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Long HA, Brooks JM, Maxwell AJ, Peters S, Harvie M, French DP. Healthcare professionals' experiences of caring for women with false-positive screening test results in the National Health Service Breast Screening Programme. Health Expect 2024; 27:e14023. [PMID: 38509776 PMCID: PMC10955228 DOI: 10.1111/hex.14023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2024] [Revised: 03/07/2024] [Accepted: 03/10/2024] [Indexed: 03/22/2024] Open
Abstract
BACKGROUND Understanding healthcare professionals' (HCPs) experiences of caring for women with false-positive screening test results in the National Health Service Breast Screening Programme (NHSBSP) is important for reducing the impact of such results. METHODS Interviews were undertaken with 12 HCPs from a single NHSBSP unit, including advanced radiographer practitioners, breast radiographers, breast radiologists, clinical nurse specialists (CNSs), and a radiology healthcare assistant. Data were analysed thematically using Template Analysis. RESULTS Two themes were produced: (1) Gauging and navigating women's anxiety during screening assessment was an inevitable and necessary task for all participants. CNSs were perceived as particularly adept at this, while breast radiographers reported a lack of adequate formal training. (2) Controlling the delivery of information to women (including amount, type and timing of information). HCPs reported various communication strategies to facilitate women's information processing and retention during a distressing time. CONCLUSIONS Women's anxiety could be reduced through dedicated CNS support, but this should not replace support from other HCPs. Breast radiographers may benefit from more training to emotionally support recalled women. While HCPs emphasised taking a patient-centred communication approach, the use of other strategies (e.g., standardised scripts) and the constraints of the 'one-stop shop' model pose challenges to such an approach. PATIENT AND PUBLIC CONTRIBUTION During the study design, two Patient and Public Involvement members (women with false-positive-breast screening test results) were consulted to gain an understanding of patient perspectives and experiences of being recalled specifically in the NHSBSP. Their feedback informed the formulations of the research aim, objectives and the direction of the interview guide.
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Affiliation(s)
- Hannah A. Long
- Division of Psychology and Mental Health, Manchester Centre for Health PsychologyUniversity of ManchesterManchesterUK
| | - Joanna M. Brooks
- Division of Psychology and Mental Health, Manchester Centre for Health PsychologyUniversity of ManchesterManchesterUK
| | - Anthony J. Maxwell
- Wythenshawe HospitalThe Nightingale Centre, Manchester University NHS Foundation TrustManchesterUK
- Division of Informatics, Imaging and Data Sciences, School of Health SciencesUniversity of ManchesterManchesterUK
| | - Sarah Peters
- Division of Psychology and Mental Health, Manchester Centre for Health PsychologyUniversity of ManchesterManchesterUK
| | - Michelle Harvie
- Wythenshawe HospitalThe Nightingale Centre, Manchester University NHS Foundation TrustManchesterUK
| | - David P. French
- Division of Psychology and Mental Health, Manchester Centre for Health PsychologyUniversity of ManchesterManchesterUK
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Long H, Brooks JM, Harvie M, Maxwell A, French DP. How do women experience a false-positive test result from breast screening? A systematic review and thematic synthesis of qualitative studies. Br J Cancer 2019; 121:351-358. [PMID: 31332283 PMCID: PMC6738040 DOI: 10.1038/s41416-019-0524-4] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2019] [Revised: 06/24/2019] [Accepted: 06/28/2019] [Indexed: 12/29/2022] Open
Abstract
BACKGROUND This is the first review to identify, appraise and synthesise women's experiences of having a false-positive breast screening test result. METHODS We systematically searched eight databases for qualitative research reporting women's experiences of receiving a false-positive screening test result. Two reviewers independently screened articles. Eight papers reporting seven studies were included. Study quality was appraised. Data were thematically synthesised. RESULTS Women passively attended screening in order to prove their perceived good health. Consequently, being recalled was unexpected, shocking and disempowering: women felt without options. They endured great uncertainty and stress and sought clarity about their health (e.g. by scrutinising the wording of recall letters and conversations with healthcare professionals). Their result was accompanied by relief and welcome feelings of certainty about their health, but some received unclear explanations of their result, contributing to lasting breast cancer-related worry and an ongoing need for further reassurance. CONCLUSION The organisation of breast screening programmes may constrain choice for women: they became passive recipients. The way healthcare professionals verbally communicate results to women may contribute to lasting breast cancer-related worry. Women need more reassurance, emotional support and answers to their questions before and during screening assessment, and after receiving their result.
