Use of Cancer Control Referrals by 2-1-1 Callers

Abstract

Background Callers to 2-1-1 have greater need for and less er use of cancer control services than other Americans. Integrating cancer risk assessment and referrals to preventive services into 2-1-1 systems is both feasible and acceptable to callers. Purpose To determine whether callers will act on these referrals. Methods In a randomized trial, 2-1-1 callers (n=1,200) received standard service and those with at least one cancer risk factor or need for screening were assigned to receive verbal referrals only, verbal referrals + a tailored reminder mailed to their home, or verbal referrals + a telephone health coach/navigator. All data were collected from June 2010 to March 2012 and analyzed in March and April 2012. Results At 1-month follow-up, callers in the navigator condition were more likely to report having contacted a cancer control referral than those receiving tailored reminders or verbal referrals only (34% vs 24% vs 18%, respectively; n=772; p<0.0001). Compared to verbal referrals only, navigators were particularly effective in getting 2-1-1 callers to contact providers for mammograms (OR=2.10, 95% CI=1.04, 4.22), Paps (OR=2.98, 95% CI=1.18, 7.54) and smoking cessation (OR=2.07, 95% CI=1.14, 3.74). Conclusions Given the extensive reach of 2-1-1s and the elevated risk profile of their callers, even modest response rates could have meaningful impact on population health if proactive health referrals were implemented nationally.

Unmet basic needs and health intervention effectiveness in low-income populations

“…The relatively greater effectiveness of the navigator intervention among participants with the most unmet basic needs reinforces a foundational aim of navigation: To improve health outcomes by reducing barriers experienced by low-SES and minority individuals. 31 Although the navigation intervention tested in this study was not designed to address basic needs, 21 the flexibility and client-centric orientation of this approach likely presents many opportunities for navigators to help in addressing basic needs. 32,33 …”

“…21 Referrals consisted of three parts: (1) risk assessment feedback (e.g., “You said you’ve never had a mammogram”); (2) recommended action and importance (e.g., “Once you turn 40, getting a mammogram every 1 to 2 years is the best way to fight breast cancer. Mammograms can find breast cancer when it’s easier to treat and cure”); and, (3) offer of referral to a free or low-cost service (e.g., “There’s a good chance you can get a free mammogram through a program called Show Me Healthy Women.…”

Impact of the Cancer Prevention and Control Research Network: Accelerating the Translation of Research Into Practice

“…6 This work was highlighted in a Supplement to the American Journal of Preventive Medicine, “Research Collaboration with 2-1-1 to Eliminate Health Disparities.” 7 Later studies tested interventions among 2-1-1 callers, demonstrating the effectiveness of using proactive referrals and phone navigation to connect callers with cancer control services. 8 In an NCI-funded study, CPCRN researchers developed an intervention to promote smoke-free home policies to 2-1-1 callers and tested it in an initial efficacy trial in Atlanta and two effectiveness trials in North Carolina and Houston; all demonstrated intervention effectiveness, 9 and the intervention is currently being disseminated to 2,410 people at 2-1-1s in Akron, Cleveland, Orlando, Tulsa, and Alabama. The team is also adapting and testing Spanish and Chinese versions.…”

The cost of implementing a 2-1-1 call center-based cancer control navigator program

“…A state-wide randomized study documented the feasibility and referral contact effectiveness of providing cancer control and prevention services by 2-1-1 call centers. The most intensive strategy included a navigation component and demonstrated a larger referral contact rate at 1 month post intervention (34%) than the standard verbal referral plus tailored mailed reminder (24%) or verbal referral only (18%) (Kreuter et al, 2012). Studies have not provided evidence of cancer service completion Evaluation and Program Planning 39 (2013) [51][52][53][54][55][56] caused by 2-1-1 call center cancer control interventions.…”