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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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2
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Conley CC, Rodriguez JD, McIntyre M, Brownstein NC, Niell BL, O'Neill SC, Vadaparampil ST. Self-reported barriers to screening breast MRI among women at high risk for breast cancer. Breast Cancer Res Treat 2023; 202:345-355. [PMID: 37640965 DOI: 10.1007/s10549-023-07085-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/01/2023] [Accepted: 08/10/2023] [Indexed: 08/31/2023]
Abstract
BACKGROUND Annual screening breast MRI is recommended for women at high (≥ 20% lifetime) breast cancer risk, but is underutilized. Guided by the Health Services Utilization Model (HSUM), we assessed factors associated with screening breast MRI among high-risk women. METHODS From August 2020-January 2021, we recruited an online convenience sample of high-risk women ages 25-85 (N = 232). High-risk was defined as: pathogenic genetic mutation in self or first-degree relative; history of lobular carcinoma in situ; history of thoracic radiation; or estimated lifetime risk ≥ 20%. Participants self-reported predisposing factors (breast cancer knowledge, health locus of control), enabling factors (health insurance type, social support), need factors (perceived risk, screening-supportive social norms, provider recommendation), and prior receipt of screening breast MRI. Multivariable logistic regression analysis with backward selection identified HSUM factors associated with receipt of screening breast MRI. RESULTS About half (51%) of participants had received a provider recommendation for screening breast MRI; only 32% had ever received a breast MRI. Breast cancer knowledge (OR = 1.15, 95% CI = 1.04-1.27) and screening-supportive social norms (OR = 2.21, 95% CI = 1.64-2.97) were positively related to breast MRI receipt. No other HSUM variables were associated with breast MRI receipt (all p's > 0.1). CONCLUSIONS High-risk women reported low uptake of screening breast MRI, indicating a gap in guideline-concordant care. Breast cancer knowledge and screening-supportive social norms are two key areas to target in future interventions. Data were collected during the COVID-19 pandemic and generalizability of results is unclear. Future studies with larger, more heterogeneous samples are needed to replicate these findings.
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Affiliation(s)
- Claire C Conley
- Department of Oncology, Georgetown University, Washington, DC, USA.
- Cancer Prevention and Control Program, Georgetown Lombardi Comprehensive Cancer Center, 2115 Wisconsin Ave NW, Suite 300, 20007, Washington, DC, USA.
| | | | - McKenzie McIntyre
- Moffitt Cancer Center, Health Outcomes and Behavior Program, Tampa, FL, USA
| | - Naomi C Brownstein
- Department of Public Health Sciences, Medical University of South Carolina, Charleston, SC, USA
| | - Bethany L Niell
- Department of Diagnostic Imaging and Interventional Radiology, Moffitt Cancer Center, Tampa, FL, USA
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Berkowitz Z, Zhang X, Richards TB, Sabatino SA, Peipins LA, Lee Smith J. Multilevel Small Area Estimation for County-Level Prevalence of Mammography Use in the United States Using 2018 Data. J Womens Health (Larchmt) 2023; 32:216-223. [PMID: 36301186 PMCID: PMC11129770 DOI: 10.1089/jwh.2022.0065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: The U.S. Preventive Services Task Force recommends biennial screening mammography for average-risk women aged 50-74 years. We aim to generate county-level prevalence estimates for mammography use to examine disparities among counties. Materials and Methods: We used data from the 2018 Behavioral Risk Factor Surveillance System (BRFSS) (n = 111,902 women) and linked them to county-level data from the American Community Survey. We defined two outcomes: mammography within the past 2 years (current); and mammography 5 or more years ago or never (rarely or never). We poststratified the data with U.S. Census estimated county population counts, ran Monte Carlo simulations, and generated county-level estimates. We aggregated estimates to state and national levels. We validated internal consistency between our model-based and BRFSS state estimates using Spearman and Pearson correlation coefficients. Results: Nationally, more than three in four women [78.7% (95% confidence interval {CI}: 78.2%-79.2%)] were current with mammography, although with large variations among counties. Also, nationally, about one in nine women [11% (95% CI: 10.8%-11.3%)] rarely or never had a mammogram. County estimates for being current ranged from 60.4% in New Mexico to 86.9% in Hawaii. Rarely or never having a mammogram ranged from 6% in Connecticut to 23.0% in Alaska, and on average, almost one in eight women in all the counties. Internal consistency correlation coefficient tests were ≥0.94. Conclusions: Our analyses identified marked county variations in mammography use across the country among women aged 50-74 years. We generated estimates for all counties, which may be helpful for targeted outreach to increase mammography uptake.
