Back to Annual Meeting Page		American Public Health Association 133rd Annual Meeting & Exposition December 10-14, 2005 Philadelphia, PA

Abstract #114310

Rena J. Pasick, DrPH, Comprehensive Cancer Center, University of California San Francisco, 74 New Montgomery Street, Suite 200, Box 0981, San Francisco, CA 94143, 415 597 8166, rpasick@cc.ucsf.edu

“If we want more evidence-based practice, we need more practice-based evidence.” (Lawrence W. Green). The behavioral research designed to increase rates of cancer screening is, for better and for worse, a highly varied mix of study designs, outcomes, intervention types, target audiences, and conceptual foundations. For better, we have demonstrated that, through a range of strategies, attitudes can be changed, those previously unscreened will obtain testing, and people can be moved to adopt routine cancer screening. For worse, it is not currently possible to match a given community with the cancer screening promotion intervention that is “just right” for them, and explanations of why an intervention worked in a particular setting or how it might fare under slightly different circumstances are relatively rare.

A “focal point framework” is suggested both to guide more practice-based research and to assist practitioners in assessing the appropriateness of interventions. A focal point is the simultaneous combination of target population, setting, and behavioral objectives (i.e., mammography use). The assumption is that different permutations of these three likely require variations in an intervention in order to achieve desired results. Research designed to accommodate such variation is needed.

An example of practice-based evidence comes from the Pathfinders study of tailored print and telephone counseling to promote breast and cervical cancer screening in a cohort of five race/ethnic and four language groups, with testing for cost-effectiveness. Most tailoring interventions were developed and tested in single race/ethnic populations, leaving unanswered questions of feasibility and effectiveness in the increasingly common multi-ethnic setting. The purpose of this study was to determine if a single strategy can target multiple ethnicities while also tailoring by culture and individual characteristics. In addition, the study was designed for participants across a spectrum of medical care utilization and insurance status for maximum applicability. Tailored print alone increased mammography use among women due for the test in two of the five ethnic groups (Latinas and Filipinas). Tailored print plus telephone counseling significantly increased recent mammography and Pap testing for the whole multi-ethnic intervention group compared with controls. The intervention cost per life year saved fell within the range that is regarded as cost-effective.

Designing studies with varying and/or real-life focal points in mind is feasible and important for promotion of evidence-based practice.

Learning Objectives: At the conclusion of this session, the participant will be able to

• Explain limits in the practical application of cancer screening intevention reserach to date.
• Describe at least one example of practice-based evidence.
• Recommend steps to foster practice-based evidence

Keywords: Cancer Screening, Evidence Based Practice

Presenting author's disclosure statement:

I wish to disclose that I have NO financial interests or other relationship with the manufactures of commercial products, suppliers of commercial services or commercial supporters.

Recorded presentation