Department of Public Health, School of Social Sciences, Humanities, and Arts, University of California , Merced, CA, USA.
Division of General Internal Medicine, Department of Medicine at the University of California San Francisco, San Francisco, CA, USA.
J Gen Intern Med. 2020 Oct;35(10):3000-3006. doi: 10.1007/s11606-020-05972-2. Epub 2020 Jun 29.
Regular mammogram screening for eligible average risk women has been associated with early detection and reduction of cancer morbidity and mortality. Delayed follow-up and resolution of abnormal mammograms limit early detection efforts and can cause psychological distress and anxiety.
The goal of this study was to gain insight from women's narratives into how organizational factors related to communication and coordination of care facilitate or hinder timely follow-up for abnormal mammogram results.
We conducted 61 qualitative in-person interviews with women from four race-ethnic groups (African American, Chinese, Latina, and White) in three different healthcare settings (academic, community, and safety-net).
Eligible participants had an abnormal mammogram result requiring breast biopsy documented in the San Francisco Mammography Registry in the previous year.
Interview narratives included reflections on experience and suggested improvements to communication and follow-up processes. A grounded theory approach was used to identify themes across interviews.
Participants' experiences of follow-up and diagnosis depended largely on communication processes. Twenty-one participants experienced a follow-up delay (> 30 days between index mammogram and biopsy). Organizational factors, which varied across different institutions, played key roles in effective communication which included (a) direct verbal communication with the ability to ask questions, (b) explanation of medical processes and terminology avoiding jargon, and (c) use of interpretation services for women with limited English proficiency.
Health organizations varied in their processes for abnormal results communication and availability of support staff and interpretation services. Women who received care from institutions with more robust support staff, such as bilingual navigators, more often than not reported understanding their results and timely abnormal mammogram follow-up. These reports were consistent across women from diverse ethnic groups and suggest the value of organizational support services between an abnormal mammogram and resolution for improving follow-up times and minimizing patient distress.
对于符合条件的普通风险女性，定期进行乳房 X 光筛查与早期发现和降低癌症发病率和死亡率有关。异常乳房 X 光片的后续随访和解决会限制早期发现的努力，并可能导致心理困扰和焦虑。
本研究的目的是从女性的叙述中了解与沟通和协调护理相关的组织因素如何促进或阻碍异常乳房 X 光片结果的及时随访。
我们对来自四个种族群体（非裔美国人、华裔、拉丁裔和白人）的 61 名女性在三个不同的医疗保健环境（学术、社区和保障网）进行了 61 次定性的面对面访谈。
符合条件的参与者在过去一年中在旧金山乳房 X 光检查登记处有异常乳房 X 光片结果需要进行乳房活检。
访谈叙述包括对经验的反思，并对沟通和随访过程提出改进建议。采用扎根理论方法来确定访谈中的主题。
参与者的随访和诊断经验在很大程度上取决于沟通过程。21 名参与者经历了随访延迟（从索引乳房 X 光片到活检之间超过 30 天）。组织因素在不同机构之间有所不同，在有效的沟通中发挥了关键作用，包括（a）直接进行口头交流并能够提问，（b）解释医疗过程和术语，避免使用行话，以及（c）为英语水平有限的女性使用口译服务。
在异常结果的沟通和支持人员和口译服务的可用性方面，不同的健康组织存在差异。从拥有更强大的支持人员的机构（如双语导航员）获得护理的女性，往往更能理解她们的结果，并能及时进行异常乳房 X 光片的随访。这些报告在来自不同族裔群体的女性中是一致的，表明在异常乳房 X 光片和解决之间的组织支持服务的价值，可以改善随访时间并最大程度地减少患者的痛苦。
