PS3-13: Patient Barriers to Mammography Identified During a Mammogram Reminder System

Abstract

Background/Aims: Patient mammogram reminders are effective at raising screening rates, but patient screening barriers remain. We evaluated patient characteristics available in electronic medical records that might be associated with mammogram completion after a reminder program, and identified patient-reported barriers that could help to explain response differences. Design: Retrospective cohort study using electronic medical record data and a sub-group patient survey. Setting/Participants: Participants were female Kaiser Permanente Northwest HMO members aged 50–69 who were 20 months past their last mammogram (index date) and who were the target of a reminder intervention (Total N=4,708). A mailed survey was completed by 336 of 665 (50.5%) members of the sub-group that received the survey. Intervention: “Mammogram due soon” post card 20 months after last mammogram, followed by a sequence of up to 2 automated phone calls and 1 live call for non-responders. Main outcome measure: Mammogram completion at 10 months following index date. Results: The characteristics associated with lower mammogram completion rates were age <60 (OR 0.69; p<0.0001); health plan membership <5 years (OR 0.81; p=0.019); family income <$40,000 per year (OR 0.77; p=.018); and obesity (OR 0.67; p<.0001). Nearly 47% of the cohort was obese. Among survey respondents, being “too busy” (OR 0.54; p=0.048), feeling “embarrassed” (OR 0.09; p=.001) and “too much pain” (OR 0.41; p<.001) were associated with lower likelihood of mammogram completion. Obese women were more likely to report “too much pain” from mammograms compared to non-obese women (31.3% of 160 vs.18.8% of 176; p<0.01). Younger women were more likely to endorse that they believed in preventive screening (84.4% vs. 71.6%; p <0.05), but also that they were “too busy” (19.1% vs. 6.4%; p<0.001) and had more worries about mammogram accuracy (2.5 vs. 2.3 on 5 point scale; p<0.05) than older women. Pain mediated the relationship between obesity and mammogram completion rates (indirect effect = −.111, 95% CI −.229 to −.025, p=.008). Conclusions: Important barriers to mammogram completion remain even with effective reminder systems. Obesity is an especially prominent barrier due to patients concerns about pain associated with mammography. Interventions to address/reduce pain may help lower this barrier.