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Affiliation(s)
- Hannah Long
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom.
| | - Joanna M Brooks
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
| | - Michelle Harvie
- Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, United Kingdom
| | - Anthony Maxwell
- Nightingale Centre, Manchester University NHS Foundation Trust, Manchester, M23 9LT, United Kingdom
- Division of Informatics, Imaging & Data Sciences, School of Health Sciences, University of Manchester, Manchester, M13 9PT, United Kingdom
| | - David P French
- Manchester Centre for Health Psychology, School of Health Sciences, University of Manchester, Manchester, M13 9PL, United Kingdom
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Selby PJ, Banks RE, Gregory W, Hewison J, Rosenberg W, Altman DG, Deeks JJ, McCabe C, Parkes J, Sturgeon C, Thompson D, Twiddy M, Bestall J, Bedlington J, Hale T, Dinnes J, Jones M, Lewington A, Messenger MP, Napp V, Sitch A, Tanwar S, Vasudev NS, Baxter P, Bell S, Cairns DA, Calder N, Corrigan N, Del Galdo F, Heudtlass P, Hornigold N, Hulme C, Hutchinson M, Lippiatt C, Livingstone T, Longo R, Potton M, Roberts S, Sim S, Trainor S, Welberry Smith M, Neuberger J, Thorburn D, Richardson P, Christie J, Sheerin N, McKane W, Gibbs P, Edwards A, Soomro N, Adeyoju A, Stewart GD, Hrouda D. Methods for the evaluation of biomarkers in patients with kidney and liver diseases: multicentre research programme including ELUCIDATE RCT. Programme Grants Appl Res 2018. [DOI: 10.3310/pgfar06030] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BackgroundProtein biomarkers with associations with the activity and outcomes of diseases are being identified by modern proteomic technologies. They may be simple, accessible, cheap and safe tests that can inform diagnosis, prognosis, treatment selection, monitoring of disease activity and therapy and may substitute for complex, invasive and expensive tests. However, their potential is not yet being realised.Design and methodsThe study consisted of three workstreams to create a framework for research: workstream 1, methodology – to define current practice and explore methodology innovations for biomarkers for monitoring disease; workstream 2, clinical translation – to create a framework of research practice, high-quality samples and related clinical data to evaluate the validity and clinical utility of protein biomarkers; and workstream 3, the ELF to Uncover Cirrhosis as an Indication for Diagnosis and Action for Treatable Event (ELUCIDATE) randomised controlled trial (RCT) – an exemplar RCT of an established test, the ADVIA Centaur® Enhanced Liver Fibrosis (ELF) test (Siemens Healthcare Diagnostics Ltd, Camberley, UK) [consisting of a panel of three markers – (1) serum hyaluronic acid, (2) amino-terminal propeptide of type III procollagen and (3) tissue inhibitor of metalloproteinase 1], for liver cirrhosis to determine its impact on diagnostic timing and the management of cirrhosis and the process of care and improving outcomes.ResultsThe methodology workstream evaluated the quality of recommendations for using prostate-specific antigen to monitor patients, systematically reviewed RCTs of monitoring strategies and reviewed the monitoring biomarker literature and how monitoring can have an impact on outcomes. Simulation studies were conducted to evaluate monitoring and improve the merits of health care. The monitoring biomarker literature is modest and robust conclusions are infrequent. We recommend improvements in research practice. Patients strongly endorsed the need for robust and conclusive research in this area. The clinical translation workstream focused on analytical and clinical validity. Cohorts were established for renal cell carcinoma (RCC) and renal transplantation (RT), with samples and patient data from multiple centres, as a rapid-access resource to evaluate the validity of biomarkers. Candidate biomarkers for RCC and RT were identified from the literature and their quality was evaluated and selected biomarkers were prioritised. The duration of follow-up was a limitation but biomarkers were identified that may be taken forward for clinical utility. In the third workstream, the ELUCIDATE trial registered 1303 patients and randomised 878 patients out of a target of 1000. The trial started late and recruited slowly initially but ultimately recruited with good statistical power to answer the key questions. ELF monitoring altered the patient process of care and may show benefits from the early introduction of interventions with further follow-up. The ELUCIDATE trial was an ‘exemplar’ trial that has demonstrated the challenges of evaluating biomarker strategies in ‘end-to-end’ RCTs and will inform future study designs.ConclusionsThe limitations in the programme were principally that, during the collection and curation of the cohorts of patients with RCC and RT, the pace of discovery of new biomarkers in commercial and non-commercial research was slower than anticipated and so conclusive evaluations using the cohorts are few; however, access to the cohorts will be sustained for future new biomarkers. The ELUCIDATE trial was slow to start and recruit to, with a late surge of recruitment, and so final conclusions about the impact of the ELF test on long-term outcomes await further follow-up. The findings from the three workstreams were used to synthesise a strategy and framework for future biomarker evaluations incorporating innovations in study design, health economics and health informatics.Trial registrationCurrent Controlled Trials ISRCTN74815110, UKCRN ID 9954 and UKCRN ID 11930.FundingThis project was funded by the NIHR Programme Grants for Applied Research programme and will be published in full inProgramme Grants for Applied Research; Vol. 6, No. 3. