Marcus Erin N, Sanders Lee M, Jones Beth A, Koru-Sengul Tulay
From the Department of Medicine, University of Miami Miller School of Medicine, Miami, Florida, the Department of Pediatrics, Stanford University School of Medicine, Stanford, California, and the Yale School of Public Health, New Haven, Connecticut.
South Med J. 2019 Jan;112(1):1-7. doi: 10.14423/SMJ.0000000000000919.
Black women are at increased risk of being called back for additional studies after a screening mammogram. With focus group input, we developed a brochure to improve awareness of the frequency of abnormal results. This study explored the brochure's acceptability and effect on understanding risk and breast cancer fears among black mammography patients at an urban safety-net breast imaging center in Miami, Florida.
A randomized controlled trial of the brochure (plus the standard result notification letter) versus usual care (standard notification letter alone). Black English-speaking women with an incomplete mammography result were randomized to the intervention or control group. Consenting participants completed a telephone questionnaire. Outcomes included awareness of result, anxiety level, and brochure acceptability. The χ or Fisher exact test was used and a univariate logistic regression was performed for intervention and control odds ratios.
A total of 106 women were randomly selected to receive the brochure plus the letter or the letter alone. One chose to opt out; a minimum of three attempts were made to reach each of the remaining 105 women by telephone. Verbal communication was established with 59 of the randomized women, and 51 of those women agreed to participate in a survey to evaluate the brochure. There was no significant difference between the surveyed groups in knowledge of the result and follow-up plan. Surveyed intervention subjects were more likely to agree that "it is very common for women to have to follow up after a mammogram" (odds ratio [OR] 25.91, = 0.029) and less likely to agree with the statement "getting a follow-up mammogram is scary" (OR 0.24, = 0.021). Most intervention subjects said the pamphlet helped them understand their result "a lot" (79%, 19) and viewed it as "extremely" or "mostly" clear (96%, 23). Intervention subjects also voiced greater awareness of a telephone number they could call for more information about cancer (OR 11.38, = 0.029).
A culturally tailored brochure explaining the frequency of abnormal mammograms was well received by women at a large safety-net health system. Pilot testing suggests that it may improve patient perception of risk and awareness of informational resources. This strategy should be considered to enhance result communication.
黑人女性在乳腺钼靶筛查后被召回进行进一步检查的风险更高。在焦点小组的意见基础上，我们制作了一本宣传册，以提高对异常结果发生率的认识。本研究探讨了该宣传册在佛罗里达州迈阿密市一家城市安全网乳腺影像中心对黑人乳腺钼靶检查患者理解风险和乳腺癌恐惧方面的可接受性及效果。
对宣传册（加标准结果通知信）与常规护理（仅标准通知信）进行随机对照试验。乳腺钼靶检查结果不完整的讲黑人英语的女性被随机分为干预组或对照组。同意参与的参与者完成一份电话调查问卷。结果包括对结果的知晓度、焦虑水平和宣传册可接受性。使用χ²检验或Fisher精确检验，并对干预组和对照组的优势比进行单因素逻辑回归分析。
总共随机选择了106名女性，分别接受宣传册加信件或仅信件。有1人选择退出；通过电话对其余105名女性每人至少进行了3次联系尝试。与59名随机分组的女性进行了口头沟通，其中51名女性同意参与一项评估宣传册的调查。在结果知晓度和后续计划方面，被调查组之间没有显著差异。接受调查的干预组受试者更有可能同意“女性在乳腺钼靶检查后必须进行后续检查是很常见的”（优势比[OR]25.91，P = 0.029），而不太可能同意“进行后续乳腺钼靶检查很可怕”这一说法（OR 0.24，P = 0.021）。大多数干预组受试者表示宣传册“非常”有助于他们理解自己的结果（79%，19人），并认为其“极其”或“大部分”清晰（96%，23人）。干预组受试者也表示对一个可拨打以获取更多癌症信息的电话号码有更高的知晓度（OR 11.38，P = 0.029）。
一本针对文化特点制作的解释乳腺钼靶异常发生率的宣传册在一个大型安全网医疗系统中受到女性的好评。初步测试表明，它可能会改善患者对风险的认知以及对信息资源的知晓度。应考虑采用这一策略来加强结果沟通。
