Working with Physicians to Make a Difference                                                                    Back to Article List

"I need a mammogram? My doctor never told me I did!" is a frequent refrain heard by many NC-BCSP lay health advisors. Lack of physician recommendation - whether perceived or real - is the number one reason reported by women for not having a mammogram. Research indicates that the single most compelling factor associated with mammography use is physician recommendation.

Boosting breast cancer screening rates is a complex challenge. Not only is it important to inform women of the need for mammography and to help them overcome barriers such as fear of the procedure, it is also important to tackle institutional barriers to breast cancer screening. One of those barriers is lack of a clear recommendation from a physician. "How a physician counsels a patient for mammography is extremely important," explains Dr. Jo Anne Earp, NC-BCSP Principal Investigator. "Physicians are pressed for time in the current era of insurance requirements and reduced reimbursements. There are new, effective counseling techniques physicians and other health care providers can learn. These strategies will enable them to compress effective counseling into a minute or two of the patient visit."

Nearly 40 physicians, researchers, and public health professionals gathered at UNC's Lineberger Cancer Center for a pilot demonstration of Time to Make a Difference: Quick and Effective Mammography Counseling. This curriculum for physicians and other primary care providers builds on work by researchers at Brown University.

The Komen Foundation partnered with NC-BCSP to refine that curriculum into a three-phase learning experience that can be adapted to different educational settings. Participants in the pilot first received a brochure inviting them to the presentation and explaining why mammography recommendations make a difference. This pilot group was also asked to complete and return a brief form evaluating the brochure. On July 11, NC-BCSP staff led a training session using PowerPoint and video focusing on quick and effective counseling techniques for mammography screening based on the Stages of Change model and the 5 A's medical interviewing model. Following the presentation, the audience was treated to a live performance of a segment from an audiotape script designed as a call-in radio show for physicians, reinforcing key concepts and skills from the presentation.

Evaluations of the event were positive. The audience enjoyed the video portion of the training, which showed a series of interactions between an older, African American female patient and her primary care physician. They commented that it was "well-acted," "true-to-life," and "gave concrete examples in how to employ strategies and address patient barriers." The presentation overall was described as "effective," having "excellent content," and as "very effective in teaching physicians a simplified version of the stages of change model."

NC-BCSP recently received funding from the Triangle Race for the Cure, the local affiliate of the Susan G. Komen Breast Cancer Foundation, to complete the Time to Make a Difference curriculum. The funds will be used to produce a 40-minute audio component that will supplement the existing curriculum.

Once the audio materials are complete, the next step will be a formal evaluation of the entire Time to Make a Difference curriculum package to determine if it leads to higher rates of mammography screening. NC-BCSP is currently exploring options with Blue Cross and Blue Shield of North Carolina to evaluate the curriculum with physician practices across North Carolina.