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Affiliation(s)
- Zahava Berkowitz
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
| | - Xingyou Zhang
- U.S. Bureau of Labor Statistics, Washington, District of Columbia, USA
| | - Thomas B. Richards
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
| | - Susan A. Sabatino
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
| | - Lucy A. Peipins
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
| | - Judith Lee Smith
- Epidemiology and Applied Research Branch, Division of Cancer Prevention and Control, National Center for Chronic Disease Prevention and Health Promotion, Centers for Disease Control and Prevention, Chamblee, Georgia, USA
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Nichol BAB, Hurlbert AC, Read JCA. Predicting attitudes towards screening for neurodegenerative diseases using OCT and artificial intelligence: Findings from a literature review. J Public Health Res 2022; 11:22799036221127627. [PMID: 36310821 PMCID: PMC9597051 DOI: 10.1177/22799036221127627] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2022] [Accepted: 09/02/2022] [Indexed: 11/25/2022] Open
Abstract
Recent developments in artificial intelligence (AI) and machine learning raise the possibility of screening and early diagnosis for neurodegenerative diseases, using 3D scans of the retina. The eventual value of such screening will depend not only on scientific metrics such as specificity and sensitivity but, critically, also on public attitudes and uptake. Differential screening rates for various screening programmes in England indicate that multiple factors influence uptake. In this narrative literature review, some of these potential factors are explored in relation to predicting uptake of an early screening tool for neurodegenerative diseases using AI. These include: awareness of the disease, perceived risk, social influence, the use of AI, previous screening experience, socioeconomic status, health literacy, uncontrollable mortality risk, and demographic factors. The review finds the strongest and most consistent predictors to be ethnicity, social influence, the use of AI, and previous screening experience. Furthermore, it is likely that factors also interact to predict the uptake of such a tool. However, further experimental work is needed both to validate these predictions and explore interactions between the significant predictors.
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Affiliation(s)
- Beth AB Nichol
- Department of Social Work, Education,
and Community Wellbeing, Northumbria University, Newcastle upon Tyne, UK,Beth AB Nichol, Department of Social Work,
Education, and Community Wellbeing, Northumbria University, Coach Lane,
Newcastle upon Tyne NE7 7XA, UK.
| | - Anya C Hurlbert
- Biosciences Institute, Newcastle
University, Newcastle upon Tyne, UK
| | - Jenny CA Read
- Biosciences Institute, Newcastle
University, Newcastle upon Tyne, UK
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5
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Jolidon V, De Prez V, Bracke P, Bell A, Burton-Jeangros C, Cullati S. Revisiting the Effects of Organized Mammography Programs on Inequalities in Breast Screening Uptake: A Multilevel Analysis of Nationwide Data From 1997 to 2017. Front Public Health 2022; 10:812776. [PMID: 35198524 PMCID: PMC8858931 DOI: 10.3389/fpubh.2022.812776] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2021] [Accepted: 01/13/2022] [Indexed: 01/04/2023] Open
Abstract
This study revisits the effects of mammography screening programs on inequalities in breast screening uptake in Switzerland. The progressive introduction of regional mammography programs by 12 out of the 26 Swiss cantons (regions) since 1999 offers an opportunity to perform an ecological quasi-experimental study. We examine absolute income and marital status inequalities in mammography uptake, and whether the cantons' implementation of mammography programs moderate these inequalities, as previous research has devoted little attention to this. We use five waves of the Swiss Health Interview Survey covering the 1997-2017 period and comprising data on 14,267 women aged 50-70. Both up-to-date and ever-screening outcomes are analyzed with multilevel models which assess the mammography programs' within-canton effect. Findings show that higher income women and married women (compared to unmarried women) had significantly higher mammography uptake probabilities. Mammography programs did not moderate absolute income differences in up-to-date screening; however, they were associated with smaller absolute income differences in ever-screening uptake. Mammography programs related to higher screening uptake for married women, more than for unmarried women. In conclusion, we showed absolute income inequalities in mammography uptake which were not revealed by previous studies using relative inequality measures. Mammography programs may have contributed to reducing income inequalities in ever-screening, yet this was not observed for up-to-date screening. This study has implication for preventive health interventions-e.g., cancer screening promotion should pay attention to women's marital status since screening programs may widen the screening gap between married and unmarried women.
