Background: Given rising breast cancer incidence rates and documented delays in completing follow-up testing among Black women, understanding factors that contribute to intention to complete the mammography screening process will be important for reducing the disproportionate burden of breast cancer in this population. Satisfaction with the mammography encounter has been routinely linked with mammography completion, but research describing the influence of patient-provider interactions on this relationship has been mixed.
Purpose: (1) To examine the connection between satisfaction with specific aspects of mammography experiences and Black women's intention to complete the mammography screening process, and (2) to determine whether discrimination or disrespect during the mammography encounter function as mediators or moderators of this relationship. We hypothesize that all aspects of patient satisfaction will positively influence mammography intention and that experiencing discrimination or disrespect will moderate this relationship.
Methods: Black women aged 40+, breast cancer free, who completed screening mammograms from January to August 2016 at participating mammography facilities in South Carolina were eligible for study inclusion. Demographic information, assessments of the women's recent screening mammography experience, and mammography intentions were collected via a paper survey tool. The Cockburn Mammography Satisfaction Scale was used to assess six aspects of satisfaction: general satisfaction, convenience and accessibility, provider interpersonal skills, patient-provider communication, physical surroundings, and perceived provider competence. Patient-provider interactions were measured using the discrimination and disrespectful office staff subscales of the Interpersonal Processes of Care Survey. Intention to complete future screening mammograms and follow-up tests were each assessed with a single item: 1) How likely are you get your next screening mammogram as scheduled? and 2) If you are asked to return for follow-up testing after your next screening mammogram, how likely are you to complete those additional tests? Multiple regression models linking each type of satisfaction to both types of mammography intention were created in STATA 13. All models controlled for survey respondents' age, education, income, health insurance status, marital status, geographic location, and history of abnormal mammograms. Moderation was tested using interaction terms created from satisfaction and patient-provider interactions variables.
Results: Analyses were limited to 129 eligible surveys with complete responses on variables of interest. None of the models describing the relationships between satisfaction and mammography screening was statistically significant. Intention to complete mammography follow-up was positively influenced by satisfaction with convenience and accessibility (R2=0.22, p=0.00), provider interpersonal skills (R2=0.21, p=0.00), and perceived provider competence (R2=0.17, p=0.02). Disrespect served as neither a mediator nor a moderator in any of the models. Discrimination did not function as a mediator, but it moderated intention to complete mammography follow-up in the three significant models. Among women experiencing discrimination, follow-up intentions increased as satisfaction increased. For women who did not encounter discrimination, follow-up intention remained constant regardless of satisfaction levels.
Discussion: Black women's experiences during and perceptions of their mammography encounters have consequences with respect to their desire to complete follow-up testing. More research is needed to understand influences on mammography follow-up in Black women.
Citation Format: Deeonna E. Farr, Heather M. Brandt, Daniela B. Friedman, Cheryl A. Armstead, Swann A. Adams, Jeanette Fulton, Douglas Bull,. Patient satisfaction and mammography intention among Black women: Contributions of patient-provider interactions [abstract]. In: Proceedings of the Tenth AACR Conference on the Science of Cancer Health Disparities in Racial/Ethnic Minorities and the Medically Underserved; 2017 Sep 25-28; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2018;27(7 Suppl):Abstract nr C69.