Background
State of the relationship between breast centres and screening programmes in Europe
The conceptual framework of the survey
Methods
Objectives
Setting
Survey development
Survey pre-testing and piloting
Eligibility criteria
Survey process
Data analysis
Type of integration | Variable |
---|---|
Structural integration | The breast centre and the screening programme use the same software for patient management (screening invitation, basic test, assessment examinations) (D52) The breast centre and the screening programme share a database with patient information (D55) There is a reference person who ensures the link between the breast centre and the screening programme for women with suspected cancer (D57) Number of activities shared by the breast centre and the screening programme using the same software for patient management (D53_CONT) Number of items of information shared between the breast centre and the screening programme via shared database (D56_CONT) Number of health workers/professionals who ensure the link between the breast centre and the screening programme (D58_CONT) Number of health professionals from the screening programme who also work in the clinical area of the breast centre (D59_CONT) |
Process integration | The screening activity is included into the diagnostic-therapeutic clinical protocol adopted by the breast centre (D65) |
Functional integration | The breast centre and the screening programme share the same budget (D51) The person responsible for the breast centre and the one responsible for the screening programme share objectives about responsiveness and promptness of treatment (D67) Frequency of coordination meetings between the breast centre and the screening programme (D70) Availability of training opportunities targeting health professionals both from the breast centre and the screening programme (D73) |
Results
Characteristics of responding breast centres
Proportion and correlates of breast centres collaborating with a screening programme
Characteristic | Total number | Collaboration with the screening programme | P valuea | |
---|---|---|---|---|
No (%) | Yes (%) | |||
Geographic area | 0.26 | |||
North | 53 | 6 (11) | 47 (89) | |
Centre | 19 | 4 (21) | 15 (79) | |
South | 10 | 3 (30) | 7 (70) | |
Hospital classification | 0.12 | |||
Public hospital | 52 | 5 (10) | 47 (90) | |
Private accredited hospital | 5 | 1 (20) | 4 (80) | |
IRCCS and AOU | 14 | 5 (36) | 9 (64) | |
Private accredited IRCCS | 11 | 2 (18) | 9 (82) | |
New breast cancer cases treated in the last year (n)b | 0.067 | |||
< 345 | 41 | 3 (7) | 38 (93) | |
≥ 345 | 41 | 10 (24) | 31 (76) | |
Staff of the multidisciplinary team (n)b | 1.00 | |||
< 21 | 41 | 7 (17) | 34 (83) | |
≥ 21 | 41 | 6 (15) | 35 (85) | |
Dedicated breast radiologists (n)bc | 1.00 | |||
< 5 | 41 | 7 (17) | 34 (83) | |
≥ 5 | 41 | 6 (15) | 35 (85) | |
Dedicated radiographers (n)bd | 0.23 | |||
< 5 | 43 | 9 (21) | 34 (79) | |
≥ 5 | 39 | 4 (10) | 35 (90) | |
Mammogram reading volume in the last year (n)b | 0.068 | |||
< 15,000 | 42 | 10 (24) | 32 (76) | |
≥ 15,000 | 40 | 3 (8) | 37 (93) | |
Availability of a data manager | 0.84 | |||
No | 17 | 3 (18) | 14 (82) | |
Yes, external | 4 | 1 (25) | 3 (75) | |
Yes, internal | 61 | 9 (15) | 52 (85) | |
Availability of a clinical database for quality assurance and research | 1.00 | |||
No | 9 | 1 (11) | 8 (89) | |
Yes | 73 | 12 (16) | 61 (84) | |
BCCert Certification | 0.095 | |||
No | 58 | 12 (21) | 46 (79) | |
Yes | 24 | 1 (4) | 23 (96) |
Analysis of expectations and conditions for integration