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Affiliation(s)
- Vladimir Jolidon
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
| | | | - Piet Bracke
- Department of Sociology, Ghent University, Ghent, Belgium
| | - Andrew Bell
- Sheffield Methods Institute, University of Sheffield, Sheffield, United Kingdom
| | | | - Stéphane Cullati
- Institute of Sociological Research, University of Geneva, Geneva, Switzerland
- Population Health Laboratory, University of Fribourg, Fribourg, Switzerland
- Department of Readaptation and Geriatrics, University of Geneva, Geneva, Switzerland
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6
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Bayard S, Fasano G, Gillot T, Bratton B, Ibala R, Taylor Fortson K, Newman L. Breast Cancer Disparities and the Digital Divide. CURRENT BREAST CANCER REPORTS 2022; 14:205-212. [PMID: 36467667 PMCID: PMC9703401 DOI: 10.1007/s12609-022-00468-w] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/31/2022] [Indexed: 11/29/2022]
Abstract
Purpose of Review Socioeconomically disadvantaged populations and minority groups suffer from high breast cancer mortality, a disparity caused by decreased access to specialty care, lower treatment adherence, co-morbidities, and genetic predisposition for biologically aggressive breast tumor subtypes. Telehealth has the potential to mitigate breast cancer disparities by increasing access to specialty care and health information. However, unequal access to high-speed/broadband internet service and telehealth itself magnifies breast cancer disparities in vulnerable populations. This review evaluates the impact of the digital divide on breast cancer outcomes, as well as strategies for leveraging telehealth to reduce breast cancer disparities. Recent Findings There is a paucity of research specific to employing telehealth to address breast cancer disparities. Previous studies provide examples of telehealth utilization for increasing screening mammography, in addition to improving access to breast cancer care, including breast cancer specialist, nurse navigators, and clinical trials. Telehealth can also be used as an approach to risk reduction, with strategies to support weight management and genetic testing. Summary Eliminating the digital divide holds enormous potential for mitigating breast cancer disparities through an intentional focus on improving access to telehealth. With increased accessibility, resource allocation, and improved digital infrastructure, telehealth can be used to address disparities in early detection, quality of breast cancer care, treatment adherence, and risk assessment. Further research is essential to elucidate best practices in breast cancer telehealth approaches in underserved communities.
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Affiliation(s)
- Solange Bayard
- Department of Surgery, Weill Cornell Medicine, 525 E 68Th Street, New York-PresbyterianNew York, NY 10065 USA
| | - Genevieve Fasano
- Department of Surgery, Weill Cornell Medicine, 525 E 68Th Street, New York-PresbyterianNew York, NY 10065 USA
| | - Tamika Gillot
- Department of Surgery, Weill Cornell Medicine, 525 E 68Th Street, New York-PresbyterianNew York, NY 10065 USA
| | - Brenden Bratton
- Department of Surgery, Weill Cornell Medicine, 525 E 68Th Street, New York-PresbyterianNew York, NY 10065 USA
| | - Reine Ibala
- Department of Surgery, Weill Cornell Medicine, 525 E 68Th Street, New York-PresbyterianNew York, NY 10065 USA
| | - Katherine Taylor Fortson
- Department of Surgery, Weill Cornell Medicine, 525 E 68Th Street, New York-PresbyterianNew York, NY 10065 USA
| | - Lisa Newman
- Department of Surgery, Weill Cornell Medicine, 525 E 68Th Street, New York-PresbyterianNew York, NY 10065 USA
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7
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Ayala-Marín AM, Colón-López V, Vélez-Álamo C, Fernández-Espada N, Pattatucci A, Fernández ME. Never Screened: Understanding Breast Cancer Nonadherence in Puerto Rico. HEALTH EDUCATION & BEHAVIOR 2021; 48:559-566. [PMID: 33666106 DOI: 10.1177/1090198120988248] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Breast cancer is the most commonly diagnosed cancer and the leading cause of cancer-related death among women in Puerto Rico (PR). The purpose of this study was to identify factors associated with never screened status among a sample of women nonadherent to the 2013 American Cancer Society guidelines. The inclusion criteria for this study were being a woman (1) aged ≥40 years old and (2) nonadherent to breast cancer screening guidelines. We used baseline data from participants (N = 300; aged ≥40 years old) enrolled in the intervention trial Cultivando la Salud, implemented in Canóvanas, Puerto Rico, from 2012 to 2014. We used multivariate logistic regression models to identify factors associated with never screening status, adjusting by sociodemographical variables and psychosocial constructs about mammography (self-efficacy, beliefs about mammography pros [benefits] and cons [disadvantages], and subjective norms) as well as by health care insurance, usual source of care, and Pap test adherence. Among nonadherent women, 18.0% reported never having a mammography. Never screened women were significantly younger than previously screened women (adjusted prevalence odds ratio [aPOR] = 7.32, 95% confidence interval (CI): [2.38, 22.50]) and almost four times as likely to have the governmental health plan (GHP; aPOR = 3.78, 95% CI: [1.15, 12.46]). In addition, never screened women perceived more cons (disadvantages) to mammography than previously screened women (aPOR = 1.81, 95% CI: [1.18, 2.78]). We found that women who were younger, had GHP insurance, and had higher levels of beliefs against mammography were more likely to have never been screened. Results from this study can be used to target never screened women with health education messages addressing perceived cons of mammography. Additionally, women with GHP insurance may experience disparities in health care access and should be targeted with policies that facilitate access to mammography screening.
