Rationale and Objectives
The diagnostic mammography suite is a microcosm of challenging physician–patient communication in radiology. Little has been written about communication practices in the diagnostic mammography suite, the effect of this communication on both physicians and patients, and implications for radiology training programs. We surveyed radiology residents and staff about communication training, practices, and experiences communicating directly with patients in the diagnostic mammography suite.
Materials and Methods
We asked the membership of the Association of Program Directors in Radiology to disseminate surveys to radiology residents and staff radiologists in their institutions. We analyzed response frequencies and correlations.
Results
We received responses from 142 residents and 120 staff radiologists. More than half of staff respondents spoke personally with every patient who had an abnormal diagnostic mammogram; 37% felt they had inadequate time to do so. Most residents and staff highly rated their own communication skills and confidence in ability to explain results and respond to patients’ emotions, but experienced stress doing so. A majority of respondents reported no formal communication skills education after medical school. Twenty-nine percent of staff respondents regularly observed residents’ communication with patients and 39% of residents reported receiving feedback about their communication. Residents’ opportunities to observe staff communicate with a patient and to receive feedback on their own patient interactions were correlated with self-rated communication skill and confidence in ability to respond to patients’ emotions ( P < .05).
Conclusions
Radiologists engage in challenging and stressful patient communication interactions. There is a paucity of educational curricula on interpersonal and communication skills in radiology. This has implications for both patient and physician satisfaction and patient outcomes.
Radiologists communicate directly with patients during diagnostic studies, including mammograms and interventional procedures. In most situations, primary care physicians, surgeons, and other health professionals are responsible for sharing “bad news” with patients, explaining the implications of test results and responding to patients’ questions and emotional reactions to learning about diagnoses that will affect their lives. A notable exception is the diagnostic mammography suite, where the radiologist may be the first health professional to explain abnormal findings that significantly affect patients’ health and well-being.
Since the passage of the Mammography Quality Standards Act of 1992, radiologists must communicate with women about mammography results in a timely and comprehensible fashion ( ). Sending a written report directly to patients has became a well-established standard in mammography practices. This standardization of result notification has improved patient satisfaction, but has not altered patient anxiety or comprehension of results, particularly the need for surgical consultation or biopsy ( ). Diagnostic follow-up of abnormal screening mammograms also remains problematic. Approximately 9% of women (∼1 million women) interviewed during a large national survey reported knowing about an abnormal mammogram but had received no follow-up, although more than 90% had health insurance and access to health care ( ). The relative contribution of patient-provider interactions and systems-related factors to this problem is unknown.
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Materials and methods
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Results
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Table 1
Demographic Information
Radiology Residents: Survey Data n (%) Radiology Residents: National Data ⁎ n (%) Radiology Staff: Survey Data n (%) Total 142 4,303 120 Female gender 50 (35) 1,174 (27) 58 (50) PGY 2–3 50 (35) 2,219 (52) PGY 4–5 92 (65) 2,084 (48) Did postresidency mammography training 41 (36)
PGY: postgraduate year.
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Setting
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Time
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Table 2
Time
Residents n (%) Staff n (%) Schedule allows adequate time to communicate Strongly disagree/disagree 64 (34) 41 (37) Strongly agree/agree 87 (66) 70 (63) Average time speaking with patient with BI-RADS 3 <10 minutes 115 (86) 102 (95) ≥10 minutes 5 (4) 5 (5) Average time speaking with patient with BI-RADS 4–5 <10 minutes 88 (76) 90 (82) >10 minutes 28 (24) 20 (18)
BI-RADS: Breast Imaging Reporting and Data System.
