Table 1.
Trials that Included Only Patient Interventions to Increase Breast Cancer Screening
| Reference | Design | Intervention(s) | Control or Limited Intervention(s) | Intervention (control n), Duration, Race/Ethnicity | Health Insurance, Income | Setting | Results (intervention vs. control, results as odds ratios, relative risk, or actual percentage) | Quality Score (out of 27) |
|---|---|---|---|---|---|---|---|---|
| Kiefe et al. 1994 | RCT | Voucher for free screening mammography at local facility. | Counseling, mammography pamphlet, referral, map, telephone number to low-cost mammogram facility. | 61 (58), 2 months, 77% black, 12% Hispanic, 13% white, 7% Other. | 100% Medicare, 92% with household income less than $10,000. | General medicine clinic at a public hospital. | Mammography; intervention (44%), control (10%), (p < .001). | 21 |
| Skinner et al. 1994 | RCT | Baseline telephone interview plus tailored letter addressing perceived barriers to mammography, breast cancer risk factors, and screening status. | Baseline telephone interview plus standard breast cancer screening letter. | ~217 (~218), 8 months, 84% white, 16% black. | Insurance not reported, 43% with income below $26,000. | 2 family practice groups in North Carolina | Mammography; intervention (44%), control (31%) p = .16) | 20 |
| Skaer et al. 1996 | RCT | Mammogram recommendation, instructions, and a free mammogram voucher. | Mammogram recommendation and instructions. | 40 (40), 2 months, 100% foreign-born Hispanic. | 77.5% to 82.5% uninsured. | Two migrant health clinics | Mammography; intervention (87.5%), control (17.5%), OR 47.03 (CI 9.28, 238.37). | 20 |
| Janz et al. 1997 | RCT | Mammography reminder letter from primary care physician, grocery coupon upon completion of mammogram, telephone counseling by community peer. | Usual care. | 223 (237), 12 months, 74% white, 23% black. | All Medicare eligible, income not reported. | Community-based primary care practices. | Mammography; intervention (38%), control (16%), (p < .001). | 20 |
| Weber and Reilly 1997 | RCT | Personalized reminder letter from primary care physician (PCP) plus standardized case management protocol using community health educators (CHE); a second reminder letter from CHE 2 wks after PCP letter, a structured outreach protocol involving patient education, reminders, identification/removal of barriers to care, and systems navigation. | Personalized PCP reminder letter followed by usual care. | 186(190), 13 months, 42% white, 36% black, 7% Hispanic, 4% Asian, 1% Other. | 5% uninsured, 21% Medicaid, 60% of household incomes less than $15,000. | 6 primary care practices affiliated with an urban community teaching hospital. | Mammography; intervention (25%), control group (9.8%), (p < .001). | 25 |
| Davis et al. 1998 | RCT | Small group interactive session with culturally relevant, learner-developed educational video +/- National Cancer Institute (NCI), mammography brochure. | In-person mammogram recommendation from study investigator. | 298 (147), 24 months, 69% black, 30% white. | Insurance not reported, 80-84% low income. | University affiliated outpatient clinics at a public hospital. | Mammography; small group interactive (29%), in-person recommendation (21%), recommendation plus NCI brochure (18%), (P = -05, χ2)- | 20 |
| Margolis et al. 1998 | RCT | Lay health advisor (LHA) mammography instructions, CBE with culturally tailored NP, and same-day mammography. | Baseline questionnaire and breast examination. | 857 (801), 25 months, ~62% white, ~18% black, ~13% Native American, ~6% Other. | 69% Medicare or Medicaid, 24% private insurance, average income $1064 per month. | Non-primary care clinics at county medical center (surgery, orthopedics, ophtho, dental, psychiatry) | Mammography; intervention (60%), control (50%), (p = .006). No difference among those up-to-date at baseline. | 22 |
| Mishra et al. 1998 | RCT | Four 2-hr breast health educational sessions. | Usual care. | 51 (37) 8 weeks, 100% Latina. | 51% uninsured, 50% with household income < $10,000. | Community-based primary care clinics and social service organizations. | Increase in proportion who conduct BSE once a month; intervention (24% to 67%) control (22% to 35%), p = .01) | 21 |
| Dolan et al. 1999 | RCT | Same-day appointment for screening mammography following PCP appointment. | Physician recommendation for screening mammography. | 408 (512), 12 months, 43% white, 39% black, 18% Other. | 14% Medicaid, 4% no insurance, income not reported. | Urban academic general internal medicine practice. | Mammography; intervention (66%), control (56%), (p = .003). | 21 |
| Mayer et al. 2000 | RCT | Reminder letters (from physicians or mammogram facility) w/ contact information for mammogram facility. | No reminder letters (during the study period only). | 1039 (523), 23 months, 83% white, 7.5% Latina, 3% black, 4% Other. | 5% uninsured, 93% other-insurance, 55% with annual family income < $40,000. | Women were patients of primary care providers who referred to 1 of 6 mammogram centers. | Mammography; physician letter (47.7%), facility letter (46.6%), control (28.3%), (p <.001). (No significant difference between interventions groups). | 20 |
| Champion et al. 2002 | RCT | Tailored telephone counseling and/or tailored primary care physician letter, information regarding breast cancer risk, instructions regarding mammography appointment logistics. | Baseline telephone interview. | 707 (683), 2 years, 21-83% black, 15-77% white. | Insurance not reported, 77% low income at high minority site, 24% low income at low minority sites. | University-based general medicine clinic and two HMO clinics. | Mammography; telephone counseling OR=1.66 (CI 1.12,2.46), tailored mailing OR=1.72(CI 1.18, 2.52), telephone counseling plus mailing OR = 2.16 (CI 1.46, 3.19). | 18 |
| Valdez et al. 2002 | RCT | Five 1-hour educational modules regarding breast cancer and screening. | Usual care. | 614 (583), 12 months, 100% Latinas. | 62% uninsured, 61% with household income less than $18,200. | Three community health centers, two HMO sites and a community-based organization. | Intention to ask physician about mammography; intervention (85%) control (74%), p < .0001, χ2). | 18 |
| Fitzgibbon et al. 2004 | RCT | Culturally tailored classroom instruction on breast health and diet (low fat/high fiber). | Mailed written materials covering same health curriculum as the classroom instruction. | 127 (129), 8 months, 100% Latinas. | Insurance not reported, income not reported. | Urban community health center. | Monthly breast self exam; intervention (45.7%), control (22.3%), (p = .003). | 21 |
| Smith-West et al. 2004 | RCT | Stage 1: Personalized reminder letter. Stage 2: If no mammogram 6 months later, woman randomized to receive either tailored breast cancer risk letter or tailored telephone call. All given information on mammography scheduling and no-cost mammography program. | Usual care. | 159 (161), 12 months, 91% black. | Insurance not reported, participants chosen from a low-income sample. | Family Health Care of Alabama, a federally qualified health center, serving mostly low-income, rural black patients. | Stage 1: Mammography following personalized letter: intervention (14%), control (14%) Stage 2: Mammography following tailored letter (13%) vs. tailored telephone call (15%), difference not significant. | 19 |