Low-income women with abnormal breast findings: results of a randomized trial to increase rates of diagnostic resolution.
BACKGROUND
Timely diagnostic resolution of abnormal breast findings represents a critical step in efforts to reduce breast cancer morbidity and mortality. Yet, follow-up rates among resource poor populations are not optimal. Efforts to mitigate this disparity are needed. We report results of a randomized trial assessing the effectiveness of a patient support and navigation intervention in increasing timely diagnostic resolution of abnormal breast findings among indigent women.


METHODS
Women (n = 1,708) diagnosed with a breast abnormality at two public hospitals were randomized to an intervention or control group. The intervention, delivered through telephone, involved one call from a professional health worker and multiple calls from a lay health worker. The outcome, timely diagnostic resolution, defined as receipt of a definitive diagnosis (malignant or benign) within 6 months of the index referral, was assessed through medical chart audit.


RESULTS
Intent-to-treat analyses revealed no significant effect of the intervention on timely diagnostic resolution. Diagnostic resolution rates were 55% and 56%, respectively, in the intervention and control arms. The significant predictors were method of abnormality identification (odds ratio = 1.50) and location of first scheduled appointment (odds ratio = 0.62).


CONCLUSIONS
The intervention was not effective in creating change within the County health system. Achieving optimum diagnostic follow-up may require more intensive interventions than the one tested. In addition, system-level rather than patient-level interventions may hold more promise.


CONCLUSIONS
There are no randomized trials reported in the literature testing interventions to increase diagnostic follow-up of breast abnormalities. Future research might test patient and system-level interventions that can be sustained beyond the study period.
Bastani
Roshan
R
School of Public Health, Division of Cancer Prevention and Control Research, University of California-Los Angeles, 650 Charles Young Drive South, Los Angeles, CA 90095, USA. bastani@ucla.edu
Mojica
Cynthia M
CM
Berman
Barbara A
BA
Ganz
Patricia A
PA
D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis*; D005260:Female; D005500:Follow-Up Studies; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006779:Hospitals, Public; D006801:Humans; D015141:Los Angeles; D008327:Mammography / Q000706:statistics & numerical data; D008875:Middle Aged; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data*; D011203:Poverty; D011369:Professional-Patient Relations; D012017:Referral and Consultation; D013689:Telephone; D013997:Time Factors