Experiences of Women Who Refuse Recall for Further Investigation of Abnormal Screening Mammography: A Qualitative Study
Abstract
:1. Introduction
2. Methods
2.1. Design
2.2. Data Collection
2.3. Analysis and Rigor
2.4. Ethical Considerations
3. Results
3.1. Participants’ Characteristics and Identified Themes
3.2. Theme 1. Negative Screening Experiences
3.2.1. Pain of Examination
“I was very uncomfortable during the examination. It was terribly painful, and it hurt constantly for two weeks. It really hurt! It was really painful. I really don’t want to do this examination ever again!”
3.2.2. Inconvenience of Medical Treatment: Waiting Time
“I don’t want to go to the hospital anymore, I’m so scared!…I waited and waited the whole morning for the doctor to see me for only 2 or 3 min…”
“I have registered at the other General Hospital for the further check-up (ultrasound examination), but it requires a lot of steps and time to wait until my turn in the afternoon, so I did not want to wait anymore.”
“The mobile mammography vehicle is very convenient for time! Normally, you have to go to the hospital for a long time to queue up for this examination. Visiting the hospital for an examination is a lot of trouble for me.”
3.2.3. Dissatisfaction about Paying for Further Examination
“Breast cancer screening is a free service. Why should I have to pay for further examination with my own money? This is terrible. Plus, during the mammography, the squeezing hurt so much; it was very uncomfortable. And now I need to pay for an examination!?! I can’t accept it. Who would be willing to do it?”
“You keep calling and telling us to go back for further examination. It makes people wonder if there is any problem. So I try to cooperate with you and follow your instructions, but the problem is…I have to pay for this on my own…do you know what I mean? I’m not happy about this.”
3.3. Theme 2. Struggling with ‘To Go or Not to Go’
3.3.1. Perceiving One’s Susceptibility to Breast Cancer as Very Low
3.3.2. Questioning the Accuracy of the Results
3.3.3. Procrastinating Ostrich Mentality
3.4. Theme 3. Rationalizing without Follow-Up Examination
3.4.1. Fatalism
3.4.2. Paying Attention to Self-Cultivation
4. Discussion
5. Study Limitations
6. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Acknowledgments
Conflicts of Interest
References
- World Health Organization. Breast Cancer. 2021. Available online: https://www.who.int/news-room/fact-sheets/detail/breast-cancer (accessed on 26 March 2021).
- Kuo, C.S.; Chen, G.R.; Hung, S.H.; Liu, Y.L.; Huang, K.C.; Cheng, S.Y. Women with abnormal screening mammography lost to follow-up: An experience from Taiwan. Medicine 2016, 95, e3889. [Google Scholar] [CrossRef]
- Health Promotion Administration, Ministry of Health and Welfare. Cancer Registry Annual Report. 2018. Available online: https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=269&pid=13498 (accessed on 22 March 2021).
- American Cancer Society. Understanding Your Mammogram Report. 2019. Available online: https://www.cancer.org/content/dam/CRC/PDF/Public/8579.00.pdf (accessed on 13 October 2019).
- Youlden, D.R.; Cramb, S.M.; Yip, C.H.; Baade, P.D. Incidence and mortality of female breast cancer in the Asia-Pacific region. Cancer Biol. Med. 2014, 11, 101–115. [Google Scholar]
- Fuller, M.S.; Lee, C.I.; Elmore, J.G. Breast cancer screening: An evidence-based update. Med. Clin. N. Am. 2015, 99, 451–468. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gartlehner, G.; Thaler, K.; Chapman, A.; Kaminski-Hartenthaler, A.; Berzaczy, D.; Van Noord, M.G.; Helbich, T.H. Mammography in combination with breast ultrasonography versus mammography for breast cancer screening in women at average risk. Cochrane Database Syst. Rev. 2013, 4, CD009632. [Google Scholar] [CrossRef] [PubMed]
- Yen, A.M.; Tsau, H.S.; Fann, J.C.Y.; Chen, S.L.S.; Chiu, S.Y.H.; Lee, Y.C.; Pan, S.L.; Chiu, H.M.; Kuo, W.H.; Chang, K.J.; et al. Population-based breast cancer screening with risk-based and universal mammography screening compared with clinical breast examination: A propensity score analysis of 1,429,890 Taiwanese women. JAMA Oncol. 2016, 2, 915–921. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Health Promotion Administration, Ministry of Health and Welfare. Statistics of Health Promotion 2019. 2021. Available online: https://www.hpa.gov.tw/Pages/Detail.aspx?nodeid=268&pid=14567 (accessed on 16 September 2021).
