Reducing Urban Cervical Cancer Disparities

NCT ID: NCT06416150

Last Updated: 2024-10-26

Study Results

Results pending

The study team has not published outcome measurements, participant flow, or safety data for this trial yet. Check back later for updates.

Basic Information

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Recruitment Status

RECRUITING

Clinical Phase

NA

Total Enrollment

546 participants

Study Classification

INTERVENTIONAL

Study Start Date

2024-08-28

Study Completion Date

2027-12-31

Brief Summary

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This study uses a hybrid Type 1 effectiveness-implementation trial to operationalize and assess the efficacy of the Health Enhancement Resource System (HERS) intervention. HERS aims to increase patient follow-up after abnormal test results through text message-based barriers counseling for women and supplemental telephone-based Health Coaching for women who miss their appointment.

Detailed Description

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Invasive cervical cancer is preventable with well-established screening and diagnostic tests. However, there is a large and persistent disparity gap in cervical cancer mortality rates among urban, underserved populations that continues to intensify. This gap is largely due to low follow-up after an abnormal test result leading to continued disease risk.

The study team developed an efficacious, tailored telephone counseling intervention delivered by a health coach \[Tailored Communication for Cervical Cancer Risk (TC3)\] that increased attendance at follow-up appointments for initial colposcopy among urban, underserved women. This evidence-based intervention is available for dissemination and implementation through the National Cancer Institute's Evidence-based Cancer Control Programs database. However, TC3 was developed prior to the upsurge of smartphones and texting usage and is resource-intensive, requiring dedicated staff to interview and counsel patients before their appointment, limiting its scalability and sustainability. Therefore, this study proposes use of a hybrid type 1 effectiveness-implementation study design to assess the impact of a Health Enhancement Resource System (HERS)-adapted from TC3-on attending follow-up appointments after an abnormal cervical test result.

Using a sequential, multiple assignment, randomized trial (SMART) design, a multi-site intervention study will be conducted at three high-volume, urban clinic sites in PA and NJ serving predominately low-income minority women: Fox Chase Cancer Center/Temple University Health System; Rutgers University, and Thomas Jefferson University. The study will target patients scheduled for first time or repeat colposcopy through (a) HERS text message-based barriers counseling and (b) supplemental telephone-based Health Coaching for women who miss their scheduled appointment.

Participants scheduled for a colposcopy after an abnormal cervical test will be recruited and randomized in a 1:1 ratio to receive either Standard of Care or HERS (text message intervention). Participants randomized to Standard of Care who do not attend the scheduled colposcopy appointment will be assigned to receive HERS. Participants randomized to HERS who do not attend the scheduled colposcopy appointment will be rerandomized to receive either HERS (repeating the text message intervention) or HERS+HC (text plus health coaching).

For the 12-month colposcopy appointment, participants will continue with the last intervention assignment they completed for the first colposcopy appointment (i.e., Standard of Care, HERS, or HERS+HC). Again, participants randomized to Standard of Care who do not attend the 12-month scheduled colposcopy appointment will be assigned to receive HERS. Participants randomized to HERS who do not attend the 12-month scheduled colposcopy appointment will be rerandomized to receive either HERS (repeating the text message intervention) or HERS+HC (text plus health coaching). Participants randomized to HERS+HC who do not attend the 12-month scheduled colposcopy appointment will be assigned to repeat HERS+HC.

All participants will complete surveys at baseline survey and a 1-week post-appointment survey for both colposcopy appointments. Participants will also complete a barriers assessment. Standard of Care participants will complete the assessment via online survey while HERS and HERS+HC participants will complete the barriers assessment via text message as part of the HERS text message intervention.

Qualitative interviews will be completed with providers at each site at pre-implementation and post-implementation. Additionally, a subset of participants will complete exit interviews after their 12-month colposcopy appointment.

Conditions

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Cervical Cancer Papilloma Viral Infection

Study Design

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Allocation Method

RANDOMIZED

Intervention Model

PARALLEL

Primary Study Purpose

SCREENING

Blinding Strategy

NONE

Study Groups

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Stage 1 and 3 SoC

Start with Stage 1 Standard of Care; patient attends baseline colposcopy appointment, no Stage 2 intervention. Continue with Stage 3 Standard of Care; patient attends 12-month follow-up appointment, no Stage 4 intervention.

