Abstract
Research suggests that women with Limited English Proficiency (LEP) and ethnic minority women are at increased risk of being inadequately informed of their mammogram result. The purpose of this study is to explore breast imaging centers’ communication practices and assess how these centers accommodate women with low literacy and LEP. A 35-question survey was distributed to a national association of more than 700 breast health centers. Descriptive analysis of the overall sample and Fisher’s exact or Chi squared testing to distinguish differences between subgroups were performed. Respondents from 206 centers completed questionnaires. 29 % of respondents stated that more than a quarter of their patients were black, 27 % of respondents stated that more than a quarter of their patients were Hispanic/Latina, and 13 % of respondents stated that more than a quarter of their patients had LEP. Overall, 18 % of respondents reported they do not routinely telephone patients with results, 15 % do not have multilingual staff or translators available to answer questions, and 69 % send result letters in English only. Of note, 69 % use patient navigators. Centers reported systemic strengths and barriers to clear communication of mammography results. Our findings are consistent with past investigations identifying a general need to improve the communication of breast imaging results and suggesting that result notification letters alone are inadequate in ensuring that every woman understands her personal results and follow-up plan.
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Kaplan CP, Crane LA, Stewart S, Juarez-Reyes M. Factors affecting follow-up among low-income women with breast abnormalities. J Women’s Health. 2004;13:195–206.
Dolan NC, Feinglass J, Priyanth A, Haviley C, Sorensen AV, Venta LA. Measuring satisfaction with mammography results reporting. J Gen Intern Med. 2001;16:157–62.
Levin K, Brauening PM, O’Malley M, Pisano E, Barrett E, Earp J. Communicating results of diagnostic mammography: what do patients think?*. Acad Radiol. 2000;7:1069–76.
Moy BB. Barriers to repeat mammography: cultural perspectives of African-American, Asian, and Hispanic women. Psycho-oncology (Chichester, England). 2006;15:623–34.
Raza S, Rosen MP, Chorny K, Mehta TS, Hulka CA, Baum JK. Patient expectations and costs of immediate reporting of screening mammography: talk isn’t cheap. AJR Am J Roentgenol. 2001;177:579–83.
Zapka JG. Processes of care in cervical and breast cancer screening and follow-up–the importance of communication. Prev Med. 2004;39:81–90.
Zapka JG. Print information to inform decisions about mammography screening participation in 16 countries with population-based programs. Patient Educ Couns. 2006;63:126–37.
McCarthy BD, Yood MU, Janz NK, Boohaker EA, Ward RE, Johnson CC. Evaluation of factors potentially associated with inadequate follow-up of mammographic abnormalities. Cancer. 1996;77:2070–6.
Mojica CM, Bastani R, Ponce NA, Boscardin WJ. Latinas with abnormal breast findings: patient predictors of timely diagnostic resolution. J Women’s Health. 2007;16:1468–77.
Poon EG, Haas JS, Puopolo A, et al. Communication factors in the follow-up of abnormal mammograms. J Gen Intern Med. 2004;19:316–23.
Yabroff KR, Breen N, Vernon SW, Meissner HI, Freedman AN, Ballard-Barbash R. What factors are associated with diagnostic follow-up after abnormal mammograms? Findings from a US National Survey. Cancer Epidemiol Biomarkers Prev. 2004;13:723–32.
Kerner JF, Yedidia M, Padgett D, et al. Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among black women. Prevent Med. 2003;37:92–101.
Jones B, Dailey A, Calvocoressi L, et al. Inadequate follow-up of abnormal screening mammograms: findings from the race differences in screening mammography process study (United States). Cancer Causes Control. 2005;16:809–21.
Press R, Carrasquillo O, Sciacca R, Giardina E. Racial/ethnic disparities in time to follow-up after an abnormal mammogram. J Women’s Health. 2008;17:923–30.
Karliner LLS, Ma L, Hofmann M, Kerlikowske K. Language barriers, location of care, and delays in follow-up of abnormal mammograms. Med Care. 2012;50:171–8.
