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Cancer Control Research

Abstract

To achieve the goal of reducing breast cancer morbidity and mortality, it is imperative that symptomatic women adhere to recommendations for definitive diagnostic procedures as a prerequisite to appropriate treatment. Failure to obtain appropriate diagnostic services can have serious psychological sequelae, grave implications for morbidity and mortality, and significant cost implications for the health care system. In the period between detection and diagnosis, women report considerable distress, anxiety, and decrease in well-being which can negatively impact adherence. Lack of adherence is particularly likely to occur in low- income, indigent populations which must negotiate complex overburdened health systems to receive care. Interventions targeting these symptomatic women to reduce psychosocial distress and enhance adherence to diagnostic follow-up procedures are urgently needed. However, in the continuum from detection through diagnosis, treatment and rehabilitation, least attention has focused on intervening to ensure timely effective diagnosis once an abnormality has been identified. The proposed study will fill this critical gap in breast cancer control research. We will test a telephone counseling intervention delivered by a team of profession and lay counselors, targeting low-income, multi- ethnic women who present with an abnormality in the breast that may be suspicious for breast cancer. Using a randomized design, we will evaluate the effectiveness of the intervention in increasing patient adherence to physician recommendations for follow-up of the problem and on decreasing psychosocial distress and improving quality of life. Specifically, the study will seek to accomplish the following: (1) Identify all women newly presenting with a breast abnormality suspicious for cancer at the two largest County hospitals in Los Angeles. (2) Select a random sample of 1000 women from this population. (3) Randomize this sample to an intervention or usual care control condition. (4) Deliver interactive telephone counseling to all intervention subjects, including a counseling session from a profession counselor and four follow-up supportive calls from a lay peer counselor. Control group subjects will have no contact with the study staff (usual care). (5) Conduct a 12-month telephone follow-up interview to evaluate the effectiveness of the intervention in reducing psychological distress and enhancing quality of life, and to obtain self-reports of adherence to follow-up recommendations. (6) Conduct a retrospective chart audit for all women in the study 12 months after the intervention to obtain an independent measure of adherence to follow-up recommendations. (7) Describe patterns of adherence in this low-income population. (8) Profile these women with respect to psychological distress and quality of life, and study the relationship of these variables to adherence behavior.