UTAUT model construct Observed correlates and effects (or expectancies) | Mean (standard error)a | P valueb | |
---|---|---|---|
Breast centres collaborating with screening (n = 62) | Breast centres not collaborating with screening (n = 12) | ||
Performance expectancy | |||
The integration makes (or I expect it makes) me more confident of the clinical quality of patient care | 93.4 (1.80) | 57.6 (11.58) | 0.000 |
The integration makes (or I expect it makes) me more confident of patient convenience (service timeliness, etc.) | 95.7 (1.59) | 65.5 (10.68) | 0.000 |
The integration eases (or I expect it eases) my job | 83.0 (3.25) | 65.1 (9.61) | 0.039 |
The integration offers (or I expect it offers) better opportunities for my professional growth | 73.7 (3.73) | 56.6 (10.40) | 0.079 |
Effort expectancy | |||
It is easy (or I expect it is easy) to acquire the management skills needed for the integration | 55.3 (3.50) | 53.8 (9.86) | 0.87 |
Managing the integration does not cost (or I expect it does not cost) me extra working time | 42.7 (3.86) | 36.3 (6.59) | 0.50 |
Social influence | |||
Do your colleagues think that the integration is important? | 85.7 (2.61) | 71.3 (11.41) | 0.065 |
Does local health authority think that the integration is important? | 76.2 (3.55) | 66.0 (10.17) | 0.27 |
Facilitating conditions | |||
Has local health authority made (or will it make) available to you the resources needed for the integration? | 42.5 (4.38) | 51.9 (10.91) | 0.40 |
Has local health authority enabled (or will it enable) you to acquire the management skills needed for the integration? | 51.5 (4.37) | 47.8 (10.21) | 0.74 |
Has local health authority developed (or will it develop) an official protocol for the management of breast cancer? | 71.3 (4.25) | 62.7 (11.58) | 0.43 |
Propensity to use | |||
Are you inclined to handling the integration personally? | 92.7 (2.16) | 82.5 (8.53) | 0.10 |
Are you inclined to keep on handle the integration personally and with conviction? | 92.6 (16.52) | NA | |
Satisfaction and motivation | |||
The integration makes (or I expect it makes) my working environment more stimulating | 85.1 (2.54) | 66.8 (10.56) | 0.015 |
The integration makes (or I expect it makes) my working environment more satisfactory | 84.2 (2.55) | 60.5 (10.42) | 0.002 |
Control variables | |||
No. of years of professional experience | 28.4 (1.01) | 27.9 (2.03) | 0.84 |
No. of working years at the breast centre | 15.7 (1.11) | 13.3 (2.53) | 0.39 |
Age (years) | 58.1 (0.92) | 55.5 (1.94) | 0.24 |
Gender (female) | 0.52 (0.06) | 0.42 (0.15) | 0.51 |
Clustering of breast centres having a relation with the screening programme
Cluster | Number of centres (%) | Type of integration |
---|---|---|
Fully integrated | 12 (19) | High integration in all the three dimensions (structural, functional and process) |
Highly integrated | 13 (20) | High integration in structural and process integration, moderate functional integration |
Moderately integrated | 8 (12) | Moderate integration in all the three dimensions |
Mildly integrated | 6 (9) | Moderate structural integration, mild process and functional integration |
Poorly integrated | 19 (30) | Mild structural and process integration, moderate functional integration |
Scarcely integrated | 6 (9) | Scarce integration in all the three dimensions |
Type of item | Mean (range) | SD | Equality-of-means test | Cluster(s) with a significantly different mean | |||||
---|---|---|---|---|---|---|---|---|---|
