Remote Intervention Increases 3 Cancer Screenings Among Women in Rural US

In a cohort of women living in rural counties in the US, the likelihood of getting 3 timely cancer screenings was increased 6-fold among those who received remote outreach that combined 2 tailored interventions, according to results of the randomized Rural Interventions for Screening Effectiveness (RISE) study.

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Compared with usual care, all women who received only a mailed interactive DVD with prompts and additional information tailored to their individual responses were twice as likely to become up to date with screenings for breast, cervical, and colorectal cancer at 1 year. Those who received the DVD plus a follow-up phone call from a patient navigator were 3 times more likely to have obtained the 3 screenings than those who did not receive the follow-up call.

“Both interventions were tailored to the unique barriers, needs and experiences of rural women by using platforms that could be delivered remotely, thereby reducing access barriers,” explained first author Victoria L. Champion, PhD, RN,distinguished professor of nursing at the Indiana University School of Nursing and colleagues, writing in JAMA Network Open.

No studies to date have studied an intervention that might simultaneously increase the guideline-recommended breast, cervical, and colorectal cancer screenings for women, wrote Champion et al. Many look at just 1 type of screening, some at 2. Each of these screenings can detect early-stage disease, they emphasize, and addressing them together may help increase women’s knowledge of the importance of screening and consideration to become current.

The randomized clinical RISE trial included 963 women aged 50 to 74 years (mean age, 58.6 years) from rural Indiana and Ohio who were not current on any or all recommended cancer screenings. Most participants (97%) self-reported as White.

Participants were randomly assigned to 1 of 3 interventions: receiving a mailed, tailored DVD that interactively assessed and provided messaging for health beliefs, benefits and self-efficacy for obtaining cancer screenings (n = 382); receiving the DVD followed by a patient navigator telephone attempt within 4 weeks to counsel on barriers to obtaining screenings (n = 388) or usual care (mailed a study newsletter) (n = 193) between November 2016 and July 2019.

The primary outcome was receipt of any or all needed screenings for breast, cervical, and colorectal cancer from baseline to 1 year and cost-effectiveness of the intervention.

FINDINGS

Champion and colleagues reported the unadjusted 12-month rate of up-to-date status with all cancer screening of 10% for usual care, 15% for the DVD alone, and 30% for the DVD plus patient navigation intervention (omnibus P<.001). When the investigators used up-to-date status for screening for any of the 3 types of cancer needed, the rates were slightly higher — 25%, 29% and 49%, respectively (omnibus P<.001).

Compared with women in the usual care group, those who received the DVD intervention alone were nearly 2 times more likely to obtain all needed cancer screenings (odds ratio [OR] 1.84; 95% CI, 1.02-3.43; P=.48). Odds were almost 6 times greater for women in the combined DVD plus follow-up navigator phone call intervention (OR 5.69; 95% CI, 3.24-10.5; P<.001) compared to the usual care group. Compared with women who received the DVD intervention alone, those who received the combination were 3 times more likely to have obtained all needed screenings (OR, 3.09; 95% CI, 2.05-4.68; P<.001).

The DVD plus telephone follow-up intervention was significantly more effective in promoting at least 1 of the recommended cancer screenings at 1 year compared with usual care (OR 4.01; 95% CI, 2.6-6.28; P<.001).

The researchers also found that both interventions were more cost-effective compared with usual care with $14 462 per woman who was up to date for the DVD intervention alone and $10 638 per woman who was up to date for the DVD intervention plus telephonic patient navigation.

“The effectiveness of these interventions that targeted all or any needed cancer screenings simultaneously offered an approach that can be delivered remotely to rural women and has paved the way to approach preventive health care holistically, fostering cancer prevention and early detection when a cure is realistic and ultimately decreasing cancer health disparities,” they concluded.

Reference: Champion VL, Paskett ED, Stump TE, et al. Comparative effectiveness of 2 interventions for increase breast, cervical and colorectal cancer screening among women in the rural US. JAMA Netw Open. 2023;6(4):e2311004. doi:10.1001/jamanetworkopen.2023.11004