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Waddell KJ, Goel K, Park SH, Linn KA, Navathe AS, Liao JM, McDonald C, Reitz C, Moore J, Hyland S, Mehta SJ. Association of Electronic Self-Scheduling and Screening Mammogram Completion. Am J Prev Med 2024; 66:399-407. [PMID: 38085196 PMCID: PMC10922640 DOI: 10.1016/j.amepre.2023.11.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/21/2023] [Revised: 11/02/2023] [Accepted: 11/02/2023] [Indexed: 01/29/2024]
Abstract
INTRODUCTION The purpose of this study was to evaluate if an electronic health record (EHR) self-scheduling function was associated with changes in mammogram completion for primary care patients who were eligible for a screening mammogram using U.S. Preventive Service Task Force recommendations. METHODS This was a retrospective cohort study (September 1, 2014-August 31, 2019, analyses completed in 2022) using a difference-in-differences design to examine mammogram completion before versus after the implementation of self-scheduling. The difference-in-differences estimate was the interaction between time (pre-versus post-implementation) and group (active EHR patient portal versus inactive EHR patient portal). The primary outcome was mammogram completion among all eligible patients, with completion defined as receiving a mammogram within 6 months post-visit. The secondary outcome was mammogram completion among patients who received a clinician order during their visit. RESULTS The primary analysis included 35,257 patient visits. The overall mammogram completion rate in the pre-period was 22.2% and 49.7% in the post-period. EHR self-scheduling was significantly associated with increased mammogram completion among those with an active EHR portal, relative to patients with an inactive portal (adjusted difference 13.2 percentage points [95% CI 10.6-15.8]). For patients who received a clinician mammogram order at their eligible visit, self-scheduling was significantly associated with increased mammogram completion among patients with an active EHR portal account (adjusted difference 14.7 percentage points, [95% CI 10.9-18.5]). CONCLUSIONS EHR-based self-scheduling was associated with a significant increase in mammogram completion among primary care patients. Self-scheduling can be a low-cost, scalable function for increasing preventive cancer screenings.
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Affiliation(s)
- Kimberly J Waddell
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Corporal Michael J. Cresencz VA Medical Center, Philadelphia, PA.
| | - Keshav Goel
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Sae-Hwan Park
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA
| | - Kristin A Linn
- Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Biostatistics, Epidemiology, and Informatics, University of Pennsylvania
| | - Amol S Navathe
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Corporal Michael J. Cresencz VA Medical Center, Philadelphia, PA
| | - Joshua M Liao
- Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Department of Medicine, University of Washington, Seattle, WA
| | - Caitlin McDonald
- Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia, PA
| | - Catherine Reitz
- Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia, PA
| | - Jake Moore
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Steve Hyland
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA
| | - Shivan J Mehta
- Perelman School of Medicine, University of Pennsylvania, Philadelphia, PA; Center for Health Incentives and Behavioral Economics, University of Pennsylvania, Philadelphia, PA; Leonard Davis Institute for Health Economics, University of Pennsylvania, Philadelphia, PA; Center for Health Care Transformation and Innovation, University of Pennsylvania, Philadelphia, PA
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Funaro K, Niell B. Screening Mammography Utilization in the United States. JOURNAL OF BREAST IMAGING 2023; 5:384-392. [PMID: 38416907 DOI: 10.1093/jbi/wbad042] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Indexed: 03/01/2024]
Abstract
Breast cancer is the second leading cause of cancer mortality in adult women in the United States. Screening mammography reduces breast cancer mortality between 22% and 48%; however, screening mammography remains underutilized. Screening mammography utilization data are available from insurance claims, electronic medical records, and patient self-report via surveys, and each data source has unique benefits and challenges. Numerous barriers exist that adversely affect the use of screening mammography in the United States. This article will review screening mammography utilization in the United States, explore factors that impact utilization, and briefly discuss strategies to improve utilization.
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Affiliation(s)
- Kimberly Funaro
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
| | - Bethany Niell
- H. Lee Moffitt Cancer Center and Research Institute, Department of Diagnostic Imaging, Tampa, FL, USA
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Shah BA, Mirchandani A, Abrol S. Impact of same day screening mammogram results on women’s satisfaction and overall breast cancer screening experience: a quality improvement survey analysis. BMC Womens Health 2022; 22:338. [PMID: 35941606 PMCID: PMC9361536 DOI: 10.1186/s12905-022-01919-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2021] [Accepted: 07/29/2022] [Indexed: 11/10/2022] Open
Abstract
Abstract
Background
Most women undergoing screening examinations in the U.S. do not receive immediate results and for many this results in increased stress, inconvenience, delayed diagnosis, and potential loss to follow-up.
Objective
To study the impact of same appointment mammogram results on breast cancer screening experience and patient satisfaction.
Materials and methods
A 6-question survey with questions focused on breast cancer screening experience with our new service of same appointment mammogram results was distributed to 200 patients, with 185 patients returning their responses. Patients evaluated their current experience on receiving their screening results during the same appointment with their prior breast cancer screening experience. Patients who did not respond to their satisfaction score either before or after same appointment results were excluded from the patient cohort analyzing satisfaction score. Remaining questions were analyzed separately as additional satisfaction assessment tools.
Results
About 48% of the patients indicated an improvement in their screening experience with same appointment mammography results service, while 47% of the patients reported no significant difference in their experience.
Conclusion
Although not statistically significant, same appointment mammogram results were able to make a positive impact on breast cancer screening experience among 48% of the patients. Further research elucidating barriers to screening and other ways to improve patient satisfaction will be required to increase breast cancer screening compliance.
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Selva A, López P, Puig T, Macià F, Selva C, Álvarez-Pérez Y, Terraza R, Burón A, Machlab ST, Pericay C, Solà I, Torà N, Rodríguez V, Barrufet C, Aymar A, Baré M. Patient experience, satisfaction and shared decision-making in colorectal cancer screening: protocol of the mixed-methods study CyDESA. BMJ Open 2022; 12:e057687. [PMID: 35636783 PMCID: PMC9152928 DOI: 10.1136/bmjopen-2021-057687] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/27/2021] [Accepted: 04/25/2022] [Indexed: 11/14/2022] Open
Abstract
INTRODUCTION Colorectal cancer (CRC) screening programmes can reduce incidence and mortality from this condition if adherence to them is high. As patient experience and satisfaction are key factors in determining adherence to screening programmes, they need to be measured. Furthermore, to promote highly patient-centred healthcare, the perception of patients regarding shared decision-making during CRC screening needs to be known. This study aims to assess the experience, satisfaction and participation in decision-making of participants in a CRC screening programme and of patients diagnosed with CRC through this programme in relation to the diagnostic and therapeutic processes of cancer. METHODS AND ANALYSIS The CyDESA study is a mixed-methods study with a four phase sequential design. In phase 1, we will conduct a systematic review of patient-reported experience measures (PREMs) for patient experience or satisfaction with CRC screening. In case no located PREM can be applied, in phase 2, we will develop a new PREM. We will use the Delphi methodology to reach consensus among experts and patients and will conduct a pilot test of the developed PREM. Phase 3 is a multicentric cross-sectional study based on self-reported questionnaires that will be conducted at three Spanish hospitals (n=843). The objective is to find out about the experience, satisfaction and participation in decision-making of participants in the CRC screening programme who have had a positive screening test result according to their final screening diagnosis: false positives, colorectal polyps or CRC. Phase 4 is a qualitative phenomenological study based on individual interviews. It will explore the experiences of participants in the CRC screening programme and of those diagnosed with CRC. ETHICS AND DISSEMINATION Ethics approval by the Ethics Committees of Corporació Sanitària Parc Taulí, Hospital de Sant Pau and Parc de Salut Mar. Findings will be published in peer-reviewed journals and presented at conferences. TRIAL REGISTRATION NUMBER NCT04610086.
