DURABILITY OF IMPROVED PHYSICIAN EARLY DETECTION OF CANCER AFTER CONCLUSION OF INTERVENTION SUPPORT

Physicians can potentially play an important role in the early detecti on of cancer. Interventions designed to encourage these activities hav e been shown to improve physician performance for up to 1 year. To ass ess their real value, improved physician performance must be judged ov er the longer term. The Cancer Prevention in Community Practice Projec t assisted a random subset of practices in implementing cancer early d etection office systems. One year later, these practices were found to have provided more indicated breast and colorectal cancer early detec tion services than practices that did not receive assistance. This rep ort addresses whether 12-month improvements in breast and colorectal c ancer early detection were durable at 24 months despite no appreciable ongoing project support. A cross-sectional survey of 20-30 establishe d patients/practice was conducted 24 months after the introduction of the intervention. These results were compared with baseline, 6-, and 1 2-month cross-sectional surveys to determine whether increases in indi cated services and recommendations persisted. A longitudinal model for binomial data was used to quantitatively assess durability of effects . Ninety-nine practices participated, and 81 provided data at all 4 ev aluation intervals. In office systems practices, improvements in stool occult blood testing and self breast examination recommendations to p atients were maintained between 12 and 24 months while improvements in mammography recommendations and clinical breast examinations declined somewhat but remained superior to performance in control practices. S ome improvements in physician early detection of cancer performance we re maintained between 12 and 24 months. Future studies of physician be havior change should include follow-up beyond 12 months.