Table 2.

Trials that Included Both Patient and Provider 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	Quality Score (out of 27)
Becker et al. 1989	RCT	For patients; preventive care services reminder letter. For providers; chart reminder regarding preventive care services.	For patients; telephone interview.	366(188), 7 months, 50-59.5% black, 40.5-50% white.	36-45% no insurance, income not reported.	University internal medicine clinic.	Mammography: physician reminder only (30.3%), physician and patient reminder (31.1%), control (10.6%), (p = .020, χ2).	22
McPhee et al. 1989	RCT	For patients; half received letters recommending CBE/mammograms and reminder postcards. For providers; chart reminders or audit-based feedback via monthly didactic sessions.	For patients; half received letters recommending CBE/mammo-grams and reminder postcards. No provider intervention.	41 physicians (20 physicians), 9 months, Patients: 41% white, 25% black, 17% Hispanic, 14% Asian, 3% Other.	37% with Medicaid, 15% uninsured, income not reported.	General internal medicine practice at an academic hospital	Percent increase in clinical breast exam: audit with feedback (14.1%, p = .006), reminders (18.5%, p <.001), patient education (1.7%, p = .666). Percent increase in mammography: audit with feedback (10%, p = .050), reminders (11%, p = .031), patient education (11.8%, p = .006).	20
Nattinger et al. 1989	CCT	For patients; educational mammography handout. For providers; ACS questionnaire plus either: monthly feedback with peer comparisons (feedback arm) or pre-completed mammogram orders for eligible patients (visit-based arm).	For providers: questionnaire about knowledge of and agreement with ACS cancer screening guidelines.	281 (227), 6 months, 60% black, 32% white, 8% Hispanic, 2% Other.	Insurance not reported, income not reported.	General internal medicine clinic at an academic hospital.	Mammography: educational handout (54%), resident physician feedback (62%), control (36%) (p < .001 when each intervention is compared to control)	19
Ornstein et al. 1991	RCT	For patients: PCP signed reminder letters. For providers: all of the elements in the control group plus cancer screening chart reminders.	For providers: health promotion educational sessions, audit with feedback.	Patients: 5821 (1576) Providers: 39 (10), 1 year, Patients: 61% black 38% white 2% Other.	18% Medicare or Medicaid, 40% uninsured, Income not reported.	Academic family practice clinic.	Percent increase in mammography: chart reminders alone (10.7%, p < .0001), chart reminders plus patient letters (15.7%, p < .0001), patient letters alone (2.8%, p = .35) control (15.7% (p < .0001).	18
Dickey and Pettiti 1992	CCT	For patients: health information sheet, provider-completed patient health diary, waiting room posters. For providers; health diary attached to chart.	For providers; verbal and written information about the full intervention and copies of patient health diary forms.	200 (100), 18 months, 49-55% Spanish speaking.	Insurance not reported, income not reported.	University-affiliated community-based family practice clinic.	Percent increase in mammography; intervention (40.9-61.8%), (p < .005). control (37.3-40.9%), (not significant).	19
Landis et al. 1992	RCT	For patients; mammography reminder letter, mammography prescription. For providers: mammography reminder on chart.	For patients; placebo mailing comprised of patient satisfaction survey.	79 (43), eight months, 83% white, 17% black.	13-40% no insurance, income not reported.	University-affiliated family practice clinic.	Mammography; intervention (25%), control (5%), (p = .07).	19
Burack et al. 1994	RCT	For patients: postcard appointment reminders, dedicated scheduling system for women who missed mammography appointment, and reduction or elimination of out-of-pocket mammogram costs. For providers; chart reminder regarding mammogram.	For patients; dedicated telephone appointment line, telephone reminders, and reduction or elimination of out-of-pocket mammogram costs. For providers and staff: breast cancer awareness program.	1363 (1322) 14 months, approximately 96% black (inferred from Burack et al. 1996).	43% Medicaid, 26% no insurance, income not reported.	Health department primary care practices, HMO clinics, outpatient practice sites of a private hospital.	Mammography appointments; intervention (rate varied by site from 38% to 65%) control (rate varied by site from 11% to 37%) intervention rate exceeded control rate by 13% (CI 6 to 20) to 29% (CI 21 to 38) depending upon site. Mammography completion: intervention (rate varied by site from 43% to 64%) control (rate varied by site from 25% to 46%) intervention rate exceeded control rate by 12% (CI 5 to 19) to 25% (CI 16 to 34) depending upon site.	19
Herman et al. 1995	RCT	For patients: mammography educational materials provided in-person and reviewed by nurses (patient education group). For providers; completed health maintenance flow sheet on chart, partially completed mammography order form on chart (prevention team).	For providers: breast cancer screening monograph plus preventive services lectures (control).	348 (192), 6 months, 41-58% white, 34-53% black, 9-13% Hispanic.	Medicare-eligible population, income not reported.	Internal medicine clinics at a university-affiliated public hospital.	Clinical breast exam offered: prevention team (31.5%), (p = .003 compared to prevention team), patient education (21.9%), p = .04 compared to prevention team), control (17.8%) Mammography; prevention team (36.4%),(p = .001 compared to control) patient education (31.4%), (p = .005 compared to control) control (18%).	19
Burack et al. 1996	RCT	For patients: personalized mammography reminder letter signed by HMO medical director and elimination of out-of-pocket mammogram costs. For providers: chart reminder regarding mammogram.	For patients: elimination of out-of-pocket mammogram costs.	1772 (596), 12 months, 96% black (among those for whom information was available).	All patients insured, 49-61% Medicaid, income not reported.	HMO clinics.	Mammography at site 1: intervention (~30%) control (~30%), (p = .524) Mammography at site 2 (fewer Medicaid patients): intervention (36%), control (22%), (p = .002).	21
