Patient satisfaction with screening mammography: Online vs off-line interpretation

doi:10.1016/S1076-6332(98)80261-4

Academic Radiology

Volume 5, Issue 11, November 1998, Pages 771-778

https://doi.org/10.1016/S1076-6332(98)80261-4 Get rights and content

Rationale and Objectives.

The purpose of this study was to determine patient satisfaction with online and off-line methods of interpreting screening mammograms and to determine those characteristics that most influence patient preferences.

Materials and Methods.

A survey consisting of 17 questions assessing satisfaction and demographics was distributed to women whose screening mammograms were read in one of two ways at the same facility: (a) the “online” method, in which all additional requested studies are completed and results are immediately communicated, and (b) the “off-line” method, in which mammograms are read in batches the next day, results are communicated at a later time, and patients return for diagnostic studies. To ensure statistical power, at least 174 surveys were collected from each group.

Results.

Of 192 women whose mammograms were interpreted online, 188 (97%) responded, and of 247 women whose mammograms were interpreted off-line, 181 (73%) responded. Overall mean satisfaction with the mammographic experience and with the time it took to receive results differed significantly between the two groups (P < .002). Analysis of the subgroup of very satisfied respondents disclosed that 92% of patients in the online group and 59% of patients in the off-line group were very satisfied with their mammography experience. If allowed to choose the method of interpretation, 97% of patients in the online group and 91% of patients in the off-line group would choose online interpretation.

Conclusion.

Patients preferred online mammographic interpretation of screening studies.

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Cited by (22)