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Peter J Selby
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Rosamonde E Banks
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Walter Gregory
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Jenny Hewison
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - William Rosenberg
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
| | - Douglas G Altman
- Centre for Statistics in Medicine, University of Oxford, Oxford, UK
| | - Jonathan J Deeks
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Christopher McCabe
- Department of Emergency Medicine, University of Alberta Hospital, Edmonton, AB, Canada
| | - Julie Parkes
- Primary Care and Population Sciences Academic Unit, University of Southampton, Southampton, UK
| | | | | | - Maureen Twiddy
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Janine Bestall
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | | | - Tilly Hale
- LIVErNORTH Liver Patient Support, Newcastle upon Tyne, UK
| | - Jacqueline Dinnes
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Marc Jones
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | | | | | - Vicky Napp
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Alice Sitch
- Institute of Applied Health Research, University of Birmingham, Birmingham, UK
| | - Sudeep Tanwar
- Institute for Liver and Digestive Health, Division of Medicine, University College London, London, UK
| | - Naveen S Vasudev
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Paul Baxter
- Leeds Institute of Cardiovascular and Metabolic Medicine, University of Leeds, Leeds, UK
| | - Sue Bell
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - David A Cairns
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | | | - Neil Corrigan
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Francesco Del Galdo
- Leeds Institute of Rheumatic and Musculoskeletal Medicine, University of Leeds, Leeds, UK
| | - Peter Heudtlass
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Nick Hornigold
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Claire Hulme
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Michelle Hutchinson
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Carys Lippiatt
- Department of Specialist Laboratory Medicine, Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | - Roberta Longo
- Leeds Institute of Health Sciences, University of Leeds, Leeds, UK
| | - Matthew Potton
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Stephanie Roberts
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sheryl Sim
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Sebastian Trainor
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
| | - Matthew Welberry Smith
- Clinical and Biomedical Proteomics Group, Leeds Institute of Cancer and Pathology, University of Leeds, Leeds, UK
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - James Neuberger
- University Hospitals Birmingham NHS Foundation Trust, Birmingham, UK
| | | | - Paul Richardson
- Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - John Christie
- Royal Devon and Exeter NHS Foundation Trust, Exeter, UK
| | - Neil Sheerin
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - William McKane
- Sheffield Teaching Hospitals NHS Foundation Trust, Sheffield, UK
| | - Paul Gibbs
- Portsmouth Hospitals NHS Trust, Portsmouth, UK
| | | | - Naeem Soomro
- Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | | | - Grant D Stewart
- NHS Lothian, Edinburgh, UK
- Academic Urology Group, University of Cambridge, Cambridge, UK
| | - David Hrouda
- Charing Cross Hospital, Imperial College Healthcare NHS Trust, London, UK
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Abstract
