A mixed-methods study of multi-level factors influencing mammography overuse among an older ethnically diverse screening population: implications for de-implementation.
A mixed-methods study of multi-level factors influencing mammography overuse among an older ethnically diverse screening population: implications for de-implementation.
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DOI：
10.1186/s43058-021-00217-7
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发表时间：
2021-09-26
影响因子：
--
通讯作者：
Shelton RC
中科院分区：
文献类型：
--
作者：
Austin JD;Tehranifar P;Rodriguez CB;Brotzman L;Agovino M;Ziazadeh D;Moise N;Shelton RC
人们越来越担心，常规乳房X光检查在老年妇女中被过度使用。成功和公平地取消乳房X光检查将需要对导致乳房X光检查过度使用的因素有多层次的了解。这项解释性的、顺序的、混合方法的研究收集了调查数据（n= 52，73.1%为西班牙裔，73.1%为西班牙语），来自接受筛查性乳腺X射线摄影检查时年龄≥70岁的女性，随后对完成调查的老年女性子集进行半结构化访谈（n=19，63.2%西班牙裔，63.2%讲西班牙语）和提供者（n=5，4初级保健，1妇产科），以更好地了解影响乳腺X射线摄影过度使用的多层次因素，并为潜在的取消实施策略提供信息。我们对调查数据进行了描述性分析，对定性访谈数据进行了内容分析。调查和访谈数据分别进行了检查，比较，整合，并根据诺顿和钱伯斯连续的影响因素去执行过程的组织。调查结果显示，87.2%的老年妇女认为计划每年进行乳房X光检查很重要，80.8%的老年妇女收到了提供者的建议，78.9%的老年妇女在过去12个月内收到了安排乳房X光检查的提醒。根据对老年妇女的采访，大多数人不知道或不认为有过度使用的经历，并打算继续进行乳房X光检查筛查。与老年妇女和提供者的访谈结果表明，老年妇女有多种机会获得乳房X光检查。根据对提供者的采访，几乎所有人都报告说，减少过度使用不被系统或其他提供者视为优先事项。提供者还讨论了不同提供者之间乳房X光检查筛查实践的差异，对不当行为的恐惧以及金钱激励可能会导致过度筛查。提供者确定了减少过度筛查的潜在策略，包括对患者和提供者进行有关筛查危害的教育，利用电子健康记录来识别可能从筛查中获得较少健康益处的女性，定制系统生成的提醒函，以及组织工作组制定围绕乳房X光检查筛查的标准护理流程。导致乳腺X线摄影过度使用的多层次因素是动态的、相互关联的和强化的。为了确保公平的去执行，有必要对理论，模型和去执行框架进行更精细和经验性的测试，其中包含一个强大的患者层面组件，该组件考虑了多层次因素和更大的护理提供过程之间的相互作用。在线版本包含补充材料，可通过10.1186/s43058-021-00217-7获得。
There is growing concern that routine mammography screening is overused among older women. Successful and equitable de-implementation of mammography will require a multi-level understanding of the factors contributing to mammography overuse. This explanatory, sequential, mixed-methods study collected survey data (n= 52, 73.1% Hispanic, 73.1% Spanish-speaking) from women ≥70 years of age at the time of screening mammography, followed by semi-structured interviews with a subset of older women completing the survey (n=19, 63.2% Hispanic, 63.2% Spanish-speaking) and providers (n=5, 4 primary care, 1 obstetrics and gynecology) to better understand multi-level factors influencing mammography overuse and inform potential de-implementation strategies. We conducted a descriptive analysis of survey data and content analysis of qualitative interview data. Survey and interview data were examined separately, compared, integrated, and organized according to Norton and Chambers Continuum of Factors Influencing De-Implementation Process. Survey findings show that 87.2% of older women believe it is important to plan for an annual mammogram, 80.8% received a provider recommendation, and 78.9% received a reminder in the last 12 months to schedule a mammogram. Per interviews with older women, the majority were unaware of or did not perceive to have experienced overuse and intended to continue mammography screening. Findings from interviews with older women and providers suggest that there are multiple opportunities for older women to obtain a mammogram. Per provider interviews, almost all reported that reducing overuse was not viewed as a priority by the system or other providers. Providers also discussed that variation in mammography screening practices across providers, fear of malpractice, and monetary incentives may contribute to overscreening. Providers identified potential strategies to reduce overscreening including patient and provider education around harms of screening, leveraging the electronic health record to identify women who may receive less health benefit from screening, customizing system-generated reminder letters, and organizing workgroups to develop standard processes of care around mammography screening. Multi-level factors contributing to mammography overuse are dynamic, interconnected, and reinforced. To ensure equitable de-implementation, there is a need for more refined and empirical testing of theories, models, and frameworks for de-implementation with a strong patient-level component that considers the interplay between multilevel factors and the larger care delivery process. The online version contains supplementary material available at 10.1186/s43058-021-00217-7.
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DOI：
10.1186/s13012-021-01097-0
发表时间：
2021-03-19
期刊：
Implementation science : IS
影响因子：
--
作者：
Brownson RC;Kumanyika SK;Kreuter MW;Haire-Joshu D
通讯作者：
Haire-Joshu D
影响因子：
105.7
作者：
Lee, Sei J.;Boscardin, W. John;Walter, Louise C.
通讯作者：
Walter, Louise C.
影响因子：
5.4
作者：
Levinson, Wendy;Kallewaard, Marjon;Kerr, Eve A.
通讯作者：
Kerr, Eve A.
影响因子：
3.6
作者：
Braithwaite D;Demb J;Henderson LM
通讯作者：
Henderson LM
影响因子：
158.5
作者：
Fletcher, SW;Elmore, JG
通讯作者：
Elmore, JG