  SWD scale  as an outcome measure Key words : patient satisfaction ; medical decision making ; decision support ( Med Decis Making 1996;16:58 - 64 Mammography has been found significantly to impact mortality in women ; however , compliance is still problematic . A theoretical model which combined Health Belief Model ( HBM ) constructs with stage of mammography adoption was used to investigate the effect of an individualized belief and /or informational intervention on mammography compliance . A control group and three intervention groups ( belief , information , and belief and information ) were used . A probability sample of 405 women ages 40–88 years without a prior history of breast cancer was r and omly assigned to groups . Subjects in the intervention group received individually tailored messages to alter beliefs or provider information related to mammography screening . Women in the combined belief/information group were over two times more likely to have been compliant with mammography 1 year postintervention than those in the control . In addition , groups who received the belief intervention had significantly more women that went from a lower to a higher stage of mammography adoption BACKGROUND Mammography is the primary method used for breast cancer screening . However , compliance with recommended screening practice s is still below acceptable levels . This study examined the cost-effectiveness of five combinations of physician recommendation and telephone or in-person individualized counseling strategies for increasing compliance with mammography . METHODS There were 808 participants who were r and omly assigned to one of six groups . A logistic regression model with compliance as the dependent variable and group as the independent variable was used to test for significant differences and a ratio of cost to improvement in mammogram compliance evaluated the cost-effectiveness . RESULTS Three of the interventions ( in-person , telephone plus letter , and in-person plus letter ) had significantly better compliance rates compared with the control , physician letter , or telephone alone . However , when considering costs , only one emerged as the superior strategy . The cost-effectiveness ratios for the five interventions show that telephone-plus-letter is the most cost-effective strategy , achieving a 35.6 % mammography compliance at a marginal cost of $ 0.78 per 1 % increase in women screened . CONCLUSIONS A tailored phone prompt and physician reminder is an effective and economical intervention to increase mammography . Future research should confirm this finding and address its applicability to practice BACKGROUND Studies have shown that a majority of women with a family history of breast cancer have exaggerated perceptions of their own risk of this disease and experience excessive anxiety . In response to the need to communicate more accurate risk information to these women , specialized programs for breast cancer risk counseling have been initiated in medical centers across the United States . PURPOSE Our purpose was 1 ) to evaluate the impact of a st and ardized protocol for individualized breast cancer risk counseling on comprehension of personal risk among first-degree relatives of index breast cancer patients and 2 ) to identify women most and least likely to benefit from such counseling . METHODS This study is a prospect i ve r and omized trial comparing individualized breast cancer risk counseling to general health counseling ( control ) . We studied 200 women aged 35 years and older who had a family history of breast cancer in a first-degree relative . Women with a personal history of cancer were excluded .  Risk comprehension was assessed as the concordance between perceived " subjective " lifetime breast cancer risk and estimated " objective " lifetime risk . RESULTS The results of logistic regression analysis showed that women who received risk counseling were significantly more likely to improve their risk comprehension , compared with women in the control condition ( odds ratio [ OR ] = 3.5 ; 95 % confidence interval [ CI ] = 1.3 - 9.5 ; P = .01 ) . However , in both groups , about two thirds of women continued to overestimate their lifetime risks substantially following counseling . Examination of subjects by treatment interaction effects indicated that risk counseling did not produce improved comprehension among the large proportion of women who had high levels of anxious preoccupation with breast cancer at base line ( P = .02 ) . In addition , white women were less likely to benefit than African-American women ( OR = 0.34 ; 95 % CI = 0.11 - 0.99 ; P = .05 ) . CONCLUSION Efforts to counsel women about their breast cancer risks are not likely to be effective unless their breast cancer anxieties are also addressed . IMPLICATION S Attention to the psychological aspects of breast cancer risk will be critical in the development of risk-counseling programs that incorporate testing for the recently cloned breast cancer susceptibility gene , BRCA1 ( and BRCA2 when that gene has also been cloned ) Health risk appraisal ( HRA ) remains one of the most widely used health promotion tools despite only equivocal evidence for its effectiveness . Theories of behavior change predict conventional HRA 's ineffectiveness because risk information alone is seldom sufficient to change complex behaviors . In this study , a r and omized trial compared the effects of feedback from an enhanced HRA with a typical HRA and a control group among adult patients from eight family medicine practice s. The enhanced HRA assessed behavior-specific psychosocial factors and provided patients with computer-generated , individually-tailored behavior change information in addition to typical HRA risk feedback . Changes in seven behaviors were assessed at a 6 month follow-up . Overall , patients receiving enhanced HRA feedback were 18 % more likely to change at least one risk behavior than