Organization Communication Factors and Abnormal Mammogram Follow-up: a Qualitative Study Among Ethnically Diverse Women Across Three Healthcare Systems.
Organization Communication Factors and Abnormal Mammogram Follow-up: a Qualitative Study Among Ethnically Diverse Women Across Three Healthcare Systems.
复制标题
组织沟通因素和异常乳房X光检查随访：对三个医疗系统的不同种族女性的定性研究。
DOI：
10.1007/s11606-020-05972-2
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发表时间：
2020
影响因子：
5.7
通讯作者：
Burke,NancyJ
中科院分区：
文献类型：
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作者：
Kenny,JazmineD;Karliner,LeahS;Kerlikowske,Karla;Kaplan,CeliaP;Fernandez-Lamothe,Ana;Burke,NancyJ
研究背景对符合条件的一般风险妇女进行定期乳房X线检查与早期发现和降低癌症发病率和死亡率有关。延迟随访和解决异常乳房X线检查限制了早期检测工作，并可能导致心理困扰和焦虑。本研究的目的是从女性的叙述中了解与护理沟通和协调相关的组织因素如何促进或阻碍对异常乳房X线检查结果的及时随访。设计我们对来自四个种族-民族群体的女性进行了61次定性面对面访谈（非裔美国人、中国人、拉丁裔和白色人）在三种不同的医疗保健环境（学术、社区和安全网）中。符合条件的参与者在前一年在旧金山弗朗西斯科乳房X线摄影登记处有异常的乳房X线摄影结果，需要进行乳房活检。一个扎根的理论方法被用来确定主题的采访。关键结果参与者的经验，后续行动和诊断在很大程度上取决于沟通过程。21名参与者经历了随访延迟（索引乳房X线检查和活检之间> 30天）。组织因素在不同机构中各不相同，在有效沟通中起着关键作用，包括（a）直接的口头沟通，能够提出问题，（B）解释医疗过程和术语，避免行话，以及（c）结论卫生组织在异常结果沟通和支持人员的可用性方面存在差异和口译服务。那些从拥有更强大的支持人员（如双语导航员）的机构接受护理的妇女，往往报告说了解他们的结果并及时进行异常乳房X光检查。这些报告在来自不同种族群体的妇女中是一致的，并表明在异常乳房X线检查和解决方案之间的组织支持服务对于改善随访时间和最大限度地减少患者痛苦的价值。
BackgroundRegular mammogram screening for eligible average risk women has been associated with early detection and reduction of cancer morbidity and mortality. Delayed follow-up and resolution of abnormal mammograms limit early detection efforts and can cause psychological distress and anxiety.ObjectiveThe goal of this study was to gain insight from women’s narratives into how organizational factors related to communication and coordination of care facilitate or hinder timely follow-up for abnormal mammogram results.DesignWe conducted 61 qualitative in-person interviews with women from four race-ethnic groups (African American, Chinese, Latina, and White) in three different healthcare settings (academic, community, and safety-net).ParticipantsEligible participants had an abnormal mammogram result requiring breast biopsy documented in the San Francisco Mammography Registry in the previous year.ApproachInterview narratives included reflections on experience and suggested improvements to communication and follow-up processes. A grounded theory approach was used to identify themes across interviews.Key ResultsParticipants’ experiences of follow-up and diagnosis depended largely on communication processes. Twenty-one participants experienced a follow-up delay (> 30 days between index mammogram and biopsy). Organizational factors, which varied across different institutions, played key roles in effective communication which included (a) direct verbal communication with the ability to ask questions, (b) explanation of medical processes and terminology avoiding jargon, and (c) use of interpretation services for women with limited English proficiency.ConclusionHealth organizations varied in their processes for abnormal results communication and availability of support staff and interpretation services. Women who received care from institutions with more robust support staff, such as bilingual navigators, more often than not reported understanding their results and timely abnormal mammogram follow-up. These reports were consistent across women from diverse ethnic groups and suggest the value of organizational support services between an abnormal mammogram and resolution for improving follow-up times and minimizing patient distress.