Increasing cancer screening: a meta-analysis.
BACKGROUND: Primary care physicians believe preventive services are important, but perform these activities infrequently. Numerous studies have attempted to increase cancer screening, employing a variety of interventions with varying results. METHODS: We conducted a meta-analysis of published studies to identify effective office-based interventions for increasing cancer screening. Selected studies: (a) evaluated an intervention in a primary care setting, (b) addressed screening for breast, cervical, or colorectal cancer, and (c) reported results allowing calculation of an effect size. Study qualities and results were coded, entered, and analyzed using DSTAT. RESULTS: Interventions targeting either physician or patient were equally successful (d = +0.1894 and d = +0.1756, respectively). However, studies targeting both physician and patient demonstrated a smaller effect size (d = +0.0514). Greater success was found for interventions targeting the physician both during and outside the patient visit (d = +0.1222 during visit, d = +0.1849 outside visit, d = +0.3375 both). Similarly, screening behavior improved when the physicians were the target of more than one, but not more than three, interventions (d = +0.1360, d = +0.2495, d = +0.6829, d = -0.0058). CONCLUSIONS: Cancer screening activities increase with interventions that target either the physician or the patient and, when physicians are targeted, multiple interventions to serve as behavior cues and increase awareness appear optimal.