Objectives: The aim of this study is to review quantitative studies on women's experiences of consequences of false-positive screening mammography to assess the adequacy of the most frequently used instruments for measuring short-term and long-term psychological consequences. Methods: Relevant papers reporting quantitative studies on consequences of false-positive screening mammography were identified using MEDLlNE, CINAHL, EMBASE and PsycInfo databases. Articles citing development and psychometric properties of the most frequently used measures were also retrieved. Finally, the review focused on studies that had used at least one of the most frequently used measures. Results: Twenty-three relevant studies were identified. The most commonly used measures were the General Health Questionnaire (GHQ), the Hospital Anxiety and Depression Scale (HADS), the Psychological Consequences Questionnaire (PCQ) and the State-Trait Anxiety Inventory (STAI). One or more of these was used in 17 of the 23 studies. Conclusions: The GHQ, the HADS and the STAI have problems with language, content relevance, and content coverage in studies of false-positive screening mammography. These instruments should not be used to measure psychological consequences of any kind of cancer screening. The PCQ is an adequate questionnaire for measuring short-term consequences, and the PCQ is preferable to other measures because of its higher sensitivity. However, there is little evidence that the PCQ is able to adequately detect all long-term consequences of screening mammography. Given the inadequacy of the measurement instruments used, any current conclusions about the long-term consequences of false-positive results of screening mammography must remain tentative.
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Affiliation(s)
- John Brodersen
- Department of General Practice, University of Copenhagen, Panum Institute, Blegdamsvej 3, DK-2200 Copenhagen, Denmark.
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Molina Y, Silva A, Rauscher GH. Racial/Ethnic Disparities in Time to a Breast Cancer Diagnosis: The Mediating Effects of Health Care Facility Factors. Med Care 2015; 53:872-8. [PMID: 26366519 DOI: 10.1097/MLR.0000000000000417] [Citation(s) in RCA: 53] [Impact Index Per Article: 6.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/02/2023]
Abstract
BACKGROUND Racial/ethnic disparities exist along the breast cancer continuum, including time to a diagnosis. Previous research has largely focused on patient-level factors, and less is known about the role that health care facilities may play in delayed breast cancer care. OBJECTIVES We examined racial/ethnic disparities in delayed diagnosis for breast cancer in the Breast Cancer Care in Chicago Study and estimated the potential mediating effects of facility factors. RESEARCH DESIGN AND SUBJECTS Breast cancer patients (N=606) contributed interview and medical record data as part of a population-based study. MEASURES Race/ethnicity was self-reported at interview. Diagnostic delay was defined as an excess of 60 days between medical presentation and a definitive diagnosis. Facility factors included the facility of medical presentation with respect to: (1) accreditation through the National Consortium of Breast Centers; (2) certification as a Breast Imaging Center of Excellence through the American College of Radiology; and (3) status as a disproportionate share hospital through the state of Illinois as well as the number of facilities used between presentation and diagnosis. RESULTS Relative to non-Hispanic whites, minorities were more likely to experience a diagnostic delay, present at a nonaccredited facility and at a disproportionate share hospital, and involve multiple facilities in their diagnosis. Together, facility factors accounted for 43% of the disparity in diagnostic delay (P<0.0001). CONCLUSIONS Initial presentation of breast cancer at higher resourced facilities can reduce diagnostic delays. Disparities in delay are partly due to a disproportionate presentation at lower resourced facilities by minorities.
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Molina Y, Hempstead BH, Thompson-Dodd J, Weatherby SR, Dunbar C, Hohl SD, Malen RC, Ceballos RM. Medical Advocacy and Supportive Environments for African-Americans Following Abnormal Mammograms. J Cancer Educ 2015; 30:447-452. [PMID: 25270556 PMCID: PMC4383730 DOI: 10.1007/s13187-014-0732-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/03/2023]
Abstract
African-American women experience disproportionately adverse outcomes relative to non-Latina White women after an abnormal mammogram result. Research has suggested medical advocacy and staff support may improve outcomes among this population. The purpose of the study was to understand reasons African-American women believe medical advocacy to be important and examine if and how staff can encourage and be supportive of medical advocacy. A convenience-based sample of 30-74-year-old women who self-identified as African-American/Black/of African descent and who had received an abnormal mammogram result was recruited from community-based organizations, mobile mammography services, and the local department of health. This qualitative study included semi-structured interviews. Patients perceived medical advocacy to be particularly important for African-Americans, given mistrust and discrimination present in medical settings and their own familiarity with their bodies and symptoms. Respondents emphasized that staff can encourage medical advocacy through offering information in general in a clear, informative, and empathic style. Cultural competency interventions that train staff how to foster medical advocacy may be a strategy to improve racial disparities following an abnormal mammogram.
