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Effectiveness of four outreach modalities to patients overdue for cervical cancer screening in the primary care setting: a randomized trial

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Abstract

Purpose

Papanicolaou (Pap) testing has dramatically decreased cervical cancer incidence in the USA, but only 83 % of women screen according to guidelines. Our study aimed to examine the real-world effectiveness of various outreach methods in engaging patients who are overdue for cervical cancer screening.

Methods

In total, 1,100 patients at an urban federally qualified health center overdue for Pap testing were randomized to receive usual care (control), letter outreach, email outreach, telephone outreach, or multimodal (letter/email/telephone) outreach over a period of 3 months. Eighteen months after randomization, medical records were used to determine whether and when each patient had obtained a Pap.

Results

Compared to patients receiving usual care, patients in the multimodal (36 vs. 21 %, AOR 2.3, 95 % CI 1.4, 3.6) and telephone (29 vs. 21 %, AOR 1.7, 95 % CI 1.1, 2.8) outreach groups were significantly more likely to receive cervical cancer screening during the follow-up period. Intervention effects were similar among older and younger patients. Telephone, multimodal, and letter outreach resulted in significantly lower median time to screening among patients who did screen (119, 122, and 157 days, respectively) in those groups as compared to the usual care group (270 days).

Conclusions

This is the first study to perform a direct, randomized comparison of four distinct cervical cancer outreach intervention modalities with a control usual care group, ensuring comparability across intervention methods. In an urban primary care setting, a multimodal outreach strategy was most effective at increasing the proportion of overdue patients who undergo cervical screening and decreasing time to screening.

Clinical Trials Registry

ClinicalTrials.gov; Registration Number: NCT02427399; https://clinicaltrials.gov/ct2/show/NCT02427399.

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Acknowledgments

This work was funded through the HRSA Bureau of Primary Health Care Supplemental 330 Community Health Center Contract (H80CS00303) provided by the Health Resources and Services Administration at the US Department of Health and Human Services.

Conflict of interest

There are no conflicts of interest to declare.

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Authors and Affiliations

  1. The Fenway Institute, Fenway Health, 1340 Boylston Street, Boston, MA, 02215-4302, USA

    S. M. Peitzmeier, K. Khullar & J. Potter

  2. Johns Hopkins Bloomberg School of Public Health, 615 N Wolfe St, Baltimore, MD, 21205, USA

    S. M. Peitzmeier

  3. University of Cincinnati College of Medicine, 231 Albert Sabin Way, Cincinnati, OH, 45267, USA

    K. Khullar

  4. Beth Israel Deaconess Medical Center, 330 Brookline Avenue, Boston, MA, 02215, USA

    J. Potter

  5. Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA

    J. Potter

Authors
  1. S. M. Peitzmeier
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  2. K. Khullar
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  3. J. Potter
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Corresponding author

Correspondence to J. Potter.

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Peitzmeier, S.M., Khullar, K. & Potter, J. Effectiveness of four outreach modalities to patients overdue for cervical cancer screening in the primary care setting: a randomized trial. Cancer Causes Control 27, 1081–1091 (2016). https://doi.org/10.1007/s10552-016-0786-6

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  • DOI: https://doi.org/10.1007/s10552-016-0786-6

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