Patterns and Predictors of Referral for Screening Breast MRI: A Mixed-Methods Study.
| Autor: | Conley, Claire C., Cheraghi, Nora, Anderson, Alaina, Rodriguez, Jennifer D., Ginocchi, Annalisa, Song, Judy H., Crane, Erin, Mishori, Ranit, O'Neill, Suzanne C. |
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| Předmět: |
BREAST tumor diagnosis
BREAST tumor risk factors RISK assessment RESEARCH funding EARLY detection of cancer INTERVIEWING LOGISTIC regression analysis CONTENT analysis MAGNETIC resonance imaging DECISION making DESCRIPTIVE statistics SOUND recordings THEMATIC analysis ODDS ratio RESEARCH methodology MAMMOGRAMS GYNECOLOGISTS CONFIDENCE intervals DATA analysis software MEDICAL referrals MEDICAL practice PREVENTIVE health services |
| Zdroj: | Journal of Women's Health (15409996); May2024, Vol. 33 Issue 5, p639-649, 11p |
| Abstrakt: | Introduction: Women with ≥20% lifetime breast cancer risk can receive supplemental breast cancer screening with MRI. We examined factors associated with recommendation for screening breast MRI among primary care providers (PCPs), gynecologists (GYNs), and radiologists. Methods: We conducted a sequential mixed-methods study. Quantitative: Participants (N = 72) reported recommendations for mammogram and breast MRI via clinical vignettes describing hypothetical patients with moderate, high, and very high breast cancer risk. Logistic regressions assessed the relationships of clinician-level factors (gender, specialty, years practicing) and practice-level factors (practice type, imaging facilities available) with screening recommendations. Qualitative: We interviewed a subset of survey participants (n = 17, 17/72 = 24%) regarding their decision-making about breast cancer screening recommendations. Interviews were audio-recorded, transcribed, and analyzed with directed content analysis. Results: Compared with PCPs, GYNs and radiologists were significantly more likely to recommend breast MRI for high-risk (ORs = 4.09 and 4.09, respectively) and very–high-risk patients (ORs = 8.56 and 18.33, respectively). Qualitative analysis identified two key phases along the clinical pathway for high-risk women. Phase 1 was "identifying high-risk women," which included three subthemes (systems for risk assessment, barriers to risk assessment, scope of practice issues). Phase 2 was "referral for screening," which included three subthemes (conflicting guidelines, scope of practice issues, legal implications). Frequency of themes differed between specialties, potentially explaining findings from the quantitative phase. Conclusions: There are significant differences between specialties in supplemental breast cancer screening recommendations. Multilevel interventions are needed to support identification and management of women with high breast cancer risk, particularly for PCPs. [ABSTRACT FROM AUTHOR] |
| Databáze: | Complementary Index |
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