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Affiliation(s)
| | - Vivian Colón-López
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico.,UPR Comprehensive Cancer Center, San Juan, Puerto Rico
| | | | | | - Angela Pattatucci
- University of Puerto Rico Medical Sciences Campus, San Juan, Puerto Rico
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8
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Esmaeili M, Ayyoubzadeh SM, Javanmard Z, R Niakan Kalhori S. A systematic review of decision aids for mammography screening: Focus on outcomes and characteristics. Int J Med Inform 2021; 149:104406. [PMID: 33640838 DOI: 10.1016/j.ijmedinf.2021.104406] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Revised: 01/28/2021] [Accepted: 02/02/2021] [Indexed: 01/02/2023]
Abstract
PURPOSE Decision Aid systems (DAs) provide information on the pros and cons of mammography. This study aimed to review the research on mammography DAs, synthesize the findings related to their outcomes and characteristics, and address the existed research gap. METHODS Relevant studies were identified through a comprehensive search on some e-databases, including PubMed, EMBASE, Scopus, and Web of Science in August 2020; by searching the keywords of "Breast cancer", "Screening", and "Decision aid systems" as well as their synonyms in the titles and abstracts of the papers with no time limits. Among the selected English journal papers with the interventional study design, those measuring outcome values of using mammography DAs were recognized as eligible for being included in this review. RESULTS The systematic search results in 16 DAs regarding mammography that were designed and then evaluated from 18 selected studies. The results showed that DAs provide improvements in knowledge and informed choice, the decreased decisional conflicts and decisional confidence, almost without changing any attitude towards mammography, mammography participation rates, psychological issues, anticipated regret, and perceived risk of breast cancer. The DAs' effects on women's inclination to screening were divergent. In other words, the DAs affect individuals' inclination in rare cases; however, on occasion, they could affect women's decision to undergo screening. CONCLUSION DAs could correct the bias attached to the existing knowledge on mammography and breast cancer in women so that they are more likely to make a precise decision. Additionally, it might be of central importance in shared decision-making and assisting health providers, in order to promote the quality of care. Accordingly, performing more studies is needed to develop more professional DAs in various countries with different facilities, cultures, and languages.
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Affiliation(s)
- Marzieh Esmaeili
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Seyed Mohammad Ayyoubzadeh
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Students' Scientific Research Center, Tehran University of Medical Sciences, Tehran, Iran.
| | - Zohreh Javanmard
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran; Department of Health Information Technology, Ferdows School of Paramedical and Health, Birjand University of Medical Sciences, Birjand, Iran.
| | - Sharareh R Niakan Kalhori
- Department of Health Information Management, School of Allied Medical Sciences, Tehran University of Medical Sciences, Tehran, Iran.
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9
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Miller BC, Sarma EA, Sun Y, Messina CR, Moyer A. Psychosocial predictors of mammography history among Chinese American women without a recent mammogram. ETHNICITY & HEALTH 2020; 25:862-873. [PMID: 29506393 DOI: 10.1080/13557858.2018.1447653] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/13/2017] [Accepted: 02/26/2018] [Indexed: 06/08/2023]
Abstract
Chinese American women have lower rates of mammography screening compared with non-Hispanic White women. Although the extent of perceived barriers, as conceptualized by the Health Belief Model, have been shown to distinguish between currently non-adherent Chinese American women who have ever and never had a mammogram, it is less clear which types of perceived barriers differentiate them. One hundred twenty-eight Chinese American women in the New York metropolitan area who had not had a mammogram in the past year completed baseline assessments for a mammography framing intervention study. Demographics, medical access variables, and perceived barriers to mammography (lack of access, lack of need for screening, and modesty) were used to predict mammography history (ever versus never screened). Fifty-five women (43%) reported having been screened at least once. A sequential logistic regression showed that English speaking ability and having health insurance significantly predicted mammography history. However, these control variables became non-significant when the three barrier factors were included in the final model. Women who reported a greater lack of access (OR = 0.36, p < .05) and greater lack of need (OR = 0.27, p < .01) were less likely to be ever screeners. Unexpectedly, women who reported greater modesty were more likely to be ever screeners (OR = 4.78, p < .001). The results suggest that interventions for Chinese American women should identify and target specific perceived barriers with consideration of previous adherence.
