Reminding patients quadrupled odds

July 17, 1995

ANN ARBOR—Pap smears and mammograms are important but sometimes uncomfortable medical tests, and too many women find them easy to “forget.” A recent study, however, in which physicians sent letters to their low-income patients reminding them to get the tests, followed by telephone calls from health educators, quadrupled the odds that women would come in for cervical and breast cancer screening, according to a researcher at the University of Michigan School of Public Health.

“The recommendation of the physician followed by a personal call is clearly a great motivator for patients,” said Paula M. Lantz, a U-M researcher who, with colleagues, conducted the study for the Marshfield Medical Research Foundation in Wisconsin. The results are reported in the June issue of the American Journal of Public Health.

According to the National Center for Health Statistics, one-fourth of U.S. women don’t have regular Pap tests and more than one-half don’t get regular mammograms. “Women with low levels of education and income have even lower screening rates and are more likely to die from cervical or breast cancer,” Lantz said.

The study included 659 patients and 110 physicians. The patients, ages 40-79, were served by a federally-funded community health center in Wisconsin that provided an insurance-like package of benefits for people with low family incomes. Pap smears and screening mammograms were included in the benefits package.

Although 16 percent of the women in the study responded to the physician’s letter alone, “in general, letters are not enough to motivate a woman to call for an appointment, particularly if the letter is a form letter from an HMO or an anonymous medical director,” Lantz said. “An individualized approach and a live phone call are considerably more effective. ”

During the follow-up phone calls, health educators queried women about why they had not come in for the tests. “Many of the women who needed mammograms delayed the test because they had no family history of breast cancer and didn’t believe they were at risk. In those instances, the educator explained that only one in five women with breast cancer has a family history of the disease,” Lantz said.

Other patients felt they knew their bodies well and were symptom-free. “In those instances, we discussed the concept of early screening and the benefit of catching cancer before symptoms develop. We also helped them find solutions to obstacles that might keep them from appointments—no car, having to take time off work, child care problems, and so on.

“We found that having to take time off work was a great impediment,” Lantz added. “These early screening tests are so important that we recommend that employers provide work site screening—perhaps using mobile vans—and that clinics extend their hours beyond the typical workday.”

Lantz’s colleagues for the study included Sarah Beversdorf of the Northern Wisconsin Area Health Education Center in Wausau; Debra Stencil, MaryAnn T. Lippert and Linda Jaros of the Marshfield Medical Research Foundation; and Patrick L. Remington of the Wisconsin Division of Health, Madison.

American Journal of Public HealthNational Center for Health StatisticsWisconsin Division of Health