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Affiliation(s)
- Yamile Molina
- Fred Hutchinson Cancer Research Center, 1100 Fairview Avenue N., M3-B232, Seattle, WA, 98109, USA,
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Bond M, Garside R, Hyde C. A crisis of visibility: The psychological consequences of false-positive screening mammograms, an interview study. Br J Health Psychol 2015; 20:792-806. [DOI: 10.1111/bjhp.12142] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2014] [Revised: 04/14/2015] [Indexed: 11/30/2022]
Affiliation(s)
- Mary Bond
- University of Exeter Medical School; University of Exeter; UK
| | - Ruth Garside
- University of Exeter Medical School; University of Exeter; UK
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Clark S, Reeves PJ. Women's experiences of the breast cancer diagnostic process: A thematic evaluation of the literature; Recall & biopsy. Radiography (Lond) 2015; 21:89-92. [DOI: 10.1016/j.radi.2014.06.011] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022]
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Abstract
OBJECTIVES To gain an understanding of the views of women with false-positive screening mammograms of screening recall services, their ideas for service improvements and how these compare with current UK guidelines. METHODS Inductive qualitative content analysis of semistructured interviews of 21 women who had false-positive screening mammograms. These were then compared with UK National Health Service (NHS) guidelines. RESULTS Participants' concerns about mammography screening recall services focused on issues of communication and choice. Many of the issues raised indicated that the 1998 NHS Breast Screening Programme guidelines on improving the quality of written information sent to women who are recalled, had not been fully implemented. This included being told a clear reason for recall, who may attend with them, the length of appointment, who they will see and what tests will be carried out. Additionally women voiced a need for: reassurance that a swift appointment did not imply they had cancer; choice about invasive assessment or watchful waiting; the offer of a follow-up mammogram for those uncertain about the validity of their all-clear and an extension of the role of the clinical nurse specialist, outlined in the 2012 NHS Breast Screening Programme (NHSBSP) guidelines, to include availability at the clinic after the all-clear for women with false-positive mammograms. CONCLUSIONS It is time the NHSBSP 1998 recall information guidelines were fully implemented. Additionally, the further suggestions from this research, including extending the role of the clinical nurses from the 2012 NHSBSP guidelines, should be considered. These actions have the potential to reduce the anxiety of being recalled.
