Rationale and Objectives
Research on communication between radiologists and women undergoing screening and diagnostic mammography is limited. We describe community radiologists’ communication practices with patients regarding screening and diagnostic mammogram results and factors associated with frequency of communication.
Materials and Methods
We received surveys from 257 radiologists (70% of those eligible) about the extent to which they talk to women as part of their health care visit for either screening or diagnostic mammograms, whether this occurs if the exam assessment is positive or negative, and how they use estimates of patient risk to convey information about an abnormal exam where the specific finding of cancer is not yet known. We also assessed characteristics of the radiologists to identify associations with more or less frequent communication at the time of the mammogram.
Results
Two hundred and forty-three radiologists provided complete data (95%). Very few (<6%) reported routinely communicating with women when screening mammograms were either normal or abnormal. Fewer than half (47%) routinely communicated with women when their diagnostic mammograms were normal, whereas 77% often or always communicated with women when their diagnostic exams were abnormal. For positive diagnostic exams, female radiologists were more likely to be frequent communicators compared to males (87.1%–72.8%; P = .02) and those who spend 40%–79% of their time in breast imaging (94.6%) were more likely to be frequent communicators compared to those who spend less time (67.2%–78.9%; P = .02). Most radiologists convey risk information using general rather than numeric statements (57.7% vs. 28.5%).
Conclusions
Radiologists are most likely to convey information about diagnostic mammographic findings when results are abnormal. Most radiologists convey risk information using general rather than numeric statements.
Communication is a key aspect of quality health care, because it fosters trust in the physician-patient relationship . Several studies have focused on patient communication in health care in general and in cancer care in general. Overall, there is consensus that physician-patient communication could be improved . For example, patients often leave health care visits confused about the need for further workup and the therapeutic value of what was done at their last procedure . Another study found that a high degree of physician-initiated communication is associated with patients’ perception of having a treatment choice, and higher satisfaction with their cancer care in the 3–6 months after breast surgery .
Though this body of literature is expanding, much less is known about the communication that occurs between radiologists and women undergoing mammography. This is in part due to the fact that the person directly interacting with the patient to obtain the exam is the radiologic technologist rather than the radiologist, but evidence regarding the anxiety women experience when undergoing mammography underscores the need for effective communication. In fact, some research indicates that women experience significant dissatisfaction with the communication they have with radiologists , with one study showing that poor communication between physicians and patients at the time of the mammogram reduced adherence to follow-up examinations . Important limitations exist with the studies conducted on this issue to date, which include assessments done only at academic medical centers and communication that occurs between trainees and patients .
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Methods
Study Population
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Measurements
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Statistical Analyses
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Results
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Table 1
Radiologist Characteristics
Characteristics_n_ (%) Total 243 (100.0) Demographics Sex Male 173 (71.2) Female 70 (28.8) Practice type Primary affiliation with academic medical center No 196 (81.7) Adjunct 22 (9.2) Primary 22 (9.2) Breast imaging experience Fellowship training No 222 (91.4) Yes 21 (8.6) Years of mammography interpretation <10 51 (21.1) 10–19 89 (36.8) ≥20 102 (42.1) Percent of time spent in breast imaging <20% 61 (25.8) 20%–39% 62 (26.3) 40%–79% 37 (15.7) 80%–100% 76 (32.2) Communication styles Screening exams When Screening exam is normal Infrequent communicator (never/rarely/sometimes) 239 (98.4) Frequent communicator (often/always) 4 (1.6) When screening exam is abnormal Infrequent communicator (never/rarely/sometimes) 230 (94.7) Frequent communicator (often/always) 13 (5.3) Diagnostic exams When diagnostic exam is normal Infrequent communicator (never/rarely/sometimes) 128 (52.7) Frequent communicator (often/always) 115 (47.3) When diagnostic exam is abnormal Infrequent communicator (never/rarely/sometimes) 56 (23.0) Frequent communicator (often/always) 187 (77.0) When discussing positive mammography exams with a patient would you use: Numbers and statistics such as “your chances of having cancer is less than 2%” Never 50 (21.3) Rarely 67 (28.5) Sometimes 51 (21.7) Often 66 (28.1) Always 1 (0.4) General statements such as “your chance of having cancer is extremely low” Never 10 (4.2) Rarely 20 (8.4) Sometimes 71 (29.7) Often 120 (50.2) Always 18 (7.5) Confident in my understanding of numbers and statistics when presenting information on mammography with patients Not at all confident 2 (0.8) Not very confident 9 (3.7) Neutral 41 (16.9) Confident 156 (64.2) Very confident 35 (14.4)
Missing data: Practice type is missing 3 responses; years interpreting mammography is missing 1 response; percent of time spent in breast imaging is missing 7 responses; use of statistics when talking about positive mammograms is missing 8 responses; and use of general statements when talking about positive mammograms is missing 4 responses.