were patients receiving typical HRA feedback or no feedback ( OR = 1.18 , 95 % CI = 1.00 , 1.39 ) . The enhanced HRA feedback appeared to promote changes in cholesterol screening , dietary fat consumption and physical activity , but not in smoking , seat belt use , mammography and Pap smears . We conclude that the addition of theory-based , individually-tailored behavior change information may improve the effectiveness of HRA BACKGROUND In response to the isolation of the BRCA1 gene , a breast-ovarian cancer-susceptibility gene , biotechnology companies are already marketing genetic tests to health care providers and to the public . Initial studies indicate interest in BRCA1 testing in the general public and in population s at high risk . However , the optimal strategies for educating and counseling individuals have yet to be determined . PURPOSE Our goal was to evaluate the impact of alternate strategies for pretest education and counseling on decision-making regarding BRCA1 testing among women at low to moderate risk who have a family history of breast and /or ovarian cancer . METHODS A r and omized trial design was used to evaluate the effects of education only ( educational approach ) and education plus counseling ( counseling approach ) , as compared with a waiting-list ( control ) condition ( n = 400 for all groups combined ) . The educational approach review ed information about personal risk factors , inheritance of cancer susceptibility , the benefits , limitations , and risks of BRCA1 testing , and cancer screening and prevention options . The counseling approach included this information , as well as a personalized discussion of experiences with cancer in the family and the potential psychological and social impact of testing . Data on knowledge of inherited cancer and BRCA1 test characteristics , perceived risk , perceived benefits , limitations and risks of BRCA1 testing , and testing intentions were collected by use of structured telephone interviews at baseline and at 1-month follow-up . Provision of a blood sample for future testing served as a proxy measure of intention to be tested ( in the education and counseling arms of the study ) . The effects of intervention group on study outcomes were evaluated by use of hierarchical linear regression modeling and logistic regression modeling ( for the blood sample outcome ) . All P values are for two-sided tests . RESULTS The educational and counseling approaches both led to significant increases in knowledge , relative to the control condition ( P < .001 for both ) . The counseling approach , but not the educational approach , was superior to the control condition in producing significant increases in perceived limitations and risks of BRCA1 testing ( P < .01 ) and decreases in perceived benefits ( P < .05 ) . However , neither approach produced changes in intentions to have BRCA1 testing . Prior to and following both education only and education plus counseling , approximately one half of the participants stated that they intended to be tested ; after the session , 52 % provided a blood sample . CONCLUSIONS St and ard educational approaches may be equally effective as exp and ed counseling approaches in enhancing knowledge . Since knowledge is a key aspect of medical decision-making , st and ard education may be adequate in situations where genetic testing must be streamlined . On the other h and , it has been argued that optimal decision-making requires not only knowledge , but also a reasoned evaluation of the positive and negative consequences of alternate decisions . Although the counseling approach is more likely to achieve this goal , it may not diminish interest in testing , even among women at low to moderate risk . Future research should focus on the merits of these alternate approaches for subgroups of individuals with different background s who are being counseled in the variety of setting s where BRCA1 testing is likely to be offered This study was design ed to identify factors that predict adherence by African American men to prostate cancer education and early detection This study compared the effects of theoretically driven interventions on compliance with mammography utilization . A 2 × 2 factorial design yielded groups : a control group , a belief intervention group , an informational intervention group , and a belief/informational intervention group .  A probability sample of 301 women , age 35 and older , without a history of breast cancer were r and omly assigned to groups . Subjects in the intervention groups received individually tailored messages to alter beliefs or provider information related mammography screening . Belief messages were developed from Health Belief Model constructs . Belief interventions significantly influenced all belief variables except perceived susceptibility in the desired direction . Women in belief/informational intervention group were almost four times more likely than those in the control group to comply with mammography recommendations in the year following intervention ( odds ratio=3.75 ) . In addition , belief variables and intervention significantly predicted mammography compliance 1 year postintervention OBJECTIVES To identify predictors of utilization of  breast-ovarian cancer susceptibility ( BRCA1 gene ) testing  and to evaluate outcomes of participation in a testing program . DESIGN Prospect i ve cohort study with baseline interview assessment of predictor variables ( eg , sociodemographic factors , knowledge about hereditary cancer and genetic testing , perceptions of testing benefits , limitations , and risks ) . BRCA1 test results were offered after an education and counseling session in a research setting . Outcome variables ( including depression , functional health status , and prophylactic surgery plans [ follow-up only ] ) were assessed at baseline and 1-month follow-up interviews . PARTICIPANTS Adult male and female members ( n=279 ) of families