Telephone counseling improves adherence to colposcopy among lower-income minority women.
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.
Lerman
C
C
Division of Population Science, Fox Chase Cancer Center, Philadelphia, PA.
Hanjani
P
P
Caputo
C
C
Miller
S
S
Delmoor
E
E
Nolte
S
S
Engstrom
P
P
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