What Women Want: Real Time Results for Screening Mammography in the Era of Value-Based Care | A Single Institution Experience During the COVID-19 SARS-COV2 Pandemic

Abstract

Objective: Direct radiologist to patient communication has been linked to higher levels of patient satisfaction, compliance, and overall treatment outcomes. Recent studies examining patient expectations in breast imaging indicate that 90% of women prefer result communication and review of imaging directly from their radiologist. Though the primary components of diagnostic breast imaging are patient centered, supplemental data suggests that screening mammography result consultation may represent an additional opportunity for engagement in the new era of patient-experience driven care. The primary aim of our study was to examine patient preferences for receiving real time screening mammography result communication (RTRC) and characteristics that may influence their willingness to participate. Material and Methods: This quality-improvement based, IRB-approved, study was performed at three community-based academic breast radiology centers in a large metropolitan area between October 5, 2020, and January 2, 2021. Female patients presenting for screening mammography were invited to opt in for RTRC and/or participate in an electronic, HIPAA-compliant, simple survey that could be completed on the personal subject’s phone or tablet. Subjects opting in for RTRC were invited to wait in a consultation room during staff radiologist review. Once interpreted, the radiologist would discuss the results and next step recommendations with the patient. Self-reported patient demographic characteristics and RTRC preferences by age, race, ethnicity, level of education, household income, prior personal or family history of breast cancer, active (non-breast) cancer history and prior history of abnormal mammogram were assessed by categorical variable analysis using Chi-squared tests. A p-value <0.05 was determined to be statistically significant. Results: 1714 screening mammograms were performed across our three community-based breast imaging centers and 11% (186/1714) of women completed the survey during the study timeframe. White women (92%) were statistically more likely to opt in for RTRC when compared with non-white (80%) counterparts (p=.026). Patients with a personal history (p=0.001) or family history (p=0.006) of breast cancer were statistically more likely to opt in for RTRC when compared with other cohorts. A positive correlation was observed between prior history of abnormal mammogram and preference for receiving RTRC (93%) but did not achieve statistical significance (p=.082). There was no correlation observed between RTRC preference and an active (non-breast) cancer diagnosis (p=0.415). Conclusion: Our study confirms previous data suggesting that patients vastly prefer direct verbal communication ahead of written letter result notification. Our study also suggests that screening mammography RTRC may be of particular interest in patients with higher (personal or familial) risk for developing breast cancer. While this service may operationally add demand on radiologist-patient face time and cost to care delivery, an awareness of patient preferences and cohorts that may find value in this service option can be prioritized to optimize both patient experience and clinical workflow. Additional studies are warranted to further validate which practice models would achieve most benefit from this tailored service offering.