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Affiliation(s)
- Anna Selva
- Clinical Epidemiology and Cancer Screening, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalunya, Spain
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Autonomous University of Barcelona, Barcelona, Catalunya, Spain
| | - Pilar López
- Clinical Epidemiology and Cancer Screening, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalunya, Spain
| | - Teresa Puig
- Department of Paediatrics, Obstetrics, Gynaecology and Preventive Medicine, Autonomous University of Barcelona, Barcelona, Catalunya, Spain
- Clinical Epidemiology and Healthcare Services, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Catalunya, Spain
| | - Francesc Macià
- Epidemiology and Evaluation Department, Hospital del Mar Institute for Medical Research, Barcelona, Catalunya, Spain
- Health Services Research on Chronic Patients Network, REDISSEC, Madrid, Spain
| | - Clara Selva
- Psychology and Educational Sciences Studies, UOC, Barcelona, Catalunya, Spain
| | - Yolanda Álvarez-Pérez
- Servicio de Evaluación del Servicio Canario de la Salud, Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Santa Cruz de Tenerife, Santa Cruz de Tenerife, Spain
| | | | - Andrea Burón
- Epidemiology and Evaluation Department, Hospital del Mar Institute for Medical Research, Barcelona, Catalunya, Spain
- Health Services Research on Chronic Patients Network, REDISSEC, Madrid, Spain
| | - Salvador Tarek Machlab
- Gastroenterology Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalunya, Spain
| | - Carles Pericay
- Medical Oncology Department, Consorci Corporació Sanitària Parc Taulí, Sabadell, Catalunya, Spain
| | - Ivan Solà
- Clinical Epidemiology and Healthcare Services, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Catalunya, Spain
- CIBERESP, CIBER, Madrid, Comunidad de Madrid, Spain
| | - Núria Torà
- Cancer Screening Programs, Althaia Foundation of Manresa, Manresa, Catalunya, Spain
| | - Vanesa Rodríguez
- TecnoCampus Superior School of Health Science, Pompeu Fabra University, Mataro, Catalunya, Spain
| | - Cristina Barrufet
- Epidemiology and Evaluation Department, Hospital del Mar Institute for Medical Research, Barcelona, Catalunya, Spain
| | - Anna Aymar
- Clinical Epidemiology and Healthcare Services, Institut d'Investigació Biomèdica Sant Pau IIB Sant Pau, Barcelona, Catalunya, Spain
| | - Marisa Baré
- Epidemiology and Cancer Screening, Consorcio Corporacion Sanitaria Parc Tauli, Sabadell, Spain
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Selva A, Selva C, Álvarez-Pérez Y, Torà N, López P, Terraza-Núñez R, Rodríguez V, Solà I. Satisfaction and experience with colorectal cancer screening: a systematic review of validated patient reported outcome measures. BMC Med Res Methodol 2021; 21:230. [PMID: 34706652 PMCID: PMC8549248 DOI: 10.1186/s12874-021-01430-7] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2021] [Accepted: 10/08/2021] [Indexed: 12/22/2022] Open
Abstract
BACKGROUND Patient satisfaction or experience with colorectal cancer screening can determine adherence to screening programs. An evaluation of validated patient reported outcome measures (PROMs) for measuring experience or satisfaction with colorectal cancer screening does not exist. Our objective was to identify and critically appraise validated questionnaires for measuring patient satisfaction or experience with colorectal cancer screening. METHODS We conducted a systematic review following the COnsensus-based Standards for the selection of health Measurement INstruments (COSMIN) methodology. We conducted searches on MEDLINE, EMBASE, PsychINFO, CINAHL and BiblioPRO and assessed the methodological quality of studies and measurement properties of questionnaires according to the COSMIN guidelines for systematic reviews of PROMs. PROSPERO registration number: CRD42019118527. RESULTS We included 80 studies that used 75 questionnaires, of which only 5 were validated. Four questionnaires measured satisfaction with endoscopy: two in the context of colorectal cancer screening (for colonoscopy and sigmoidoscopy) and two for non-screening endoscopy. One questionnaire measured satisfaction with bowel preparation. The methodological quality of studies was variable. The questionnaires with evidence for sufficient content validity and internal consistency were: the CSSQP questionnaire, which measures safety and satisfaction with screening colonoscopy, and the Post-Procedure questionnaire which measures satisfaction with non-screening endoscopic procedures. CONCLUSIONS This systematic review shows that a minority of existing PROMs for measuring patient satisfaction with colorectal cancer screening are validated. We identified two questionnaires with high potential for further use (CSSQP and the Post-Procedure questionnaire).
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Affiliation(s)
- A Selva
- Clinical Epidemiology and Cancer Screening, Parc Taulí Hospital Universitari, Corporació Sanitària Parc Taulí, Edifici Santa Fè. Parc Taulí 1, Sabadell, 08208, Barcelona, Catalonia, Spain.
- Universitat Autònoma de Barcelona, Bellaterra, Spain.
- REDISSEC (Health Services Research on Chronic Patients Network), Madrid, Spain.
| | - C Selva
- Universitat Oberta de Catalunya (Estudis de Psicologia i Ciències de l'Educació), Barcelona, Catalonia, Spain
| | - Y Álvarez-Pérez
- Fundación Canaria Instituto de Investigación Sanitaria de Canarias (FIISC), Tenerife, Spain
| | - N Torà
- Cancer Screening Programms. Althaia Xarxa Assistencial Universitària de Manresa, Manresa, Catalonia, Spain
| | - P López
- Clinical Epidemiology and Cancer Screening, Parc Taulí Hospital Universitari, Corporació Sanitària Parc Taulí, Edifici Santa Fè. Parc Taulí 1, Sabadell, 08208, Barcelona, Catalonia, Spain
| | - R Terraza-Núñez
- Direcció General de Planificació en Salut, Departament de Salut, Generalitat de Catalunya, Barcelona, Catalonia, Spain
| | - V Rodríguez
- Tecnocampus, Universitat Pompeu Fabra, Mataró, Catalonia, Spain
| | - I Solà
- Institute of Biomedical Research, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- Iberoamerican Cochrane Centre, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
- CIBER Epidemiología y Salud Pública, Instituto de Salud Carlos III, Madrid, Spain
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Unim B, Boggi R, Napoli M, Fulgenzi R, Landi A, La Torre G. Predictors of Mammography Uptake Among Italian Women Aged 50-69: a Cross-sectional Study. JOURNAL OF CANCER EDUCATION : THE OFFICIAL JOURNAL OF THE AMERICAN ASSOCIATION FOR CANCER EDUCATION 2020; 35:1089-1093. [PMID: 31183766 DOI: 10.1007/s13187-019-01560-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/09/2023]
Abstract
Screening coverage is of concern in several countries, including Italy. The aim of the study is to assess predictors of participation in the mammography screening program at the Local Health Unit RMA (Rome, Italy). A telephone-based questionnaire was administered to randomly selected eligible women. The study population was interviewed by the personnel of the health center. Five hundred two women were interviewed, of which 264(52.6%) have attended the breast cancer screening program at least once. The attendees received the invitation letter more often than the non-attendees (88.3% vs. 77.7%; p = 0.002) and were more willing to participate (85.6% vs. 69.3%; p < 0.001). Employees were more among the non-attendees of the screening program (66% vs. 52.3%; p = 0.002). Age over-61 (OR = 2.75; 95%CI 1.84-4.09), receiving the invitation letter (OR = 2.54; 95%CI = 1.52-4.24), and intention to participate (OR = 3.09; 95%CI = 1.94-4.91) were significantly associated with participation in the screening program. Although the invitation rate of the Local Health Unit RMA has improved in recent years, the mammography uptake rate remains very low. The presence of opportunistic screening activities, younger age, and low educational status could explain the low participation rates. Organizational barriers (e.g., screening hours coinciding with work hours, screening facilities located far away) may also limit participation. Major efforts should be made towards the regulation of opportunistic screening activities and reorganization of the screening centers and communication strategies to better comply with the needs of the target population. In this light, the involvement of different healthcare professionals, especially general practitioners, and gynecologists, is crucial.
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Affiliation(s)
- Brigid Unim
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy
| | - Roberto Boggi
- Local Health Unit ASL Roma A, Department of Prevention - Hygiene and Public Health Service, 00187, Rome, Italy
| | - Massimo Napoli
- Local Health Unit ASL Roma A, Department of Prevention - Hygiene and Public Health Service, 00187, Rome, Italy
| | - Roberta Fulgenzi
- Local Health Unit ASL Roma A, Department of Prevention - Hygiene and Public Health Service, 00187, Rome, Italy
| | - Adelaide Landi
- Local Health Unit ASL Roma A, Department of Prevention - Hygiene and Public Health Service, 00187, Rome, Italy
| | - Giuseppe La Torre
- Department of Public Health and Infectious Diseases, Sapienza University of Rome, Piazzale Aldo Moro 5, 00185, Rome, Italy.
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Lee SC, Higashi RT, Sanders JM, Zhu H, Inrig SJ, Mejias C, Argenbright KE, Tiro JA. Effects of program scale-up on time to resolution for patients with abnormal screening mammography results. Cancer Causes Control 2018; 29:995-1005. [PMID: 30140972 DOI: 10.1007/s10552-018-1074-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 08/17/2018] [Indexed: 01/07/2023]
Abstract
PURPOSE Effects of geographic program expansion to rural areas on screening program outcomes are understudied. We sought to determine whether time-to-resolution (TTR) varied significantly by service delivery time period, location, and participant characteristics across 19 North Texas counties. METHODS We calculated proportions undergoing diagnostic follow-up and resolved ≤ 60 days. We calculated median TTR for each time period and abnormal result BI-RADS 0, 4, 5. Cox proportional hazards regressions estimated time period and patient characteristic effects on TTR. Wilcoxon rank sum tests evaluated whether TTR differed between women who did or did not transfer between counties for services. RESULTS TTR ranged from 14 to 17 days for BI-RADs 0, 4, and 5; 12.4% transferred to a different county, resulting in longer median TTR (26 vs. 16 days; p < .001). Of those completing follow-up, 92% were resolved ≤ 60 days (median 15 days). For BI-RAD 3, TTR was 208 days (including required 180 day waiting period). Follow-up was significantly lower for women with BI-RAD 3 (59% vs. 96%; p < .0001). CONCLUSION Expansion maintained timely service delivery, increasing access to screening among rural, uninsured women. Policies adding a separate quality metric for BI-RAD 3 could encourage follow-up monitoring to address lower completion and longer TTR among women with this result.
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Affiliation(s)
- Simon Craddock Lee
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA.
- Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Drive, Dallas, TX, 75390, USA.
| | - Robin T Higashi
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Joanne M Sanders
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Hong Zhu
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Drive, Dallas, TX, 75390, USA
| | - Stephen J Inrig
- Mount St. Mary's University, 10 Chester Place, Los Angeles, CA, 90007, USA
| | - Caroline Mejias
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
| | - Keith E Argenbright
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Drive, Dallas, TX, 75390, USA
- Moncrief Cancer Institute, 400 W. Magnolia Ave, Fort Worth, TX, 76104, USA
| | - Jasmin A Tiro
- Department of Clinical Sciences, University of Texas Southwestern Medical Center, 5323 Harry Hines Blvd, Dallas, TX, 75390-9066, USA
- Harold C. Simmons Comprehensive Cancer Center, 2201 Inwood Drive, Dallas, TX, 75390, USA
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Rosenkrantz AB, Moy L, Fleming MM, Duszak R. Associations of County-level Radiologist and Mammography Facility Supply with Screening Mammography Rates in the United States. Acad Radiol 2018; 25:883-888. [PMID: 29373212 DOI: 10.1016/j.acra.2017.11.023] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2017] [Revised: 11/10/2017] [Accepted: 11/24/2017] [Indexed: 01/12/2023]
Abstract
RATIONALE AND OBJECTIVES The present study aims to assess associations of Medicare beneficiary screening mammography rates with local mammography facility and radiologist availability. MATERIALS AND METHODS Mammography screening rates for Medicare fee-for-service beneficiaries were obtained for US counties using the County Health Rankings data set. County-level certified mammography facility counts were obtained from the United States Food and Drug Administration. County-level mammogram-interpreting radiologist and breast imaging subspecialist counts were determined using Centers for Medicare & Medicaid Services fee-for-service claims files. Spearman correlations and multivariable linear regressions were performed using counties' facility and radiologist counts, as well as counts normalized to counties' Medicare fee-for-service beneficiary volume and land area. RESULTS Across 3035 included counties, average screening mammography rates were 60.5% ± 8.2% (range 26%-88%). Correlations between county-level screening rates and total mammography facilities, facilities per 100,000 square mile county area, total mammography-interpreting radiologists, and mammography-interpreting radiologists per 100,000 county-level Medicare beneficiaries were all weak (r = 0.22-0.26). Correlations between county-level screening rates and mammography rates per 100,000 Medicare beneficiaries, total breast imaging subspecialist radiologists, and breast imaging subspecialist radiologists per 100,000 Medicare beneficiaries were all minimal (r = 0.06-0.16). Multivariable analyses overall demonstrated radiologist supply to have a stronger independent effect than facility supply, although effect sizes remained weak for both. CONCLUSION Mammography facility and radiologist supply-side factors are only weakly associated with county-level Medicare beneficiary screening mammography rates, and as such, screening mammography may differ from many other health-care services. Although efforts to enhance facility and radiologist supply may be helpful, initiatives to improve screening mammography rates should focus more on demand-side factors, such as patient education and primary care physician education and access.
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Affiliation(s)
- Andrew B Rosenkrantz
- Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, 660 First Ave, 3rd Floor, NYU Langone Medical Center, New York, NY 10016.
| | - Linda Moy
- Department of Radiology, Center for Biomedical Imaging, NYU School of Medicine, 660 First Ave, 3rd Floor, NYU Langone Medical Center, New York, NY 10016
| | - Margaret M Fleming
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
| | - Richard Duszak
- Department of Radiology and Imaging Sciences, Emory University School of Medicine, Atlanta, Georgia
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Parks MJ, Kim S. Interpersonal Communication in Response to an Intervention and Its Impact on Smoking Cessation Within a Low-Income Population. HEALTH EDUCATION & BEHAVIOR 2017; 45:550-558. [PMID: 29258347 DOI: 10.1177/1090198117749258] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
BACKGROUND It is a priority to develop population-based strategies for reducing barriers to smoking cessation among low-income populations. Harnessing secondary transmission such as interpersonal communication (IC) has helped to reduce tobacco use, but there is a dearth of quasi-experimental research that examines IC and the full spectrum of smoking cessation behaviors, particularly in the context of population-level programs. AIMS Using quasi-experimental methods, we examined IC in response to a population-level intervention and its impact on the full spectrum of smoking cessation outcomes among low-income smokers. METHOD We used propensity score matching; three different propensity score matching procedures were used to estimate and approximate experimental effects. We assessed four cessation outcomes: utilization of a free tobacco quitline (QL), making a quit attempt, and being smoke-free for 7 and 30 days at follow-up. We also examined predictors of IC. RESULTS IC was significantly related to QL utilization (effect sizes ranging from 0.135 to 0.166), making a quit attempt (effect sizes ranging from 0.115 to 0.147), being smoke-free for 7 days (effect sizes ranging from 0.080 to 0.121), and being smoke-free for 30 days at follow-up (effect sizes ranging from 0.058 to 0.082). Program-related and participant characteristics predicted IC, such as receiving emotional direct mail materials and living with a fellow smoker. DISCUSSION IC in response to a population-based program affected the cessation process, and IC had a marked impact on sustained cessation. CONCLUSION Population-based programs should aim to harness psychosocial dynamics such as IC to promote sustained cessation among low-income populations.
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Affiliation(s)
- Michael J Parks
- 1 Minnesota Department of Health, St. Paul, MN, USA.,2 University of Minnesota, Minneapolis, MN, USA
| | - Soyoon Kim
- 3 University of Miami, Coral Gables, FL, USA
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10
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Benito L, Farre A, Binefa G, Vidal C, Cardona A, Pla M, García M. Factors related to longitudinal adherence in colorectal cancer screening: qualitative research findings. Cancer Causes Control 2017; 29:103-114. [PMID: 29170881 DOI: 10.1007/s10552-017-0982-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2017] [Accepted: 11/15/2017] [Indexed: 12/13/2022]
Abstract
BACKGROUND The effectiveness of screening in colorectal cancer prevention depends on sustained participation rates. The objective of this study was to explore factors related to the longitudinal adherence of screening behavior in the context of a biennial population-based cancer screening program. METHODS Eight focus groups were conducted with individuals who were invited two or three consecutive times to a population-based colorectal cancer screening program using a fecal occult blood test and who agreed to participate in the program at least once (n = 45). The criteria used to select the study members included adherence to fecal occult blood test maintenance, factors regarding their initial participation in the colorectal cancer screening, sex, and contextual educational level. RESULTS The participants expressed a high level of satisfaction with the program; however, they showed a low level of understanding with respect to cancer screening. Consulting a general practitioner was cited by all participants as an important factor that mediated their final decision or influenced their behavior as a whole with regard to the program. Fear played a different role in the screening behavior for regular and irregular adherent participants. In the adherent participants, fear facilitated their continued participation in the screening program, whereas for the irregular participants, fear led them to avoid or refuse further screening. Having a close person diagnosed with colorectal cancer was a facilitator for the regular adherent participants. The irregular adherent participants showed some relaxation with respect to screening after a negative result and considered that further screening was no longer necessary. CONCLUSION Considering the importance of primary healthcare professionals in the decision regarding sustained participation, it is important to better engage them with cancer screening programs, as well as improve the communication channels to provide accurate and balanced information for both health professionals and individuals.
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Affiliation(s)
- Llucia Benito
- Cancer Prevention and Control Program, Catalan Institute of Oncology, Av. Gran Via, 199-203, 08908, Hospitalet de Llobregat (Barcelona), Spain.,Institute of Biomedical Research, IDIBELL, Av. Gran Via, 199-203, 08908, Hospitalet de Llobregat (Barcelona), Spain.,Fundamental Care and Medical-Surgical Nursing Department, School of Nursing, University of Barcelona, C/Feixa Llarga, s/n. Campus de Bellvitge, 08907, Hospitalet de Llobregat (Barcelona), Spain
| | - Albert Farre
- Institute of Applied Health Research, University of Birmingham, Edgbaston, Birmingham, B15 2TT, UK
| | - Gemma Binefa
- Cancer Prevention and Control Program, Catalan Institute of Oncology, Av. Gran Via, 199-203, 08908, Hospitalet de Llobregat (Barcelona), Spain.,Institute of Biomedical Research, IDIBELL, Av. Gran Via, 199-203, 08908, Hospitalet de Llobregat (Barcelona), Spain
| | - Carmen Vidal
- Cancer Prevention and Control Program, Catalan Institute of Oncology, Av. Gran Via, 199-203, 08908, Hospitalet de Llobregat (Barcelona), Spain.,Institute of Biomedical Research, IDIBELL, Av. Gran Via, 199-203, 08908, Hospitalet de Llobregat (Barcelona), Spain
| | - Angels Cardona
- AreaQ Evaluation and Qualitative Research SL, Domenech 7, Barcelona, Spain
| | - Margarita Pla
- Public Health, Mental Health and Perinatal Nursing Department, School of Nursing, University of Barcelona, C/Feixa Llarga, s/n. Campus de Bellvitge, 08907, Hospitalet de Llobregat (Barcelona), Spain
| | - Montse García
- Cancer Prevention and Control Program, Catalan Institute of Oncology, Av. Gran Via, 199-203, 08908, Hospitalet de Llobregat (Barcelona), Spain. .,Institute of Biomedical Research, IDIBELL, Av. Gran Via, 199-203, 08908, Hospitalet de Llobregat (Barcelona), Spain.
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Osborne JM, Wilson C, Duncan A, Cole SR, Flight I, Turnbull D, Hughes DL, Young GP. Patterns of participation over four rounds of annual fecal immunochemical test-based screening for colorectal cancer: what predicts rescreening? BMC Public Health 2017; 18:81. [PMID: 28764667 PMCID: PMC5540393 DOI: 10.1186/s12889-017-4634-8] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2017] [Accepted: 07/26/2017] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Participation at the recommended intervals is critical for screening to be effective in reducing colorectal cancer (CRC) incidence. This study describes patterns of screening participation over four rounds of fecal immunochemical testing (FIT) to identify whether demographic variables and prior screening satisfaction are significantly associated with patterns of re-participation. METHODS Baseline surveys were mailed to 4000 South Australians randomly selected from the electoral-roll. Respondents (n = 1928/48.2%) were offered four annual FIT rounds. Screening participation and satisfaction at each round were recorded. RESULTS Study participation was 58.5, 66.9, 73.1 and 71.4% respectively over four rounds. Three participation patterns were described: consistent participation (43.1%), consistent non-participation (26.4%) and inconsistent participation (changeable; 30.5%), including intermittent and sustained change patterns. Sustained change described those who changed participatory behavior and then maintained for at least two rounds (n = 375/19.5%). Older people, and those not working were most likely to sustain participation. Younger invitees, especially men, were more likely to change participatory behavior and sustain the change. People with higher disadvantage, less education, not working and with no prior (pre-trial) screening experience were more likely to start participating and drop out. People dissatisfied with a prior screening test, including finding aspects embarrassing or unpleasant, were also more likely not to participate in annual screening or to drop out. CONCLUSIONS The findings identify those at risk of non- or inconsistent participation in rescreening. They should aid targeting of interventions for demographic groups at risk and ensuring screening experiences are not perceived as unpleasant or difficult.
