‘It was daunting’: Experience of women with a diagnosis of breast cancer attending for breast imaging

Patients' perceptions of targeted breast ultrasound and digital breast tomosynthesis in the diagnostic setting: A mixed methods study

BACKGROUND

Although DBT is the standard initial imaging modality for women with focal breast symptoms, the importance of ultrasound has grown rapidly in the past decades. Therefore, the Breast UltraSound Trial (BUST) focused on assessing the diagnostic value of ultrasound and digital breast tomosynthesis (DBT) for the evaluation of breast symptoms by reversing the order of breast imaging; first performing ultrasound followed by DBT. This side-study of the BUST evaluates patients' perceptions of ultrasound and DBT in a reversed setting.

METHODS

After imaging, 1181/1276 BUST participants completed a survey consisting of open and closed questions regarding both exams (mean age 47.2, ±11.74). Additionally, a different subset of BUST participants (n = 29) participated in six focus group interviews 18-24 months after imaging to analyze their imaging experiences in depth.

RESULTS

A total of 55.3% of women reported reluctance to undergoing DBT, primarily due of pain, while the vast majority also find bilateral DBT reassuring (87.3%). Thematic analysis identified themes related to 1) imaging reluctance (pain/burden, result, and breast harm) and 2) ultrasound and DBT perceptions. Regarding the latter, the theme comfort underscores DBT as burdensome and painful, while ultrasound is largely perceived as non-burdensome. Ultrasound is also particularly valued for its interactive nature, as highlighted in the theme interaction. Perceived effectiveness reflects women's interest in bilateral breast evaluation with DBT and the visibility of lesions, while they express more uncertainty about the reliability of ultrasound. Emotional impact portrays DBT as reassuring for many women, whereas opinions on the reassurance provided by ultrasound are more diverse. Additional themes include costs, protocols and privacy.

CONCLUSIONS

Ultrasound is highly tolerated, and particularly valued is the interaction with the radiologist. Nearly half of women express reluctance towards DBT; nevertheless, a large portion report feeling more confident after undergoing bilateral DBT, reassuring them of the absence of abnormalities. Understanding patients' perceptions of breast imaging examinations is of great value when optimizing diagnostic pathways.

Experiences of Patients Undergoing Bowel Preparation and Colonoscopy: A Qualitative Longitudinal Study

Introduction

Colonoscopy remains the reference standard for diagnosing and monitoring colorectal cancer and for diagnosis and surveillance of inflammatory bowel disease. However, there is a limited knowledge of the patients’ needs when undergoing colonoscopy and the challenges within in order to reduce the number of cancelled colonoscopies. The purpose of the study was to explore the experiences of undergoing bowel preparation and colonoscopy.

Methods

The study was designed as a qualitative longitudinal interview study with an inductive research approach. Patients were considered for inclusion consecutively and selected based on the following criteria of variation: way of referral for colonoscopy (outpatient or screening), age and gender. The interviews were analyzed using qualitative content analysis, and results reported according to COREQ guidelines.

Results

Based on the findings, three categories emerged: To weigh up participation, A greater challenge than expected, and Not so challenging after all. Throughout these categories, the experience of uncertainty was reported.

Discussion

The process of undergoing bowel preparation and colonoscopy was influenced by uncertainty due to insufficient information. There is a need to strengthen the patient-centered care by adjusting the information to patient’s needs to better support them in decision-making for participation, to better prepare them for the bowel preparation and to better prepare them for the procedure. In addition, it is vital that patients are provided with results of the colonoscopy that correspond to the timeframe specified in written information.

Women's stories of living with breast cancer: A systematic review and meta-synthesis of qualitative evidence

RATIONALE

Globally, breast cancer is by far the most frequently occurring cancer amongst women. Whilst the physical consequences of the disease and associated treatments are well documented, a comprehensive picture of how breast cancer is experienced at all stages of disease progression is lacking.

OBJECTIVE

This systematic review aimed to synthesize qualitative studies documenting women's breast cancer narratives into an empirically based explanatory framework.

METHODS

Two investigators independently searched Academic Search Premiere, CINAHL, Health Source: Nursing/Academic Edition, MEDLINE, PsycARTICLES, PubMed, Science Direct, SCOPUS, Web of Science and three international dissertation repositories using a pre-specified search strategy to identify qualitative studies on women's breast cancer narratives across all geographic and income-level settings. Of the 7840 studies that were screened for eligibility, included in the review were 180 studies, which were assessed using the Critical Appraisal Skills Programme. Using a 'meta-study' approach, an explanatory model of the breast cancer experience was formulated. Finally, we assessed the confidence in the review findings using the 'Confidence in the Evidence from Reviews of Qualitative Research' (CERQual) guidelines.

RESULTS

Eight core themes were identified: the burden of breast cancer, existential ordeal, illness appraisal, sources of support, being in the healthcare system, the self in relation to others, changes in self-image, and survivor identity. Together, these form the proposed Trajectory of Breast Cancer (TBC) framework.

CONCLUSION

The Trajectory of Breast Cancer explanatory framework offers a theoretically defensible synthesis of women's experiences of breast cancer. This framework provides an empirical basis for future reviewers conducting qualitative and narrative breast cancer research.

