An evaluation of mammography beliefs using a decision model

Busy lifestyles and mammography screening: time pressure and women's reattendance likelihood

Time pressure is often cited as a reason for non-attendance at mammography screening, although evidence from other areas of psychology suggests that time pressure can improve performance when barriers such as time pressure provide a challenge. We predicted that time pressure would negatively predict attendance in women whose self-efficacy for overcoming time pressure is low, but positively predict attendance when self-efficacy is high. Time pressure was operationalised as the self-reported number of dependent children and others, and average number of working hours per week. Australian women were surveyed after being invited to attend second or subsequent screenings at a free public screening service, and subsequent attendance monitored until six months after screening was due. The majority (87.5%) attended screening. Women with more dependent children and higher self-efficacy showed greater attendance likelihood, and women with fewer non-child dependants and lower self-efficacy were less likely to attend. Working hours did not predict attendance. Findings provide partial support for the idea that time pressure acts as a challenge for women with high self-efficacy.

Perceptions of the screening mammography experience by Hispanic and non-Hispanic White women

PURPOSE

To uncover perceptive differences in mammography experiences (from scheduling the mammography appointment to receipt and reporting of mammography results) between women from two different racial/ethnic groups.

METHODS

Focus groups (n = 9) were conducted with Hispanic, and non-Hispanic White women (n = 88) who were aged 40 years or older and had a mammogram within the preceding 36 months. We used a qualitative ethnographic approach with content analysis to identify key categories present in the transcripts and domain analysis to discover domains of meaning. A matrix was designed to determine which domains differed by racial/ethnic group. The primary mammography-related topics of focus group discussion included 1) the scheduling process, 2) the day of the mammogram, 3) receipt of results, and 4) recommendations to improve the mammography process.

MAIN FINDINGS

Six domains uniquely described issues women of the differing racial/ethnic groups experience and perceive as important. Hispanic women highlighted embarrassment surrounding the examination and fear of negative news about their mammography results. Non-Hispanic White women focused on instructions given before or during the examination as a critical process feature.

CONCLUSIONS

Perceptions of the mammography experience vary by race/ethnicity. Mammography experiences might be improved through enhanced sensitivity of healthcare personnel to cultural differences in perceptions of mammogram testing. Future research to investigate the extent to which the domains of meanings uncovered in this study influence a women's decision to return for routine mammograms would be of great value.

Mammograms and the management of existential discomfort: threats associated with the physicality of the body and neuroticism

The current research employs ideas from terror management theory to investigate why mammograms may be psychologically problematic. This perspective suggests that individuals, particularly those high in neuroticism, are threatened by that which reminds them of their physical and mortal nature. In Study 1, a laboratory experiment demonstrated that when concerns about mortality were primed, reminders of one's physical nature (i.e. creatureliness) led women who were high in neuroticism to report reduced willingness to imagine undergoing a mammogram. In Study 2, a field experiment among women receiving a mammogram showed that priming creatureliness increased perceptions of discomfort with the procedure for women high in neuroticism. Theoretical and practical implications are discussed.

Collaborative Breast Health Intervention for African American Women of Lower Socioeconomic Status

PURPOSE/OBJECTIVES

To describe all phases of a collaborative breast health intervention delivered by paraprofessionals or specially trained community health advisors (CHAs) for African American women designed to increase mammography screening.

DESIGN

Collaborative pretest, post-test breast health intervention.

SETTING

Large city in Ohio.

SAMPLE

68 African American women with a median age of 57.8 (SD = 5.28) obtained mammography screening and participated in the breast health intervention.

METHODS

Specially trained CHAs used aggressive recruitment strategies to increase mammography screening and knowledge of breast health and mammography screening in African American women aged 50 and older.

MAIN RESEARCH VARIABLES

Knowledge scores of breast health and mammography screening.

FINDINGS

Ninety women (81%) met the inclusion criteria and were recruited into the intervention, but only 68 (76%) obtained mammography screening. The women demonstrated increased knowledge by change in pre- to post-test scores. Several questions were statistically significant.

CONCLUSIONS

Collaborative breast health interventions delivered by trained CHAs are effective in increasing screenings as well as knowledge of breast health and mammography screening in African American women. The unique role of the CHA is especially important in recruitment of hard-to-reach women and was vital to the success of the educational intervention. Most importantly, the women valued the individualized attention to their breast health and agreed to share the information with significant others. Further collaborative interventions designed to increase screenings and increase knowledge of breast health and mammography screening are needed to reduce the health disparities of later-stage detection and poorer survival of breast cancer in African American women.

IMPLICATIONS FOR NURSING

Oncology nurses should build on the findings and deliver further outreach programs to increase mammography screening and knowledge of breast health in a larger number of women of lower socioeconomic status. Future research is needed to determine the influence of reminder phone calls for mammography screening. Oncology nurses should incorporate evaluation strategies at baseline and periodically throughout an intervention to provide more comprehensive data and enhance the credibility of findings. To maximize success, oncology nurses should work collaboratively with other healthcare professionals such as certified x-ray technicians and influential people in the community to increase knowledge of breast health and mammography screening.

