Communication Practices of Mammography Facilities and Timely Follow-up of a Screening Mammogram with a BI-RADS 0 Assessment

Schapira, Marilyn M.; Barlow, William E.; Conant, Emily F.; Sprague, Brian L.; Haas, Jennifer S.; Onega, Tracy; Beaber, Elisabeth F.; Goodrich, Martha; McCarthy, Anne Marie; Herschorn, Sally D.; Skinner, Celette Sugg; Harrington, Tory O.; Geller, Berta M.

doi:10.1016/j.acra.2017.12.028

Cited by 14 publications

(5 citation statements)

References 34 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…20 The quest for efficiency affects key patient outcomes: receiving mammography results by letter vs telephone is associated with decreased understanding, increased frustration and distress, and delayed followup. [21][22][23][24] Many patients in our study reported they did not understand medical jargon in letters and were left uncertain about the meaning of their results, a particular concern for vulnerable patients with low health literacy or limited English proficiency. [24][25][26] Patients were frustrated by the inability to immediately clarify with their clinician the likelihood of cancer and did not like having the onus put on them to call with questions.…”

Section: Discussion and Interpretationmentioning

confidence: 83%

Patient vs Clinician Perspectives on Communication About Results of Lung Cancer Screening

Wiener

Clark

Koppelman

et al. 2020

Chest

View full text Add to dashboard Cite

BACKGROUND: In the incidental pulmonary nodule and breast cancer screening settings, highquality patient-centered communication can improve adherence to evaluation and mitigate patient distress. Although guidelines emphasize shared decision-making before lung cancer screening, little is known about patient-clinician communication after lung cancer screening. RESEARCH QUESTION: How do patients and clinicians perceive communication and results notification after lung cancer screening, and are there approaches that may mitigate or exacerbate distress? STUDY DESIGN AND METHODS: We conducted interviews and focus groups with 49 patients who underwent lung cancer screening in the prior year and 36 clinicians who communicate screening results (primary care providers, pulmonologists, nurses), recruited from lung cancer screening programs at 4 hospitals. We analyzed transcripts using conventional content analysis. RESULTS: Clinicians and patients diverged in their impressions of the quality of communication after lung cancer screening. Clinicians recognized the potential for patient distress and tailored their approach to disclosure based on how clinically concerning they perceived results to be. Disclosure of normal or low-risk findings usually occurred by letter; clinicians believed this process was efficient and well received by patients. Yet many patients were dissatisfied: several could not recall receiving results at all, and others reported that receiving results by letter left them confused and concerned, with little opportunity to ask questions. By contrast, patients with larger nodules typically received results during an immediate phone call or clinic visit, and both patients and clinicians agreed that these conversations represented high-quality communication that met patient needs. Regardless of their cancer risk, patients who learned their results in a conversation appreciated the opportunity to discuss both the meaning of the nodule and the evaluation plan, and to have their concerns addressed, preempting distress. INTERPRETATION: Tension exists between clinicians' interest in efficiency of results notification by letter in low-risk cases and patients' need to understand and be reassured about screening results, their implications, and the plan for subsequent screening or nodule evaluation-even when clinicians did not perceive results as concerning. Brief conversations to discuss lung cancer screening results may improve patient understanding and satisfaction while reducing distress.

show abstract

Section: Discussion and Interpretationmentioning

confidence: 83%

Patient vs Clinician Perspectives on Communication About Results of Lung Cancer Screening

Wiener

Clark

Koppelman

et al. 2020

Chest

View full text Add to dashboard Cite

show abstract

“…19 Patients in facilities that used electronic medical records to notify patients for follow-up were also more likely to experience delay compared with those who received results via telephone. 20 Interventions to address communication barriers will need to focus on providers and healthcare facilities to improve follow-up rates. 21 Recommendations for abnormal test result communication include clearly defining timely follow-up, outlining provider responsibility to communicate results, having fail-safe procedures to ensure delivery, and specifying preferred mechanism of patient notification for critical tests.…”