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Table 2
Characteristics of Radiologists who Report Being Frequent (vs. Infrequent) Communicators According to Screening and Diagnostic Mammograms and their Interpretations
Screening Exams Diagnostic Exams Normal Abnormal Normal Abnormal_n_ % Frequent Communicators % Frequent Communicators % Frequent Communicators % Frequent Communicators Total 243 1.6 5.3 47.3 77.0 Sex Male 173 1.2 5.2 44.572.8 Female 70 2.9 5.7 54.387.1 Primary affiliation with academic medical center No 196 2.0 6.1 45.9 77.0 Adjunct 22 0.0 0.0 63.6 77.3 Primary 22 0.0 0.0 45.5 77.3 Fellowship training No 222 1.4 5.0 46.4 75.7 Yes 21 4.8 9.5 57.1 90.5 Years of mammography interpretation <10 51 3.9 0.029.4 72.5 10–19 89 1.1 4.550.6 76.4 ≥20 102 1.0 8.853.9 80.4 Percent of time spent in breast imaging <20% 61 0.0 0.0 45.967.2 20%–39% 62 3.2 4.8 46.875.8 40%–79% 37 2.7 2.7 48.694.6 80%–100% 76 1.3 9.2 48.778.9 Confident in understanding numbers and statistics No (not confident to neutral) 52 0.0 1.9 51.9 73.1 Yes (confident to very confident) 191 2.1 6.3 46.1 78.0
Bold indicates a statistically significant difference ( P value < .05) using a chi-square score test from a logistic regression model for the binary outcome of being a frequent communicator.
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Table 3
Communication Content According to Level of Communication of Abnormal Diagnostic Exams and Confidence in Use of Statistics
n and % who are Confident in use of Statistics_n_ and % who are Frequent Communicators of Abnormal Diagnostic Exams_n_ and % who are Frequent Communicators of Abnormal Diagnostic Exams Among those not Confident in use of Statistics Among those Confident in use of Statistics Total n__n (%)n (%)n (%)n (%) Total 243 191 (78.6) 187 (77.0) 38 (73.1) 149 (78.0) When discussing positive mammography exams with a patient would you use: Numbers and statistics such as “your chances of having cancer is less than 2%” Never 50 38 (76.0)30 ( 60.0) 8 (66.7) 22 (57.9) Rarely/sometimes 118 88 (74.6) 96 (81.4) 23 (76.7) 73 (83.0) Often/always 6760 ( 89.6) 59 (88.1) 6 (85.7) 53 (88.3) General statements such as “your chance of having cancer is extremely low”, n (%) Never 10 9 (90.0)2 ( 20.0) 0 (0.0) 2 (22.2) Rarely/sometimes 91 74 (81.3) 72 (79.1) 12 (70.6) 60 (81.1) Often/always 138 105 (76.1) 112 (81.2) 26 (78.8) 86 (81.9)
Missing data: using numbers and statistics, such as “your chance of having cancer is less than 2%” is missing 8 responses. Using general statements such as “your chance of having cancer is extremely low” is missing 4 responses.
Bold indicates a statistically significant difference ( P value < .05) between the responses in a given category and all other categories.
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Discussion
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