Decision making and counseling around mammography screening for women aged 80 or older

BACKGROUND

Despite uncertain benefit, many women over age 80 (oldest-old) receive screening mammography.

OBJECTIVE

To explore decision-making and physician counseling of oldest-old women around mammography screening.

DESIGN

Qualitative research using in-depth semi-structured interviews.

PARTICIPANTS

Twenty-three women aged 80 or older who received care at a large academic primary care practice (13 had undergone mammography screening in the past 2 years) and 16 physicians at the same center.

APPROACH

We asked patients and physicians to describe factors influencing mammography screening decisions of oldest-old women. We asked physicians to describe their counseling about screening to the oldest-old.

RESULTS

Patients and/or physicians identified the importance of physician influence, patient preferences, system factors, and social influences on screening decisions. Although physicians felt that patient's health affected screening decisions, few patients felt that health mattered. Three types of elderly patients were identified: (1) women enthusiastic about screening mammography; (2) women opposed to screening mammography; and (3) women without a preference who followed their physician's recommendation. However, physician counseling about mammography screening to elderly women varies; some individualize discussions; others encourage screening; few discourage screening. Physicians report that discussions about stopping screening can be uncomfortable and time consuming. Physicians suggest that more data could facilitate these discussions.

CONCLUSIONS

Some oldest-old women have strong opinions about screening mammography while others are influenced by physicians. Discussions about stopping screening are challenging for physicians. More data about the benefits and risks of mammography screening for women aged 80 or older could inform patients and improve provider counseling to lead to more rational use of mammography.

Older women and mammography screening behavior: do possible selves contribute?

This study sought to explore the contribution of the self-concept to older women's adherence to regular mammography screening behavior. The PRECEDE and health belief model concepts were incorporated with a measure of the women's future selves to determine whether the self-concept adds to our ability to predict screening. A self-administered questionnaire was completed by 210 community-dwelling women ages 50 to 75 years, recruited from urban and rural women's groups. Logistic regression analyses revealed that predictors of adherence were clinical breast examination, physician recommendation, age, barriers, benefits, feared health-related possible self, and self-efficacy in the feared domain. The addition of the self measures significantly improved the overall fit of the model. Implications for theory development, practice, and future research are discussed.

Women's approaches to decision making about mammography

Health professionals have an obligation to understand women's decision making about mammography and to advocate for their active participation in health care decision making. Although mammography is a major screening measure for the second largest cancer killer of women, only approximately half of women older than age 50 years, and fewer older than age 70 years, undergo mammography in accordance with American Cancer Society (ACS) guidelines. Therefore, the purpose of this study was to identify women's overall decision-making approaches when considering mammography. Subjects were a purposive, convenience sample of 50 women in the community who had made a decision about mammography; they included those who chose to have mammograms and those who decided not to have mammograms according to the pre-1997 ACS guidelines. Subjects participated in audiotaped interviews. Results indicated that women approached the mammography decision differently, regardless of the decision they made. Three overall decision-making approaches to addressing risk factors, issues about mammography, or other factors before their decision were evident. The approaches were (1) thoughtful consideration; (2) cursory consideration; and (3) little or no consideration. Each approach has implications for nurses who assist women in making decisions about mammography.

The effects of major depression and phobia on stage at diagnosis of breast cancer

OBJECTIVE

To examine the longitudinal effects of major depression and phobia on stage at diagnosis of subsequent breast cancer.

METHOD

Data from the New Haven Epidemiologic Catchment Area (ECA) study were linked to the Connecticut Tumor Registry (CTR). The sample comprised of seventy-two women with a first primary breast cancer diagnosed sometime after their baseline ECA study interview. In the ECA study, lifetime psychiatric history was assessed using the Diagnostic Interview Schedule based on DSM-III criteria. Stage at diagnosis of breast cancer was taken from CTR records and dichotomized into early stage (in situ and localized tumors) versus late stage (regional and distant tumors).

RESULTS

A positive history of major depression was associated with an increased likelihood of late-stage diagnosis of breast cancer (odds ratio [OR] = 9.81, p = 0.039), whereas a positive history of phobic disorders was associated with a decreased likelihood of late-stage diagnosis (OR = 0.01, p = 0.021), controlling for sociodemographic characteristics of the sample.

CONCLUSIONS

These analyses revealed a longitudinal association between reported lifetime psychiatric history and stage at diagnosis of subsequent breast cancer. Phobia may motivate women to adhere to breast cancer screening recommendations and to report suspicious symptoms to a physician without delay. Major depression, on the other hand, was identified as an important predictor of late-stage diagnosis; proper recognition and management of depression in the primary care setting may have important implications for breast cancer detection and survival.

