AR: Patient communication could boost mammo screening

Radiologists need to make a potentially radical transition and embrace patient communication and education to counteract the potentially negative effects of the U.S. Preventive Services Task Force screening mammography recommendations, according to an editorial published online Aug. 11 in Academic Radiology.

The revised USPSTF guidelines provide no recommendation for screening mammography for women ages 40 to 49 and leave the decision in the hands of individual women and their physicians. However, whether or not busy primary care providers can and will discuss screening with women remains in doubt.

“A recent study describing patient-physician discussion about breast cancer screening during a routine visit demonstrated that there is overall limited informed and shared decision-making. Only [2] percent of women reported a complete discussion of all elements of informed decision-making,” wrote Gelareh Sadigh, MD, from the department of radiology at University of Michigan Health Center in Ann Arbor, and colleagues.

This gap may harm patients and opens the door for radiologists to discuss screening mammography with women and potentially clarify conflicting recommendations about the exam.

Sadigh and colleagues offered several avenues for radiologist-patient communication. Face-to-face consultation before, during and after screening is one way for radiologists to establish a caregiver role. Patient-physician communication, they continued, is particularly critical among women in the 40 to 49 age group and those less likely to adhere to screening programs, such as minorities and women of lower socioeconomic and educational status.

The editorialists acknowledged that face-to-face communication is not always feasible and presented additional strategies for radiologists to broadcast their message and reinforce the value of screening mammography. These include conventional media like patient brochures, decision aids and interactive websites and may extend to avatars and online communication portals in the future.

The ideal breast imaging center
Sadigh and colleagues offered strategies for designing a patient-centered practice. These include:

• Improved scheduling (web-based or single-call);
• Minimal wait times;
• Adequate preprocedural explanation of the study;
• Same sex screening staff; and
• Face-to-face interaction with radiologists to discuss the result.

“These strategies not only satisfy the individual patient, but also increase the patient return rate because the patient may act as an indirect marketing tool via word of mouth,” Sadigh and colleagues wrote.

Although changing the current breast cancer screening workflow may represent a financial and administrative burden, it can be approached on a step-by-step basis, according to the editorialists.

Initial steps—educating residents and specialists about shared decision-making and communication, training staff regarding patient-centered service and producing educational materials—are relatively low cost, they noted. Additional strategies, including decision coaches, tailored decision aids and individualized risk information, can be developed and implemented over the longer term.

The editorialists reinforced two key points, writing, “Optimization of the radiology practice requires potentially radical changes but may be viewed as the cost of doing business.” It also may deliver a competitive advantage, they continued.

Finally, participation ultimately makes or breaks a screening program. “High attendance is a prerequisite for a successful screening program,” the editorialists concluded.

For more about screening mammography, read the September Health Imaging & IT cover story “USPSTF Guidelines Two Years Later: The Fallout Continues.”