F | P value | Clustera | Cluster mean | Mean of the other clusters | P value | ||||
Breast centre characteristics | |||||||||
New breast cancer cases treated in the last year | Number | 418.3 (345.1–656.5) | 339.1 | 1.11 | 0.37 | Medium | 656.5 | 374.8 | 0.021 |
Dedicated breast radiologists | Number | 5.5 (4.5–7.2) | 3.2 | 1.19 | 0.33 | High | 7.2 | 5.1 | 0.039 |
Dedicated radiographers | Number | 7.13 (5.15–9.25) | 4.67 | 2.07 | 0.082 | High | 9.2 | 6.6 | 0.079 |
Mammogram reading volume in the last year | Number | 24,595 (16,592–35,330) | 21,076 | 1.31 | 0.27 | High | 35,330 | 21,268 | 0.031 |
Availability of a data manager | No/yes | 0.78 (0.50–1.00) | 0.42 | 1.98 | 0.096 | Medium | 1.00 | 0.72 | 0.088 |
Availability of a clinical database for quality assurance and research | No/yes | 0.89 (0.50–1.00) | 0.32 | 2.95 | 0.019 | Medium–low | 0.50 | 0.92 | 0.002 |
Performance expectancy | |||||||||
The integration makes me more confident of the clinical quality of patient care | Score 1–100 | 93.4 (86.8–99.2) | 14.20 | 1.49 | 0.21 | Low | 87.8 | 95.9 | 0.038 |
The integration makes me more confident of patient convenience (service timeliness, etc.) | Score 1–100 | 95.7 (89.0–100.0) | 12.55 | 1.41 | 0.24 | Low | 90.9 | 97.8 | 0.046 |
The integration eases my job | Score 1–100 | 83.0 (43.8–96.2) | 25.58 | 4.37 | 0.002 | None | 43.8 | 86.4 | 0.000 |
High | 96.2 | 79.8 | 0.046 | ||||||
The integration offers better opportunities for my professional growth | Score 1–100 | 73.7 (47.4–89.7) | 29.40 | 2.22 | 0.065 | None | 47.4 | 76.0 | 0.036 |
High | 89.7 | 69.9 | 0.035 | ||||||
Effort expectancy | |||||||||
It is easy to acquire the management skills needed for the integration | Score 1–100 | 55.3 (45.1–71.0) | 27.56 | 1.78 | 0.13 | Low | 45.1 | 59.8 | 0.051 |
High | 71.0 | 51.5 | 0.027 | ||||||
Managing the integration does not cost me extra working time | Score 1–100 | 42.7 (32.6–62.6) | 30.42 | 1.02 | 0.41 | NC | |||
Social influence | |||||||||
Do your colleagues think that the integration is important? | Score 1–100 | 85.7 (73.0–94.2) | 20.57 | 1.09 | 0.37 | NC | |||
Does local health authority think that the integration is important? | Score 1–100 | 76.2 (63.7–92.0) | 27.93 | 1.34 | 0.26 | Low | 63.7 | 81.7 | 0.018 |
Facilitating conditions | |||||||||
Has local health authority made available to you the resources needed for the integration? | Score 1–100 | 42.5 (23.2–62.2) | 34.46 | 2.59 | 0.036 | Low | 23.2 | 51.0 | 0.003 |
Has local health authority enabled you to acquire the management skills needed? | Score 1–100 | 51.5 (36.7–67.3) | 34.43 | 1.49 | 0.21 | Low | 36.7 | 58.0 | 0.023 |
High | 67.3 | 47.7 | 0.077 | ||||||
Has your local health authority developed an official protocol for the management of breast cancer? | Score 1–100 | 71.3 (48.4–90.1) | 33.48 | 2.84 | 0.023 | Low | 58.3 | 77.1 | 0.040 |
High | 90.1 | 66.8 | 0.029 | ||||||
Propensity to use | |||||||||
Are you inclined to handling the integration personally? | Score 1–100 | 92.6 (84.9 -100.0) | 16.99 | 2.00 | 0.093 | Low | 85.5 | 95.8 | 0.027 |
Are you inclined to keep on handle the integration with conviction? | Score 1–100 | 92.6 (84.8–97.7) | 16.52 | 1.17 | 0.33 | NC | |||
Satisfaction and motivation | |||||||||
The integration makes my working environment more stimulating | Score 1–100 | 85.1 (61.6–92.4) | 20.03 | 2.59 | 0.036 | None | 61.6 | 87.2 | 0.005 |
The integration makes my working environment more satisfactory | Score 1–100 | 84.1 (66.2–93.8) | 20.09 | 2.28 | 0.059 | None | 66.2 | 85.7 | 0.036 |
High | 93.8 | 81.8 | 0.065 |