Mammography quality standards reauthorization act. US 105th Congress. US public law; 1998. p. 105–248. Available at: http://www.gpo.gov/fdsys/pkg/PLAW-105publ248/html/PLAW-105publ248.htm. Accessed 28 Feb 2012.
Priyanth A, Feinglass J, Dolan NC, Haviley C, Venta LA. Patient satisfaction with the communication of mammographic results before and after the mammography quality standards reauthorization act of 1998. Am J Radiol. 2002;178:451–6.
Karliner LS, Kaplan CP, Juarbe T, Pasick R, Perez-Stable EJ. Poor patient comprehension of abnormal mammography results. J Gen Intern Med. 2005;20:432–7.
Jones BA, Reams K, Calvocoressi L, Dailey A, Kasl SV, Liston NM. Adequacy of communicating results from screening mammograms to african-american and white women. Am J Public Health. 2007;97:531–8.
Marcus EN, DelToro Y, Pereyra M, Romilly AP, Velasquez V, Yepes M, Sanders L. Mammography result notification letters: can most women understand them? JGIM. 2009;24(Suppl 1):S119.
Marcus EN, Sanders L, Pereyra M, DelToro Y, Romilly AP, Yepes M, Webb Hooper M, Jones BA. Mammography result letters: are they easy to read and understand? J Women’s Health. 2011;20:545–51.
Kutner M, Greenberg E, Jin Y, Paulsen C. The health literacy of America’s Adults: Results From the 2003 National Assessment of Adult Literacy. Institute of Education Science, National Center for Education Statistics. NCES; 2006. p. 483. Available at: http://nces.ed.gov/pubs2006/2006483.pdf. Accessed Feb 28 2012.
Shea J, Beers B, McDonald V, Quistberg D, Ravenell K, Asch D. Assessing health literacy in African American and caucasian adults: disparities in rapid estimate of adult literacy in medicine (REALM) scores. Fam Med. 2004;36:575–81.
Battaglia TA, Roloff K, Posner MA, Freund KM. Improving follow-up to abnormal breast cancer screening in an urban population. Cancer. 2007;109:359–67.
Ell K, Vourlekis B, Lee PJ, Xie B. Patient navigation and case management following an abnormal mammogram: a randomized clinical trial. Prev Med. 2007;44:26–33.
Palmieri FM, Deperi ER, Mincey BA, Smith JA, Wen LK, Chewar DM, Abaya R, Colon-Otero G, Perez EA. Comprehensive diagnostic program for medically underserved women with abnormal breast screening evaluations in an urban population. Mayo Clin Proceed. 2009;84:317–22.
Lown BA, Roy E, Gorman P, Sasson JP. Women’s and residents’ experiences of communication in the diagnostic mammography suite. Patient Educ Couns. 2009;77:328–37.
Jones BA, Culler CS, Kasl SV. Is variation in the quality of mammographic services race linked? J Health Care Poor Underserved. 2001;12:113–26.
Rudd RE, Anderson JE. The health literacy environment of hospitals and health centers. 2006. Available at: http://www.hsph.harvard.edu/healthliteracy/files/healthliteracyenvironment.pdf. Downloaded 28 Feb 2012.
US Government Accountability Office Report to Congressional Requesters. Mammography: current nationwide capacity is adequate, but access problems may exist in certain locations. 2006; GAO-06-724. Available at: http://www.gao.gov/new.items/d06724.pdf. Accessed 28 Feb 2012.
Phillips C, Rothstein J, Beaver K, Sherman BJ, Freund KM, Battaglia TA. Patient navigation to increase mammography screening among inner city women. J Gen Intern Med. 2011;6:123–9.
Wells KJ, Battaglia TA, Dudley DJ, et al. Patient navigation: state of the art or is it science? Cancer. 2008;113:1999–2010.