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Affiliation(s)
| | | | - Yiyuan Sun
- Stony Brook University, Stony Brook, NY, USA
| | | | - Anne Moyer
- Stony Brook University, Stony Brook, NY, USA
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10
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Nanda AD, Mann MP, Cheng AL, Moormeier J, Ahmadiyeh N. Impact of Phone-Call and Access-Enhancing Intervention on Mammography Uptake among Primary Care Patients at an Urban Safety-Net Hospital: A Randomized Controlled Study. Ann Surg Oncol 2020; 27:4643-4649. [PMID: 32696304 DOI: 10.1245/s10434-020-08884-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 06/27/2020] [Indexed: 12/29/2022]
Abstract
BACKGROUND Our urban safety-net hospital (SNH) has very low screening mammogram rates within its primary care clinics. Despite Commission on Cancer (CoC) accreditation, we see ~ 3 × more late-stage breast cancer diagnoses than other CoC sites across the country, and recently showed this to be strongly associated with lack of screening (Ahmadiyeh et al. in J Health Care Poor Underserved, in press, 2020). Here we study whether a two-step intervention (phone calls and assistance scheduling mammograms) increases uptake over usual care. PATIENTS AND METHODS Randomized controlled study of 890 women aged 50-65 years who were due for biennial screening mammograms and who were established within one of five primary care clinics at an urban SNH. Each patient in the intervention group was called with overdue status (up to three times, voicemail left if needed) and offered assistance scheduling mammogram appointment. Mammography uptake at 3 and 6 months was analyzed. RESULTS Intervention significantly increased uptake compared with usual care at both timepoints (18% versus 6% at 3 months; χ2 = 27.597, p < 0.0001; 23% versus 12% at 6 months; χ2 = 18.0, p < 0.0001), with scheduling component driving effectiveness. Of those who were successfully contacted, uptake was significantly greater among those who scheduled appointments versus those who did not (47% versus 9%, χ2 = 95, p < 0.0001), and uptake was no different between contacted but not scheduled patients and usual care controls. CONCLUSIONS Phone call with access-enhancing intervention (facilitating mammogram appointments) increased screening mammogram uptake among primary care patients in an urban safety-net setting and may be applicable to other urban SNHs around the country.
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Affiliation(s)
- Asha D Nanda
- University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | | | - An-Lin Cheng
- Department of Biomedical and Health Informatics, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Jill Moormeier
- Truman Medical Centers, Kansas City, MO, USA.,Department of Medicine, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA
| | - Nasim Ahmadiyeh
- Truman Medical Centers, Kansas City, MO, USA. .,Department of Surgery, University of Missouri-Kansas City School of Medicine, Kansas City, MO, USA. .,Department of Surgery, Truman Medical Center, Kansas City, MO, USA.
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11
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Arana-Chicas E, Kioumarsi A, Carroll-Scott A, Massey PM, Klassen AC, Yudell M. Barriers and facilitators to mammography among women with intellectual disabilities: a qualitative approach. DISABILITY & SOCIETY 2019; 35:1290-1314. [PMID: 34408338 PMCID: PMC8370097 DOI: 10.1080/09687599.2019.1680348] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/22/2019] [Revised: 10/10/2019] [Accepted: 10/11/2019] [Indexed: 06/13/2023]
Abstract
Although women with intellectual disabilities have the same breast cancer incidence rate as women without intellectual disabilities, they have fewer mammograms and higher mortality rates. Qualitative inquiry was employed to explore barriers and facilitators to mammography among this population. In-depth qualitative interviews were conducted with 30 women with intellectual disabilities and their caregivers in Philadelphia during 2015-2016. Thematic analysis was conducted using inductive and deductive coding. While results provide further evidence for prior research on barriers to mammography among women with intellectual disabilities (e.g. being unprepared, fear of the exam), this study generated novel barriers such as lack of breast ultrasound awareness, sedation failing to work, and lack of mammogram education in adult day programs, and novel facilitators such as extended family support and positive attitudes. Results support the need to address barriers and promote facilitators to improve the breast cancer screening experience among women with intellectual disabilities.