Group Type EXPERIMENTAL

Stage 1 SOC

Intervention Type BEHAVIORAL

Participants will receive high Standard Care, consisting of a telephone call approximately one month before the appointment to confirm the appointment date for the baseline colposcopy appointment, followed by a notification letter including scheduled appointment date and clinic contact information should the clinic be unable to reach the patient by telephone.

Stage 3 SOC

Intervention Type BEHAVIORAL

Participants will receive a telephone call before their 12-month follow-up appointments to remind participants about their upcoming appointment and schedule/reschedule if needed.

Stage 1 and 3 SoC + Stage 4 HERS

Start with Stage 1 Standard of Care; patient attends baseline colposcopy appointment, no Stage 2 intervention. Continue with Stage 3 Standard of Care; patient does not attend 12-month follow-up appointment, continue with Stage 4 HERS intervention.

Group Type EXPERIMENTAL

Stage 1 SOC

Intervention Type BEHAVIORAL

Participants will receive high Standard Care, consisting of a telephone call approximately one month before the appointment to confirm the appointment date for the baseline colposcopy appointment, followed by a notification letter including scheduled appointment date and clinic contact information should the clinic be unable to reach the patient by telephone.

Stage 3 SOC

Intervention Type BEHAVIORAL

Participants will receive a telephone call before their 12-month follow-up appointments to remind participants about their upcoming appointment and schedule/reschedule if needed.

Stage 4 HERS

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Stage 1 SoC + Stage 2 and 3 HERS

Start with Stage 1 Standard of Care; patient does not attend baseline colposcopy appointment, continue with Stage 2 HERS intervention. Continue with Stage 3 HERS intervention; patient attends 12-month follow-up appointment, no Stage 4 intervention.

Group Type EXPERIMENTAL

Stage 1 SOC

Intervention Type BEHAVIORAL

Participants will receive high Standard Care, consisting of a telephone call approximately one month before the appointment to confirm the appointment date for the baseline colposcopy appointment, followed by a notification letter including scheduled appointment date and clinic contact information should the clinic be unable to reach the patient by telephone.

Stage 2 HERS

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Stage 3 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 1 SoC + Stage 2, 3, and 4 HERS

Start with Stage 1 Standard of Care; patient does not attend baseline colposcopy appointment, continue with Stage 2 HERS intervention. Continue with Stage 3 HERS intervention; patient does not attend 12-month follow-up appointment, continue with Stage 4 HERS intervention.

Group Type EXPERIMENTAL

Stage 1 SOC

Intervention Type BEHAVIORAL

Participants will receive high Standard Care, consisting of a telephone call approximately one month before the appointment to confirm the appointment date for the baseline colposcopy appointment, followed by a notification letter including scheduled appointment date and clinic contact information should the clinic be unable to reach the patient by telephone.

Stage 2 HERS

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Stage 3 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 4 HERS

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Stage 1 SoC + Stage 2 and 3 HERS + Stage 4 HERS+HC

Start with Stage 1 Standard of Care; patient does not attend baseline colposcopy appointment, continue with Stage 2 HERS intervention. Continue with Stage 3 HERS intervention; patient does not attend 12-month follow-up appointment, continue with Stage 4 HERS+HC intervention.

Group Type EXPERIMENTAL

Stage 1 SOC

Intervention Type BEHAVIORAL

Participants will receive high Standard Care, consisting of a telephone call approximately one month before the appointment to confirm the appointment date for the baseline colposcopy appointment, followed by a notification letter including scheduled appointment date and clinic contact information should the clinic be unable to reach the patient by telephone.

Stage 2 HERS

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Stage 3 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 4 HERS+HC

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message barriers counseling as well as HC. Participants that miss their scheduled appointment will receive a HC call within 2 business days. HC calls will be flexibly scheduled based on the preference of the patients and limited to 15 minutes or less.

Stage 1 and 3 HERS

Start with Stage 1 HERS intervention; patient attends baseline colposcopy appointment, no Stage 2 intervention. Continue with Stage 3 HERS intervention; patient attends 12-month follow-up appointment, no Stage 4 intervention.

Group Type EXPERIMENTAL

Stage 1 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 3 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 1, 3, and 4 HERS

Start with Stage 1 HERS intervention; patient attends baseline colposcopy appointment, no Stage 2 intervention. Continue with Stage 3 HERS intervention; patient does not attend 12-month follow-up appointment, continue with Stage 4 HERS intervention.

