Personally Relevant Information about Screening Mammography (PRISM)

Program Title Personally Relevant Information about Screening Mammography (PRISM)
Purpose Designed to enhance knowledge in the decision making process for breast cancer screening. (2002)
Program Focus Awareness building and Improve decision making
Population Focus Women
Topic Informed Decision Making
Age Adults (40-65 years)
Gender Female
Race/Ethnicity American Indian, Asian, Black, not of Hispanic or Latino origin, Hispanic or Latino, White, not of Hispanic or Latino origin
Setting Home-based
Origination United States
Funded by NCI (Grant number(s): CA72099)
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The Need
Increasingly, it is recognized that people should make informed decisions about whether, when and how often to receive various cancer screening tests. For some cancers, such as colorectal cancer, there also may be choices about which cancer screening test to obtain. Yet, few interventions have been developed and tested to facilitate informed decision making (IDM).
The Program
Personally Relevant Information about Screening Mammography (PRISM) is a tailored decision-aid intervention developed specifically for women in their 40s and 50s.  The program aims to increase women's knowledge, the accuracy of their risk perceptions about, and mammography use.  PRISM is based on the Transtheoretical Model and Precaution Adoption Process Model.  The intervention is comprised of tailored print materials and telephone counseling to help women weigh the risks and benefits of mammography and reduce decisional conflict. The data are based on their responses to a telephone interview.  But other approaches could be used to obtain data for creating the tailored interventions. Print materials are tailored on the basis of about 20 variables, e.g., benefits and limitations of mammography, barriers to screening, and risk factors for breast cancer such as current age, age of menarche, previous breast biopsy, and personal and family history of breast cancer.  Telephone counseling answers questions and concerns and facilitates discussion about breast cancer and mammography.
Implementation Guide

The Implementation Guide is a resource for implementing this program. It provides important information about the staffing and functions necessary for administering this program in the user's setting. Additionally, the steps needed to carry out the research-tested program, relevant program materials, and information for evaluating the program are included. The Implementation Guide can be viewed and downloaded in the Products page.

Community Preventive Services Task Force Finding
Guide to Community Preventive Services This program uses the following intervention approach for which the Community Preventive Services Task Force finds insufficient evidence: interventions promoting informed decision making for cancer screening (Informed Decision Making). Insufficient evidence means the available studies do not provide sufficient evidence to determine if the intervention is or is not effective. This does not mean that the intervention does not work. It means that additional research is needed to determine whether the intervention is effective.

To expand understanding of this intervention category consider communicating with members from NCI's Research to Reality (R2R) community of practice who may be able to help you with your research efforts. Following is a link to start an online discussion with the R2R community of practice, after completing registration on the R2R site:

Time Required
Delivery time varies by intervention. By mail, women receive a tailored booklet 2 to 3 weeks after a baseline telephone survey and a newsletter 2 to 3 weeks after a 12-month follow-up telephone survey.  The phone surveys are approximately 30 minutes long but would be shorter if done as part of service delivery rather than research. Moreover, not all questions need to be asked if done outside of research.  Two weeks after women get the print materials, they receive a 5-7 minute counseling call.  Telephone counselors were trained for about 3 weeks.
Intended Audience

Study participants were North Carolina women aged 40 to 44 years and 50 to 54 years.  82% were White; 15% were Black; and 3% were classified as "Other". 80% were married; and 40% had at least a college education.  However, there is no reason to believe the interventions would not be acceptable to and appropriate for women in their 60s. And there have not been differential responses by race/ethnicity.

Suitable Settings
The intervention is suitable for implementation in the home. In fact, this is the preferred setting.
Required Resources
Required resources include two sample booklets, a sample newsletter, and the first- and second-year telephone counseling protocol and script for participants in their 40s and 50s.  The baseline and 12- and 24-month surveys are also required but outside the research setting, the questions could be reduced by about half to include only those used for tailoring.   In addition, two fact sheets regarding how self-report variables can be used to develop individually tailored print materials like the PRISM booklet and newsletter are provided for review. Costs associated with the program are not provided.
About the Study

Participants (N = 1287) recruited for the study included women aged 40 to 44 years and 50 to 54 years who were also enrolled by a large insurance carrier.  Women were stratified by age and mammography use, and randomized to receive usual care (UC), tailored print materials (TP), or tailored print materials plus tailored telephone counseling (TP+TC).  Usual care was the standard information sent by the insurance carrier and included a mailed mammography reminder letter sent on the woman's birthday and letters to providers identifying their patients in need of mammograms.  In addition to usual care, TP women received a tailored booklet 2 to 3 weeks after completing baseline surveys, and a tailored newsletter 2 to 3 weeks after completing the 12-month survey.  Women assigned to the TP+TC group also received a brief counseling call approximately 2 weeks after the booklet and newsletter were sent.  Print materials were tailored according to responses from baseline and 12-month surveys.  Women were interviewed again by phone at the 24-month follow-up. This last interview was for research purposes.