- Wells, K.J.; Luque, J.S.; Miladinovic, B.; Vargas, N.; Asvat, Y.; Roetzheim, R.G.; Kumar, A. Do community health worker interventions improve rates of screening mammography in the United States? A systematic review. Cancer Epidemiol. Biomark. Prev. 2011, 20, 1580–1598. [Google Scholar] [CrossRef] [Green Version]
- Allen, B., Jr.; Bazargan-Hejazi, S. Evaluating a tailored intervention to increase screening mammography in an urban area. J. Natl. Med. Assoc. 2005, 97, 1350–1360. [Google Scholar] [PubMed]
- Geller, B.M.; Bogart, A.; Carney, P.A.; Sickles, E.A.; Smith, R.A.; Monsees, B.; Bassett, L.W.; Buist, D.M.; Kerlikowske, K.; Onega, T.; et al. Educational interventions to improve screening mammography interpretation: A randomized, controlled trial. AJR Am. J. Roentgenol. 2014, 202, W586–W596. [Google Scholar] [CrossRef] [Green Version]
- Yabroff, K.R.; O’Malley, A.; Mangan, P.; Mandelblatt, J. Inreach and outreach interventions to improve mammography use. J. Am. Med. Womens Assoc. 2001, 56, 166–173. [Google Scholar]
- Anagnostopoulos, F.; Dimitrakaki, C.; Fitzsimmons, D.; Potamianos, G.; Niakas, D.; Tountas, Y. Health beliefs and illness perceptions as related to mammography uptake in randomly selected women in Greece. J. Clin. Psychol. Med. Settings 2012, 19, 147–164. [Google Scholar] [CrossRef] [PubMed]
- Qin, X.; Nagler, R.H.; Fowler, E.F.; Gollust, S.E. U.S. women’s perceived importance of the harms and benefits of mammograms and associations with screening ambivalence: Results from a national survey. Prev. Med. 2019, 123, 130–137. [Google Scholar] [CrossRef]
- Montgomery, M.; McCrone, S.H. Psychological distress associated with the diagnostic phase for suspected breast cancer: Systematic review. J. Adv. Nurs. 2010, 66, 2372–2390. [Google Scholar] [CrossRef] [PubMed]
- Hafslund, B.; Nortvedt, M.W. Mammography screening from the perspective of quality of life: A review of the literature. Scand. J. Caring Sci. 2009, 23, 539–548. [Google Scholar] [CrossRef] [PubMed]
- Montgomery, M. Uncertainty during breast diagnostic evaluation: State of the science. Oncol. Nurs. Forum. 2010, 37, 77–83. [Google Scholar] [CrossRef] [Green Version]
- Bredal, I.S.; Kåresen, R.; Skaane, P.; Engelstad, K.S.; Ekeberg, Ø. Recall mammography and psychological distress. Eur. J. Cancer 2013, 49, 805–811. [Google Scholar] [CrossRef]
- Kitano, A.; Yamauchi, H.; Hosaka, T.; Yagata, H.; Hosokawa, K.; Ohde, S.; Nakamura, S.; Takimoto, M.; Tsunoda, H. Psychological impact of breast cancer screening in Japan. Int. J. Clin. Oncol. 2015, 20, 1110–1116. [Google Scholar] [CrossRef] [PubMed]
- Reece, J.C.; Neal, E.F.; Nguyen, P.; McIntosh, J.G.; Emery, J.D. Delayed or failure to follow-up abnormal breast cancer screening mammograms in primary care: A systematic review. BMC Cancer 2021, 21, 1–14. [Google Scholar] [CrossRef] [PubMed]
- Graneheim, U.H.; Lundman, B. Qualitative content analysis in nursing research: Concepts, procedures and measures to achieve trustworthiness. Nurs. Educ. Today 2004, 24, 105–112. [Google Scholar] [CrossRef]
- Lincoln, Y.S.; Guba, E.G. Naturalistic Inquiry; Sage: Newbury Park, CA, USA, 1985. [Google Scholar]
- Brett, J.; Austoker, J. Women who are recalled for further investigation for breast screening: Psychological consequences 3 years after recall and factors affecting re-attendance. J. Public Health Med. 2001, 23, 292–300. [Google Scholar] [CrossRef] [Green Version]
- Bond, M.; Pavey, T.; Welch, K.; Cooper, C.; Garside, R.; Dean, S.; Hyde, C. Systematic review of the psychological consequences of false-positive screening mammograms. Health Technol. Assess. 2013, 17, 1–170. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Sandin, B.; Chorot, P.; Valiente, R.M.; Lostao, L.; Santed, M.A. Adverse psychological effects in women attending a second-stage breast screening. J. Psychosom. Res. 2002, 52, 303–309. [Google Scholar] [CrossRef]
- Kilbourn, K.; Martens, K. Available evidence suggests women with false-positive mammograms less likely to return for screening. Evid. Based Nurs. 2014, 17, 73. [Google Scholar] [CrossRef]