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Affiliation(s)
- Joanne M Osborne
- Bowel Health Service and Flinders Centre for Innovation in Cancer, Adelaide, Australia.,Flinders Centre for Innovation in Cancer, Flinders University of South Australia, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Carlene Wilson
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, GPO Box 2100, Adelaide, SA, 5001, Australia. .,Olivia Newton John Cancer, Wellness and Research Centre, Heidelberg, Victoria, 3084, Australia. .,School of Psychology and Public Health, La Trobe University, Bundoora, Victoria, 3086, Australia.
| | - Amy Duncan
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Stephen R Cole
- Bowel Health Service and Flinders Centre for Innovation in Cancer, Adelaide, Australia.,Flinders Centre for Innovation in Cancer, Flinders University of South Australia, GPO Box 2100, Adelaide, SA, 5001, Australia
| | - Ingrid Flight
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, GPO Box 2100, Adelaide, SA, 5001, Australia.,Olivia Newton John Cancer, Wellness and Research Centre, Heidelberg, Victoria, 3084, Australia
| | - Deborah Turnbull
- University of Adelaide, North Terrace, Adelaide, SA, 5005, Australia
| | - Donna L Hughes
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, GPO Box 2100, Adelaide, SA, 5001, Australia.,Olivia Newton John Cancer, Wellness and Research Centre, Heidelberg, Victoria, 3084, Australia
| | - Graeme P Young
- Flinders Centre for Innovation in Cancer, Flinders University of South Australia, GPO Box 2100, Adelaide, SA, 5001, Australia
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12
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Gabel P, Larsen MB, Nielsen PB, Svendstrup DB, Andersen B. Satisfaction, discomfort, obligations, and concerns in population-based breast cancer screening: cross-sectional study in a Danish population. BMC Health Serv Res 2017; 17:489. [PMID: 28709436 PMCID: PMC5513139 DOI: 10.1186/s12913-017-2438-2] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2016] [Accepted: 07/06/2017] [Indexed: 11/27/2022] Open
Abstract
Background Potential barriers to breast cancer screening adherence include patient satisfaction, as well as pain, feeling obliged to participate, and other concerns that might compromise the level of satisfaction. The present study aimed to assess the overall satisfaction of Danish citizens with their breast cancer screening experiences, as well as their level of discomfort, concerns, and feelings of obligation to participate. Furthermore, we analyzed the associations between overall satisfaction and the remaining outcomes. Methods Questionnaires were mailed to 3000 women in the Central Denmark Region who received screening examination results in the fall of 2013. The questionnaire assessed satisfaction (overall, telephone hot-line, and web-based self-service), discomfort (pain and boundaries of modesty), concerns (at invitation, while waiting for results, and after receiving results), and feelings of obligation to participate. Background information was retrieved from Statistics Denmark. Pearson’s chi-square test was used to test differences in outcomes and demographic characteristic distributions between respondents and non-respondents and highly satisfied vs. less satisfied participants. Prevalence ratios (PR) with 95% CI were assessed using Poisson regression with robust variance, to estimate associations between satisfaction and the remaining outcomes. Results Among the participants, 70.3% and 29.4%, respectively, reported really good and good impressions of the screening program. Lower satisfaction was associated with feeling pain (prevalence ratio (PR), 0.82), feeling that modesty boundaries were transgressed (PR, 0.79), experiencing screening-induced concerns (PR, 0.84), and feeling obliged to participate (PR, 0.96). Of the participants, 36.2% and 12.9%, respectively, felt very much and moderately obliged to participate. A total of 72.6% reported no screening-induced concerns, including 73.3% of those with negative screening results and 38.1% of those with positive screening results. Conclusions Overall satisfaction with breast cancer screening was very high, but discomfort, feelings of obligation, and concerns were associated with lower satisfaction levels. A continuing focus on high service in breast cancer screening is important for achieving the highest benefit from the program. This includes initiatives to employ the least painful techniques, to respect the patients’ modesty as much as possible, and to deliver fast screening results and thus minimize concerns among women awaiting results. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-2438-2) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Pernille Gabel
- Department of Public Health Programmes, Regional Hospital Randers, Skovlyvej 15, DK-8930, Randers NØ, Denmark.
| | - Mette Bach Larsen
- Department of Public Health Programmes, Regional Hospital Randers, Skovlyvej 15, DK-8930, Randers NØ, Denmark
| | | | | | - Berit Andersen
- Department of Public Health Programmes, Regional Hospital Randers, Skovlyvej 15, DK-8930, Randers NØ, Denmark
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13
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Burón A, Posso M, Sivilla J, Grau J, Guayta R, Castells X, Castells A, Macià F. Analysis of participant satisfaction in the Barcelona colorectal cancer screening programme: Positive evaluation of the community pharmacy. GASTROENTEROLOGIA Y HEPATOLOGIA 2016; 40:265-275. [PMID: 27292268 DOI: 10.1016/j.gastrohep.2016.04.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/02/2015] [Revised: 04/22/2016] [Accepted: 04/25/2016] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVE Population-based bowel screening programmes with faecal occult blood (FOB) tests need to achieve high uptake rates and offer quality services. We invited participants in the Barcelona Programme to complete a satisfaction survey, in order to explore factors influencing uptake and respondents' opinion and satisfaction with each step of the screening process. MATERIAL AND METHOD Telephone survey using an ad hoc questionnaire (see annex) administered to a final sample of 1189 people: 310 non-participants in the programme (NoP), 553 participants with a negative test result (PNeg), and 326 participants with a positive result (PPos). RESULTS High scores were obtained for the clarity of the information provided by the programme (mean 8.9 on a scale 0-10), and for the accessibility and attention at the pharmacy as well as its role as the point for collection and return of FOB test cards (mean >9.3). Aspects that were not so highly rated were: preparation for the colonoscopy (41.6% reported quite a lot or a lot of discomfort), and to a lesser extent telephone accessibility (27.1% reported some difficulties). Participants also expressed concern about receiving a positive test result by telephone (78.9% reported some concern). CONCLUSIONS Respondents' opinion of the programme was positive overall, and supports the pharmacy as the point for distributing and collecting FOB test cards, as well as the role of the pharmacist in the context of the programme. Some aspects of the screening process will be reviewed in order to improve participant satisfaction and eventually increase uptake.
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Affiliation(s)
- Andrea Burón
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España.
| | - Margarita Posso
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - Judit Sivilla
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España
| | - Jaume Grau
- Servicio de Medicina Preventiva y Epidemiología, Hospital Clínic, Universitat de Barcelona, Barcelona, España
| | - Rafael Guayta
- Direcció de Projectes i Recerca. Consell de Col·legis Farmacèutics de Catalunya, Barcelona, España
| | - Xavier Castells
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España
| | - Antoni Castells
- Servicio de Gastroenterología, Hospital Clínic, IDIBAPS, CIBEREHD, Universitat de Barcelona, Barcelona, España
| | - Francesc Macià
- Servicio de Epidemiología y Evaluación, Hospital del Mar, Barcelona, España; Instituto Hospital del Mar de Investigaciones Médicas (IMIM), Barcelona, España; Red de investigación en servicios de salud en enfermedades crónicas (REDISSEC), España
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Fernández-Feito A, Lana A, Cabello-Gutiérrez L, Franco-Correia S, Baldonedo-Cernuda R, Mosteiro-Díaz P. Face-to-face Information and Emotional Support from Trained Nurses Reduce Pain During Screening Mammography: Results from a Randomized Controlled Trial. Pain Manag Nurs 2015; 16:862-70. [DOI: 10.1016/j.pmn.2015.07.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2014] [Revised: 07/21/2015] [Accepted: 07/23/2015] [Indexed: 12/25/2022]
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15
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Ent MR, Gerend MA. Cognitive dissonance and attitudes toward unpleasant medical screenings. J Health Psychol 2015; 21:2075-84. [PMID: 27535832 DOI: 10.1177/1359105315570986] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
Two studies suggest that cognitive dissonance can lead people to adopt negative attitudes toward beneficial-yet unpleasant-medical screenings. People who thought that they were candidates for an unpleasant medical screening reported less favorable attitudes toward the screening than people who thought that they were ineligible (Study 1). The unpleasantness of a medical screening affected candidates' attitudes toward the screening to a greater extent than non-candidate's attitudes (Study 2). Limitations, including ambiguity regarding the extent to which participants' attitudes were affected specifically by dissonance, are discussed. This preliminary research suggests people attempt to reduce dissonance associated with their anticipated behavior.