Batch Reading and Interrupted Interpretation of Digital Screening Mammograms Without and With Tomosynthesis
2021, Journal of the American College of Radiology
Citation Excerpt :
Factors affecting performance can be divided into three categories: characteristics of the radiologist, technology and techniques used for interpretation, and radiology practice characteristics. Radiologist characteristics such as increasing years of experience, fellowship training in breast imaging, and higher annual interpretive volumes have all been found to positively influence mammographic performance [6-10]. Digital breast tomosynthesis (DBT) is a newer imaging technology that, when combined with digital mammography (DM), improves recall rates (RRs) and cancer detection rates (CDRs) compared with DM alone [11,12].
To compare batch reading and interrupted interpretation for modern screening mammography.
We retrospectively reviewed digital mammograms without and with tomosynthesis that were originally interpreted with batch reading or interrupted interpretation between January 2015 and June 2017. The following performance metrics were compared: recall rate (per 100 examinations), cancer detection rate (per 1,000 examinations), and positive predictive values for recall and biopsy.
In all, 9,832 digital mammograms were batch read, yielding a recall rate of 9.98%, cancer detection rate of 4.27, and positive predictive values for recall and biopsy of 4.40% and 35.5%, respectively. There were 49,496 digital mammograms that were read with interrupted interpretation, yielding a recall rate of 11.3%, cancer detection rate of 4.44, and positive predictive values for recall and biopsy of 3.92% and 30.1%, respectively. Of the digital mammograms with tomosynthesis, 7,075 were batch read, yielding a recall rate of 6.98%, cancer detection rate of 5.37, and positive predictive values for recall and biopsy of 7.69% and 38.0%, respectively. Of the digital mammograms with tomosynthesis, 24,380 were read with interrupted interpretation, yielding a recall rate of 8.30%, cancer detection rate of 5.41, and positive predictive values for recall and biopsy of 6.52% and 33.3%, respectively. For both digital mammograms without and with tomosynthesis, recall rates improved with batch reading compared with interrupted interpretation (P < .001), but no significant differences were seen for other metrics.
Batch reading digital mammograms without and with tomosynthesis improves recall rates while maintaining cancer detection rates and positive predictive values compared with interrupted interpretation.
Satisfaction With Same-Day-Read Baseline Mammography
2019, Journal of the American College of Radiology
Impact of Immediate Interpretation of Screening Tomosynthesis Mammography on Performance Metrics
2019, Academic Radiology
Citation Excerpt :
The biopsy rate (number of biopsies/total number of screening exams) was 1.6% (19/1212) in the delayed interpretation group and 1.8% (78/4306) in the immediate interpretation group. Several surveys of patients have shown that patients and referring providers prefer immediate results (3,4,13,17). However, previous research found a higher RR (13), which has deterred many centers from offering this service.
This study aimed to compare performance metrics for immediate and delayed batch interpretation of screening tomosynthesis mammograms.
This HIPAA compliant study was approved by institutional review board with a waiver of consent. A retrospective analysis of screening performance metrics for tomosynthesis mammograms interpreted in 2015 when mammograms were read immediately was compared to historical controls from 2013 to 2014 when mammograms were batch interpreted after the patient had departed. A total of 5518 screening tomosynthesis mammograms (n = 1212 for batch interpretation and n = 4306 for immediate interpretation) were evaluated. The larger sample size for the latter group reflects a group practice shift to performing tomosynthesis for the majority of patients. Age, breast density, comparison examinations, and high-risk status were compared. An asymptotic proportion test and multivariable analysis were used to compare performance metrics.
There was no statistically significant difference in recall or cancer detection rates for the batch interpretation group compared to immediate interpretation group with respective recall rate of 6.5% vs 5.3% = +1.2% (95% confidence interval −0.3 to 2.7%; P = .101) and cancer detection rate of 6.6 vs 7.2 per thousand = −0.6 (95% confidence interval −5.9 to 4.6; P = .825). There was no statistically significant difference in positive predictive values (PPVs) including PPV1 (screening recall), PPV2 (biopsy recommendation), or PPV 3 (biopsy performed) with batch interpretation (10.1%, 42.1%, and 40.0%, respectively) and immediate interpretation (13.6%, 39.2%, and 39.7%, respectively). After adjusting for age, breast density, high-risk status, and comparison mammogram, there was no difference in the odds of being recalled or cancer detection between the two groups.
There is no statistically significant difference in interpretation performance metrics for screening tomosynthesis mammograms interpreted immediately compared to those interpreted in a delayed fashion.
Risk Factors for Late Screening Mammography
2019, Current Problems in Diagnostic Radiology
Citation Excerpt :
Factors that have been previously identified as contributing to patient’s mammography experience include pain, anxiety, and embarrassment relating to examination technique, interactions with the mammography technologist, and interactions with radiologists, in addition to factors relating to obtaining an appointment or the mammography facility itself.6,19-21 In addition, patient satisfaction and compliance has also been tied to the rapidity at which mammography results are communicated to the patient.22 Taken together, efforts to reduce waiting time for mammography appointments, and to maximize comfort during the mammography experience, such as through clear and personable communication from mammography technologists and radiologists, may lead to greater on-time screening behavior in the future.
Background: Breast cancer has the highest incidence of cancers in women in the United States. Previous research has shown that screening mammography contributes to reduced breast cancer mortality. This study aimed to clarify why late screening might occur in an at-risk population.
This study was a prospective cross-sectional study including 758 patients presenting to our radiology department for routine screening mammography who completed a 30-question survey regarding personal characteristics and mammography history. Univariate and multivariate logistic regression were performed to determine whether survey responses correlated with late screening.
