Psychological consequences of screening mammography.

OBJECTIVE: To examine the psychological consequences at a number of stages in the screening process for women attending a screening mammography programme. SETTING: A pilot mammographic screening programme in Melbourne, Australia. METHOD: The psychological consequences questionnaire (PCQ; a reliable and valid measure of the psychological consequences of screening mammography) was used to measure the emotional, social, and physical functioning of women in a mammographic screening programme and a control community sample. A screening group (in whom no abnormality was detected at initial screen; n = 142) had four measurements: at screening clinic; before results were received; one week after all-clear results were received; and eight months after initial visit. The recall group (who were recalled for further investigation which showed the detected abnormality to be benign; n = 58) had measurements at the same points as the screening group and an additional measurement while waiting at the recall assessment clinic. A randomly selected community control group (n = 52) had measurements one week, two weeks, three weeks, and eight months after consenting to participate. RESULTS: Emotional, social, and physical functioning of women in the screening group did not change over time and at no point differed significantly from that of community controls. The profiles of emotional and physical dysfunction of women in the recall group differed significantly from those of the screening and control groups. The level of emotional and physical dysfunction in the recall group was highest while waiting at recall assessment clinic, and scores were still significantly higher than scores obtained at comparable times from screening and control groups one week after obtaining notification that there was no sign of cancer (emotional P < 0.001; physical P < 0.05). This difference had disappeared eight months after the screening visit, when the level of emotional and physical functioning was similar to that of the screening and control groups. Social dysfunction scores did not change significantly over time and were similar for all three groups. CONCLUSIONS: Given that up to 10% of women are recalled for further investigations on first round screening, significant numbers of women may have psychological consequences. This speaks for the necessity for accurate reading of mammograms to minimise the false positive recall rate, and for counselling services to be available at recall assessment centres.

Satisfaction of attenders during the establishment of an Australian mammography screening program.

We aimed to examine the satisfaction and the predictors of reported satisfaction with the service offered by a pilot mammography screening service. Information was collected from 481 attenders at the screening clinic and from 318 consecutive attenders at the recall clinic using two different standard self-administered questionnaires covering respectively six and five dimensions of satisfaction. For the screening clinic attenders, mean scores on most subscales indicated quite high levels of satisfaction. There were no significant differences among different samples over time for the perceptions of technical competence of the staff. Decreases in reported level of satisfaction were found for subscales measuring interpersonal skills, information giving, physical surroundings, convenience and accessibility, and general satisfaction. Waiting times, age and marital status were predictors in most satisfaction subscales. For those attending the recall clinic, mean satisfaction scores for most scales were high, except for the scale measuring satisfaction with the way the results were received. The median time between screening and recall visits for women in this study was 27 days (range 3 to 112 days). Attenders were most dissatisfied with the delay in getting results, an area where the service might improve.

An analysis of reported discomfort caused by mammographic X-ray amongst attenders at an Australian pilot breast screening program.

The aims of the study were to describe levels of discomfort experienced by women undergoing screening mammography; examine correlates of discomfort experienced and to examine whether the degree of discomfort experienced was perceived as a deterrent for re-screening. The study involved ninety five attenders at the pilot mammography screening program in Melbourne, Victoria. Women completed a questionnaire one or two days after having a screening mammogram. Pain was assessed on a seven point scale. Information was obtained on a number of possible correlates such as breast tenderness, perceptions of the service received and expectations of discomfort. Eighty-eight women were re-interviewed three months later about recall of discomfort and whether this would deter them from future mammography. Results were as follows: Thirty per cent of women reported no discomfort, 60% mild or moderate discomfort and 10% severe discomfort or worse. The degree of discomfort reported was not significantly related to age, breast tenderness in the previous three days, previous symptoms, previous mammographic experience, or outcome of visit. The degree of discomfort was related to retrospectively reported expectation of discomfort (r = .336; p = .001); reported lack of confidence in the staff taking the X-ray (r = .184; p = .039); perceptions of awkwardness (r = .175; p = .049) and unpleasantness (r = .297; p = .002) of the examination position. No woman said discomfort would definitely stop her having another screening mammogram. Three per cent said that it might stop them, while 97% of women said that it would not stop them at all.(ABSTRACT TRUNCATED AT 250 WORDS)

Development and validation of the PCQ: a questionnaire to measure the psychological consequences of screening mammography.