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Affiliation(s)
- Evelyn Arana-Chicas
- Cancer Disparities Center, Hackensack University Medical Center, Hackensack, NJ, USA
| | - Avat Kioumarsi
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Amy Carroll-Scott
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Philip M. Massey
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Ann C. Klassen
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
| | - Michael Yudell
- Dornsife School of Public Health, Community Health and Prevention, Drexel University, Philadelphia, PA, USA
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12
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Bonafede MM, Miller JD, Pohlman SK, Troeger KA, Sprague BL, Herschorn SD, Winer IH. Breast, Cervical, and Colorectal Cancer Screening: Patterns Among Women With Medicaid and Commercial Insurance. Am J Prev Med 2019; 57:394-402. [PMID: 31377088 PMCID: PMC7433028 DOI: 10.1016/j.amepre.2019.04.010] [Citation(s) in RCA: 31] [Impact Index Per Article: 6.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/26/2018] [Revised: 04/03/2019] [Accepted: 04/04/2019] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Despite healthcare reforms mandating expanded insurance coverage and reduced out-of-pocket costs for preventive care, cancer screening rates remain relatively static. No study has measured cancer screening rates for multiple tests among non-Medicare patients. METHODS This retrospective, population-based claims analysis, conducted in 2016-2017, of commercially insured and Medicaid-insured women aged 30-59 years enrolled in IBM MarketScan Commercial and Medicaid Databases (containing approximately 90 and 17 million enrollees, respectively) during 2010-2015 describes screening rates for breast, cervical, and colorectal cancer. Key outcomes were (1) proportion screened for breast, cervical, and colorectal cancer among the age-eligible population compared with accepted age-based recommendations and (2) proportion with longer-than-recommended intervals between tests. RESULTS One half (54.7%) of commercially insured women aged 40-59 years (n=1,538,444) were screened three or more times during the 6-year study period for breast cancer; for Medicaid-insured women (n=78,897), the rates were lower (23.7%). One third (43.4%) of commercially insured and two thirds (68.9%) of Medicaid-insured women had a >2.5-year gap between mammograms. Among women aged 30-59 years, 59.3% of commercially insured women and 31.4% of Medicaid-insured women received two or more Pap tests. The proportion of patients with a >3.5-year gap between Pap tests was 33.9% (commercially insured) and 57.1% (Medicaid-insured). Among women aged 50-59 years, 63.3% of commercially insured women and 47.2% of Medicaid-insured women were screened at least one time for colorectal cancer. Almost all women aged 30-59 years (commercially insured, 99.1%; Medicaid-insured, 98.9%) had at least one healthcare encounter. CONCLUSIONS Breast and cervical cancer screenings remain underutilized among both commercially insured and Medicaid-insured populations, with lower rates among the Medicaid-insured population. However, almost all women had at least one healthcare encounter, suggesting opportunities for better coordinated care.
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Affiliation(s)
| | | | - Scott K Pohlman
- Outcomes Research, Hologic, Inc., Marlborough, Massachusetts
| | | | - Brian L Sprague
- Department of Surgery, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont; Department of Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
| | - Sally D Herschorn
- Department of Radiology, University of Vermont Cancer Center, University of Vermont, Burlington, Vermont
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13
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Mehta JM, MacLaughlin KL, Millstine DM, Faubion SS, Wallace MR, Shah AA, Fields HE, Ruddy BE, Bryan MJ, Patel B, Temkit MH, Buras MR, Golafshar MA, Kling JM. Breast Cancer Screening: Women's Attitudes and Beliefs in Light of Updated United States Preventive Services Task Force and American Cancer Society Guidelines. J Womens Health (Larchmt) 2019; 28:302-313. [DOI: 10.1089/jwh.2017.6885] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Affiliation(s)
- Jaya M. Mehta
- Department of Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Denise M. Millstine
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Stephanie S. Faubion
- Division of General Internal Medicine, Women's Health Clinic, Mayo Clinic Rochester, Rochester, Minnesota
| | - Mark R. Wallace
- Division of Community Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Amit A. Shah
- Division of Community Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Heather E. Fields
- Division of Community Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Barbara E. Ruddy
- Division of Community Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Michael J. Bryan
- Department of Family Medicine and Mayo Clinic Arizona, Scottsdale, Arizona
| | - Bhavika Patel
- Department of Diagnostic Radiology, Mayo Clinic Arizona, Scottsdale, Arizona
| | - M' hamed Temkit
- Division of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona
| | - Matthew R. Buras
- Division of Health Science Research, Mayo Clinic Arizona, Scottsdale, Arizona
| | | | - Juliana M. Kling
- Division of Women's Health Internal Medicine, Mayo Clinic Arizona, Scottsdale, Arizona
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14
