The importance of physician encouragement in breast cancer screening of older women

doi:10.1016/0091-7435(92)90083-T

Preventive Medicine

Volume 21, Issue 6, November 1992, Pages 766-780

https://doi.org/10.1016/0091-7435(92)90083-T Get rights and content

Abstract

Methods. The relationship between physician encouragement and breast cancer screening is examined with a population-based survey of 630 women between the ages of 45 and 75. Although the women interviewed were selected on the basis of their noncompliance with mammography guidelines, nearly half had previously had at least one mammogram.

Results. Women reported having received more physician encouragement of breast self-examination than of mammography. Older women reported less encouragement of both screening modalities than younger women. Multivariate analyses revealed physician encouragement to be more strongly associated with screening mammography than with health status, health care utilization, attitudes, and sociodemographic characteristics: those who reported having received physician encouragement were nearly four times more likely to have ever had screening mammography.

Conclusions. These and related findings are used to highlight the critical importance of physician behavior in the secondary prevention of breast cancer in older women and to identify types of patients whose needs for screening are most likely to be overlooked by physicians.

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This study examined perceptions of and communication about mammography as drivers of gaps in screening among individuals with non-English language preference (NELP). A survey was fielded in fall 2021 in five languages (Cantonese, English, Russian, Spanish, or Vietnamese) to individuals identified using electronic medical records in Oregon and Washington. The analytic sample consisted of 420 respondents with a median age of 61; approximately 45% of respondents identified as Asian, 37% as Hispanic, Latino, or Spanish origin, and 18% as some other race, ethnicity, or origin. Logistic regression models examined associations between screening and perception and communication items. Individuals who believed mammograms are unnecessary when healthy (aRR = 0.72 [0.57, 0.91]) or absent symptoms (aRR = 0.85 [0.72, 1.00]) were less likely to report a mammogram within the past two years (i.e., be current). Having a provider recommend (aRR = 1.27 [1.09, 1.47]) and discuss mammography (aRR = 1.18 [1.05, 1.32]) were associated with a higher likelihood of being current. Few respondents received written or verbal information in their preferred language (35% and 28.3%, respectively). Financial and logistical support, including language services were most frequently identified as types of support needed to obtain a mammogram. Overall, misperceptions about mammography may act as a barrier but communication may act as a facilitator for individuals with NELP. Provider-patient communication could be an effective way to encourage mammography. Culturally-responsive health promotion materials and provider communication, available in patients’ preferred language, are needed to combat misperceptions and support ongoing, on-time mammography for NELP patients.
Physical activity levels and counseling by health care providers in cancer survivors
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Self-efficacy, outcome expectations, and social support – the key constructs of SCT, can be capitalized on by HCPs to influence the PA engagement among cancer survivors (Husebø et al., 2013; Loprinzi and Lee, 2014). Compared to adults without cancer or those with other chronic conditions, cancer survivors may have more clinical issues demanding attention during HCP visits (Grady et al., 1992; American Cancer Society, 2016), which may necessarily limit health behavior counseling. In a comparison of HCPs' counseling rates of cancer survivors with those of adults without cancer adjusting for comorbid illnesses and other salient characteristics, cancer survivors were less likely to report receiving a PA recommendation.
Physical activity guidelines for cancer survivors issued by the American Cancer Society and the American College of Sports Medicine emphasize the essential role of a health care provider (HCP) in counseling cancer survivors to achieve healthier lifestyles. However, research has not established whether HCP's recommendations to engage in physical activity are associated with increased physical activity levels of cancer survivors. The study examines this potential association using the 2005 and 2010 National Health Interview Survey data. The final analytic sample consisted of 3320 cancer survivors and 38,955 adults without cancer who reported seeing or talking to a HCP and if or not they had received a physical activity recommendation in the prior year. Consistent with the aforementioned guidelines, physical activity levels were categorized as inactive, insufficiently active, and sufficiently active (i.e., meeting guidelines). Average adjusted predictions and marginal effects were estimated from generalized ordered logit models. Multivariable regressions controlled for socio-demographic and health-related characteristics and survey year. On average, receipt of a HCP's physical activity recommendation was associated with a lower adjusted prevalence of inactivity by 8.3 percentage points and a higher adjusted prevalence of insufficient and sufficient activity by 4.6 and 3.7 percentage points, respectively, regardless of cancer diagnosis (P's < 0.05). A HCP's recommendation is associated with higher levels of leisure-time aerobic physical activity among cancer survivors and adults without cancer. The communication between cancer survivors and their HCPs may act as a ‘window’ of opportunity to increase physical activity levels among the U.S. cancer survivors.
Mammography FastTrack: An Intervention to Facilitate Reminders for Breast Cancer Screening across a Heterogeneous Multi-clinic Primary Care Network
2009, Journal of the American Medical Informatics Association
Health care information technology can be a means to improve quality and efficiency in the primary care setting. However, merely applying technology without addressing how it fits into provider workflow and existing systems is unlikely to achieve improvement goals. Improving quality of primary care, such as cancer screening rates, requires addressing barriers at system, provider, and patient levels. The authors report the development, implementation, and preliminary use of a new breast cancer screening outreach program in a large multicenter primary care network. This installation paired population-based surveillance with customized information delivery based on a validated model linking patients to providers and practices. In the first six months, 86% of physicians and all case managers voluntarily participated in the program. Providers intervened in 83% of the mammogram-overdue population by initiating mailed reminders or deferring contact. Overall, 63% of patients were successfully contacted. Systematic population-based efforts are promising tools to improve preventative care.