Group Type EXPERIMENTAL

Stage 1 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 3 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 4 HERS

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Stage 1 and 3 HERS + Stage 4 HERS+HC

Start with Stage 1 HERS intervention; patient attends baseline colposcopy appointment, no Stage 2 intervention. Continue with Stage 3 HERS intervention; patient does not attend 12-month follow-up appointment, continue with Stage 4 HERS+HC intervention.

Group Type EXPERIMENTAL

Stage 1 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 3 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 4 HERS+HC

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message barriers counseling as well as HC. Participants that miss their scheduled appointment will receive a HC call within 2 business days. HC calls will be flexibly scheduled based on the preference of the patients and limited to 15 minutes or less.

Stage 1, 2, and 3 HERS

Start with Stage 1 HERS intervention; patient does not attend baseline colposcopy appointment, continue with Stage 2 HERS intervention. Continue with Stage 3 HERS intervention; patient attends 12-month follow-up appointment, no Stage 4 intervention.

Group Type EXPERIMENTAL

Stage 1 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 2 HERS

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Stage 3 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 1, 2, 3, and 4 HERS

Start with Stage 1 HERS intervention; patient does not attend baseline colposcopy appointment, continue with Stage 2 HERS intervention. Continue with Stage 3 HERS intervention; patient does not attend 12-month follow-up appointment, continue with Stage 4 HERS intervention.

Group Type EXPERIMENTAL

Stage 1 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 2 HERS

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Stage 3 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 4 HERS

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Stage, 2, and 3 HERS + Stage 4 HERS+HC

Start with Stage 1 HERS intervention; patient does not attend baseline colposcopy appointment, continue with Stage 2 HERS intervention. Continue with Stage 3 HERS intervention; patient does not attend 12-month follow-up appointment, continue with Stage 4 HERS+HC intervention.

Group Type EXPERIMENTAL

Stage 1 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 2 HERS

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Stage 3 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 4 HERS+HC

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message barriers counseling as well as HC. Participants that miss their scheduled appointment will receive a HC call within 2 business days. HC calls will be flexibly scheduled based on the preference of the patients and limited to 15 minutes or less.

Stage 1 HERS + Stage 2 and 3 HERS+HC

Start with Stage 1 HERS intervention, patient does not attend baseline colposcopy appointment, continue with Stage 2 HERS+HC intervention. Continue with Stage 3 HERS+HC intervention; patient attends 12-month follow-up appointment, no Stage 4 intervention.

Group Type EXPERIMENTAL

Stage 1 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 2 HERS+HC

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message barriers counseling as well as health coaching (HC) after their missed appointment. Participants that miss their scheduled appointment will receive a HC call within 2 business days. HC calls will be flexibly scheduled based on the preference of the patients and limited to 15 minutes or less.

Stage 3 HERS+HC

Intervention Type BEHAVIORAL

Participants will receive text message barriers counseling as well as HC after their missed appointment. Participants that miss their scheduled appointment will receive a HC call within 2 business days. HC calls will be flexibly scheduled based on the preference of the patients and limited to 15 minutes or less.

Stage 1 HERS + Stage 2, 3, and 4 HERS+HC

Start with Stage 1 HERS intervention, patient does not attend baseline colposcopy appointment, continue with Stage 2 HERS+HC intervention. Continue with Stage 3 HERS+HC intervention; patient does not attend 12-month follow-up appointment, continue with Stage 4 HERS+HC intervention.

Group Type EXPERIMENTAL

Stage 1 HERS

Intervention Type BEHAVIORAL

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Stage 2 HERS+HC

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message barriers counseling as well as health coaching (HC) after their missed appointment. Participants that miss their scheduled appointment will receive a HC call within 2 business days. HC calls will be flexibly scheduled based on the preference of the patients and limited to 15 minutes or less.

Stage 3 HERS+HC

Intervention Type BEHAVIORAL

Participants will receive text message barriers counseling as well as HC after their missed appointment. Participants that miss their scheduled appointment will receive a HC call within 2 business days. HC calls will be flexibly scheduled based on the preference of the patients and limited to 15 minutes or less.