Of the 758 patients, 184 (24%) were noncompliant with screening mammography guidelines. Risk factors for late screening included younger age (P = 0.001), white race/ethnicity (P = 0.03), self-reported lack of financial means or health insurance (P = 0.005), lack of satisfaction with a previous mammogram experience (P = 0.001), inadequate mammography education by a physician (P = 0.001), and lack of awareness/comprehension of screening mammography guidelines (P = 0.002).
Many factors contribute to late screening mammography. Although some are outside physician control, others can be influenced: patient education regarding screening mammography guidelines, and patient satisfaction with the mammography experience. This study highlights the importance of communication with and education of patients.
Screening Mammography Utilization and Medicare Beneficiaries' Perceptions of Their Primary Care Physicians
2018, Academic Radiology
Citation Excerpt :
Attention to such issues will be increasingly important for radiology practices as screening rates are being applied as a quality metric in existing and new federal programs for assessing the performance of physicians and their health system clinical partners (25,26). In considering factors impacting screening adherence, prior studies have explored women's perceptions of the screening mammography experience, including not only the process of actually undergoing the mammogram, but also aspects of the facility, its staff, as well as the breast imager (27–29). Insights from such studies have been useful for breast imagers in better understanding how to optimize the patient experience in mammography so as to improve screening rates (21,30–32).
To assess associations between screening mammography utilization and Medicare beneficiaries' relationships with, and impressions of, their primary care physicians.
Using the Medicare Current Beneficiary Survey Access to Care Public Use File, we retrospectively studied responses from a national random cross section of Medicare beneficiaries surveyed in 2013 regarding perceptions of their primary care physicians and their screening mammography utilization. Statistical analysis accounted for subject weighting factors to estimate national screening utilization.
Among 7492 female Medicare beneficiaries, 62.0% (95% confidence interval 59.8%–64.2%) underwent screening mammography. Utilization was higher for beneficiaries having (vs. not) a regular medical practice or clinic (63.2% vs. 34.6%) and a usual physician (63.8% vs. 50.3%). Utilization was higher for beneficiaries very satisfied (vs. very dissatisfied) with the overall quality of care they received (66.0% vs. 35.8%), their ease of getting to a doctor (67.7% vs. 43.2%), and their physician's concerns for their health (65.7% vs. 53.4%), as well as for beneficiaries strongly agreeing (vs. strongly disagreeing) that their physician is competent (66.0% vs. 54.1%), understands what is wrong (66.3% vs. 47.1%), answers all questions (67.0% vs. 46.7%), and fosters confidence (66.0% vs. 50.6%). Independent predictors of screening mammography utilization (P < .05) were satisfaction with quality of care, having a regular practice or clinic, and satisfaction with ease of getting to their physician.
Screening mammography utilization is higher among Medicare beneficiaries with established primary physician relationships, particularly when those relationships are favorable. To optimize screening mammography utilization, breast imagers are encouraged to support initiatives to enhance high-quality primary care relationships.
Assessment of mammography experiences and satisfaction among American Indian/Alaska Native Women
2013, Women's Health Issues
Citation Excerpt :
In addition, a body of information has formed regarding patient preferences for learning about the results of their mammograms. These studies have found that women prefer to be told about abnormal results by their primary care physician (Lind, Kopans, & Good, 1992) and that satisfaction increases if results are directly interpreted so that further diagnostic studies can be performed while they are still at the facility (Hulka et al., 1997; Wilson et al., 1998). However, these studies were conducted using instruments whose psychometric properties were not tested.
American Indian/Alaska Native (AI/AN) women have lower breast cancer (BCA) screening and 5-year survival rates than non-Hispanic Whites. Understanding reasons for low screening rates is important to combatting later stage diagnoses. The purpose of this study was to assess mammography experiences and satisfaction among AI/AN women.
Nine focus groups were held with rural (N = 15) and urban (N = 38) AI/AN women 40 years and older in Kansas and Kansas City, Missouri, living both near and far from Indian Health Service (IHS) and tribal facilities, to examine experiences and satisfaction with mammography. Transcripts were coded and themes identified using a community-based participatory research approach.
Themes were classified under knowledge, communication, and awareness of BCA; barriers to mammography; mammogram facility size; impressions of mammogram technologist; motivations for getting a mammogram; and how to improve the mammogram experience. Participants had knowledge of prevention, but described cultural reasons for not discussing it and described better experiences in smaller facilities. Participants indicated having a mammogram technologist who was friendly, knowledgeable, respectful, competent, and explained the test was a determining factor in satisfaction. Other factors included family history, physician recommendation, and financial incentives. Barriers included transportation, cost, perceptions of prejudice, and time constraints. Participants on reservations or near IHS facilities preferred IHS over mainstream providers. Suggestions for improvement included caring technologists, better machines with less discomfort, and education.
Interventions to enhance the professionalism, empathy, and cultural awareness of mammogram technologists; reduce barriers; and provide positive expectations and incentives could improve satisfaction and compliance with screening mammography.

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View full text

Original investigationPatient satisfaction with screening mammography: Online vs off-line interpretation

Rationale and Objectives.

Materials and Methods.

Results.

Conclusion.

Acad Radiol

How to initiate and operate a low-cost screening mammography center

Radiology

Mammographic screening: how to operate successfully at low cost

Radiology

Quality-oriented mass mammography screening

Radiology

Medical audit of a rapid-throughput mammography screening practice: methodology and results of 27,114 examinations

Radiology

Cost-effective management of breast cancer

Cancer Supplement

Women's attitude about receiving mammographic results directly from radiologists

Radiology

Benefit of independent double reading in a population-based mammography-screening program

Radiology

Original investigation
Patient satisfaction with screening mammography: Online vs off-line interpretation