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Cancer screening, managed care and the underserved (Pathfinders)
Pathfinders is a program project grant, an NCI funding mechanism that supports a collection of related studies united by a common theme and common core resources. The primary aims of this collection of studies are to develop new, cost-effective methods to increase periodic breast and cervical cancer screening, and to improve rates of follow-up and resolution for mammography and Pap smear screening abnormalities.
Pathfinders consists of three component studies and three core functions:
Project 1:
Access and Early Cancer Detection for the Underserved
Regina Otero-Sabogal, Ph.D. and Rena J. Pasick, Dr.P.H.
Goal: To improve initial breast and cervical cancer screening and maintenance of interval screening under conditions of shifting access to medical care in a low-income, multiethnic sample of women in Alameda County.
Methods: This study has developed and is evaluating a unique constellation of culturally tailored outreach and educational strategies designed for cost-effective use by managed care plans or health departments. Interventions include computer-generated, tailored letters and telephone counseling by lay health workers. This is a randomized controlled trial with a cohort of 1,465 ethnically diverse women in Alameda County (African American, white, Chinese, Filipina, and Latina).
Project 2:
A Strategy to Improve Pap Smear Follow-Up in A High-Risk, Underserved, Inner-City Population
Linda P. Engelstad, M.D.
Goal: To improve rates of resolution of Pap smear abnormalities among women screened in a public hospital clinic or emergency department through outreach, to minimize the number of appointments not kept, and to evaluate the cost-effectiveness of the outreach.
Methods: This study assesses and compares the effectiveness and cost-effectiveness of two interventions: i.) an integrated system of follow-up using community outreach workers to bridge the communication gap between the medical care system and women at high-risk for advanced cervical cancer; and ii.) a local standard of practice using telephone or letter. This is a randomized, controlled trial of 400 women.
Project 3:
Ethnic Differences in Evaluation of Abnormal Mammography
Eliseo J. Pérez-Stable, M.D.
Goal: To assess barriers to follow-up of abnormal mammograms among multiethnic women in order to develop interventions that effectively increase rates of abnormality resolution.
Methods: This study is recruiting 1,000 women with mammogram abnormalities and following them for 24 months to identify income or ethnic differences in barriers to follow-up among African American, Chinese, Latina, and white women. In the final year of the study, three intervention strategies will be developed and pilot-tested for effectiveness in improving follow-up.
Core A:
Senior Leadership and Administration
Rena J. Pasick, Dr.P.H. and Eliseo J. Pérez-Stable, M.D.
This Core resource provides administrative services and leadership functions for quality control, economies of effort, and to bind projects together as a functional unit.
Core B:
Biostatistics and Survey Resources
Susan L. Stewart, Ph.D.
Through this resource, all biostatistical services are provided, and surveys are developed and administered.
Core C:
Methodological Studies
Stephen J. McPhee, M.D. and Carol Somkin, Ph.D.
This Core addresses several research questions common to all the projects. Focusing on low-income, multiethnic women, this Core team: i.) monitors changes in the health care system and their impact on use of cancer screening; ii.) develops culturally appropriate measures of access to, satisfaction with and quality of care; iii.) assesses the cost-effectiveness of interventions in Projects 1 and 2, and studies women's willingness to pay for screening services; iv.) assesses the magnitude and causes of attrition in longitudinal studies of underserved populations; and v.) validates the reliability of self-reported data on screening adherence and insurance.
NCCC Principal Investigator: Rena J. Pasick, Dr.P.H.
Co-Principal Investigator: Eliseo J. Perez-Stable, M.D.
Collaborators:
Joyce A. Bird, Ph.D. (NCCC)
Linda Engelstad, M.D. (NCCC)
Teh-wei Hu, Ph.D. (UCB)
Teresa Juarbe, Ph.D. (UCSF)
Celia Kaplan, Ph.D. (UCSF)
Stephen McPhee, M.D. (UCSF)
Bang Nguyen, Dr.P.H. (NCCC)
Regina Otero-Sabogal, Ph.D. (UCSF)
Carol Somkin, Ph.D. (Kaiser Foundation Research Institute)
Susan Stewart, Ph.D. (NCCC)
Noe Tuason (NCCC)
Todd Wagner, Ph.D. (Stanford/VA)
Funding Source: National Cancer Institute
Dates: 1998-2002
Publications:
Wagner TH, Hu TW, Dueñas G, Pasick RJ. Willingness to pay for mammography: Item development and testing among five ethnic groups. Health Policy 53:105-121,
2000.
Wagner TH, Hu T-W, Duenas GV, Kaplan CP, Nguyen BH, Pasick RJ. Does willingness to pay vary by race/ethnicity? An analysis in mammography among low-income women. Health Policy 2001 Dec;58(3):275-88.
McPhee SJ, Nguyen TT, Shema SJ, Nguyen B, Somkin C, Vo P, Pasick RJ. Validation of recall of breast and cervical screening by women in an ethnically diverse population. Prev Med 2002 Nov;35(5):463-73. |