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Affiliation(s)
- Mary Bond
- University of Exeter Medical School, University of Exeter, Exeter, UK
| | - Ruth Garside
- University of Exeter Medical School, University of Exeter, Truro, UK
| | - Christopher Hyde
- University of Exeter Medical School, University of Exeter, Exeter, UK
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Davis CM, Myers HF, Nyamathi AM, Brecht ML, Lewis MA, Hamilton N. Biopsychosocial Predictors of Psychological Functioning Among African American Breast Cancer Survivors. J Psychosoc Oncol 2014; 32:493-516. [DOI: 10.1080/07347332.2014.936650] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023]
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Bolejko A, Zackrisson S, Hagell P, Wann-Hansson C. A roller coaster of emotions and sense--coping with the perceived psychosocial consequences of a false-positive screening mammography. J Clin Nurs 2013; 23:2053-62. [PMID: 24313329 DOI: 10.1111/jocn.12426] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/30/2013] [Indexed: 11/30/2022]
Abstract
AIMS AND OBJECTIVES To explore coping with the perceived psychosocial consequences of a false-positive screening mammography. BACKGROUND Mammographic screening has been found effective to decrease breast cancer (BC) mortality, yet there are adverse effects. Psychosocial consequences of false-positive mammographic screening have mainly been investigated from a population-based perspective. A call for qualitative studies to further explore these consequences has thus been postulated. To date, qualitative studies have elucidated women's experiences following their recall breast examinations, but their coping with perceived psychosocial consequences of a false-positive screening mammography has not yet been explored. DESIGN An explorative qualitative study. METHODS Face-to-face interviews were held with a purposive heterogeneous sample of 13 Swedish-speaking women with a false-positive screening mammography. The transcripts were analysed by the use of an inductive content analysis. RESULTS Coping with the perceived psychosocial consequences of a false-positive screening mammography implied a roller coaster of emotion and sense. Women described how they imagined the worst and were in a state of uncertainty feeling threatened by a fatal disease. Conversely, they felt protected, surrounded by their families and being professionally taken care of, which together with perceived sisterhood and self-empowerment evoked strength and hope. Being aware of family responsibility became a crucial matter. Experiencing false-positive screening raised thoughts of thankfulness and reappraisal of life, although an ounce of BC anxiety remained. Consequently, gained awareness about BC screening and values in life surfaced. CONCLUSIONS Experiencing a false-positive screening mammography triggers agonising experiences evoking a variety of coping strategies. Provision of screening raises the issue of responsibility for an impact on psychosocial well-being among healthy women. RELEVANCE TO CLINICAL PRACTICE Gained knowledge might provide a basis for interventions to prevent psychosocial consequences of false-positive mammographic screening and provide support for women with a potentially compromised ability to overcome such consequences.
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Affiliation(s)
- Anetta Bolejko
- Department of Health Sciences, Lund University, Lund, Sweden; Diagnostic Centre of Imaging and Functional Medicine, Skåne University Hospital Malmö, Malmö, Sweden
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Lindberg LG, Svendsen M, Dømgaard M, Brodersen J. Better safe than sorry: a long-term perspective on experiences with a false-positive screening mammography in Denmark. Health, Risk & Society 2013. [DOI: 10.1080/13698575.2013.848845] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
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Solbjør M, Forsmo S, Skolbekken JA, Sætnan AR. Experiences of Recall After Mammography Screening—A Qualitative Study. Health Care Women Int 2011; 32:1009-27. [DOI: 10.1080/07399332.2011.565530] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/17/2022]
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Abstract
Decades of empirical research have demonstrated psychological and behavioural consequences of false-positive medical tests. To organise this literature and offer novel predictions, we propose a model of how false-positive mammography results affect return for subsequent mammography screening. We propose that false-positive mammography results alter how women think about themselves (e.g., increasing their perceived likelihood of getting breast cancer) and the screening test (e.g., believing mammography test results are less accurate). We further hypothesise that thoughts elicited by the false-positive experience will, in turn, affect future use of screening mammography. In addition, we discuss methodological considerations for statistical analyses of these mediational pathways and propose two classes of potential moderators. While our model focuses on mammography screening, it may be applicable to psychological and behavioural responses to other screening tests. The model is especially timely as false-positive medical test results are increasingly common, due to efforts to increase uptake of cancer screening, new technologies that improve existing tests' ability to detect disease at the cost of increased false alarms, and growing numbers of new medical tests.