A qualitative study to determine Kuwaiti Women's knowledge of breast cancer and barriers deterring attendance at mammography screening

INTRODUCTION

Although a Mammography Screening Service (MSS) has been established in Kuwait since 2014, the attendance rate for eligible women is only 4.2% in comparison to 72.1% attendance in the United Kingdom (UK) mammography screening service. The aim of this study was to determine Kuwaiti women's knowledge of breast cancer (BC), their attitudes toward BCS and the reasons for not attending Mammography Screening (MS).

METHODS

A pragmatic qualitative methodology was used which included the use of two focus groups conducted at two women only social organisations in Kuwait with a total of 23 women. One focus group was conducted at a social and cultural organisation; the second focus group took place at a social organisation whose primary role is the improvement of literacy though the use of religious scripture. Thematic analysis was applied to the recorded verbal transcripts from each focus group.

RESULTS

Thematic analysis revealed four major themes, accompanied by a series of subthemes (1) knowledge and awareness of BC health, (2) knowledge of MS (3) personal factors, (4) medical provision and social environment.

CONCLUSION

Findings suggest that participant's knowledge of BC and the decision to attend MS is influenced by a series of factors both personal and external. An increase in the awareness of BC, MS and the process of accessing MSS will enhance the uptake of MS among Kuwaiti women. Furthermore, doctors and health care providers will need to play a significant role in encouraging women to self-refer.

Client and practitioner perspectives on the screening mammography experience

Mammography can be painful and unpleasant, but effective interventions to improve the experience remain scarce. As a first step towards more effective interventions, we aimed to achieve a thorough, contemporary understanding of thoughts, feelings and behaviours which affect and arise from mammography experiences. Research and professional experience suggest that the interaction between client and practitioner may be paramount in determining the quality of a client's experience. Therefore, this study aimed to capture the perspectives of clients and mammography staff from UK breast screening programmes. Thematic analysis of semi-structured qualitative in-depth interviews with 22 clients and 18 staff revealed that clients had positive attitudes to breast screening and mostly low knowledge about potential harms. Staff data indicated that some women attend for breast screening under pressure from others. Pain and coping with it were prominent themes, with wide variations in pain experiences. Clients recognised differences in mammographers' abilities to put them at ease. Staff difficulties included empowering clients within the confines of a taxing technique, and maintaining compassionate care when under strain. Future intervention development should focus on the information and support needs of women prior to the appointment and on effectively training and supporting mammographers to deal with challenging encounters.

European radiographers' challenges from mammography education and clinical practice - an integrative review

Objectives

This study aims to identify European radiographers’ challenges in clinical performance in mammography and the main areas of mammography that require more and better training.

Methods

An extensive search was performed to identify relevant studies focused on clinical practice, education and training in mammography published between January 2010 and December 2015 in the English language. The data were analysed by using deductive thematic analysis.

Results

A total of 27 full text articles were read, evaluating their quality. Sixteen articles out of 27 were finally selected for this integrative review. The main challenges of radiographers’ mammography education/training can be divided into three groups: training needs, challenges related to radiographers, and challenges related to the organization of education. The most common challenges of clinical performance in mammography among European radiographers involved technical performance, the quality of practices, and patient-centeredness.

Conclusions

The introduction of harmonized mammography guidelines across Europe may serve as an evidence-based tool to be implemented in practice and education. However, the variability in human and material resources as well as the different cultural contexts should be considered during this process.

Teaching Points

• Radiographers’ awareness of their professional identity and enhancing multiprofessional cooperation in mammography.

• Radiographers’ responsibilities regarding image quality (IQ) and optimal breast imaging performance.

• Patient-centred mammography services focusing on the psychosocial needs of the patient.

• Challenges: positioning, QC-testing, IQ-assessment, optimization of breast compression, communication, teamwork, and patient-centred care.

• Introduction of evidence-based guidelines in Europe to harmonize mammography practice and education.

Multiprovider and Patient Perspectives on Conveying Diagnostic Imaging Investigation Results in a South African Public Health Care System

INTRODUCTION

This study explored interaction processes in conveying messages about the results of diagnostic imaging investigations in a public hospital complex in South Africa from the perspective of health care providers and patients.

METHODS

The study was part of a qualitative inquiry into the interaction and communication processes relating to diagnostic imaging investigations in the public health care system. Data collection included individual interviews with 24 patients and 62 health care providers (ie, medical practitioners, specialists, radiologists, registrars, radiographers, and nurses). In addition, 12 focus group interviews were conducted with health care providers. The transcribed data were coded and analysed to identify categories and themes.

RESULTS

Three main themes emerged from the study. The first theme deals with the medical territory, specifically who should interpret and convey the diagnostic results to the patient. The second theme highlights the role of radiographers and nurses in communicating parts of the diagnostic results. The last theme focuses on patient experience, interpretation, and comprehension in the provider-patient communication process.

CONCLUSIONS

The findings provide a multidimensional view about the disclosure of imaging results to patients by medical and nonmedical health care providers. Further research is needed on the role of nonmedical providers in the context of ethical and moral obligation toward patients and the professional restrictions inherent in their scope of practice.