University of Wisconsin Carbone Cancer Center, Madison, Wisconsin.
Mayo Clinic Cancer Center, Rochester, Minnesota.
WMJ. 2024 Sep;123(4):259-266.
Women living in rural areas are more likely to be diagnosed with advanced-stage breast cancer than their urban counterparts. The advanced stage at diagnosis is potentially attributable to lower rates of mammogram screening. We aimed to elucidate factors affecting women in decision-making about mammogram screening in a rural area in Wisconsin served by a critical access hospital.
We conducted an observational cross-sectional mixed-methods study, collecting data from various sources using 3 methods. Virtual interviews with hospital staff, virtual focus groups with community members, and a survey of women 40 years and older occurred from September 2021 through February 2022. Qualitative data were organized into themes of facilitators and barriers to mammogram screening. Survey responses were reported descriptively.
Eleven hospital staff interviewed and 21 community members who joined 1 of 3 virtual focus groups voiced similar perceptions of facilitators and barriers to mammogram screening. Clinician recommendation was among facilitators, while insurance concerns were the primary barrier. Among survey respondents (N = 282), mean age was 58.7, 98% self-identified as White, and 91% saw a health care provider in the past year. Top reasons for having their first mammogram were doctor recommendation (70%), family history (19%), and personal decision (18%). Top reasons they did not have a mammogram screening at least every year were putting it off (23%), lack of problems (17%), and pandemic-related reasons (15%).
Improving patient education and supporting clinicians to deliver screening recommendations may increase appropriate screening. Future studies should focus on reaching women not engaged with the health system.
与城市女性相比，农村地区的女性更有可能被诊断出患有晚期乳腺癌。诊断时的晚期可能归因于乳房 X 光筛查率较低。我们旨在阐明影响威斯康星州一个农村地区接受关键通道医院服务的女性接受乳房 X 光筛查决策的因素。
我们进行了一项观察性横断面混合方法研究，使用 3 种方法从各种来源收集数据。2021 年 9 月至 2022 年 2 月，对医院工作人员进行了虚拟访谈，对社区成员进行了虚拟焦点小组讨论，并对 40 岁及以上的女性进行了调查。定性数据被组织成促进和阻碍乳房 X 光筛查的主题。调查报告以描述性方式报告。
11 名医院工作人员接受了采访，21 名参加了 3 个虚拟焦点小组之一的社区成员对乳房 X 光筛查的促进因素和障碍有类似的看法。临床医生的建议是促进因素之一，而保险问题是主要障碍。在调查受访者（N=282）中，平均年龄为 58.7 岁，98%自认为是白人，91%在过去一年中看过医疗保健提供者。进行首次乳房 X 光检查的主要原因是医生建议（70%）、家族史（19%）和个人决定（18%）。他们没有每年至少进行一次乳房 X 光筛查的主要原因是推迟（23%）、没有问题（17%）和与大流行有关的原因（15%）。
提高患者教育水平并支持临床医生提供筛查建议可能会增加适当的筛查。未来的研究应重点关注那些未与卫生系统接触的女性。