Zapka J, Taplin SH, Anhang Price R, Cranos C, Yabroff R. Factors in quality care—the case of follow-up to abnormal cancer screening tests—problems in the steps and interfaces of care. JNCI Cancer Spectr. 2010;40:58–71.
Barton M, Morley DS, Moore S, Allen D, Kleinman KP, Emmons KM, Fletcher SW. Decreasing women’s anxieties after abnormal mammograms: a controlled trial. J Natl Cancer Inst. 2004;96:529–38.
Lobb R, Allen JD, Emmons KM, Ayanian JZ. Timely care after an abnormal mammogram among low-income women in a public breast cancer screening program. Arch Intern Med. 2010;170:521–8.
Masi C, Blackman D, Peek M. Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women. Med Care Res Rev. 2007;64:195S–242S.
Baker DW, Hayes R, Fortier JP. Interpreter use and satisfaction with interpersonal aspects of care for Spanish-speaking patients. Med Care. 1998;36:1461–70.
Ngo-Metzger Q, Sorkin DH, Phillips RS, Greenfield S, Massagli MP, Clarridge B, Kaplan SH. Providing high-quality care for limited English proficient patients: the importance of language concordance and interpreter use. J Gen Intern Med. 2007;22:324–30.
Weech-Maldonado R, Morales LS, Elliott M, Spritzer K, Marshall G, Hays RD. Race/ethnicity, language, and patients’ assessments of care in medicaid managed care. Health Ser Res. 2003;38:789–808.
Karliner L, Kim S, Meltzer D, et al. Influence of language barriers on outcomes of hospital care for general medicine inpatients. J Hosp Med. 2010;5:276–82.
US Department of Health and Human Services, Food and Drug Administration: MQSA final guidance documents for industry, MQSA Inspectors and FDA Staff. Available at: http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/Guidance/ucm127070.htm Page last updated 11/23/2010, Accessed 28 Feb 2012.
US Department of Health and Human Services, Food and Drug Administration. Radiation-Emitting Products. Communication of Results to Patients. MQSA Guidance: Communication of Results to Patients. Policy guidance help system page Updated 12/1/2010; Available at http://www.fda.gov/Radiation-EmittingProducts/MammographyQualityStandardsActandProgram/Guidance/PolicyGuidanceHelpSystem/ucm052093.htm. Accessed 28 Feb 2012.
Carney PA. An assessment of the likelihood, frequency, and content of verbal communication between radiologists and women receiving screening and diagnostic mammography. Acad Radiol. 2009;16:1056–63.
Collins KC, Hughes DL, Doty MM, Ives BL, Edwards JN, Tenney K. Report: diverse communities, common concerns: assessing health care quality for minority Americans. New York: Commonwealth Fund; 2002.
DeVoe JE, Fryer GE, Phillips R, Green L. Receipt of preventive care among adults: insurance status and usual source of care. Am J Public Health. 2003;93:786–91.
Mayberry RM, Mili F, Ofili E. Racial and ethnic differences in access to medical care. Med Care. 2000;57:108–45.
Acknowledgments
Dr. Marcus receives grant support from the American Cancer Society (ACS CCCDA-09-216-01) and the Ford Foundation (1095-0885). The authors thank the following individuals for sharing their expertise and their invaluable assistance with the study: Marsha Stevens, Dorothy Parker, and the UMiami/Sylvester Comprehensive Cancer Center Disparities and Community Outreach Core; Dr. Beth Jones; Dr. Bernard Roos; Dr. Ada Patricia Romilly; Ms. Margaret Roelans; Dr. Barbara Rabinowitz; and members of the National Consortium of Breast Centers, Inc.
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Marcus, E.N., Koru-Sengul, T., Miao, F. et al. How do Breast Imaging Centers Communicate Results to Women with Limited English Proficiency and Other Barriers to Care?. J Immigrant Minority Health 16, 401–408 (2014). https://doi.org/10.1007/s10903-012-9771-7
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DOI: https://doi.org/10.1007/s10903-012-9771-7