Burack and Gimotty 1997	RCT	For patients: postcard appointment reminders, dedicated scheduling system for women who missed mammogram appointments, and reduction or elimination of out-of-pocket mammogram costs. For providers: chart reminder regarding mammogram.	For patients; dedicated telephone appointment line, telephone reminders, and reduction or elimination of out-of-pocket mammogram costs. Breast cancer awareness program for providers and staff.	1413 (1413), 26 months, approximately 96% black (inferred from Burack et al. 1996).	55% from health department clinics not insured, 100% insured at HMO clinic, income not reported.	Health department primary care practices and an HMO clinic.	Mammography at health department clinics: full intervention (44%), limited intervention (28%), (OR = 1.84 CI 1.4, 2.4). Mammography at HMO clinic: full intervention (45%), limited intervention (46%), (OR = 1.06 CI .8, 1.42).	19
Dietrich et al. 1998	RCT	For patients: health education materials and patient-held health diary. For providers: preventive care flow sheet in patient charts, workshop and ongoing education for key clinic personnel.	Usual care.	1381 (1499), 24 months, 23-31% black, 22% Hispanic, 22-26% white, 2.3-4.9% Other, 21-27% unknown.	25-28% Medicaid, 26-33% no insurance, income not reported.	Community-based migrant health centers.	Percent increase in breast self-exam advice from providers: intervention (8.6%, p < .001) control (5.5%, p = .06). No intervention effect on mammography or clinical breast exam.	20
Manfredi et al. 1998	RCT	For patients: mailed health maintenance cards. For providers: chart flow sheets, chart reminders, protocols, continuing medical education, provider feedback, on-site staff training, use of cancei-screening guidelines.	For providers: chart flow sheets and an HMO letter recommending adoption of NCI guidelines.	24 intervention centers (23 control centers), 2 years, 39 of 47 practices were located in census tracts that were 75 to 99% black and/or Hispanic	43% private insurance, 44% Medicare or Medicaid, 6% uninsured, income not reported.	Primary care HMO-affiliated practices located in low-income, urban minority communities	HMO patients: Mammography rate change: intervention (-13.9%), control (-1.0%) (not significant). CBE rate change: intervention (7.7%) and control (9%) (not significant) Non-HMO pts: Mammography rate change: intervention (-7.9%), control (-17.3%) (not significant). CBE rate change: intervention (9.9%), control (-5.4%), (p ≤ .05).	18
Paskett et al. 1999	CCT	Intervention City: For patients: educational sessions, health literature, community events, advertisements, church program, birthday cards, personalized follow-up letters for abnormal tests. For providers; chart reminders, exam room prompts, in-service meetings, alerts for abnormal test results, follow-up protocol.	Usual care in the comparison city.	908 (1021) 36 months, 66% black at baseline, 64% black at follow-up.	Insurance not reported, Participants had “low incomes.”	Housing communities in two cities.	Increase in mammography: in intervention city (from 31% to 56%) (p = .049) comparison city (from 33% to 40%) (not significant)	16
Rimer et al. 1999	RCT	For patients: tailored print communications (TPC) or tailored print communications plus tailored telephone counseling (TPC + TTC).	For providers: tailored chart prompt intervention (PI).	384 total, 24 months, 81% black, 19% white.	21%-34% uninsured, 77% with income less than $20,000.	Community health centers providing care for low-income patients.	Mammography; PI (86%) TPC (82%) TPC + TTC (85%) (group differences not significant).	20
Taylor et al. 1999	RCT	For patients: motivational video, informational pamphlet, bus passes, telephone and postcard reminder. For providers: one-on-one mammography education and computer-generated chart prompts for physicians and nurses.	Usual care.	232 (82), 15 months, 39% black, 42% white, 18% Other.	10% uninsured, income not reported.	Adult medicine clinic of a county-owned hospital serving inner-city residents.	Mammography: intervention (49%) control (22%) p <.001).	18
Nguyen et al. 2000	RCT	For patients: Vietnamese-language educational materials. For providers: manual and computerized reminders, continuing medical education, newsletters, and enrollment in the NCI Physician's Data Query oncology information program.	Usual care.	9 physicians and their patients (11 physicians and their patients), 30 months, Vietnamese American physicians and their Vietnamese American patients.	Insurance not reported, income not reported.	Private practice physician offices throughout California	Increase in clinical breast examination; intervention (81.3% to 85.9%) p = .081)control (72.9% to 81.8%) (p = .003) Increase in mammography: intervention (68.1% to 79.2%) p = .O81) control (61.4% to 79.5%) (p = .003)	12
Roetzheim et al. 2004	RCT	For patients: completion of screening checklist For providers: chart stickers indicating status of screening tests, patient-completed cancer screening checklists in chart, 45 min training session, training manual, feedback on intervention compliance and ongoing support from research staff.	Usual care.	600 (596), 12 months, 24-34% black, 45-51% white, 21-24% Hispanic.	100% insured, 13.9-16.8% Medicaid, income not reported.	8 primary care clinics participating in a county-funded health insurance plan.	Mammography at 12 months; intervention (75.7%), control (71.1%), (p = .023).	21
Roetzheim et al. 2005	RCT	As above for Roetzheim et al 2004 except no ongoing support from research staff.	Usual care.	600 (596) 24 months, 24-34% black, 45-51% white, 21-24% Hispanic.	100% insured, 13.9-16.8% Medicaid income not reported.	8 primary care clinics participating in a county-funded health insurance nlan.	Mammography at 24 months; intervention (67%), control (64.5%), (p = .023).	20