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Goossens M, Van Hal G, Van der Burg M, Kellen E, Van Herck K, De Grève J, Martens P, Van Limbergen E. Quantifying independent risk factors for failing to rescreen in a breast cancer screening program in Flanders, Belgium. Prev Med 2014; 69:280-6. [PMID: 25456812 DOI: 10.1016/j.ypmed.2014.10.019] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/20/2014] [Revised: 10/11/2014] [Accepted: 10/13/2014] [Indexed: 10/24/2022]
Abstract
BACKGROUND Mammographic screening may reduce breast cancer mortality by about 20%, provided participation is high and women screen regularly. We quantified independent risk factors for failing to rescreen and built a model to predict how rescreening rates change if these risk factors would be modified. METHODS Multivariate analysis was used to analyze data from a prospective study which included a self-administered questionnaire and rescreening status 30months after a t0 mammogram, using a random sample of women 50-67years (Belgium 2010-2013). RESULTS A false positive result at the most recent past mammogram (Odds Ratio=5.0, 95% Confidence Interval 3.6-6.8), an interval until new invitation greater than 25months (Odds Ratio=4.8 for >29months, 95% Confidence Interval 2.9-8.1), waiting times in the mammography unit >1h (Odds Ratio=2.1, 95% Confidence Interval 1.2-3.7) and difficulties in reaching the unit (Odds Ratio=2.5, 95% Confidence Interval 1.4-4.4) were the strongest independent predictors for failing to rescreen. The area under the curve of the receiver operating characteristic analysis was 0.705 for the model development stage and 0.717 for the validation stage and goodness-of-fit was good. CONCLUSIONS Maintaining an invitation cycle of maximum 25months, limiting waiting time in the mammography unit and lowering the number of false positives could increase breast cancer screening compliance.
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Affiliation(s)
- M Goossens
- Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium; Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium.
| | - G Van Hal
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University of Antwerp, Medical Sociology and Health Policy, Universiteitsplein 1, 2610 Antwerp, Belgium. https://www.bevolkingsonderzoek.be
| | - M Van der Burg
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University of Antwerp, Medical Sociology and Health Policy, Universiteitsplein 1, 2610 Antwerp, Belgium. https://www.bevolkingsonderzoek.be
| | - E Kellen
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University Hospital Leuven, Campus St. Rafael, Kapucijnenvoer 33, 3000 Leuven, Belgium. https://www.bevolkingsonderzoek.be
| | - K Van Herck
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; Ghent University, Department of Public Health, De Pintelaan 185, 9000 Ghent, Belgium. https://www.bevolkingsonderzoek.be
| | - J De Grève
- Vrije Universiteit Brussel, Laarbeeklaan 103, 1090 Brussels, Belgium
| | - P Martens
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium
| | - E Van Limbergen
- Centrum voor kankeropsporing (Center for Cancer Detection), Ruddershove 4, 8000 Brugge, Belgium; University Hospital Leuven, Campus St. Rafael, Kapucijnenvoer 33, 3000 Leuven, Belgium. https://www.bevolkingsonderzoek.be
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Duncan A, Turnbull D, Wilson C, Osborne JM, Cole SR, Flight I, Young GP. Behavioural and demographic predictors of adherence to three consecutive faecal occult blood test screening opportunities: a population study. BMC Public Health 2014; 14:238. [PMID: 24606951 PMCID: PMC4234274 DOI: 10.1186/1471-2458-14-238] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2013] [Accepted: 03/03/2014] [Indexed: 12/12/2022] Open
Abstract
Background Social cognitive variables are often examined for their association with initial participation in colorectal cancer screening. Few studies have examined the association of these variables with adherence to multiple screening offers i.e., rescreening. This study aimed to describe patterns of participatory behaviour after three rounds of screening using faecal immunochemical tests (FIT) and to determine social cognitive, demographic and background variables predictive of variations in adherence. Methods Participants were 1,540 men and women aged 50 to 75 living in South Australia who completed a behavioural survey measuring demographic (for example, age, gender) and social cognitive variables relevant to FIT screening (for example, perceived barriers, benefits, self-efficacy). The survey was followed by three, free FIT screening offers mailed on an annual basis from 2008 to 2010. Patterns of participation after three screening rounds were described as one of five screening behaviours; 1) consistent re-participation (adherent with all screening rounds), 2) consistent refusal (adherent with no screening rounds), 3) drop out (adherent with earlier but not later rounds), 4) intermittent re-participation (adherent with alternate rounds) and 5) delayed entry (adherent with later but not initial round(s)). Univariate (Chi Square and Analysis of Variance) and multivariate (Generalised Estimating Equations) analyses were conducted to determine variables predictive of each category of non-adherence (those that did not participate in every screening offer, groups 2, 3, 4 and 5) relative to consistent re-participation. Results Significant social cognitive predictors of non-adherence were; less self-efficacy (drop out and consistent refusal), greater perceived barriers (drop out) and lower levels of response efficacy (consistent refusal). Demographic predictors of non-adherence included; male gender (delayed entry), younger age (intermittent, delayed and consistent refusal), less frequent GP visits (intermittent re-participation) and 'ancillary only' private health insurance (drop out). Less satisfaction with screening at baseline predicted drop out, consistent refusal and delayed entry. Conclusions Different combinations of demographic and behavioural variables predicted different patterns of rescreening adherence. Rescreening interventions may benefit from a targeted approach that considers the different needs of the population subgroups. Satisfaction with past FOBT screening measured prior to the study screening offers was an important predictor of adherence.
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Affiliation(s)
- Amy Duncan
- School of Psychology, The University of Adelaide, Adelaide 5005, South Australia, Australia.
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Bairati I, Turcotte S, Doray G, Belleau F, Grégoire L. Development and validation of an instrument assessing women's satisfaction with screening mammography in an organized breast cancer screening program. BMC Health Serv Res 2014; 14:9. [PMID: 24397342 PMCID: PMC3893508 DOI: 10.1186/1472-6963-14-9] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2013] [Accepted: 01/02/2014] [Indexed: 02/26/2023] Open
Abstract
Background The assessment of the quality of mammography services delivered in organized breast cancer screening programs should include measures centered on women’s perceptions. The objective of this study was to develop and validate an instrument in French designed to evaluate the satisfaction of women having a screening mammography. Methods An instrument evaluating women’s satisfaction with mammography services was developed using published research, the perceptions of screened women, the expertise of health professionals and a pilot study. Between November 9 and 21, 2011, the questionnaire was sent to 1500 consecutive women having had a screening mammography in eight radiologic facilities designated by the Québec Breast Cancer Screening Program, in Quebec City, Canada. Construct validity, convergent and discriminant validity, reliability and sensitivity of the instrument were examined. Results A total of 819 women (55%) participated in the validation study. The factor analysis retained four satisfaction dimensions: satisfaction with 1) the technician’s skills (four items), 2) the physical environment (four items), 3) the staff’s communication skills (three items) and 4) the information given by the program (3 items). The multitrait-scaling analysis showed good convergent and discriminant validity: scaling success was 100% for all subscales. All subscales had good internal consistency (Cronbach’s alphas ≥ 0.86). The satisfaction scores were able to identify groups of women with lower levels of satisfaction, such as younger women or women with pain during breast compression. Conclusion This brief satisfaction instrument, developed in French, showed good psychometric properties to evaluate satisfaction in women receiving mammographic services in an organized breast cancer screening program.
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Affiliation(s)
- Isabelle Bairati
- Public Health Agency of the Capitale-Nationale, Quebec City, Canada.
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Whelehan P, Evans A, Wells M, MacGillivray S. The effect of mammography pain on repeat participation in breast cancer screening: A systematic review. Breast 2013; 22:389-94. [DOI: 10.1016/j.breast.2013.03.003] [Citation(s) in RCA: 97] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2012] [Revised: 02/20/2013] [Accepted: 03/03/2013] [Indexed: 11/29/2022] Open
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Plescia M, White MC. The National Prevention Strategy and breast cancer screening: scientific evidence for public health action. Am J Public Health 2013; 103:1545-8. [PMID: 23865665 DOI: 10.2105/ajph.2013.301305] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Mammography screening rates in the United States have remained fairly stable over the past decade, and screening rates remain low for some groups. We examined insights from recent public health research on breast cancer screening to identify promising new approaches to improve screening rates and address persistent health disparities in mammography use. We considered this research in the context of the four strategic directions of the National Prevention Strategy: elimination of health disparities, empowered people, healthy and safe community environments, and clinical and community preventive services. This research points to the value of direct outreach and case management services, interventions to support more patient-centered models of care, and more organized, population-based approaches to identify women who are eligible to be screened, encourage participation, and monitor results.
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Affiliation(s)
- Marcus Plescia
- Centers for Disease Control and Prevention, Division of Cancer Prevention and Control, Atlanta, GA 30341, USA.
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Schou Bredal I, Kåresen R, Skaane P, Engelstad KS, Ekeberg Ø. Recall mammography and psychological distress. Eur J Cancer 2013; 49:805-11. [DOI: 10.1016/j.ejca.2012.09.001] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2012] [Revised: 08/30/2012] [Accepted: 09/03/2012] [Indexed: 10/27/2022]
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Survival analysis applied to proportion data: comparing mammography visits in high and low repeat rate facilities. HEALTH SERVICES AND OUTCOMES RESEARCH METHODOLOGY 2013. [DOI: 10.1007/s10742-012-0084-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/28/2022]
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Satisfaction with initial screen and compliance with biennial breast screening at centers with and without nurses. Cancer Nurs 2011; 34:293-301. [PMID: 21681146 DOI: 10.1097/ncc.0b013e3181f96bef] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
BACKGROUND A woman's experience during her initial breast screen can influence her participation in subsequent screening. OBJECTIVE The purpose of this study was to determine the association between a woman's satisfaction with her initial screening experience and compliance to biennial screening at centers with and without nurses. METHODS A stratified random sample of compliers and noncompliers to biennial screening was selected from a cohort of 16 858 eligible women aged 50 to 65 years attending centers with and without nurses for their initial screen at the Ontario Breast Screening Program in 2002. Of these eligible women, 3387 were sent questionnaires, 2640 (77.9%) were contacted, and 1901 (72.0%) were interviewed. The association between satisfaction with initial screen and compliance was estimated separately for centers with and without nurses using logistic regression. RESULTS Women attending centers with nurses were significantly less likely to comply with their next screen after their clinical breast examination if they were not completely satisfied with the service they received (odds ratio, 0.21; 95% confidence interval, 0.08-0.57) or agreed that the clinical breast examination caused discomfort to their breasts (odds ratio, 0.65; 95% confidence interval, 0.45-0.94). In addition, women attending centers with or without nurses were significantly less likely to comply if they did not understand why they needed to return for screening. CONCLUSIONS : Nurses at screening centers have an opportunity to significantly impact a woman's compliance to biennial breast screening by providing a positive initial screening experience. IMPLICATIONS FOR PRACTICE Emphasis should be placed on improving a woman's overall satisfaction with her initial screening experience.
