Telephone Counseling and Attendance in a National breast cancer-screening Program - A Randomized Controlled Trial

The study was conducted to investigate whether additional barrier-specific telephone counseling (telephone counseling +reminder letter) improves attendance in the German national mammography-screening program among nonresponders. Eligible women living in a predefined region (based on ZIP codes) receive mailed invitation letters biennially for each screening round, starting with the 50th birthday. The invitation letters are sent out once a week, offering appointments two weeks in advance. After six weeks, non-responders are sent written reminders, again offering appointments two weeks in advance. These non-responders are the base population of the present study. For each of the non-responders, during the two weeks between the reminder was mailed and the appointment at the screening unit, the counselor obtained the mailing addresses and retrieved the telephone numbers for telephone counseling. In barrier-specific TC, the counselor uses a standardized protocol, identifies the subject’s barriers to performing a health behavior, and then provides information to address and overcome the barriers. First, women are asked whether they wish information on the role of mammography-screening. If so, the counselor provides a brief description of mammography. Second, according to women’s current stage of readiness for mammography the counselor provides appropriate stage-specific information. During the most extensive part of telephone counseling the counselor tries to identify and overcome the woman’s individual barriers to screening and answers the woman’s questions. In her answers, the counselor is trained to refer to a set of preformulated facts, which are derived from guidelines or other validated sources and are implemented in the information system that the counselor uses for interview documentation. The components of the protocol include information on breast cancer risk, usefulness of a screening mammogram, inclusion and exclusion criteria for the German mammography screening program, details of the mammography examination, e.g. breast compression, possible pain, and radiation exposure, information on the reliability of mammography findings, consequences of mammography findings, the screening facility, the trip to the facility, and costs. All telephone calls and topics discussed are documented during the consultations using a dedicated database.