with BRCA1-linked hereditary breast-ovarian cancer ( HBOC ) . RESULTS Of subjects who completed a baseline interview ( n=192 ) , 60 % requested BRCA1 test results ( 43 % of all study subjects requested results ) . Requests for results were more frequent for persons with health insurance ( odds ration [ OR ] , 3.74 ; 95 % confidence interval [ CI ] , 2.06 - 6.80 ) ; more first-degree relatives affected with breast cancer ( OR , 1.59 ; 95 % CI , 1.16 - 2.16 ) ; more knowledge about BRCA1 testing ( OR , 1.85 ; 95 % CI , 1.36 - 2.50 ) ; and indicating that test benefits are important ( OR , 1.45 ; 95 % CI , 1.13 - 1.86 ) . At follow-up , noncarriers of BRCA1 mutations showed statistically significant reductions in depressive symptoms and functional impairment compared with carriers and nontested individuals . Individuals identified as mutation carriers did not exhibit increases in depression and functional impairment . Among unaffected women with no prior prophylactic surgery , 17 % of carriers ( 2/12 ) intended to have mastectomies and 33 % ( 4/12 ) to have oophorectomies . CONCLUSIONS Only a subset of HBOC family members are likely to request BRCA1 testing when available . Rates of test use may be higher in persons of a higher socioeconomic status and those with more relatives affected with breast cancer . For some high-risk individuals who receive test results in a research setting that includes counseling , there may be psychological benefits . More research is needed to assess the generalizability of these results and evaluate the long-term consequences of BRCA1 testing BACKGROUND We assessed the short-term impact of decision-making interventions on knowledge about mammography , accuracy of women 's breast cancer risk perceptions , attitudes toward mammography , satisfaction with decisions , and mammography use since the intervention . METHODS The study was conducted among women who were members of Blue Cross Blue Shield of North Carolina and were in their 40s or 50s at the time the study began in 1997 . Women were r and omly assigned to usual care ( UC ) , tailored print booklets ( TP ) alone , or TP plus telephone counseling ( TP+TC ) . RESULTS 12-month interviews were completed by 1127 women to assess short-term intervention effects . Generally , women who received TP+TC were significantly more knowledgeable about mammography and breast cancer risk and were more accurate in their breast cancer risk perceptions than women in the TP and UC groups . They also were more likely to have had a mammogram since the baseline interview . In multivariable analyses , we found significant benefits of the combination of TP+TC compared to TP and to UC for knowledge , accuracy of risk perceptions , and mammography use . DISCUSSION For complex decision-making tasks , such as women 's decisions about mammography in the face of controversy , the combination of TP and TC may be more effective than TP alone , and certainly more effective than UC . It is critical that investigators determine the topics for which TP is appropriate and the situations that require additional supportive interventions Objective To find out how presenting information about the benefits of screening for cancer in different ways affects an individual 's decision to accept or reject  screening .  Methods A telephone survey of the Wellington region , New Zeal and was carried out . Results A response rate of 75.6 % was obtained . Respondents were most likely to accept screening  when the benefits of screening were presented as a relative risk reduction . They were most likely to reject screening  when the benefits were presented as numbers needed to screen to save one life . Conclusions An individual 's decision about screening for cancer is affected by the way the benefits are framed . Health professionals must choose between framing the benefits of screening in the most positive light , to enhance participation rates , and presenting information in such a way as to reduce framing effects — for example , by expressing the benefits in a variety of forms . Clearly there may be a tension between these approaches ; the former is arguably manipulation , and the latter may enhance informed choice , but may also reduce participation rates in screening programmes BACKGROUND Evidence indicates that although first-degree relatives of breast cancer cases are at increased risk of developing the disease themselves , they may be underutilizing screening mammography . Therefore , interventions to increase the use of mammography in this group are urgently needed . METHODS A r and omized two-group design was used to evaluate an intervention to increase mammography use  among women ( N = 901 ) with at least one first-degree relative with breast cancer . A statewide cancer registry was used to obtain a r and om sample of breast cancer cases who identified eligible relatives . The mailed intervention consisted of personalized risk notification and other theoretically driven material s tailored for high-risk women . RESULTS An overall significant intervention effect was observed ( 8 % intervention group advantage ) in mammography at post-test . There was an interaction of the intervention with age such that there was no effect among women < 50 years of age and a fairly large ( 20 % advantage ) effect among women 50 + and 65 + . Health insurance , education , and having had a mammogram in the year before baseline assessment were positive predictors of mammography at post-test . Perceived risk , calculated risk , and relationship to index cancer case were not associated with mammography receipt . CONCLUSION The intervention was successful in increasing mammography rates among high-risk women 50 + years of age . Further work is needed to determine why it was ineffective among younger women
OBJECTIVE To assess the effects of different types of individualised risk communication for patients who are deciding whether to participate in screening .