title: Telephone counseling improves adherence to colposcopy among lower-income minority women.
abstract: OBJECTIVE
  A randomized trial was conducted to evaluate the impact of a telephone counseling intervention to improve patient adherence to colposcopic examination for suspected cervical intraepithelial neoplasia (CIN).
  
  
  METHODS
  Subjects were lower-income, minority women who missed a scheduled initial appointment for colposcopy at an urban medical clinic. Patients were randomly assigned to either a control condition (n = 42) or a telephone counseling condition (n = 48). The 15-minute, structured telephone counseling intervention protocol addressed educational, psychosocial, and practical barriers to colposcopy adherence.
  
  
  RESULTS
  The most common patient-reported barriers to colposcopy adherence included a lack of understanding of the purpose of colposcopy (50%), worry about or fear of cancer (25%), and forgetting (23%). Telephone counseling was found to be highly effective in addressing these barriers and improving adherence to diagnostic follow-up and treatment. Of patients in the control condition, 43% complied with a rescheduled colposcopy appointment, compared with 67% in the telephone counseling condition. Logistic regression analysis indicated that the effect of telephone counseling was independent of sociodemographic confounder variables (odds ratio = 2.6; P less than .003). Additionally, 74% of patients who received the initial telephone counseling adhered to recommended treatment, compared with 53% of patients in the control condition.
  
  
  CONCLUSIONS
  Brief, structured telephone contact may be a cost-effective mechanism for improving adherence to diagnostic follow-up and treatment for a variety of cancer screening tests.
authors.affiliation: Division of Population Science, Fox Chase Cancer Center, Philadelphia, PA.
authors.forename: C
authors.initials: C
authors.lastname: Lerman
authors.forename: P
authors.initials: P
authors.lastname: Hanjani
authors.forename: C
authors.initials: C
authors.lastname: Caputo
authors.forename: S
authors.initials: S
authors.lastname: Miller
authors.forename: E
authors.initials: E
authors.lastname: Delmoor
authors.forename: S
authors.initials: S
authors.lastname: Nolte
authors.forename: P
authors.initials: P
authors.lastname: Engstrom
mesh_terms: D000293:Adolescent; D000328:Adult; D003127:Colposcopy / Q000523:psychology; D003376:Counseling / Q000379:methods; D004522:Educational Status; D005260:Female; D006801:Humans; D007182:Income; D016015:Logistic Models; D008913:Minority Groups / Q000523:psychology; D010342:Patient Acceptance of Health Care; D010349:Patient Compliance; D010353:Patient Education as Topic; D013689:Telephone; D014505:Urban Population; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis* / Q000208:ethnology