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Center for Healthcare Policy and Research

Center for Healthcare Policy and Research

Intervening to increase follow-up to abnormal mammograms

Principal Investigator
PI Home Department
Source of Support
Dates
Total Cost
Carol Ashton, M.D.
Health Services Research
AHRQ
9/01/2001 - 8/31/2005
$921,862

Too many women fail to follow-up on their abnormal mammograms and in doing so may reduce their chances of surviving breast cancer. Ethnic minority women with breast cancer have poorer survival rates than white women, even when they have similar access to care. Interaction with health professionals is key to patient compliance with medical recommendations, especially in older populations where barriers to follow-up are more significant. To design an intervention that will enhance communication between women and health professionals, we must first understand the barriers to action and perceived self-efficacy that restrict timely follow-up to abnormal mammograms by patients of different racial/ethnic backgrounds. The goal of this 4-year randomized controlled trial is to develop an intervention that will assist health professionals and women to communicate about barriers to timely abnormal mammogram follow-up (FU) in order to increase FU to abnormal mammograms and improve outcomes in women with breast disease. By increasing the likelihood that women and their health professionals can talk about barriers to follow-up to abnormal mammograms, we hope to increase early detection of breast cancer and enhance survival rates.

The first phase of the study was to understand barriers to timely follow-up in order to develop an intervention to assist women in communication with health professionals about barriers to follow-up. Women 50 years of age and over who had a mammogram requiring follow-up from January through August 2001 at a not-for-profit breast clinic in Houston, Texas were participants in the first phase of the study. Study design included medical record review and focus group interviews. Review of medical record data involved an abstraction form and notes on the process of care and follow-up. Abstracted data were summarized using descriptive statistics, and timely follow-up by patient characteristics was assessed. Medical record data showed White women were twice as likely to adhere to timely follow-up on abnormal mammography as women of other ethnicities (African American, Latina, or other ethnicity status) (p=.003). Patient reports of family history of breast cancer were not significantly related to follow-up. A subset of women agreed to focus group interviews and was invited to participate in four group discussions about mammogram follow-up. Prominent themes and coding categories regarding perceived efficacy and follow-up emerged from a systematic iterative review process. Qualitative analysis suggested women’s perspectives on insurance were inversely related to their perceived self-efficacy and intent to follow-up. Faith played an important role in perceived efficacy related to follow-up in African American and lower-income women and in those women with late follow-up. Perspectives on insurance were important to perceived self-efficacy and follow-up, yet perceived insurance barriers shaped reported self-efficacy differently in White versus non-White women. These findings suggest that tailored information related to insurance barriers and alternatives for timely follow-up are necessary for transmission of information for follow-up on inconclusive or abnormal mammogram.