Section: Introductionmentioning

confidence: 99%

Organization Communication Factors and Abnormal Mammogram Follow-up: a Qualitative Study Among Ethnically Diverse Women Across Three Healthcare Systems

et al. 2020

View full text Add to dashboard Cite

BACKGROUND: Regular mammogram screening for eligible average risk women has been associated with early detection and reduction of cancer morbidity and mortality. Delayed follow-up and resolution of abnormal mammograms limit early detection efforts and can cause psychological distress and anxiety. OBJECTIVE: The goal of this study was to gain insight from women's narratives into how organizational factors related to communication and coordination of care facilitate or hinder timely follow-up for abnormal mammogram results. DESIGN: We conducted 61 qualitative in-person interviews with women from four race-ethnic groups (African American, Chinese, Latina, and White) in three different healthcare settings (academic, community, and safety-net). PARTICIPANTS: Eligible participants had an abnormal mammogram result requiring breast biopsy documented in the San Francisco Mammography Registry in the previous year. APPROACH: Interview narratives included reflections on experience and suggested improvements to communication and follow-up processes. A grounded theory approach was used to identify themes across interviews. KEY RESULTS: Participants' experiences of follow-up and diagnosis depended largely on communication processes. Twenty-one participants experienced a follow-up delay (> 30 days between index mammogram and biopsy). Organizational factors, which varied across different institutions, played key roles in effective communication which included (a) direct verbal communication with the ability to ask questions, (b) explanation of medical processes and terminology avoiding jargon, and (c) use of interpretation services for women with limited English proficiency. CONCLUSION: Health organizations varied in their processes for abnormal results communication and availability of support staff and interpretation services. Women who received care from institutions with more robust support staff, such as bilingual navigators, more often than not reported understanding their results and timely abnormal mammogram follow-up. These reports were consistent across women from diverse ethnic groups and suggest the value of organizational support services between an abnormal mammogram and resolution for improving follow-up times and minimizing patient distress.

show abstract

“…This demonstrates the need to assess processes of care at the facility level that may be contributing to timely or delayed follow‐up. While one study has demonstrated a relationship between communication processes and timeliness of follow‐up after an indeterminate mammogram result (Breast Imaging‐Reporting and Data System—BI‐RADS—0), no studies have investigated facility processes of care for more concerning BI‐RADS 4 or 5 results and follow‐up, or their relationship to disparities in follow‐up.…”

Section: Introductionmentioning

confidence: 99%

Mammography facilities serving vulnerable women have longer follow‐up times

Karliner

Kaplan

Livaudais‐Toman

et al. 2018

Health Services Research

View full text Add to dashboard Cite

Objective To investigate mammography facilities’ follow‐up times, population vulnerability, system‐based processes, and association with cancer stage at diagnosis. Data Sources Prospectively collected from San Francisco Mammography Registry (SFMR) 2005‐2011, California Cancer Registry 2005‐2012, SFMR facility survey 2012. Study Design We examined time to biopsy for 17 750 abnormal mammogram results (BI‐RADS 4/5), categorizing eight facilities as short or long follow‐up based on proportion of mammograms with biopsy at 30 days. We examined facility population vulnerability (race/ethnicity, language, education), and system processes. Among women with a cancer diagnosis, we modeled odds of advanced‐stage (≥IIb) cancer diagnosis by facility follow‐up group. Data Extraction Methods Merged SFMR, Cancer Registry and facility survey data. Principal Findings Facilities (N = 4) with short follow‐up completed biopsies by 30 days for 82% of mammograms compared with 62% for facilities with long follow‐up (N = 4) (P < 0.0001). All facilities serving high proportions of vulnerable women were long follow‐up facilities. The long follow‐up facilities had fewer radiologists, longer biopsy appointment wait times, and less communication directly with women. Having the index abnormal mammogram at a long follow‐up facility was associated with higher adjusted odds of advanced‐stage cancer (OR 1.45; 95% CI 1.10‐1.91). Conclusions Providing mammography facilities serving vulnerable women with appropriate resources may decrease disparities in abnormal mammogram follow‐up and cancer diagnosis stage.

show abstract

Communication Practices of Mammography Facilities and Timely Follow-up of a Screening Mammogram with a BI-RADS 0 Assessment

Abstract: Our findings support the value of telephone communication to patients in relation to timely follow-up. Future research is needed to evaluate the role of communication in completing the breast cancer screening episode.

Cited by 14 publications

References 34 publications

Patient vs Clinician Perspectives on Communication About Results of Lung Cancer Screening

Patient vs Clinician Perspectives on Communication About Results of Lung Cancer Screening

Organization Communication Factors and Abnormal Mammogram Follow-up: a Qualitative Study Among Ethnically Diverse Women Across Three Healthcare Systems

Mammography facilities serving vulnerable women have longer follow‐up times

Contact Info

Product

Resources

About