IMPROVING COMPLIANCE WITH BREAST-CANCER SCREENING IN OLDER WOMEN - RESULTS OF A RANDOMIZED CONTROLLED TRIAL

Background: To compare three approaches for improving compliance with breast cancer screening in older women. Methods: Randomized controlled trial using three parallel group practices at a public hospital. Subj ects included women aged 65 years and older (n=803) who were seen by r esidents (n=66) attending the ambulatory clinic from October 1, 1989, through March 31, 1990. All provider groups received intensive educati on in breast cancer screening. The control group received no further i ntervention. Staff in the second group offered education to patients a t their visit. In addition, flowsheets were used in the ''Prevention T eam'' group and staff had their tasks redefined to facilitate complian ce. Results: Medical records were reviewed to determine documented off ering/receipt of clinical breast examination and mammography. A subgro up of women without previous clinical breast examination (n=540) and w ithout previous mammography (n=471) were analyzed to determine the eff ect of the intervention. During the intervention period, women without a previous clinical breast examination were offered an examination si gnificantly more often in the Prevention Team group than in the contro l group, adjusting for age, race, and comorbidity and for physicians' gender and training level. The patients in the Prevention Team group w ere offered clinical breast examination (31.5%) more frequently than t hose in the patient education or control groups, but this was not sign ificant after adjusting for the above covariates. Likewise, mammograph y was offered more frequently to patients in the Prevention Team and i n the patient education group than to patients in the control group, a fter adjusting for the factors above using logistic regression. Conclu sions: The results provide support for patient education and organizat ional changes that involve nonphysician personnel to enhance breast ca ncer screening among older women, particularly those without previous screening.