Urban Women's Preferences for Learning of Their Mammogram Result: a Qualitative Study

Theoretical Background and research questions/hypothesis: 1. Research suggests that communication of mammogram results is suboptimal for many ethnic minority women. The goals of our project were 1. To improve understanding of low income inner city English-speaking women's experiences learning of their mammogram result; 2. To elicit their preferences as to how the communication of mammogram results could be improved; and 3. To gather information to help inform the development of a new tool for communicating mammogram results.

Methods: A convenience sample of 34 women was recruited in the community to participate in 4 focus groups, each of which was led by an African-American female moderator. Themes discussed included how each woman had learned of her result, how result reporting could be improved, and what types of interventions might be effective to improve women's understanding of their results. The investigators also showed the women a typical mammogram result letter and asked for their opinions. Two investigators separately performed a thematic analysis of the transcripts using an immersion and crystallization approach.

Results: 36 women participated in the study. 85 % (n=29) self-identified as African-American. 39 % (n=14) qualified for Medicaid; 36% (n=13) reported that they lacked insurance. 56 % (n=20) reported an annual income of less than $10,000. Salient themes included general dissatisfaction with how results were reported, with some women saying that they did not recall receiving a letter or receiving a call informing them of their results. Several women reported anxiety simply learning of their results, even if they were normal. Many of the women said that the result notification letter contained words they could not understand, was vague, and did not effectively convey the need for follow-up. Women expressed a preference for learning of the result directly from their physician. Women were unaware of how common it is to be called back for a repeat imaging study, and wanted to be prepared for this possibility in advance, through informational videos and pamphlets. Women expressed a preference for print materials that included pictures, testimonials, and an action plan including a hotline to call with questions.

Conclusions: This qualitative study of a predominantly African-American, low-income population of inner city women suggests that current methods for reporting mammogram results are flawed. Advance education about what occurs after a mammogram may improve patients' understanding of their results and reduce anxiety.

Implications for research and/or practice: To increase patient satisfaction, print materials informing women of their results should incorporate photographs and testimonials and include information about where to obtain a more detailed explanation about specific results.