Assessing the Impact of a Patient Navigator Intervention Program for Vietnamese-American Women with Abnormal Mammograms

Breast cancer incidence among Asian Americans increased at a rate of 1.8% per year from 2014 to 2018, while the general population's incidence rate remained stable. Vietnamese-American women have been found to have the longest follow-up time after an abnormal mammogram. This study assesses the impact of a patient navigator program for Vietnamese-American women who received abnormal mammograms. Ninety-six Vietnamese-American participants with abnormal mammograms were assigned a Vietnamese patient navigator to provide emotional support, education, translation, and assistance with medical bills and doctor's appointments. Data collected from pre-test, post-test (1 year after initial enrollment in program), and 3-month follow-up surveys measured psychosocial outcomes and participant satisfaction. All 96 participants attended follow-up appointments for their abnormal mammograms. Psychosocial outcomes worsened from pre- to post-test, though these results were not statistically significant. Feeling in control of situations in one's life improved and was significant for participants who did not receive a breast cancer diagnosis (4.31, 5.04, p = .039). A majority of the participants reported satisfaction with their patient navigators. Vietnamese-American women have been found to be the least adherent to appropriate follow-up after an abnormal mammogram; in this study, all 96 participants attended a follow-up appointment within 90 days. Findings did not show improvements in psychosocial outcomes. Past research suggests that sociocultural factors may be at play: the initial abnormal mammogram may have triggered fatalistic thoughts affecting the reactions of the participants, even though the abnormal mammogram did not result in a breast cancer diagnosis.

Delayed or failure to follow-up abnormal breast cancer screening mammograms in primary care: a systematic review

Background

Successful breast cancer screening relies on timely follow-up of abnormal mammograms. Delayed or failure to follow-up abnormal mammograms undermines the potential benefits of screening and is associated with poorer outcomes. However, a comprehensive review of inadequate follow-up of abnormal mammograms in primary care has not previously been reported in the literature. This review could identify modifiable factors that influence follow-up, which if addressed, may lead to improved follow-up and patient outcomes.

Methods

A systematic literature review to determine the extent of inadequate follow-up of abnormal screening mammograms in primary care and identify factors impacting on follow-up was conducted. Relevant studies published between 1 January, 1990 and 29 October, 2020 were identified by searching MEDLINE®, Embase, CINAHL® and Cochrane Library, including reference and citation checking. Joanna Briggs Institute Critical Appraisal Checklists were used to assess the risk of bias of included studies according to study design.

Results

Eighteen publications reporting on 17 studies met inclusion criteria; 16 quantitative and two qualitative studies. All studies were conducted in the United States, except one study from the Netherlands. Failure to follow-up abnormal screening mammograms within 3 and at 6 months ranged from 7.2–33% and 27.3–71.6%, respectively. Women of ethnic minority and lower education attainment were more likely to have inadequate follow-up. Factors influencing follow-up included physician-patient miscommunication, information overload created by automated alerts, the absence of adequate retrieval systems to access patient’s results and a lack of coordination of patient records. Logistical barriers to follow-up included inconvenient clinic hours and inconsistent primary care providers. Patient navigation and case management with increased patient education and counselling by physicians was demonstrated to improve follow-up.

Conclusions

Follow-up of abnormal mammograms in primary care is suboptimal. However, interventions addressing amendable factors that negatively impact on follow-up have the potential to improve follow-up, especially for populations of women at risk of inadequate follow-up.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12885-021-08100-3.

Psychological Outcomes After a False Positive Mammogram: Preliminary Evidence for Ethnic Differences Across Time

Adverse psychological consequences of screening mammography are well-documented for women who receive a false positive result. However, little is known about ethnic differences. To address this gap, we examine distress associated with an abnormal mammogram (results-related distress) and perceived lifetime risk of breast cancer (perceived risk) among Latinas and non-Latina White (NLW) women 3 months after receipt of a false positive result. A sample of 28 Latina and 27 NLW women who received an initial abnormal mammogram result and later, a definitive non-cancer diagnosis were recruited for this descriptive, longitudinal study. Women were interviewed twice: within 30 days and 3 months after a false positive result. Questionnaires included standard sociodemographic questions, the Impact of Events Scale-Revised, and two perceived breast cancer risk items. All participants experienced decreased distress 3 months after the initial results. Latinas experienced higher levels of distress, F(1,45) = 4.58, p = 0.04, and had a significant increase in perceived breast cancer risk over time, F(1,45) = 3.99, p = 0.05. Larger population-based studies are necessary to confirm ethnic differences in mental health consequences of false positive results. Given cultural emphases concerning respect for authority figures, healthcare professionals may be particularly helpful in working with Latinas to mitigate distress and clarify accurate perceptions of breast cancer risk through evidence-based practice.