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Lee HY, Lim SM, Han MA, Jun JK, Choi KS, Hahm MI, Park EC. Assessment of participant satisfaction with upper gastrointestinal endoscopy in South Korea. World J Gastroenterol 2011; 17:4124-9. [PMID: 22039328 PMCID: PMC3203365 DOI: 10.3748/wjg.v17.i36.4124] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/12/2010] [Revised: 05/19/2011] [Accepted: 05/26/2011] [Indexed: 02/06/2023] Open
Abstract
AIM: To measure the perceived satisfaction with gastric cancer screening as part of the National Cancer Screening Program (NCSP) in South Korea.
METHODS: Data were derived from the participants in a satisfaction survey of the Quality Evaluation of National Cancer Screening in 2009. This is a population-based nationwide telephone survey of participants who were screened by the NCSP between May and October 2009. This study included 4412 participants who provided full sets of data and who had upper endoscopies for the purpose of gastric cancer screening.
RESULTS: The negative appraisal percentages for each of the seven questions were as follows: explanation in preparation for the upper endoscopy, 12.3%; explanation about the process and procedure of the upper endoscopy, 13.8%; explanation about any pain or discomfort related to the upper endoscopy, 27.5%; level of pain during the procedure, 30.3%; physical environment, 16.2%; manner of the staff, 11.2%, and privacy protection, 8.8%.
CONCLUSION: The critical issues identified by the Pareto analysis include the adequacy of the explanation about any pain or discomfort associated with the upper endoscopy and the level of pain experienced during the procedure.
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Consedine NS. The Demographic, System, and Psychosocial Origins of Mammographic Screening Disparities: Prediction of Initiation Versus Maintenance Screening Among Immigrant and Non-Immigrant Women. J Immigr Minor Health 2011; 14:570-82. [DOI: 10.1007/s10903-011-9524-z] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Use of evidence-based strategies to promote mammography among medically underserved women. Am J Prev Med 2011; 40:561-5. [PMID: 21496756 DOI: 10.1016/j.amepre.2010.12.024] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/01/2010] [Revised: 12/01/2010] [Accepted: 12/23/2010] [Indexed: 11/20/2022]
Abstract
BACKGROUND Several web-based resources recommend effective intervention strategies to promote use of mammography but there is limited information on whether the strategies are used, particularly by organizations that serve medically underserved women. PURPOSE In 2010, data collected by the Avon Breast Health Outreach Program (BHOP) were analyzed to examine the diffusion of evidence-based intervention strategies among funded organizations. METHODS Data on intervention strategies were obtained from a 2009 survey of Avon BHOP organizations funded during 2006-2009. Self-reported use of mammography was reported from annual intake forms administered to medically underserved women aged ≥40 years, excluding those with a history of breast cancer or initial enrollees not exposed to the strategies. Strategies reflected interventions reviewed in the Guide to Community Preventive Services. Those recommended to increase demand and use of mammography included (1) client reminders; (2) small media; (3) one-to-one education; (4) removal of structural barriers to rescreening; and (5) group education-and one that lacked sufficient evidence to warrant a recommendation (6) client incentives. RESULTS Among 86 organizations, 96% used three or more intervention strategies. The most common strategies were group education (91%) and client reminders (83%). The overall crude-percentage of recent mammography use was 84%. This percentage was similar for clinical sites and nonclinical sites, despite the disproportionate enrollment of medically underserved women in nonclinical sites. CONCLUSIONS The wide use of evidence-based strategies among Avon BHOP-funded organizations and high percentage of recent mammography use among women exposed to the strategies suggests that medically underserved women are benefiting from effective interventions to increase use of mammography.
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Rivet Amico K. A situated-Information Motivation Behavioral Skills Model of Care Initiation and Maintenance (sIMB-CIM): An IMB Model Based Approach to Understanding and Intervening in Engagement in Care for Chronic Medical Conditions. J Health Psychol 2011; 16:1071-81. [DOI: 10.1177/1359105311398727] [Citation(s) in RCA: 91] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A sizable portion of adults living with chronic medical conditions (CMCs) delay initiation of care or maintain it inconsistently, which has tremendous personal and public costs. However, few explanatory models with high yield for intervention development and implementation have been proposed to date that would help to characterize and support care use for CMCs. A situated Information, Motivation, Behavioral Skills model of Care Initiation and Maintenance (sIMB-CIM) is presented here as an application of the IMB model to medical care use for CMCs. An example of a sIMB model for characterizing and intervening to support maintenance in HIV-care is provided.
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Tsai HW, Twu NF, Ko CC, Yen MS, Yang MJ, Chao KC, Wen L, Chen CY, Chou YH, Chen YJ. Compliance with screening mammography and breast sonography of young Asian women. Eur J Obstet Gynecol Reprod Biol 2011; 157:89-93. [PMID: 21439713 DOI: 10.1016/j.ejogrb.2011.02.010] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2010] [Revised: 12/16/2010] [Accepted: 02/24/2011] [Indexed: 10/18/2022]
Abstract
OBJECTIVE We evaluated compliance with mammography and breast sonography and the factors related to compliance. STUDY DESIGN From August 2005 through July 2006, 1239 asymptomatic women, aged 40-49 years, were enrolled in the study. Compliance in the second year was calculated. Telephone interviews examined the impact of the women's experience during mammography or sonography on adherence to rescreening. RESULTS The rates of compliance with mammography and sonography for breast cancer screening were 73.5% and 80.1%, respectively (p=0.006). More women receiving mammography (12.2%) reported unsatisfactory results (BI-RADS category 0) than those undergoing sonography (6.2%) (p<0.001). During the telephone interview, 74.9% of the women complained of pain during mammography, but none (0%) during sonography (p<0.001); 69.8% felt embarrassed during mammography and 55.6% during sonography (p<0.001). Multivariate logistic regression analysis showed that pain (OR 0.096, 95% CI 0.044-0.213) and unsatisfactory examination results (BI-RADS category 0) (OR 0.042, 95% CI 0.020-0.090) were barriers to not following up mammography. Embarrassment (OR 0.645, 95% CI 0.419-0.994) and unsatisfactory examination results (OR 0.169, 95% CI 0.085-0.336) were barriers to not following up sonography. CONCLUSIONS For young Asian women with dense breast tissue, compliance with sonography for breast cancer screening was better than that with mammography.
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Affiliation(s)
- Hsiao-Wen Tsai
- Department of Obstetrics and Gynecology, Taipei Veterans General Hospital, National Yang-Ming University, Taipei, Taiwan
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Jeon BY, Lee HY, Park EC, Choi KS, Jun JK, Kim Y, Han MA, Yoon NH, Kim EJ, Jeon SM. Satisfaction with mammography in the National Cancer Screening Programme participants of age 40s in Korea. Eur J Cancer Care (Engl) 2010; 20:803-9. [PMID: 20649810 DOI: 10.1111/j.1365-2354.2010.01210.x] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
The aim of this study was to evaluate satisfaction with the National Cancer Screening Programme of mammography in Korea and to examine the association between subscales of satisfaction and general satisfaction. We conducted a cross-sectional telephone survey for women who had obtained a National Cancer Screening Programme mammographic screening at general hospitals between May and October 2008. The present study included 2005 women in their forties. We performed multivariate linear regression using dependent variable as general satisfaction and independent variables as subscales of satisfaction, such as pre-screening information transfer, staff interpersonal skills, physical surroundings and results reporting. Participants were stratified according to the result of their mammogram as negative or positive. Mean score of satisfaction was above 2.5 of 4 for all subscales. Women who received positive results were less satisfied with all of subscale factors. Staff interpersonal skills were the most important factor that contributed to general satisfaction. Future efforts such as staff training programme of communication/attitude skills, ensuring privacy and explanation of possible discomfort of the screening would be needed.
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Affiliation(s)
- B Y Jeon
- National Cancer Control Research Institute, National Cancer Center, Goyang-si, Gyeonggi-do, Korea
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Gierisch JM, Earp JA, Brewer NT, Rimer BK. Longitudinal predictors of nonadherence to maintenance of mammography. Cancer Epidemiol Biomarkers Prev 2010; 19:1103-11. [PMID: 20354125 DOI: 10.1158/1055-9965.epi-09-1120] [Citation(s) in RCA: 68] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND Regular adherence to screening mammography, also known as maintenance of mammography, reduces breast cancer morbidity and mortality. However, mammography maintenance is uncommon and little is known about why women do not maintain regular screening schedules. We investigated longitudinal predictors of women not maintaining adherence. METHODS Participants were insured women enrolled in an intervention trial who had screening mammograms 8 to 9 months before study enrollment (n = 1,493). Data were collected from 2003 to 2008. We used discrete event history analysis to model nonadherence to mammography maintenance over three successive annual screening intervals (+ 2 months). RESULTS Most (54%) women did not maintain screening adherence over 3 years. Women who did not maintain adherence were more likely to be ages 40 to 49 years, rate their health fair or poor, be less satisfied with their last mammography experiences, report one or more barriers to getting mammograms, be less than completely confident about getting their next mammograms (lower self-efficacy), or have weaker behavioral intentions. The odds of not maintaining adherence decreased over time. DISCUSSION Although great strides have been achieved in increasing the proportion of women who have received mammograms, most women still are not maintaining regular mammography use over time. Our findings provide insights into targets for future mammography maintenance interventions.
