How do Breast Imaging Centers Communicate Results to Women with Limited English Proficiency and Other Barriers to Care?
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.
KeywordsCancer screening Mammography Breast imaging Breast cancer Limited English proficiency Minority health Cancer disparities
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.
- 16.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.
- 17.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.Google Scholar
- 20.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.Google Scholar
- 22.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.
- 29.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.
- 30.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.
- 33.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.Google Scholar
- 41.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.
- 42.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.
- 44.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.Google Scholar