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Vang S, Margolies LR, Jandorf L. Mobile Mammography Participation Among Medically Underserved Women: A Systematic Review. Prev Chronic Dis 2018; 15:E140. [PMID: 30447104 PMCID: PMC6266518 DOI: 10.5888/pcd15.180291] [Citation(s) in RCA: 55] [Impact Index Per Article: 9.2] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023] Open
Abstract
Introduction Although breast cancer deaths have declined, the mortality rate among women from medically underserved communities is disproportionally high. Screening mammography is the most effective tool for detecting breast cancer in its early stages, yet many women from medically underserved communities do not have adequate access to screening mammograms. Mobile mammography may be able to bridge this gap by providing screening mammograms at no cost or low cost and delivering services to women in their own neighborhoods, thus eliminating cost and transportation barriers. The objective of this systematic review was to describe the scope and impact of mobile mammography programs in promoting mammographic screening participation among medically underserved women. Methods We searched electronic databases for English-language articles published in the United States from January 2010 through March 2018 by using the terms “mobile health unit,” “mammogram,” “mammography,” and “breast cancer screening.” Of the 93 articles initially identified, we screened 55; 16 were eligible to be assessed and 10 qualified for full text review and data extraction. Each study was coded for study purpose, research design, data collection, population targeted, location, sample size, outcomes, predictors, analytical methods, and findings. Results Of the 10 studies that qualified for review, 4 compared mobile mammography users with users of fixed units, and the other 6 characterized mobile mammography users only. All the mobile mammography units included reached underserved women. Most of the women screened in mobile units were African American or Latina, low income, and/or uninsured. Mobile mammography users reported low adherence to 1-year (12%–34%) and 2-year (40%–48%) screening guidelines. Some difficulties faced by mobile clinics were patient retention, patient follow-up of abnormal or inconclusive findings, and women inaccurately perceiving their breast cancer risk. Conclusion Mobile mammography clinics may be effective at reaching medically underserved women. Adding patient navigation to mobile mammography programs may promote attendance at mobile sites and increase follow-up adherence. Efforts to promote mammographic screening should target women from racial/ethnic minority groups, women from low-income households, and uninsured women. Future research is needed to understand how to best improve visits to mobile mammography clinics.
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Affiliation(s)
- Suzanne Vang
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, One Gustave Levy Pl, Box 1077, New York, NY 10029.
| | - Laurie R Margolies
- Department of Radiology, Icahn School of Medicine at Mount Sinai and Mount Sinai Hospital, New York, New York
| | - Lina Jandorf
- Department of Population Health Science and Policy, Icahn School of Medicine at Mount Sinai, New York, New York
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Horsley RK, Kling JM, Vegunta S, Lorans R, Temkit H, Patel BK. Baseline Mammography: What Is It and Why Is It Important? A Cross-Sectional Survey of Women Undergoing Screening Mammography. J Am Coll Radiol 2018; 16:164-169. [PMID: 30219346 DOI: 10.1016/j.jacr.2018.07.002] [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: 05/24/2018] [Revised: 06/22/2018] [Accepted: 07/03/2018] [Indexed: 11/18/2022]
Abstract
OBJECTIVES Studies have shown that having a baseline mammogram, the first screening mammogram, available for comparison at the time of interpreting a subsequent mammogram significantly decreases the potential of a false-positive examination. Our aim was to evaluate knowledge of and perception about the significance of baseline mammograms in those women undergoing screening mammography. MATERIALS AND METHODS A cross-sectional prospective survey study was conducted in women without a history of breast cancer presenting for their screening mammogram. Respondents were surveyed anonymously between March and April 2017. The questionnaire was developed by primary care providers and radiologists and pretested for readability and clarity. RESULTS In all, 401 women (87% white, 93% educated beyond high school) completed surveys in which 77% of women reported having yearly mammograms, 31% reported having a history of an abnormal mammogram, and 45% had not heard the term baseline mammogram. Of those who had heard the term, the most commonly reported source was their primary care provider (31%). Although 74% chose the correct definition of a baseline mammogram, 67% did not think that a baseline mammogram was important for decreasing associated cost, time, and discomfort due to the number of mammograms incorrectly read as abnormal. CONCLUSION In a group of educated women who routinely get mammograms, almost one-half had not heard the term baseline mammogram. Furthermore, most women did not think baseline mammography was important for decreasing associated cost, time, and discomfort due to mammograms incorrectly read as abnormal. This study suggests that efforts to improve women's understanding of baseline mammograms and their importance are warranted, with greatest opportunity for health care providers and radiologists.