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Affiliation(s)
- Jessica T. DeFrank
- Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, 325 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA
| | - Noel Brewer
- Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, 325 Rosenau Hall, CB# 7440, Chapel Hill, NC 27599, USA
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Carney PA, Kettler M, Cook AJ, Geller BM, Karliner L, Miglioretti DL, Bowles EA, Buist DS, Gallagher TH, Elmore JG. 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. [PMID: 19442539 DOI: 10.1016/j.acra.2009.02.023] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2009] [Revised: 02/18/2009] [Accepted: 02/18/2009] [Indexed: 11/20/2022]
Abstract
RATIONALE AND OBJECTIVES Research on communication between radiologists and women undergoing screening and diagnostic mammography is limited. We describe community radiologists' communication practices with patients regarding screening and diagnostic mammogram results and factors associated with frequency of communication. MATERIALS AND METHODS We received surveys from 257 radiologists (70% of those eligible) about the extent to which they talk to women as part of their health care visit for either screening or diagnostic mammograms, whether this occurs if the exam assessment is positive or negative, and how they use estimates of patient risk to convey information about an abnormal exam where the specific finding of cancer is not yet known. We also assessed characteristics of the radiologists to identify associations with more or less frequent communication at the time of the mammogram. RESULTS Two hundred and forty-three radiologists provided complete data (95%). Very few (<6%) reported routinely communicating with women when screening mammograms were either normal or abnormal. Fewer than half (47%) routinely communicated with women when their diagnostic mammograms were normal, whereas 77% often or always communicated with women when their diagnostic exams were abnormal. For positive diagnostic exams, female radiologists were more likely to be frequent communicators compared to males (87.1%-72.8%; P=.02) and those who spend 40%-79% of their time in breast imaging (94.6%) were more likely to be frequent communicators compared to those who spend less time (67.2%-78.9%; P=.02). Most radiologists convey risk information using general rather than numeric statements (57.7% vs. 28.5%). CONCLUSIONS Radiologists are most likely to convey information about diagnostic mammographic findings when results are abnormal. Most radiologists convey risk information using general rather than numeric statements.
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Affiliation(s)
- Patricia A Carney
- Department of Family Medicine, Oregon Health and Science University, 3181 SW Sam Jackson Park Rd, Mail Code: FM, Portland, OR 97239, USA.
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Brodersen J, McKenna SP, Doward LC, Thorsen H. Measuring the psychosocial consequences of screening. Health Qual Life Outcomes 2007; 5:3. [PMID: 17210071 PMCID: PMC1770907 DOI: 10.1186/1477-7525-5-3] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/19/2006] [Accepted: 01/08/2007] [Indexed: 11/13/2022] Open
Abstract
The last three decades have seen a dramatic rise in the implementation of screening programmes for cancer in industrialised countries. However, in contrast to screening for infectious diseases, most cancer screening programmes only have the potential to reduce mortality; they cannot lower the incidence of cancer in a population. In fact, most cancer screening programmes have been shown to increase the incidence of the disease as a consequence of over-diagnosis. A further dilemma of cancer screening programmes is that they do not distinguish between healthy people and those with disease. Rather, they identify a continuum of disease severity. Consequently, many healthy people who have abnormal screening tests are wrongly diagnosed. Indeed, studies have demonstrated that for each screening-prevented death from cancer, at least 200 false-positive results are given. Therefore, screening has the potential to be harmful as well as beneficial. The psychosocial consequences of false-positive screening results cannot be determined by diagnostic tests or by other technical means. Instead, patient reported outcome measures must be employed. To measure the outcomes of screening accurately and comprehensively patient reported outcome measures have to capture; the nature and extent of the psychosocial consequences and how these change over time. The outcome measures used must have high content validity and their psychometric properties should be determined prior to their use in the specific population. In particular it is important to establish unidimensionality, additivity and item ordering through the application of Item Response Theory.
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Affiliation(s)
- John Brodersen
- Department and Research Unit of General Practice, University of Copenhagen, Oester Farimagsgade 5, 24Q, Postbox 2099, DK-1014 Copenhagen, Denmark
| | - Stephen P McKenna
- Galen Research, Enterprise House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, UK
| | - Lynda C Doward
- Galen Research, Enterprise House, Manchester Science Park, Lloyd Street North, Manchester M15 6SE, UK
| | - Hanne Thorsen
- Department and Research Unit of General Practice, University of Copenhagen, Oester Farimagsgade 5, 24Q, Postbox 2099, DK-1014 Copenhagen, Denmark
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Abstract
BACKGROUND The present study had two research questions. First, what is the average waiting time between diagnosis and treatment for Alberta women with breast cancer relative to Canadian Society for Surgical Oncology (CSSO) recommendations? Second, does patient age, cancer stage, patient community size, and year of diagnosis have a significant relationship to waiting time? METHODS The sample consisted of all Alberta women diagnosed with breast cancer between 1997 and 2000. Waiting time was defined as number of days between definitive diagnosis and treatment initiation. Multiple regression examined the relative influence of the predictor variables on waiting time. RESULTS There were 6,418 cases of breast cancer between 1997 and 2000. Mean waiting time was 20.2 days (SD 21.6) and median waiting time was 17 days. Longer waiting time was significantly associated with year of diagnosis (progressively longer from 1997 to 2000), patients younger than 70, and Stage 1 cancer. Waiting time increase from 1997 to 2000 appears to be due to increased demand for services without corresponding increases in resources. Less treatment delay for women older than 70 is due to more of these women being treated the same day they received their diagnosis. CONCLUSION Only 44% of women had a waiting time of 14 days or less as recommended by the CSSO. The number of women who will have to wait longer than recommended for treatment will likely increase without a significant increase in oncological resources. The basis for differences in waiting times as a function of age needs to be further investigated to ensure equitable access to care.