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Affiliation(s)
- Jennifer M Gierisch
- Duke University Medical Center-Division of General Internal Medicine, Durham, NC, USA.
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Breast and cervical cancer screening among women in metropolitan areas of the United States by county-level commuting time to work and use of public transportation, 2004 and 2006. BMC Public Health 2010; 10:146. [PMID: 20302614 PMCID: PMC2848633 DOI: 10.1186/1471-2458-10-146] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2009] [Accepted: 03/19/2010] [Indexed: 11/26/2022] Open
Abstract
Background Commuting times and behaviors have been associated with a variety of chronic disease outcomes and health behaviors. We examined the relationships between ecologic measures of commuting time and use of public transportation in relation to breast and cervical cancer screening among women in U.S. metropolitan areas who participated in the 2004 and 2006 Behavioral Risk Factor Surveillance System (BRFSS) surveys. Methods Self-reported county of residence was used to classify respondents as residents of metropolitan statistical areas (MSAs). Only BRFSS respondents who resided in the 39 MSAs with a population of ≥ 1.5 million in 2007--representing a total of 337 counties--were included in this analysis. A total of 76,453 women aged ≥ 40 years were included in analyses on mammography. Analyses on Pap testing were limited to women aged ≥18 years with no history of hysterectomy (n = 80,959). Area-based measures of socio-economic status (SES) were obtained by utilizing county-level information from the 2000 U.S. Census. Results With adjustment for age, no important associations were observed between receipt of a recent mammogram and either a county-level measure of commute time or residence in an area where more residents had access to a car. Similarly, women living in counties where at least four percent of the residents used public transportation were as likely to have had a recent mammogram or Pap test compared with women in areas where less than four percent of residents used public transportation. However, women living in counties where < 2% of residents had no access to a car were somewhat more likely to have had a Pap test in the past 3 years than women in areas where ≥ 3% of the residents had no access to a car (87.3% versus 84.5%; p-value for test for trend < 0.01). In multivariate analysis, living in a county with a median commute time of at least 30 minutes was not significantly associated with having had a Pap test in the past 3 years (adjusted odds ratio (OR) = 1.1, 95% CI 0.9-1.2, p = .50), or with having had a mammogram in the past 2 years (adjusted OR = 0.9, 95% CI 0.9-1.1, p = .28). A weak positive association was observed between residence in a county with less use of public transportation and having had a Pap test in the past 3 years, which was of borderline significance (adjusted OR 1.2, 95% CI 1.0-1.4, p = .05). Conclusions In large U.S. metropolitan areas, transportation issues may play a role in whether a woman obtains cancer screening along with other factors (e.g., Hispanic ethnicity, low income, and no physician visit in the past year). In this contextual analysis, a longer commute time was not associated with breast and cervical cancer screening.
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Tang TS, Patterson SK, Roubidoux MA, Duan L. Women's mammography experience and its impact on screening adherence. Psychooncology 2009; 18:727-34. [PMID: 19035468 DOI: 10.1002/pon.1463] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
OBJECTIVES Although rates for first-time and recent mammography screening have increased for women in the US in the past decade, rates for repeat mammography remain low. This study aimed to conduct an analysis of women's mammography experience, to examine the rates of repeat mammography and to identify the significant predictors of repeat mammography within 12 and 18 months of the index mammogram. METHODS Participants were 397 women obtaining a screening mammogram (i.e. index) at three university-affiliated radiology clinics. Following the index mammogram, women completed the measures assessing demographic background, health history, breast cancer knowledge, risk, and screening history, and aspects of the mammography experience. Eighteen months following the index mammogram, 296 women were contacted via telephone to assess repeat mammography behavior. RESULTS Factor analysis of a mammography experience survey yielded four major components including satisfaction with clinic services, physical experience, psychological experience, and communication with clinic staff. Twelve-month and 18-month repeat mammography rates were 37 and 68%, respectively. Logistic regression models found lifetime number of mammograms to predict repeat mammography at 12 and 18 months. In addition, the number of clinical breast exams obtained in the past 5 years predicted repeat mammography at 12 months, while having scheduled a mammography appointment predicted repeat mammography at 18 months. CONCLUSIONS Based on these findings, strategies to increase mammography adherence include implementing a formal reminder system that prompts patients (e.g. postcard, automated telephone call) to schedule an annual mammogram or training clinic staff to automatically schedule an annual mammogram at the time of the current screening appointment.
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Affiliation(s)
- Tricia S Tang
- Department of Medical Education, University of Michigan Medical School, Ann Arbor, MI 48109-5201, USA.
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Bodurtha J, Quillin JM, Tracy KA, Borzelleca J, McClish D, Wilson DB, Jones RM, Quillin J, Bowen D. Mammography screening after risk-tailored messages: the women improving screening through education and risk assessment (WISER) randomized, controlled trial. J Womens Health (Larchmt) 2009; 18:41-7. [PMID: 19105686 DOI: 10.1089/jwh.2007.0703] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022] Open
Abstract
AIMS A randomized trial investigated the impact of risk-tailored messages on mammography in diverse women in the Virginia Commonwealth University Health System's gynecology clinics. METHODS From 2003 to 2005, 899 patients > or =40 years of age were randomized to receive risk-tailored information or general information about breast health. Multiple logistic regression analyses summarize their breast health practices at 18 months. RESULTS At baseline, 576 (64%) women reported having a mammogram in the past year. At 18-month follow-up, mammography rates were 72.6% in the intervention group and 74.2% in the control group (N.S.). Women (n = 123) who reported worrying about breast cancer "often" or "all the time" had significantly higher mammography rates with the intervention (85.0%) vs. the controls (63.5%). No significant differences existed in clinical breast examination, self-examination, or mammography intentions between the two study arms. However, intervention women with lower education reported significantly fewer clinical breast examinations at follow-up. CONCLUSIONS The brief intervention with a risk-tailored message did not have a significant effect overall on screening at 18 months. However, among those who worried, mammography rates in the intervention group were higher. Individual characteristics, such as worry about breast cancer and education status, may impact interventions to improve breast cancer prevention practices.
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Affiliation(s)
- Joann Bodurtha
- Human and Molecular Genetics, Massey Cancer Center, Virginia Commonwealth University, Richmond, VA 23298, USA.
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Yoon NH, Kwon SM, Lee HY, Park EC, Choi KS, Kwak MS. Factors affecting satisfaction in National Cancer Screening Program. HEALTH POLICY AND MANAGEMENT 2009. [DOI: 10.4332/kjhpa.2009.19.1.031] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
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Liu SY, Clark MA. Breast and cervical cancer screening practices among disabled women aged 40-75: does quality of the experience matter? J Womens Health (Larchmt) 2009; 17:1321-9. [PMID: 18788985 DOI: 10.1089/jwh.2007.0591] [Citation(s) in RCA: 39] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023] Open
Abstract
BACKGROUND Women with disabilities (WWD) face significant barriers accessing healthcare, which may affect rates of routine preventive services. We examined the relationship between disability status and routine breast and cervical cancer screening among middle-aged and older unmarried women and the differences in reported quality of the screening experience. METHODS Data were from a 2003-2005 cross-sectional survey of 630 unmarried women in Rhode Island, 40-75 years of age, stratified by marital status (previously vs. never married) and partner gender (women who partner with men exclusively [WPM] vs. women who partner with women exclusively or with both women and men [WPW]). RESULTS WWD were more likely than those without a disability to be older, have a high school education or less, have household incomes <$30,000, be unemployed, and identify as nonwhite. In addition, WWD were less likely to report having the mammogram or Pap test procedure explained and more likely to report that the procedures were difficult to perform. After adjustment for important demographic characteristics, we found no differences in cancer screening behaviors by disability status. However, the quality of the cancer screening experience was consistently and significantly associated with likelihood of routine cancer screening. CONCLUSIONS Higher quality of cancer screening experience was significantly associated with likelihood of having routine breast and cervical cancer screening. Further studies should explore factors that affect quality of the screening experience, including facility characteristics and interactions with medical staff.
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Affiliation(s)
- Sze Y Liu
- Department of Community Health, Brown Medical School, Providence, Rhode Island 02903, USA
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Yoon NH, Lee HY, Kwak MS, Choi KS, Jun JK, Kim MK, Park EC. Comparison of satisfaction with cancer screening at mobile van and static sites: National Cancer Screening Program in Korea. Jpn J Clin Oncol 2009; 39:169-74. [PMID: 19179364 DOI: 10.1093/jjco/hyn156] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVES Our objectives were to evaluate participant satisfaction in the National Cancer Screening Program (NCSP) and to examine differences in satisfaction between mobile vans and static sites. METHODS A total of 243 967 participants who were screened by NCSP between January and May 2007 were eligible for the study. Of these, 3416 samples were randomly chosen and stratified by the type of cancer screened and screening unit. A telephone survey was conducted in July 2007, and 1672 participants (48.9%) were responded. The questionnaire included participant satisfaction with screening, screening service use and demographic data. Five multiple regression models were used to determine the relation between screening location (mobile van or static site) and each of five satisfaction measures (information transfer, staff interpersonal skills, privacy protection, physical surroundings and general satisfaction). RESULTS Of the participants, 764 (45.7%) were screened at a mobile van and 908 (54.3%) at a static site. Relatively high scores were reported for all satisfaction measures, but satisfaction with screening at a mobile van was lower than that at a static site. Even after adjusting for potential confounders, screening at a mobile van was significantly associated with lower satisfaction for information transfer (P = 0.005), staff interpersonal skills (P = 0.025), privacy protection (P = 0.019), physical surroundings (P < 0.001) and general satisfaction (P < 0.001). CONCLUSIONS Improving the satisfaction with and quality of mobile screening services is important to increase compliance and achieve the aims of the NCSP. Therefore, further efforts such as quality assurance or continuous monitoring are required.