- Brett, J.; Bankhead, C.; Henderson, B.; Watson, E.; Austoker, J. The psychological impact of mammographic screening. A systematic review. Psycho-Oncology 2005, 14, 917–938. [Google Scholar] [CrossRef] [PubMed]
- He, X.; Schifferdecker, K.E.; Ozanne, E.M.; Tosteson, A.N.; Woloshin, S.; Schwartz, L.M. How do women view risk-based mammography screening? A qualitative study. J. Gen. Intern. Med. 2018, 33, 1905–1912. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Kornguth, P.J.; Keefe, F.J.; Conaway, M.R. Pain during mammography: Characteristics and relationship to demographic and medical variables. Pain 1996, 66, 187–194. [Google Scholar] [CrossRef]
- Sapir, R.; Patlas, M.; Strano, S.D.; Hadas-Halpern, I.; Cherny, N.I. Does mammography hurt? J. Pain Symptom. Manag. 2003, 25, 53–63. [Google Scholar] [CrossRef]
- de Groot, J.E.; Broeders, M.J.; Grimbergen, C.A.; den Heeten, G.J. Pain-preventing strategies in mammography: An observational study of simultaneously recorded pain and breast mechanics throughout the entire breast compression cycle. BMC Womens Health 2015, 15, 1–9. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Gierisch, J.M.; O’Neill, S.C.; Rimer, B.K.; DeFrank, J.T.; Bowling, J.M.; Skinner, C.S. Factors associated with annual-interval mammography for women in their 40s. Cancer Epidemiol. 2009, 33, 72–78. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Chiang, H.H.; Lu, Z.Y. Cultural perspectives of health and illness in the context of nursing. J. Nurs. 1996, 43, 42–48. [Google Scholar]
Code | Age | Education | Number of Children | Breast Related Diseases | Family History of Breast Cancer | Mobile Mammography Vehicle | Abnormal Mass |
---|---|---|---|---|---|---|---|
A | 68 | Illiterate | 5 | No | sister | Yes | No |
B | 66 | Secondary | 3 | colorectal cancer | No | Yes | Yes |
C | 67 | Secondary | 0 | No | No | Yes | No |
D | 49 | Higher education | 3 | benign | No | No | No |
E | 55 | Higher education | 2 | benign | No | No | Yes |
F | 57 | College/University | 2 | No | No | No | No |
G | 64 | College/University | 2 | No | No | No | Yes |
H | 64 | College/University | 0 | No | No | No | No |
I | 54 | College/University | 1 | No | sister | No | No |
J | 64 | Elementary | 6 | No | No | Yes | No |
K | 51 | Higher education | 2 | No | No | No | No |
L | 56 | College/University | 2 | No | No | Yes | No |
M | 58 | Higher education | 2 | No | No | Yes | No |
Theme | Sub-Theme | Number (Percentage) |
---|---|---|
Negative screening experiences | Pain of examination | 7(53.8%) |
Inconvenience of medical treatment: waiting time | 4(30.8%) | |
Dissatisfaction with having to pay for a further examination | 2(15.4%) | |
Struggling with ’to go or not to go’ | Perceived susceptibility to breast cancer very low | 10(76.9%) |
Questioning the accuracy of the results | 3(23.1%) | |
Procrastinating ostrich mentality | 4(30.8%) | |
Rationalizing without follow-up examination | Fatalism | 5(38.5%) |
Paying attention to self-cultivation | 4(30.8%) |
Publisher’s Note: MDPI stays neutral with regard to jurisdictional claims in published maps and institutional affiliations. |
© 2022 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
Share and Cite
Sung, W.-Y.; Yang, H.-C.; Liao, I.-C.; Su, Y.-T.; Chen, F.-H.; Chen, S.-L. Experiences of Women Who Refuse Recall for Further Investigation of Abnormal Screening Mammography: A Qualitative Study. Int. J. Environ. Res. Public Health 2022, 19, 1041. https://doi.org/10.3390/ijerph19031041
Sung W-Y, Yang H-C, Liao I-C, Su Y-T, Chen F-H, Chen S-L. Experiences of Women Who Refuse Recall for Further Investigation of Abnormal Screening Mammography: A Qualitative Study. International Journal of Environmental Research and Public Health. 2022; 19(3):1041. https://doi.org/10.3390/ijerph19031041
Chicago/Turabian StyleSung, Wei-Ying, Hui-Chuan Yang, I-Chen Liao, Yu-Ting Su, Fu-Husan Chen, and Shu-Ling Chen. 2022. "Experiences of Women Who Refuse Recall for Further Investigation of Abnormal Screening Mammography: A Qualitative Study" International Journal of Environmental Research and Public Health 19, no. 3: 1041. https://doi.org/10.3390/ijerph19031041