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Cancer Screening: Small Media Targeting Clients – Cervical Cancer

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What the CPSTF Found

About The Systematic Review

The CPSTF finding is based on evidence from a systematic review of 12 studies (search period 1966 - 2004). The review was conducted on behalf of the CPSTF by a team of specialists in systematic review methods, and in research, practice, and policy related to cancer prevention and control.

Context

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Summary of Results

Detailed results from the systematic review are available in the CPSTF finding pdf icon [PDF - 124 kB].

Twelve studies qualified for the systematic review.

  • Proportion of study participants completing screening by Pap test: median increase of 4.5 percentage points (interquartile interval: 0.2 to 9.0 percentage points; 12 study arms).
  • Tailoring was either less effective or, at best, no more effective than untailored interventions (2 studies).

Summary of Economic Evidence

Detailed results from the systematic review are available in the CPSTF finding pdf icon [PDF - 124 kB].

Five studies qualified for the review and reported a wide range of cost effectiveness estimates based on different metrics and assumptions.

Applicability

Findings should apply across a range of populations and settings, provided the intervention is appropriately adapted to the target population and delivery context.

Evidence Gaps

Each Community Preventive Services Task Force (CPSTF) review identifies critical evidence gaps—areas where information is lacking. Evidence gaps can exist whether or not a recommendation is made. In cases when the CPSTF finds insufficient evidence to determine whether an intervention strategy works, evidence gaps encourage researchers and program evaluators to conduct more effectiveness studies. When the CPSTF recommends an intervention, evidence gaps highlight missing information that would help users determine if the intervention could meet their particular needs. For example, evidence may be needed to determine where the intervention will work, with which populations, how much it will cost to implement, whether it will provide adequate return on investment, or how users should structure or deliver the intervention to ensure effectiveness. Finally, evidence may be missing for outcomes different from those on which the CPSTF recommendation is based.

Identified Evidence Gaps

The following outlines evidence gaps for these reviews of interventions to increase breast, cervical, and colorectal cancer screening: Client Reminders (archived); Small Media Targeting Clients; One-on-One Education for Clients (archived).

Research Questions for Future Studies – Small Media

  • Does effectiveness of small media differ by choice of medium (e.g., letter, video, brochure, or Internet-delivered application), information source (e.g., personal physician, educator), or intensity or frequency of delivery?
  • What is the relative cost effectiveness of tailored versus untailored messages?

Research Questions for Future Studies – Overall

  • How does the effectiveness of interventions to increase community demand for screening vary with the health literacy of a target population or subpopulation?
  • How can newer methods of communication—including automated telephone calls and Internet-delivered applications—be used to improve delivery, acceptance, and effectiveness of these interventions?
  • How effective are these interventions in increasing screening by colorectal endoscopy or by double contrast barium enema (for which no qualifying studies were identified)?
  • What is required to disseminate and implement effective interventions in community settings across the United States?
  • How can or should these approaches be applied to assure that screening, once initiated, is maintained at recommended intervals?
  • With respect to interventions that may be tailored to individuals, how are effective tailoring programs adapted, disseminated, and implemented in community-based settings across the United States?

Study Characteristics

  • Reviewed studies were conducted in both rural and urban communities and among different racial, ethnic, and socioeconomic groups.
  • Studies used personal checklists or record booklets to inform and prompt participants; videos in patient waiting areas with or without posters; mailed leaflets, brochures, letters; or a combination of mailed information in printed and video format.

Publications