Stage 4 HERS+HC

Intervention Type BEHAVIORAL

Participants will receive another barriers assessment and another round of text message barriers counseling as well as HC. Participants that miss their scheduled appointment will receive a HC call within 2 business days. HC calls will be flexibly scheduled based on the preference of the patients and limited to 15 minutes or less.

Interventions

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Stage 1 SOC

Participants will receive high Standard Care, consisting of a telephone call approximately one month before the appointment to confirm the appointment date for the baseline colposcopy appointment, followed by a notification letter including scheduled appointment date and clinic contact information should the clinic be unable to reach the patient by telephone.

Intervention Type BEHAVIORAL

Stage 1 HERS

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Intervention Type BEHAVIORAL

Stage 2 HERS

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Intervention Type BEHAVIORAL

Stage 2 HERS+HC

Participants will receive another barriers assessment and another round of text message barriers counseling as well as health coaching (HC) after their missed appointment. Participants that miss their scheduled appointment will receive a HC call within 2 business days. HC calls will be flexibly scheduled based on the preference of the patients and limited to 15 minutes or less.

Intervention Type BEHAVIORAL

Stage 3 SOC

Participants will receive a telephone call before their 12-month follow-up appointments to remind participants about their upcoming appointment and schedule/reschedule if needed.

Intervention Type BEHAVIORAL

Stage 3 HERS

Participants will receive text message appointment reminders and barriers messages. Text messages will be sent on a prescheduled basis over the course of 2 weeks preceding the scheduled target appointment.

Intervention Type BEHAVIORAL

Stage 3 HERS+HC

Participants will receive text message barriers counseling as well as HC after their missed appointment. Participants that miss their scheduled appointment will receive a HC call within 2 business days. HC calls will be flexibly scheduled based on the preference of the patients and limited to 15 minutes or less.

Intervention Type BEHAVIORAL

Stage 4 HERS

Participants will receive another barriers assessment and another round of text message appointment reminders and barriers messages.

Intervention Type BEHAVIORAL

Stage 4 HERS+HC

Participants will receive another barriers assessment and another round of text message barriers counseling as well as HC. Participants that miss their scheduled appointment will receive a HC call within 2 business days. HC calls will be flexibly scheduled based on the preference of the patients and limited to 15 minutes or less.

Intervention Type BEHAVIORAL

Eligibility Criteria

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Inclusion Criteria

* 18 to 90 years of age (screening is still recommended for some women over 65-depending on screening and medical history and proceeds until age 90 in the study's clinic recruitment sites),
* referral for colposcopic evaluation at the clinic sites,
* able to communicate with ease in English,
* have a cell phone with texting ability, and
* competent to give consent.

Exclusion Criteria

* are pregnant at the time of recruitment,
* display current evidence or have a history of positive invasive carcinoma of the cervix, or
* require follow-up but not a colposcopy.
Minimum Eligible Age

18 Years

Maximum Eligible Age

90 Years

Eligible Sex

FEMALE

Accepts Healthy Volunteers

Yes

Sponsors

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Rutgers, The State University of New Jersey

OTHER

Sponsor Role collaborator

Thomas Jefferson University

OTHER

Sponsor Role collaborator

Temple University

OTHER

Sponsor Role collaborator

University of South Carolina

OTHER

Sponsor Role collaborator

Fox Chase Cancer Center

OTHER

Sponsor Role lead

Responsible Party

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Responsibility Role SPONSOR

Principal Investigators

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Suzanne M Miller, PhD

Role: PRINCIPAL_INVESTIGATOR

Fox Chase Cancer Center

Locations

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Rutgers, The State University of New Jersey

New Brunswick, New Jersey, United States

Site Status RECRUITING

Thomas Jefferson University

Philadelphia, Pennsylvania, United States

Site Status RECRUITING

Fox Chase Cancer Center

Philadelphia, Pennsylvania, United States

Site Status RECRUITING

Countries

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United States

Central Contacts

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Suzanne M Miller, PhD

Role: CONTACT

215-728-4069

Erin K Tagai, PhD, MPH

Role: CONTACT

215-728-5621

Facility Contacts

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Shawna Hudson, PhD

Role: primary

(848) 932-0215

Kuang-Yi Wen, PhD

Role: primary

215-503-4623

Erin Tagai, PhD, MPH

Role: primary

215-728-5621

Suzanne M Miller, Ph.D.

Role: backup

Other Identifiers

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23-1035

Identifier Type: -

Identifier Source: org_study_id

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