We have developed a reliable and valid questionnaire to measure the psychological consequences of screening mammography. The questionnaire measures the effect of screening on an individual's functioning on emotional, social, and physical life domains. Content validity was ensured by extensive review of the relevant literature, discussion with professionals and interviews with attenders at a pilot Breast X-ray Screening Program in Melbourne, Australia. Discriminant validity was assessed by having expert judges sort items into dimensions which they appeared to be measuring. Acceptable levels of concordance (above 80%) with a priori classifications were found. Concurrent validity was demonstrated by comparison of subscale scores of 53 attenders at the Breast X-ray Program with an independent interview assessment of dysfunction on each of the emotional, social and physical dimensions. There was over 79% agreement between interview scores and questionnaire scores for each dimension. Construct validity was confirmed by showing that subscale scores varied in predicted ways. For women who were recalled for further investigation, scores on each subscale measuring negative consequences, were higher at the recall clinic than at screening clinic (emotional: t = -7.28; df = 70; P less than 0.001; physical: t = -2.53; df = 70; P = 0.014; social: t = -2.49; df = 70; P = 0.015). The internal consistency of all subscales was found to be acceptable. This questionnaire is potentially useful for assessing the psychological consequences of the screening process and should have wide application.

Preferences of rural Victorian women for screening mammography services.

The aim of this study was to examine rural women's access to regional fixed-site screening mammography services and their preferences for either a mobile service or a fixed-site centre. One hundred and thirty-seven women aged 49 to 69 from rural Victoria were interviewed in June 1991. Eighty-five per cent of women normally go to major towns which are possible screening sites at least once every six months, spending an average of five hours each visit. Around 77% of women said they would be likely to go to a fixed site while 86% said they would be likely to go to a mobile service. If the fixed-site centre was at a major town not usually frequented, this would be a deterrent to 58% of women. A decision to widely implement mobile screening in rural areas of Victoria is not justified at this time, but pilot mobile services should be considered.

Development and validation of an instrument to measure satisfaction of participants at breast screening programmes.

A reliable and valid questionnaire has been developed to measure the satisfaction of participants with service offered at mammography screening programmes. The questionnaire measures five specific aspects: convenience and accessibility, staffs' interpersonal skills, information transfer between staff and client, physical surroundings and perceived technical competence of staff. A general satisfaction dimension was also included. Systematic procedures were followed to ensure that the initial pool of items met the criteria for satisfactory content validity. These procedures included extensive literature review and interviews with participants and service providers. Discriminant validity was assessed by a modified Q-sort procedure, where eight expert judges sorted items into relevant dimensions. The sample for other validity and reliability testing consisted of 584 women who were participants at a breast X-ray programme in Melbourne, Australia. Concurrent validity was demonstrated by considering the correlation of the sum of the subscale scores for each respondent with their score on the general subscale (r = 0.76; P less than 0.001). Multiple regression was used to provide further evidence for the discriminant validity of the proposed subscales and support for the multidimensional conceptualism of satisfaction. Scores on the general satisfaction subscale were used as an outcome variable and other subscale scores were predictor variables. All subscale scores significantly contributed to the prediction of satisfaction, over and above that of other subscales (R2 = 0.59). This indicates that these subscales are measuring distinct dimensions of satisfaction. Cronbach's alpha of each subscale was over 0.50, indicating that the subscales are reliable. The instrument is a potentially useful tool for assessing the quality of care at mammographic screening services and could be used routinely by such services to monitor satisfaction.

Clinical factors influencing the efficacy of pooled platelet transfusions.

To determine the relative importance of clinical factors on the efficacy of platelet transfusions, 941 pooled platelet transfusions from HLA-unmatched donors were studied prospectively in 133 patients with bone marrow failure. Multiple linear regression analyses identified the major factors influencing one-hour-corrected increments (CI) as prior splenectomy, bone marrow transplantation, disseminated intravascular coagulation, concurrent intravenous amphotericin B, splenomegaly, and HLA antibody grade. The relative impact of these factors on CI has been quantitated by using a formula developed from these data. A linear relationship was demonstrated between increasing percentage of HLA antibody grade and decreasing CI. A number of other factors were less important in the linear regression model than the aforementioned major factors. These included platelet-specific antibodies, concurrent antibacterial antibiotics, clinical bleeding grade, and temperature. Factors that did not influence CI included the number of prior platelet transfusions, prior granulocyte transfusions, prior red cell transfusions, infection, age, blood group, diagnosis, sex, pretransfusion platelet count, prior pregnancies, and concurrent antineoplastic drugs. This study identified major clinical factors that significantly influenced CI and were major causes of refractoriness to pooled platelet transfusions.