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Affiliation(s)
- Alyssa D Reed
- Faculty of Medicine, University of Calgary, Calgary AB.
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Kerner JF, Yedidia M, Padgett D, Muth B, Washington KS, Tefft M, Yabroff KR, Makariou E, Freeman H, Mandelblatt JS. Realizing the promise of breast cancer screening: clinical follow-up after abnormal screening among Black women. Prev Med 2003; 37:92-101. [PMID: 12855208 DOI: 10.1016/s0091-7435(03)00087-2] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND Delayed or incomplete follow-up after abnormal screening results may compromise the effectiveness of breast cancer screening programs, particularly in medically underserved and minority populations. This study examined the role of socioeconomic status, breast cancer risk factors, health care system barriers, and patient cognitive-attitudinal factors in the timing of diagnostic resolution after abnormal breast cancer screening exams among Black women receiving breast cancer screening at three New York city clinics. METHODS We identified 184 Black women as having an abnormal mammogram or clinical breast exam requiring immediate follow-up and they were interviewed and their medical records examined. Bivariate and multivariate logistic regression analyses were used to assess the association between patient and health care system factors and diagnostic resolution within 3 months of the abnormal finding. RESULTS Within 3 months, 39% of women were without diagnostic resolution and 28% within 6 months. Neither socioeconomic status nor system barriers were associated with timely diagnostic resolution. Timely resolution was associated with mammogram severity, patients asking questions (OR, 2.73; 95% CI, 1.25-5.96), or receiving next step information (OR, 2.6; 95% CI, 1.08-6.21) at the initial mammogram. Women with prior breast abnormalities were less likely to complete timely diagnostic resolution (OR, 0.42; 95% CI, 0.20-0.85), as were women with higher levels of cancer anxiety (OR, 0.50; 95% CI, 0.27-0.92). CONCLUSIONS Interventions that address a woman's prior experience with abnormal findings and improve patient/provider communication may improve timely and appropriate follow-up.
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Affiliation(s)
- Jon F Kerner
- Division of Cancer Control and Population Sciences, National Cancer Institute, NIH, Bethesda, MD 20892-0001, USA.
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Menon U, Champion VL, Larkin GN, Zollinger TW, Gerde PM, Vernon SW. Beliefs associated with fecal occult blood test and colonoscopy use at a worksite colon cancer screening program. J Occup Environ Med 2003; 45:891-8. [PMID: 12915791 PMCID: PMC3042891 DOI: 10.1097/01.jom.0000083038.56116.30] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
Abstract
Colorectal cancer (CRC) is the second leading cause of cancer death in the United States. Although regular screening can decrease morbidity and mortality from CRC, screening rates nationwide are very low. This descriptive study assessed beliefs associated with fecal occult blood test and colonoscopy use among participants of a worksite colon cancer screening program. Randomly selected employees, aged 40 and older, were mailed a survey on CRC screening-related beliefs. Instruments were tested for reliability and validity. Results indicated that fecal occult blood test use was significantly associated with being female, Caucasian, having low perceived barriers, and provider recommendation. Colonoscopy use was significantly associated with higher knowledge, lower barriers, higher benefits, higher self-efficacy, and provider recommendation. Findings may be used to develop interventions designed to improve CRC screening rates.
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Affiliation(s)
- Usha Menon
- University of Utah College of Nursing, Salt Lake City, UT 84112, USA.
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