Interventions For Breast Cancer Screening Non-adherence Research Paper FROM THE ATTACHED ARTICLE PLEASE WRITE A CONCLUSION INCLUDING THE FOLLOWING ITEMS BE

Interventions For Breast Cancer Screening Non-adherence Research Paper FROM THE ATTACHED ARTICLE PLEASE WRITE A CONCLUSION INCLUDING THE FOLLOWING ITEMS BELOW. Conclusion What were the recommendations?Are the findings relevant to consumers or health care professionals or both?How could you as a health care administrator use the information within this article? Example: The reporting of the Ebola outbreak in West Africa caused global panic, but also brought awareness of its cause and measure that can be taken to prevent its spread. The research conducted… As a health care administrator, I can use the information to… JOURNAL OF WOMEN’S HEALTH
Volume 26, Number 10, 2017
ª Mary Ann Liebert, Inc.
DOI: 10.1089/jwh.2016.5939
Improving Breast Cancer Screening Adherence
Among Hospitalized Women
Waseem Khaliq, MD, MPH, Regina Landis, BA, and Scott M. Wright, MD
Abstract
Background: More than a third of hospitalized women are both overdue for breast cancer screening and at high
risk for developing breast cancer. The purpose of the study was to evaluate if inpatient breast cancer screening
education, scheduling an outpatient mammography appointment before hospital discharge at patients’ convenience, phone call reminders, and a small monetary incentive ($10) would result in improved adherence with
breast cancer screening for these patients.
Methods: A prospective intervention pilot study was conducted among 30 nonadherent women aged 50–75
years hospitalized to a general medicine service. Sociodemographic, reproductive history, family history for
breast cancer, and medical comorbidity data were collected for all patients. Chi-square and unpaired t-tests were
utilized to compare characteristics among women who did and did not get a screening mammogram at their
prearranged appointments.
Results: Of the 30 women enrolled who were nonadherent to breast cancer screening, the mean age for the
study population was 57.8 years (SD = 6), mean 5-year Gail risk score was 1.68 (SD = 0.67), and 57% of women
were African American. Only one-third of the enrolled women (n = 10) went to their prearranged appointments
for screening mammography. Not feeling well enough after the hospitalization and not having insurance were
reported as main reasons for missing the appointments. Convenience of having an appointment scheduled was
reported to be a facilitator of completing the screening test.
Conclusion: This intervention was partially successful in enhancing breast cancer screening among hospitalized
women who were overdue and at high risk. Future studies may need to evaluate the feasibility of inpatient screening
mammography to improve adherence and overcome the significant barriers to compliance with screening.
Keywords: breast cancer screening, nonadherent population, hospitalized women
Introduction
B
reast cancer is the most commonly diagnosed cancer
and second leading cause of cancer death among women
in the United States.1,2 A recent study has shown that *40% of
the hospitalized women, in the age group of 50–75 years, were
nonadherent to breast cancer screening guidelines, and almost a
third of nonadherent women were at high risk for developing
breast cancer (Gail model 5-year risk prediction ‡1.7).3,4 It has
been reported that women living in disadvantaged areas were
less likely to have screening mammography, even after adjusting
for individual-level socioeconomics and access to healthcare.5
The two most common barriers to screening cited by hospitalized women were remembering to schedule an appointment and
a lack of transportation.3 In the study of hospitalized women,
a majority (91%) welcomed the prospect of discussion about
breast cancer screening by their hospital provider. This may be
due to the fact that the time in hospital is known to promote
reflection and deeper consideration of health and behaviors.3
The purpose of the current study was to evaluate whether an
intervention that included breast cancer screening education
during a hospital stay, coupled with scheduling an outpatient
mammography appointment before hospital discharge, would
improve adherence with screening. We hypothesized that the
intervention would result in a 50% increase in breast cancer
screening adherence.
Methods
Study design and sample
In this prospective intervention study, all women between
50 and 75 years of age admitted to the general medical
Department of Medicine, Johns Hopkins Bayview Medical Center, Johns Hopkins University School of Medicine, Baltimore, Maryland.
1094
SCREENING MAMMOGRAPHY PILOT FOR HOSPITALIZED WOMEN
service at Johns Hopkins Bayview Medical Center ( JHBMC)
were assessed to determine study eligibility. Only women
who were nonadherent to breast screening guidelines were
approached for study participation between October 2012
and March 2013. ‘‘Nonadherence with breast cancer
screening’’ recommendations was defined as having had a
screening mammography more than 24 months before enrollment among women aged 52 or older—in accordance
with guidelines by the United States Preventive Services
Task Force (USPSTF).6 Patients who had multiple admissions during the study period were only offered enrollment
during their first hospitalization. Of the 655 eligible women,
245 (37%) were adherent to screening mammography (selfreported last screening mammogram less than 24 months),
and many met exclusion criteria (32 [5%] had a history of
breast cancer, 40 [6%] reported a history of cancer other than
breast with metastasis or were undergoing active treatment,
69 [11%] admitted with confusion, 26 [4%] were residents of
nursing homes, 36 [5.5%] were significant physically disabled, and 22 [3.3%] had communication constraints that
limited interaction with the research assistant [deaf, aphasia,
non-English speaking]). Taking the abovementioned into
account, only 185 women were eligible for the study. Of
these qualified hospitalized women, 100 (54%) refused to
participate, and 54 (29%) were discharged from the hospital
before the study coordinator could consent them. Only 31
(17%) hospitalized women were nonadherent to breast cancer
FIG. 1.