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Personal Communication Practices
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Table 3
Personal Communication Practice Patterns
Residents n (%) Staff n (%) Standardized approach to communicating abnormal results is preferable Strongly disagree/disagree 47 (34) 60 (54) Strongly agree/agree 93 (66) 52 (46) Speak personally with each patient Yes 32 (24) 62 (55) No 62 (47) 21 (19) Sometimes 38 (29) 29 (26) Review films with patient Yes 49 (39) 39 (36) No 22 (17) 15 (14) Sometimes 56 (44) 55 (50)
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Self-Assessed Communication Skills, Confidence, and Stress
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Table 4
Self-Assessed Skills, Confidence, and Stress
Residents n (%) Staff n (%) Skill communicating abnormal results (excluding mammography) Poor 3 (2) 1 (1) Good/very good 107 (75) 58 (51) Excellent 32 (23) 54 (48) Skill at communicating abnormal mammography results Poor 7 (5) 0 Good/very good 111 (83) 50 (45) Excellent 16 (12) 61 (55) Confident in expertise reading mammograms Strongly disagree/disagree 65 (47) 1 (1) Strongly agree/agree 73 (53) 110 (99) Confident in explaining BI-RADS category 3 Strongly disagree/disagree 15 (12) 1 (1) Strongly agree/agree 113 (88) 108 (99) Confident in explaining BI-RADS category 4/5 Strongly disagree/disagree 10 (8) 0 (0) Strongly agree/agree 120 (92) 114 (100) Confident in ability to communicate with patients who demonstrate a strong emotional reaction Strongly disagree/disagree 21 (16) 4 (4) Strongly agree/agree 108 (84) 107 (96) Stress communicating BI-RADS category 3 None 34 (27) 51 (47) Some/moderate 92 (73) 58 (53) Severe 0 0 Stress communicating BI-RADS category 4/5 None 17 (14) 21 (19) Some/moderate 108 (85) 88 (80) Severe 1 (1) 1 (1)
BI-RADS: Breast Imaging Reporting and Data System.
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Teaching and Training Experiences
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Table 5
Teaching and Training Experiences
Residents n (%) Staff n (%) Attended communication courses/workshops Yes 27 (20) 25 (22) No 107 (80) 86 (78) Allow residents to communicate about bad news with patients Yes 27 (25) No 39 (35) Sometimes 44 (40) If yes, do you observe? Yes 22 (29) No 16 (21) Sometimes 37 (49) Been given feedback about communication based on an observed interaction Yes 48 (37) 50 (47) No 83 (63) 57 (53) Allow residents to observe you communicating with patients Yes 53 (48) No 9 (8) Sometimes 49 (44) Interest in learning strategies to improve communication Yes 93 (68) 86 (78) No 44 (32) 24 (22)
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Correlates of Teaching and Training Experiences
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Table 6
Correlates of Resident Training Experiences
Number of Times Resident was Observed by an Attending while Communicating with a Patient None n = 47 1–9 times n = 67 10+ times n = 20 Fisher’s P value Confident in expertise reading mammograms Strongly disagree/disagree 27 (57%) 30 (45%) 5 (25%) .05 Strongly agree/agree 20 (43%) 37 (55%) 15 (75%) Confident in ability to explain BI-RADS categories 4 and 5 to patients Strongly disagree/disagree 6 (14%) 1 (2%) 2 (10%) .03 Strongly agree/agree 38 (86%) 63 (98%) 18 (90%) Number of times resident observed an attending communicating with a patient
Confident in ability to communicate with patients with strong emotional reactions Strongly disagree/disagree 15 (26%) 5 (11%) 1 (4) .02 Strongly agree/agree 43 (74%) 39 (89%) 26 (96%) Self-rated skill in communicating abnormal diagnostic mammography results in person to patients Poor 3 (5%) 3 (6%) .007 Good/very good 53 (90%) 39 (85%) 19 (68%) Excellent 3 (5%) 4 (9%) 9 (32%) Been given feedback on communication skills Yes No Confident in ability to communicate with patients with strong emotional reactions Strongly disagree/disagree 3 (6) 18 (22) .02 Strongly agree/agree 44 (94) 63 (78) Self-rated skill in communicating abnormal diagnostic mammography results in person to patients Poor 0 4 (5) .006 Good/very good 37 (77) 72 (89) Excellent 11 (23) 5 (6)
BI-RADS: Breast Imaging Reporting and Data System.
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Discussion
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Acknowledgments
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Appendix A
Radiology Resident Survey of Communication Practices
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