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- 1. Cancer Prevention and Control Program, Catalan Institute of Oncology, IDIBELL, L’Hospitalet (Spain); 2. Catalan
Cancer Plan, Catalan Health Department, L’Hospitalet (Spain)
Montse Garcia1, Llúcia Benito1, Carmen Vidal1, Josep M. Borràs2, Víctor Moreno1 UICC World Cancer Congress 28 August 2012, Montreal
Use of text message reminders to improve uptake in a population-based breast cancer screening program, Catalonia (Spain)
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Background Non-attendance for routine screening appointments 1) results wasted resources 2) disturbs the planned work-schedules 3) impacts patient outcomes because of missed opportunities for diagnosis and treatment. ! To analyze the effect of a mobile text message service reminder on the uptake of screening mammogram in Catalonia, Spain. Objective
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Screening Area
Screening procedure Data collection & analysis Study Population
Methods
! A biennial screening program for breast cancer addressed to women aged 50-69 years who lived in the area (n= 171,000). ! BCSP is located in Catalonia, a region in the north-east of Spain
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Population density (people per km2)
Screening procedure Data collection & analysis Study Population
Methods
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Screening procedure Data collection & analysis Study Population
Methods
n=3,719 (29.1%) SMS reminder Invitation letter
+
INTERVENTION GROUP n=8,715 OUTCOME Mammogram (October, 2011) STUDY POPULATION Women who had a scheduled appointment for a mammogram (June - July, 2011) n=12,786 n=9,067 (70.9%) Invitation letter only CONTROL GROUP
SLIDE 6 Variables
! Dependent: Timely participation in the Breast Cancer Screening Program (mammogram) ! Independent:
○ 50-59 years, ○ 60-69 years
- We recoded the variable ‘screening units’ according with the population growth
from 2003 to 2010 and rurality (%) of the municipalities to assess ‘accessibility’:
○ Easily-to-reach areas ○ Hard-to-reach areas
○ [Previously] Unscreened: women who had never had a prior mammogram ○ [Previously] Screened: women with at least one prior mammogram
Data collection & analysis Screening procedure Study Population
Methods
Analysis
! Multivariate logistic regression models
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Results
Adjusted OR* CI95% Age 50-59 years 1 60-69 years 0.96 (0.95-0.96) SMS reminders No 1 Yes 1.84 (1.56-2.18) Previously Screened No 1 Yes 14.62 (13.04-16.39) Accessibility Easily to reach pop. 1 Hard to reach pop. 0.84 (0.75-0.93)
* Odds ratios adjusted by Age, SMS reminders, previous participation, accessibility and the following interaction terms: SMS_previous participation (p-value=0.000) + SMS_accessibility (p-value=0.000) Multivariate analysis
Are SMS reminders effective?
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30.5 83.9 52.2 89.4 10 20 30 40 50 60 70 80 90 100 Invitation letter only SMS Reminders
n=4,093 n=8,382
Results
21.7% 5.5%
Interaction terms
Previously Unscreened Previously Screened
Timely participation according to previous screening behavior and SMS reminders
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65.0 66.3 78.4 71.1 10 20 30 40 50 60 70 80 90 100 Easily to reach areas Hard to reach areas Invitation letter only SMS Reminders
Participation (%)
n=5,875 n=6,911 Interaction terms
12.1% 6.1%
Timely participation according to accessibility and SMS reminders
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Rescheduled appointments Women who received only the invitation letter rescheduled their appointment (n=636): 7.0%; 95%CI: 6.9-7.9 Women who received the SMS reminder rescheduled their appointment (n= 308 ): 8.3%; 95%CI:7.3-9.2 Timely participation (mammogram) among women who had rescheduled their appointments
Results
Women who received only the invitation letter rescheduled their appointment (n=513): 80.7%; 95%CI: 77.6-83.7 Women who received the SMS reminder rescheduled their appointment (n= 224 ): 74.2.%; 95%CI:69.2-79.1
Rescheduled appointments
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! Sending text messages to patients’ mobile phone number three days before their scheduled appointments reduces failure to attend rate at relatively low cost. ! The breast cancer screening program could use text messaging as an alternative approach to contact hard to reach population. Conclusions
