Decreasing Over Screening and Treatment of Cervical Precancers in Young Women
Randomized Trial to Increase Adherence to Cervical Cancer Screening Guidelines for Young Women
Study Overview
Status
Conditions
Intervention / Treatment
Detailed Description
In this study, we compare two different intervention arms that are designed to prevent over screening and over treatment by increasing adherence to the new US cervical cancer screening guidelines and the American Society for Colposcopy and Cervical Pathology (ASCCP) guidelines for the management of abnormal cervical cancer screening tests and cancer precursors. Specifically, the interventions will focus on the newly recommended cervical cancer screening intervals and decreasing the number of colposcopy procedures and cervical procedures for abnormal cytology.
This is a cluster randomized trial with individual clinics serving as the clusters. Clinics from the California Family PACT provider network who serve at least 200 female clients per year under 30 years of age will be randomized to one of two arms: 1) ASCCP mobile application (ProvAPP)-based intervention for providers, or 2) ProvAPP + Patient education Tool (Tab) intervention. These groups will be compared to a control comparison group of 28 clinics chosen using propensity score matching based on clinic characteristics such as county and private versus public from the Family PACT claims data. The ProvAPP intervention is for clinicians' mobile phones and will help them maneuver through current guidelines based on patient age and condition. An existing application from the ASCCP will be updated to include screening guidelines and to be more user-friendly. The patient-based Tab intervention will be a patient education tool accessible via URL on a tablet device at the time of check-in to assist in asking questions and evaluating treatment options. The tool will be developed with input from women age 21-29 as well as other stakeholders including Latinas Contra Cancer and the National Cervical Cancer Coalition. It is hypothesized that the ProvAPP+Tab approach will be most successful; all interventions will be more successful than no intervention.
Family PACT serves predominantly uninsured women and 40% of clients are Latina. We plan to enroll 7 sites (ProvAPP) and 7 sites (ProvAPP+Tab) into the other intervention arm with an average of 2,800 women to 3,500 women aged 21-29 years per arm (14 sites) with a similar number of sites and women randomly chosen for the comparison arm (28 sites) resulting in a total of 39 sites and 8,400-10,500 women. We will use Family PACT claims data to examine, by age, the number of and average interval between cytology specimens, colposcopy examinations, and the number of excisional procedures.
Study Type
Enrollment (Actual)
Phase
- Not Applicable
Contacts and Locations
Study Locations
-
-
California
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Los Angeles, California, United States, 90095
- University of California, Los Angeles
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San Francisco, California, United States, 94143
- University of California, San Francisco
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-
Participation Criteria
Eligibility Criteria
Ages Eligible for Study
Accepts Healthy Volunteers
Genders Eligible for Study
Description
Inclusion Criteria - Patients:
- English or Spanish speaking
- Women
- Age 21-29 years
- History of one or more of the following: abnormal Pap smear, normal Pap smear, no Pap smear, cervical cancer
Exclusion Criteria - Patients:
- Language other than English or Spanish
- Male
- Younger than 21 or older than 29
Inclusion Criteria - Clinics:
- Family PACT provider
- Not a Planned Parenthood affiliate
- Located in one of ten identified Southern California study counties
- Sends cytology/histology specimens to Quest Diagnostics West Hills
- Clinical care visits occurred to at least 200 women age 21-29 years in fiscal year 2011/2012
- Has a calculated average cytology interval of less than 30 months (based on last three years)
Exclusion Criteria - Clinics:
- Not a Family PACT provider
- Planned Parenthood affiliate
- Not located in one of ten identified Southern California study counties
- Sends cytology/histology specimens to a lab other than Quest Diagnostics West Hills
- Clinical care visit occurred to less than 200 women age 21-29
- Has a calculated average cytology interval of more than 30 months
Study Plan
How is the study designed?
Design Details
- Primary Purpose: Screening
- Allocation: Randomized
- Interventional Model: Parallel Assignment
- Masking: None (Open Label)
Arms and Interventions
Participant Group / Arm |
Intervention / Treatment |
|---|---|
|
Experimental: Provider Mobile Application (ProvAPP)
Mobile phone application for providers.
|
Mobile phone application to maneuver clinicians through the cervical cancer screening and treatment guidelines based on patient age and condition.
|
|
Experimental: ProvAPP + Patient Educational Tool (Tab)
Patient educational tool; plus the Mobile phone application for providers.
|
Patient Educational Tool (Tab): A patient educational tool (mobile tablet) will educate women on cervical cancer screening and treatment. Patients' self-assessment using a tablet at the time of clinic check-in will help them to understand current guidelines and their choices for treatment if they have abnormal cytology. It will allow them to assess the risks and benefits of screening intervals and of treatment choices. ProvAPP: Mobile phone application to maneuver clinicians through the cervical cancer screening and treatment guidelines based on patient age and condition. |
|
No Intervention: ProvAPP Control Group
Clinics in this group are those NOT randomized - receiving no intervention.
These clinics will be chosen at random for comparison using Family PACT claims data.
|
|
|
No Intervention: ProvAPP+Tab Control Group
Clinics in this group are those NOT randomized - receiving no intervention.
These clinics will be chosen at random for comparison using Family PACT claims data.
|
What is the study measuring?
Primary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Rate of Cervical Cancer Screening
Time Frame: Change from baseline screening rate (3 months prior to intervention) to 15-18 months after start of intervention
|
Rate of women 21-29 years who received cervical cytology tests.
|
Change from baseline screening rate (3 months prior to intervention) to 15-18 months after start of intervention
|
Secondary Outcome Measures
Outcome Measure |
Measure Description |
Time Frame |
|---|---|---|
|
Rate of Colposcopy
Time Frame: Change from baseline colposcopy rate (3 months prior to intervention) to 15-18 months after start of intervention
|
Rate of women 21-29 years who receive colposcopy for cervical cancer screening over the total number of women 21-29 years.
|
Change from baseline colposcopy rate (3 months prior to intervention) to 15-18 months after start of intervention
|
Collaborators and Investigators
Collaborators
Investigators
- Principal Investigator: Anna-Barbara Moscicki, MD, University of California, San Francisco
Publications and helpful links
Study record dates
Study Major Dates
Study Start (Actual)
Primary Completion (Actual)
Study Completion (Actual)
Study Registration Dates
First Submitted
First Submitted That Met QC Criteria
First Posted (Estimate)
Study Record Updates
Last Update Posted (Actual)
Last Update Submitted That Met QC Criteria
Last Verified
More Information
Terms related to this study
Additional Relevant MeSH Terms
Other Study ID Numbers
- 13-12257
- CD-1304-6551 (Other Grant/Funding Number: PCORI)
Drug and device information, study documents
Studies a U.S. FDA-regulated drug product
Studies a U.S. FDA-regulated device product
product manufactured in and exported from the U.S.
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