Comparative Effectiveness of 2 Interventions to Increase Breast, Cervical, and Colorectal Cancer Screening Among Women in the Rural US

Key Points Question What is the comparative effectiveness of 2 tailored interventions delivered remotely compared with usual care for increasing any or all needed cancer screenings in rural women? Findings In this randomized clinical trial of 963 women, digital video disc (DVD) plus patient navigation, compared with usual care, significantly increased the odds of obtaining any needed screening after adjusting for other prognostic covariates. Meaning These findings suggest that tailored interventions delivered remotely may increase needed screenings in rural women, ultimately decreasing cancer mortality.


Cancer screening beliefs and knowledge
Perceived barriers to mammography screening score (   Two-sided Fisher's exact test. c Two-sided independent-groups t-test. d For the 12% of participants whose medical record health care system location was not re-confirmed at 12 months, the location reported at their baseline interview was used to assess 12-month outcomes; only 5 persons had no medical record data or location confirmation at baseline or 12 months, and, among those 5, the 12-month self-report screening data was available and used for 4 persons in all analyses. eTable 2. Logistic Regression for All Cancer Screenings at 12 Months Postbaseline (n = 852): Sensitivity analysis for persons aged 66 or greater were coded to be UTD at baseline for cervical cancer screening.

eAppendix. Intervention Cost Methods
The cost of the interventions can be broken down into two sections: DVD only intervention and DVD plus PN intervention. The DVD-only intervention involves costs of the DVDs, personnel time cost for DVD production and distribution, and consultant costs for DVD production.
The DVD/PN intervention contains costs that were involved in the DVD intervention as well as costs of PN time.
All costs were converted to 2022-dollar values.

DVD Costs:
Within the cost of the DVD, there were two main costs. The first was related to personnel time and the second was related to payments given to a third part consultant to assist in the production of the DVD.

Personnel Time Costs:
The personnel costs associated with the implementation of the DVD intervention was determined by a detailed account of the operational costs of the intervention, excluding costs that were purely attributable to the research. Personnel contributed to the production and distribution of the DVD by assisting in the development, design, CAB meetings to revise, editing, packaging, and printing of the DVD. Average hours worked over the course of the two-year development were found retrospectively after the completion of the study to determine the cost of the DVD. This information along with salary and fringe benefits were used to calculate much of the cost of the DVD intervention. Finally, costs were updated to reflect 2022 dollars.

Consultant Costs:
There a consultant was hired to assist with the production of the DVD. The service performed by the consultant was video production, including strategy, production, and post-production services. The total cost of the consultant was $53,000. This cost along with personnel costs consist of the total cost of the DVD intervention. Finally, costs were updated to reflect 2022 dollars.

DVD/PN Costs:
The costs of the DVD/PN intervention were the summation of the DVD costs and the PN costs and were broken down between the costs of the creation and dissemination of the DVD, which was described in the section above, and the costs of the patient navigators.

PN Costs:
Time logs were used to track the broad categories of patient navigator time use, which were used to estimate costs for specific PN activities (e.g., arranging transportation). Navigators were assumed to have 10% effort in the first two years of the study. During this time, they prepared the navigation contact forms and the respective codebooks.