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Affiliation(s)
| | - Juliana M Kling
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Suneela Vegunta
- Division of Women's Health Internal Medicine, Mayo Clinic, Scottsdale, Arizona
| | - Roxanne Lorans
- Department of Diagnostic Radiology, Mayo Clinic, Phoenix, Arizona
| | - H'hamed Temkit
- Department of Research Biostatistics, Mayo Clinic, Phoenix, Arizona
| | - Bhavika K Patel
- Department of Diagnostic Radiology, Mayo Clinic, Phoenix, Arizona
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Barriers to Breast Cancer Screening among Diverse Cultural Groups in Melbourne, Australia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2018; 15:ijerph15081677. [PMID: 30087259 PMCID: PMC6121647 DOI: 10.3390/ijerph15081677] [Citation(s) in RCA: 32] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 07/03/2018] [Revised: 07/18/2018] [Accepted: 08/05/2018] [Indexed: 01/29/2023]
Abstract
This study explored the association between health literacy, barriers to breast cancer screening, and breast screening participation for women from culturally and linguistically diverse (CALD) backgrounds. English-, Arabic- and Italian-speaking women (n = 317) between the ages of 50 to 74 in North West Melbourne, Australia were recruited to complete a survey exploring health literacy, barriers to breast cancer screening, and self-reported screening participation. A total of 219 women (69%) reported having a breast screen within the past two years. Results revealed that health literacy was not associated with screening participation. Instead, emotional barriers were a significant factor in the self-reported uptake of screening. Three health literacy domains were related to lower emotional breast screening barriers, feeling understood and supported by healthcare providers, social support for health and understanding health information well enough to know what to do. Compared with English- and Italian-speaking women, Arabic-speaking women reported more emotional barriers to screening and greater challenges in understanding health information well enough to know what to do. Interventions that can improve breast screening participation rates should aim to reduce emotional barriers to breast screening, particularly for Arabic-speaking women.
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Moghaddam Tabrizi F, Vahdati S, Khanahmadi S, Barjasteh S. Determinants of Breast Cancer Screening by Mammography in Women Referred to Health Centers of Urmia, Iran. Asian Pac J Cancer Prev 2018; 19:997-1003. [PMID: 29693968 PMCID: PMC6031808 DOI: 10.22034/apjcp.2018.19.4.997] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background: In women, breast cancer accounts for 30 percent of all cancers and it is the second leading cause of mortality. Mammography is considered an effective procedure to detect early breast cancer recommended by World Health Organization. This study was aimed to evaluate breast cancer screening determinants in women referred to health centers of Urmia for mammography in 2017. Materials and Methods: In this descriptive-analytic cross-sectional study, 348 women referred to health centers of Urmia were selected using multistage sampling. Data were collected using a standard questionnaire for mammography screening determinants, with a checklist including demographic characteristics, family, social and economic factors and midwifery background. Analysis was with SPSS software version 20for descriptive and inferential statistic tests, P<0.05 being considered significant. Results: The proportion performing mammography was 12%. Significant relationships were noted with income, menopause status, a history of breast cancer in close relatives, beliefs, inaccessibility, knowledge, cues to action, emotions, self-care, and life priorities (P<0.05). There were no significant links with age at marriage, first age of delivery, number of children, duration of breastfeeding, status of residency, education, marital status, occupation, history of breastfeeding, and previous breast problems (P>0.05). Conclusions: The findings of this study showed that the status of breast cancer screening in participating women was not satisfactory. Therefore, promotion of screening methods by health policy makers in Iran is necessary and given that reliance solely on education is not sufficient, it is essential to pay attention to barriers and eliminate them.
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Cadet TJ, Burke SL, Stewart K, Howard T, Schonberg M. Cultural and emotional determinants of cervical cancer screening among older Hispanic women. Health Care Women Int 2017; 38:1289-1312. [PMID: 28825525 DOI: 10.1080/07399332.2017.1364740] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022]
Abstract
Older adults are at highest risk of cancer and yet have the lowest rates of cancer screening participation. Older minority adults bear the burden of cancer screening disparities leading to late stage cancer diagnoses. This investigation, utilization data from the 2008 wave of the Health and Retirement study examined the cultural and emotional factors thought to influence cervical cancer screening among older Hispanic women. We utilized logistic regression models to conduct the analyses. Findings indicate that the emotional factors were not significant but the cultural factor, time orientation was a significant predictor for older Hispanics' cervical cancer screening behaviors.
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Affiliation(s)
- Tamara J Cadet
- a Simmons College School of Social Work , Boston , Massachusetts , USA.,b Harvard School of Dental Medicine Department of Oral Health Policy and Epidemiology , Boston , Massachusetts , USA
| | - Shanna L Burke
- c Florida International University , Robert Stempel College of Public Health and Social Work , Miami , Florida, USA
| | | | - Tenial Howard
- a Simmons College School of Social Work , Boston , Massachusetts , USA
| | - Mara Schonberg
- e Harvard Medical School , Beth Israel Deaconess Medical Center , Boston , Massachusetts , USA
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Cadet TJ, Berrett-Abebe J, Stewart K. Mental health and breast cancer screening utilization among older Hispanic women. J Women Aging 2016; 29:163-172. [DOI: 10.1080/08952841.2015.1113726] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
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Glanz K, Yackle A. Tackling the burden of cancer in the 21st century: understanding and communicating in new and future contexts. HEALTH EDUCATION & BEHAVIOR 2015; 42:5-7. [PMID: 25583969 DOI: 10.1177/1090198114567450] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Karen Glanz
- University of Pennsylvania, Philadelphia, PA, USA
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