Screening mammography behavior after a false positive mammogram

This pilot study describes women's interpretations of the experience of a false positive mammogram followed by a negative biopsy and the impact of this experience on subsequent participation in screening mammography. A 25-min, open-ended telephone interview was administered in 1992 to 30 women over age 39 who had negative biopsies in 1987 preceded by abnormal mammograms. Almost twice as many women reported getting regular mammograms after the biopsy (60%) as did before 1987 (33%). Most received their next mammogram after the biopsy within the recommended interval (73%), and those getting regular mammograms prior to the biopsy experience were more likely than those who did not have a prior habit of undergoing mammography to continue to get them afterwards. These preliminary findings suggest that a negative breast biopsy after a positive mammogram does not reduce a patient's likelihood of undergoing screening in the future. In fact, it may serve as an impetus for increased compliance with screening recommendations.

Breast and cervical cancer screening among women with physical disabilities

OBJECTIVE

This article reports findings from the National Study of Women with Physical Disabilities about rates of screening for breast and cervical cancer and factors associated with regular screening in a large sample of women with a variety of physical disabilities and a comparison group of women without disabilities.

DESIGN

Case-comparison study using written survey. Data were analyzed using measures of central tendency, chi 2 analysis, logistic regression, and risk using odds ratios.

SETTING

General community.

PARTICIPANTS

A total of 843 women, 450 with disabilities and 393 of their able-bodied friends, aged 18 to 65, who completed the written questionnaire. The most common primary disability type was spinal cord injury (26%), followed by polio (18%), neuromuscular disorders (12%), cerebral palsy (10%), multiple sclerosis (10%), and joint and connective tissue disorders (8%). Twenty-two percent had severe functional limitations, 52% had moderate disabilities, and 26% had mild disabilities.

MAIN OUTCOME MEASURES

Outcomes were measured in terms of frequency of pelvic exams and mammograms.

RESULTS

Women with disabilities tend to be less likely than women without disabilities to receive pelvic exams on a regular basis, and women with more severe functional limitations are significantly less likely to do so. No significant difference was found between women with and without disabilities, regardless of severity of functional limitation, in receiving mammograms within the past 2 years. Perceived control emerged as a significant enhancement factor for mammograms and marginally for pelvic exams. Severity of disability was a significant risk factor for noncompliance with recommended pelvic exams, but not mammograms. Race was a significant risk factor for not receiving pelvic exams, but not mammograms. Household income and age did not reach significance as risk factors in either analysis.

CONCLUSIONS

Women with physical disabilities are at a higher risk for delayed diagnosis of breast and cervical cancer, primarily for reasons of environmental, attitudinal, and information barriers. Future research should focus on the subpopulations that were not surveyed adequately in this study, women with disabilities who have low levels of education or income, or who are of minority status.

Predicting mammography and breast self-examination in African American women

Breast cancer mortality is significantly greater in African American women than in their Caucasian counterparts. The purpose of this study was to identify variables associated with the breast cancer screening behaviors of mammography utilization and breast self-examination (BSE) in a convenience sample of low income African American women. A total of 328 African American women, living in a large midwestern metropolitan area, who were at < or = 150% of poverty level, and between the ages of 45 and 64 years were included in this study. Data were collected over a period of 18 months. Predisposing, enabling, and need variables from Anderson's theoretical framework included perceived susceptibility, benefits, barriers, confidence, knowledge, physician recommendation, demographic characteristics, and past experiences, as well as health-care and insurance information. Variables that significantly predicted mammography utilization included perceived barriers, mammography suggested by health-care professionals, recent thoughts about mammography, and a regular medical doctor. Variables that significantly predicted either frequency or proficiency of BSE included susceptibility, benefits, confidence, knowledge, barriers, and a regular physician. Implications for clinical practice include (a) recognizing predictors of screening among low-income African American women; (b) addressing culturally specific barriers, e.g., cancer fatalism, in order to increase compliance with screening; (c) establishing consistency in primary care providers; and (d) increasing confidence and knowledge through education.

Hispanic women's beliefs about breast cancer and mammography

Although breast cancer rates are lower among Hispanic women than among White women, Hispanics are more likely to die from this disease if they do get it. This may be related to the fact that Hispanic women are less likely to participate in mammographic screening. This study used a two-stage decision model to describe a group of rural, Hispanic women's beliefs and attitudes about breast cancer and mammography. The first stage consisted of exploratory interviews to identify factors, both positive and negative, that affect the mammography decision. The second stage will use a survey to weigh the identified factors in order to determine their importance to the decision. This article presents the stage 1 findings of this study. Twenty-nine rural, Hispanic women between the ages of 38 and 74 participated in the interviews. The majority had annual incomes of < $10,000, and 30% completed < or = 8 years of education. The subjects identified 18 factors, which fell into three general categories: Knowledge and Attitudes (How Well It Works, Personal Risk, Other Ways of Knowing, Fear of Cancer and/or treatment, Belief in Fate, Cultural Issues), Issues Related to Participation (Language, Getting There, Time, Cost, Radiation Exposure, Pain), and Social Concerns (Role Model, Responsibility to Self, Responsibility to Others, Influence of Family/Friends, Influence of Doctors, Influence of Society). Verbatim description of each of these factors are presented. The implication of the findings to health professionals is discussed.