A qualitative study of medically underserved women's psychosocial sequelae after receiving abnormal mammography results

Objective: To explore medically underserved women's personal feelings, thoughts, and values about barriers and facilitators to receiving diagnostic services following abnormal mammography results. Background: Although there is a body of literature on barriers to annual mammography screening and on factors associated with delay in seeking care for breast symptoms, few studies have investigated factors associated with timely follow-up of abnormal mammography findings in minority and medically underserved women. African-American women experience higher breast cancer mortality rates compared with white women (33.0 of 100,000 vs. 22.0 of 100,000, respectively) and continue to have a lower-five year survival (77%) compared to white women (90%) despite comparable mammography screening rates. Screening mammography has been shown to effectively identify breast cancer at an early stage; yet, delay of mammography follow-up diminishes the maximal benefit of mammography as an early detection breast cancer tool. Methods: Qualitative analysis of focus groups of 14 minority and medically underserved patients with abnormal mammography results were interviewed about psychosocial and etiologic breast cancer risk factors that affect mammography follow-up in the public hospital setting. Two sets of thematic focus groups were conducted; one set of focus groups for women who resolved their abnormal mammograms >45 days and the other set of focus groups for women who resolved their abnormal mammograms ≤ 45 days. Results: Using standard qualitative techniques, patient's responses were analyzed and grouped into taxonomy of major themes reflecting: 1) Patient's attitudes, beliefs and personal characteristics, 2) Environmental barriers, 3) Interpersonal relationships, 4) Community and cultural beliefs. Conclusions: Factors associated with a women's decision to return for follow-up care after being informed of abnormal screening results can be profound and may diminish their ability to get necessary information and services. Women who received care in ≤ 45 days more often reported an appreciation of efforts by providers and clinic staff to support their prompt follow-up. Prominent themes among women who delayed care for >45 days included anxiety and fear about a possible cancer diagnosis. A comprehensive approach to improving timely diagnostic follow-up among underserved groups must address patient beliefs and attitudes, provider practices and communication, and clinical processes at the health care systems level.