Cancer Screening in Women. Body Mass Index and Adherence to Physician Recommendations
2007, American Journal of Preventive Medicine
Citation Excerpt :
Obese women, particularly those with a BMI > 35 to 40, have lower rates of mammograms and Papanicolaou tests (Pap smears).11–18 One of the strongest and most consistent predictors of cancer screening is a physician’s recommendation.19–21 It is unclear whether the lower rates of cancer screening in obese women are due to lack of physician recommendations or patients failing to adhere to physician recommendations.
The reasons that obese women are less likely to obtain mammograms and Papanicolaou tests (Pap smears) are poorly understood. This study evaluated associations between body mass index (BMI) and receipt of and adherence to physician recommendations for mammography and Pap smear.
Data from the 2000 National Health Interview Survey (8289 women aged 40 to 74 years) were analyzed in 2006 using logistic regression. Women with previous hysterectomy were excluded from Pap smear analyses (n=5521). Outcome measures were being up-to-date with screening, receipt of physician recommendations, and women’s adherence to physician recommendations for mammography and Pap smear.
After adjusting for sociodemographic variables, healthcare access, health behaviors, and comorbidity, severely obese women (BMI > 40 kg/m²) were less likely to have had mammography within 2 years (odds ratio [OR]=0.50, 95% confidence interval [CI]=0.37–0.68) and a Pap smear within 3 years (OR=0.43, 95% CI=0.27–0.70). Obese women were as likely as normal-weight women to receive physician recommendations for mammography and Pap smear. Severely obese women were less likely to adhere to physician recommendations for mammography (OR=0.49, 95% CI=0.32–0.76). Women in all obese categories (BMI > 30 kg/m²) were less likely to adhere to physician recommendations for Pap smear (ORs ranged from 0.17 to 0.28, p<0.001).
Obese women are less likely to adhere to physician recommendations for breast and cervical cancer screening. Interventions focusing solely on increasing physician recommendations for mammography and Pap smears will probably be insufficient for obese women. Additional strategies are needed to make cancer screening more acceptable for this high-risk group.
Communication between older women and physicians: Preliminary implications for satisfaction and intention to have mammography
2006, Patient Education and Counseling
To explore the associations between physician communication styles and their older patients’ intentions to get mammography and satisfaction with physician communication.
This cross-sectional mixed methods study was conducted in a teaching hospital outpatient clinic with faculty general internists (n = 7) and their female patients aged 65 years and older (n = 56). Audiotaped communication was coded by researchers using the multidimensional interactional analysis and assisted doctor–elderly patient transactions coding systems. Demographic data was collected prior to the visit. Data on intention to have mammography and satisfaction with communication were collected immediately post-visit.
The majority of encounters had some degree of joint decision-making. Communication styles tended to be associated with women's intentions to have screening mammography. Patients who described communication as “deep”, “trusting” and “bonding” were more satisfied with communication than women who rated physician communication as less trusting (p = 0.03, 0.02 and 0.02, respectively).
Physicians’ communication styles affect their older female patients’ satisfaction. In this preliminary study, older women who rated communication as being deep, trusting and bonding tended to have a greater intention to have mammography.
Improving physicians’ communication styles may increase satisfaction with physician communication and result in higher mammography adherence among older female patients.
Efficacy of a simple, low-cost educational intervention in improving knowledge about risks and benefits of screening mammography
2006, Mayo Clinic Proceedings
To assess the efficacy of a minimal cost and involvement educational intervention in improving women's knowledge about screening mammography and to explore patient perceptions of the educational intervention.
During the study period (March 10, 2005, to July 1, 2005), 1446 participants in the Mayo Mammography Health Study scheduled for a mammogram within 4 weeks at the Mayo Clinic in Rochester, Minn, were randomized to 2 study groups and mailed surveys about mammograms. The 2 groups received separate surveys; both surveys contained knowledge-based questions about mammography, but the educational intervention group survey also contained qualitative questions that assessed the educational pamphlets.
Of the 668 surveys returned (responders), 248 (34.4%) were from the control group, and 420 (58.3%) were from the intervention group. Approximately 80% of responders had had more than 7 prior mammograms. Significant increases in knowledge about mammography were found in the educational intervention compared with the control group on questions regarding age to begin screening mammography (67.9% vs 54.4%; P<.001), recommended frequency of mammograms (86.4% vs 75.4%; P<.001), overall reduction in mortality due to screening mammography (55.2% vs 8.9%; P<.001), and proportions of women who required follow-up mammograms (35.5% vs 14.9%; P<.001) or biopsy (59.5% vs 13.3%; P<.001). Qualitative data results indicated that most women who received the educational intervention found the pamphlets helpful and informative despite having had many previous mammograms.
The results suggest that providing women scheduled for screening mammograms with physician-approved educational material before their appointment significantly increases knowledge about screening mammography, risks and benefits, and possible follow-up.

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^☆: This research was supported by National Cancer Institute Grant CA36798 to Massachusetts Institute of Behavioral Medicine.

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The importance of physician encouragement in breast cancer screening of older women☆

Abstract

Maturitas

Prev Med

Cancer facts and figures—1990

Survey of physicians' attitudes and practices in early cancer detection

Ca—A Cancer J Clin

Frequency of breast self-examination practice as a function of physician reinforcement

Patient Educ Counseling

Report of the working group to review the National Cancer Institute—American Cancer Society breast cancer detection demonstration projects

J Nat Cancer Inst

Use of mammography for breast cancer screening: Rhode Island, 1987

MMWR

Trends in screening mammograms for women 50 years of age and older: Behavioral risk factor surveillance system, 1987