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Affiliation(s)
- Nan-He Yoon
- National Cancer Control Research Institute, National Cancer Center, Gyeonggi-do, Republic of Korea
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Barriers and facilitators related to mammography use among lower educated Mexican women in the USA. Soc Sci Med 2009; 68:832-9. [PMID: 19152992 DOI: 10.1016/j.socscimed.2008.12.023] [Citation(s) in RCA: 57] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2008] [Indexed: 11/20/2022]
Abstract
This study explores barriers to and facilitators of breast cancer screening and how people in a woman's social network influence these screening behaviors. A total of 40 semi-structured qualitative interviews were conducted in rural Washington State (USA) among Mexican women aged 50 and over. Eligible women reported either having had a mammogram within the last two years, over two years ago, or never. We found that lack of health insurance, the perception that the mammogram is painful, and fear of finding cancer were cited as barriers to participation in mammography screening. Women who had lived in the US for a shorter period were more likely to report never having had a mammogram than women who had lived in the US for a longer period. Women often cited daughters and female friends as those from whom they received advice or encouragement to receive a mammogram. Few differences were found related to network size and mammography use among the groups. These findings may be useful in designing interventions to promote mammography use. Including daughters in intervention activities may help facilitate mammography use among Mexican women.
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Are health-care relationships important for mammography adherence in Latinas? J Gen Intern Med 2008; 23:2024-30. [PMID: 18839258 PMCID: PMC2596511 DOI: 10.1007/s11606-008-0815-6] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2007] [Revised: 04/18/2008] [Accepted: 09/12/2008] [Indexed: 01/15/2023]
Abstract
BACKGROUND Latinas are the fastest growing racial ethnic group in the United States and have an incidence of breast cancer that is rising three times faster than that of non-Latino white women, yet their mammography use is lower than that of non-Latino women. OBJECTIVES We explored factors that predict satisfaction with health-care relationships and examined the effect of satisfaction with health-care relationships on mammography adherence in Latinas. DESIGN AND SETTING We conducted a cross-sectional survey of 166 Latinas who were >or=40 years old. Women were recruited from Latino-serving clinics and a Latino health radio program. MEASUREMENTS Mammography adherence was based on self-reported receipt of a mammogram within the past 2 years. The main independent variable was overall satisfaction with one's health-care relationship. Other variables included: self report of patient-provider communication, level of trust in providers, primary language, country of origin, discrimination experiences, and perceptions of racism. RESULTS Forty-three percent of women reported very high satisfaction in their health-care relationships. Women with high trust in providers and those who did not experience discrimination were more satisfied with their health-care relationships compared to women with lower trust and who experienced discrimination (p < .01). Satisfaction with the health-care relationship was, in turn, significantly associated with mammography adherence (OR: 3.34, 95% CI: 1.47-7.58), controlling for other factors. CONCLUSIONS Understanding the factors that impact Latinas' mammography adherence may inform intervention strategies. Efforts to improve Latina's satisfaction with physicians by building trust may lead to increased use of necessary mammography.
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Ekwueme DU, Hall IJ, Richardson LC, Gardner JG, Royalty J, Thompson TD. Estimating personal costs incurred by a woman participating in mammography screening in the National Breast and Cervical Cancer Early Detection Program. Cancer 2008; 113:592-601. [DOI: 10.1002/cncr.23613] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Almog R, Hagoel L, Tamir A, Barnett O, Rennert G. Quality control in a National Program for the Early Detection of Breast Cancer: women's satisfaction with the mammography process. Womens Health Issues 2008; 18:110-7. [PMID: 18319148 DOI: 10.1016/j.whi.2007.12.007] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2007] [Revised: 10/29/2007] [Accepted: 12/20/2007] [Indexed: 10/22/2022]
Abstract
INTRODUCTION The experience of the mammography testing process and related satisfaction influence women's willingness to undergo the test again. The study goal was to assess women's overall satisfaction with the mammography examination service provided by participating units in the National Program for the Early Detection of Breast Cancer in Israel. METHODS Between August 2003 and March 2004, a random sample of 3,295 women from 38 mammography units nationwide was drawn. Women were interviewed within 48 hours of their mammography, regarding their assessment of the examination process: discomfort, overall satisfaction, and intention to rescreen. Overall satisfaction and process items were measured on an ordinal scale ranging from 1 (lowest) to 6 (highest). Multivariate binomial regression was performed to identify significant predictors of being less satisfied and to estimate the associated relative risks with 95% confidence interval (CI). RESULTS A response of "very satisfied" (score 6), indicating overall satisfaction with the mammography process, was reported by 77% (95% CI, 73%-80%) of the women, 19% (95% CI, 17%-21%) said they were satisfied. Willingness to rescreen was reported by 95%. Negative assessment of staff attitude was the most influential predictor of being less satisfied. Twenty-six percent of women reported experiencing very discomforting pain. This response was associated with a diagnostic test indication, and with process items directly related to the test (technician's attitude toward the patient; information provided by her; privacy during the test). CONCLUSIONS Women's satisfaction was high, as was intention to rescreen. The gap between intention and rescreening begs further investigations as to other types of barriers preventing women from adherence to rescreening.
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Affiliation(s)
- Ronit Almog
- Department of Community Medicine and Epidemiology, Carmel Medical Center, The Faculty of Medicine, Technion, Haifa, Israel
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Kapp JM, Ryerson AB, Coughlin SS, Thompson TD. Racial and ethnic differences in mammography use among U.S. women younger than age 40. Breast Cancer Res Treat 2008; 113:327-37. [PMID: 18264758 DOI: 10.1007/s10549-008-9919-2] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2008] [Accepted: 01/24/2008] [Indexed: 10/22/2022]
Abstract
OBJECTIVE Evidence-based recommendations for routine breast cancer screening suggest that women begin mammography at age 40, although some women receive a mammogram before that age. Little is known about mammography use among younger women, especially with respect to race and ethnicity. METHODS We used data from the 2005 National Health Interview Survey to examine racial/ethnic differences in mammography use among U.S. women ages 30-39. We examined descriptive characteristics of women who reported ever having a mammogram, and used logistic regression to estimate associations between race/ethnicity and mammography use among women at average risk for breast cancer. RESULTS Our sample comprised 3,098 women (18% Hispanic, 13% non-Hispanic [NH] black, 69% NH white), of whom 29% reported having ever had a mammogram. NH black women were more likely than NH white women to report ever having a mammogram and receiving multiple mammograms before age 40 among women of average risk. Patterns of mammography use for Hispanic women compared to NH white women varied. CONCLUSION Findings suggest differential utilization of mammograms by race/ethnicity among women outside current recommendations and of average risk. Future studies should examine the role of practice patterns and patient-provider communication.
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Affiliation(s)
- Julie M Kapp
- Department of Family and Community Medicine, University of Missouri-Columbia, MA306 Medical Sciences Bldg, 1 Hospital Drive, Columbia, MO 65212, USA.
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Miller D, Livingstone V, Herbison P. Interventions for relieving the pain and discomfort of screening mammography. Cochrane Database Syst Rev 2008; 2008:CD002942. [PMID: 18254010 PMCID: PMC8989268 DOI: 10.1002/14651858.cd002942.pub2] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
BACKGROUND The pain of mammography is recognised as a significant deterrent for women considering this examination, and may affect participation in breast screening. OBJECTIVES To review interventions to reduce or relieve the pain and discomfort of screening mammography. SEARCH STRATEGY For this update, the Cochrane Breast Cancer Group Specialised Register was searched on the 18th May 2006. Other databases searched were MEDLINE (1966 to November 2006), CINAHL (1982 to December 2006), EMBASE (1988 to 2006) and reference lists of articles. We also searched Current Controlled Trials (www.controlled-trials.com, accessed September 2007) and the UK National Research Register (www.update-software.com/national/, accessed September 2007) for ongoing and completed research projects. Researchers in the field were also contacted. SELECTION CRITERIA Randomised controlled trials and quasi-randomised trials with a comparison group were considered. Studies had to include assessment of pain or discomfort and, if the intervention could have impacted on the quality of the mammograms, an assessment of image quality was also required. DATA COLLECTION AND ANALYSIS Two authors (DM and VL) reviewed identified studies to determine whether they met the inclusion criteria. Each study was reviewed for quality, including concealment and generation of allocation sequence, comparability between groups at baseline, inclusion of all randomised participants in analysis and blinding after allocation. Data extraction was performed by these two authors. MAIN RESULTS Seven RCTs, involving 1671 women were identified for inclusion. The review found that giving women information about the procedure prior to the mammogram may reduce pain and discomfort. Increasing women's control over breast compression could reduce pain experienced during the procedure, though mammogram image quality was only maintained if the technologist controlled the first compression. If the technologist reduced compression force of the mammogram, discomfort experienced was unchanged. The use of breast cushions reduced pain of mammography; however, image quality was impaired in 2% of women in the intervention group. Acetoaminophen as a premedication did not affect discomfort of mammography. Differences in interventions, and inconsistency in measures, validation of pain scales, and in assessment of mammogram quality, mean that results of these studies cannot be combined. All results are based on single studies. Further research is required. AUTHORS' CONCLUSIONS Currently there are very few proven interventions to reduce pain and discomfort of screening mammography, especially procedures that can be readily introduced to screening programmes. With mammography continuing as the preferred method for breast screening, more research on such interventions is needed.
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Affiliation(s)
- D Miller
- Dunedin School of Medicine, University of Otago, Women's and Children's Health, PO Box 913, Dunedin, New Zealand.
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