Results indicated:

  • Women in the TP+TC condition had more accurate perceptions of their breast cancer risk at 12 and 24 months than women in the TP or UC conditions.

Graph of Study Results

  • Women in the TP+TC condition had greater knowledge of mammography efficacy at 12 and 24 months than women in the TP or UC conditions.
  • The effect on mammography use was significant in bivariate relationships although the differences were more modest in multivariate analyses.  At 12 and 24 months, 18% to 20% of the UC group, 13% to 16% of the TP group, and 22% to 24% of the TP+TC group had mammograms. The ranges reflect different windows for reporting mammography use.

Dominick KL, Skinner CS, Bastian LA, Bosworth HB, Strigo TS, Rimer BK. (2003). Provider Characteristics and Mammography Recommendations Among Women in Their 40s and 50s. Journal of Women's Health, 12, 61-71.

Keller PA, Lipkus IM, Rimer BK. (2003). Affect, Framing, and Persuasion. Journal of Marketing Research, 40 , 54-65.

Keller PA, Lipkus IM, Rimer BK. (2002). Depressive Realism and Health Risk Accuracy: The Negative Consequences of Positive Mood. Journal of Consumer Research, 29 , 57-69.

Bastian LA, Lipkus IM, Kuchibhatla MN, Weng HH, Halabi S, Ryan PD, Skinner CS, Rimer BK. (2001). Women's Interest in Chemoprevention for Breast Cancer. Archives of Internal Medicine, 161, 1639-1644.

Bosworth HB, Bastian LA, Kuchibhatla MN, Steffens DC, McBride CM, Skinner CS, Rimer BK, Siegler IC. (2001). Depressive Symptoms, Menopausal Status, and Climacteric Symptoms in Women at Mid-Life. Psychosomatic Medicine, 63, 603-608.

Lipkus IM, Biradavolu M, Fenn K, Keller P, Rimer BK. (2001). Informing Women about Their Breast Cancer Risks: Truth and Consequences. Health Communication, 13, 205-226.

Lipkus IM, Klein WMP, Rimer BK. (2001). Communicating Breast Cancer Risks to Women Using Different Formats. Cancer Epidemiology, Biomarkers and Prevention, 10, 895-898.

Lipkus IM, Samsa G, Rimer BK. (2001). General Performance on a Numeracy Scale among Highly Educated Samples. Medical Decision Making, 21, 37-44.

Rimer BK, Halabi S, Skinner CS, Kaplan EB, Crawford Y, Samsa GP, Strigo TS, Lipkus IM. (2000). The Short-Term Impact of Tailored Mammography Decision-Making Interventions. Patient Education and Counseling, 43, 269-285.

Halabi S, Skinner CS, Samsa GP, Strigo TS, Crawford YS, Rimer BK. (2000). Factors Associated with Repeat Mammography Screening. The Journal of Family Practice, 49, 1104-1112.

Lipkus IM, Kuchibhatla M, McBride CM, Bosworth HB, Pollak KI, Siegler IC, Rimer BK. (2000). Relationships Among Breast Cancer Perceived Absolute Risk, Comparative Risks and Worries. Cancer Epidemiology, Biomarkers and Prevention, 9, 973-975.

Lipkus IM, Halabi S, Strigo TS, Rimer BK. (2000). The Impact of Abnormal Mammograms on Psychosocial Outcomes and Subsequent Screening. Psycho-oncology, 9, 402-410.

Rimer BK. (2000). Cancer Control Research (2001). Cancer Causes & Control, 11, 257-270.

Rimer BK, Glassman B. (1999). Is There a Use for Tailored Print Communications in Cancer Risk Communication?. Journal of the National Cancer Institute. Monographs, 25, 140-148. Bethesda:National Cancer Institute.

Rimer BK, Halabi S, Strigo TS, Crawford Y, Lipkus IM. (1999). Confusion About Mammography: Prevalence and Consequences. Journal of women's health & gender-based medicine, 8(4), 509-520.

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Updated: 08/30/2011