1095
screening recommendations and willing to participate in the
study. One patient dropped out of the study after agreeing to
participate. Thus, final study population consisted of 30
(16%) women, of whom 23% (n = 7) never had a screening
mammogram. Detailed enrollment information can be seen in
Figure 1.
Protocol and measures
The bedside data collection consisted of survey questions
regarding sociodemographic information such as race, education, and annual household income. Several questions
regarding breast cancer risk factors, including reproductive
history, family history of breast cancer, and personal history of breast biopsy, were also asked to generate ‘‘Gail
Risk Prediction Score’’ using the National Cancer Institute
Breast Cancer Risk Tool (www.cancer.gov/bcrisktool).7–12
Family history of breast cancer was judged to be positive in
subjects reporting a breast cancer diagnosis in first-degree
relatives (namely mother, sisters, or daughters). We evaluated access to healthcare with the variables health insurance status and having a primary care physician. Disease
burden was characterized by assessing medical comorbidities, including those needed for the Charlson comorbidity
index, a method of categorizing comorbidities by mortality
risk status based on the International Classification of
Diseases diagnosis codes.13
Study population.
1096
KHALIQ ET AL.
Study intervention
Statistical methods
The study coordinator provided bedside education about
breast cancer and the benefits of screening mammography,
handouts with information, and pictures were also given to patients. The same individual also did general counseling and offered encouragement to the patients. Participants were then
scheduled by the study coordinator to have an appointment for
outpatient screening mammography at a convenient day/time
and at their preferred mammography facility/center. Attempts
were made to schedule the screening appointments 2–4 weeks
after hospital discharge. After discharge from the hospital, patients received a reminder about their forthcoming appointments
by phone call, 24 hours before their scheduled appointments. On
successfully completing their screening appointment, a $10 gift
card was mailed to their home address. Patients were explained
that the gift card could be used to offset the cost associated with
transportation to their appointments. A short follow-up survey
was done within 1 week after the scheduled appointment to
assess the patient’s compliance with their scheduled appointments and to evaluate their experience with their appointments or
barriers if they missed the mammogram.
The Institutional Review Board at JHBMC approved the
study protocol. All study participants provided their written
informed consent for participation.
Respondent characteristics are presented as proportions and
means. Unpaired t-test and Fisher’s exact tests were used to
compare demographic and socioeconomic characteristics
among women who did and did not get a screening mammogram at their prearranged appointments. T-tests and Fisher’s exact tests determined significance at p-value £0.05. Data
were analyzed using the Stata statistical software (StataCorp
LP, Version 13.1).
Outcome and evaluation
Our primary outcome of interest was the proportion of
women who underwent a screening mammogram posthospitalization. We also evaluated patients’ satisfaction with
the study intervention (via phone survey) after completion of
screening appointments as a secondary outcome.
Results
The mean age of the study population was 57.8 years, 57%
were African American, 3% were uninsured, and 37% women
were at high risk for breast cancer (5-year risk prediction Gail
score ‡1.7%). Characteristics of the study participants are shown
in Table 1. There were almost no differences in characteristics
among women who did and did not get their screening mammogram except that women who received outpatient screening
mammogram were more likely to be Caucasian ( p = 0.007),
admitted under observation status ( p = 0.05), and had a shorter
hospital length of stay ( p = 0.009).
Three-quarters of the screening mammography appointments were scheduled between 2 and 4 weeks after hospital
discharge. The others, 26% (n = 8) were scheduled 4–5 weeks
after discharge because of patient preference.
One-third of the study population, 10 women, successfully
completed the screening mammography appointments. Of
them, five women (50%) required additional imaging and
follow-up.
The most common barriers described by the 30 women
who enrolled in our study who were previously nonadherence
Table 1. Characteristics of the Study Population
Characteristics
Age (years), mean (SD)
Race
Caucasians, n (%)
African American, n (%)
Married, n (%)
High school or more years of education, n (%)
Employed, n (%)
Chronic disability, wheel chair, or bed bound, n (%)
5-year risk prediction using Gail model, mean (SD)c
Family history of breast cancer, n (%)d
BMI (kg/m2), mean (SD)
Annual household income
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