Mammography screening journeys: An action research study

Sağlık Akademisyenleri Dergisi http://dergipark.gov.tr/sagakaderg Sağ Aka Derg, 2021; 8(1): 1-7 Araştırma / Research Article Mammography screening journeys: An action research study Mamografi taraması yolculuğu: Bir eylem araştırması Kirstin Öztürk1, Mehveş Tarım2 Marmara University, Health Sciences Institute, , 0000-0002-1746-6689 Marmara University, Health Sciences Institute, , 0000-0002-3726-9439 1 2 ABSTRACT Key Words: Mammography, Cancer Screening, Breast Cancer, Action Research Anahtar Kelimeler: Mamografi, Kanser Tarama, Meme Kanseri, Eylem Araştırma Corresponding Author/Sorumlu Yazar: Kirstin Öztürk, Marmara University, Health Sciences Institute, Received Date/Gönderme Tarihi: 05.08.2020 Accepted Date/Kabul Tarihi: 17.02.2021 Published Online/Yayımlanma Tarihi: 01.03.2021 Objective: To observe the mammographies of women targeted by the national breast cancer mammography screening guidelines to identify process-based barriers to compliance. Materials and Methods: This study was conducted between December of 2018 and May of 2020. Recruitment was done during a larger study that recruited 12 focus groups of 87 women between the ages of 40-69 living in Istanbul. Observation of mammography scheduling, screening, and reporting processes was done using action research, an approach that allows the researcher to fully interact with, and advocate for, study subjects to stimulate empowerment and change. A form developed by the Susan G. Komen® Breast Cancer Foundation was used to guide and document observations. Results: Mammographies for ten women aged 40-57 at ten distinct public, foundation, and private facilities in Istanbul were observed. Scheduling duration ranged from two to seven minutes. The earliest available appointments ranged from the same day to 20 days later. The largest barrier to access was a prerequisite examination and referral. Signed consent forms were required at four facilities. Screening duration, including wait times, ranged from eight to 100 minutes. Out-of-pocket costs ranged from $US 0-58. Wait times for results ranged from 15 minutes to 33 days. Report formats were electronic at five facilities; others provided paper reports with compact discs. Conclusion: This study looked at mammography screenings through the experiences of ten women targeted by national breast cancer prevention guidelines. Opportunities for improvement were identified at facility, national, and policy levels in the areas of privacy, consent, referrals, and reporting. ÖZ Amaç: Ulusal meme kanseri mamografi tarama rehberinde hedeflenen kadınların mamografilerini, uyum sürecine yönelik engelleri belirlemek amacıyla gözlemlemek. Gereç ve Yöntem: Bu çalışma Aralık 2018 ile Mayıs 2020 arasında gerçekleştirildi. İstanbul’da yaşayan 40-69 yaşları arasında olan 87 kadınların katıldığı 12 odak grubunda yürütülen çalışmadan rekrutman yapıldı. Randevu alma, tarama ve sonuç raporlama süreçlerinin gözlenmesi, eylem araştırması ile yapıldı. Bu yaklaşım ile, katılımcılara güçlenmelerini ve değişimlerini teşvik etmek için, araştırmacı, çalışma süresinde etkileşim içinde olabilir ve savunma yapabilir. Gözlemlere rehberlik etmek ve dokümante etmek için Susan G. Komen® Meme Kanseri Vakfı tarafından geliştirilen bir form kullanıldı. Bulgular: İstanbul’da farklı kamu, vakıf ve özel kuruluşlarda 40-57 yaşları arasındaki on kadının mamografileri gözlendi. Randevu alma süresi iki ila yedi dakika arasında sürdü. İlk müsait randevular aynı günden 20 gün sonrasına kadar değişti. Erişime en büyük engel, muayene ve sevk önkoşulları olarak gözlendi. Dört tesiste imzalanmış onam formları istendi. Bekleme süreleri dahil tarama süresi sekiz ile 100 dakika arasında değişmekteydi. Cepten ödemeler 0-58 US$ arasındaydı. Sonuçların bekleme süreleri 15 dakika ile 33 gün arasında değişiyordu. Rapor formatları beş tesiste elektronikti; diğerleri ise kompakt disklerle kağıt raporlar halindeydi. Sonuç: Bu çalışma, ulusal meme kanseri tarama rehberi tarafından hedeflenen on kadının mamografi taramasına gözlemledi. Gizlilik, rıza, sevk ve raporlama konularında kurum, ulusal ve politika düzeylerinde iyileştirme fırsatları belirlendi. INTRODUCTION Around the world, more than 2 million women are diagnosed with, and more than 500,000 women die from breast cancer annually making it the most common type of cancer seen among women and the most common cancer overall in 76% of the world’s countries. In Turkey, 22,345 women were diagnosed with, and 5,542 women Health Care Acad J ● Year 2021 ● Vol 8 ● Issue 1 died from breast cancer in 2018 (1, 2). It is estimated that the incidence rate will grow by more than 60% by 2040 which, adjusting for projected population growth in the year 2040, will result in over 35,000 breast cancer diagnoses and the deaths of over 8,500 women in Turkey (3, 4). Diagnosing breast cancer in the early stages can offer women more options for treatment and an increased 1 Öztürk & Tarım: Mammography screening journeys chance of survival. There are ongoing scientific debates regarding harm vs. benefit analysis (5), limitations (6), and age/frequency guidelines of mammographies (7). In addition, new technologies like artificial intelligence and genetics are under development that may prove to be more effective than mammographies in early state diagnosis of breast cancer. At present, the World Health Organization (WHO) maintains that mammography is still the most effective method for population-based screening of breast cancer today (8) and national and international health authorities continue to recommend mammography screening as an important tool in reducing the burden of disease (9-12). The Turkish Ministry of Health’s Breast Cancer Screening Program National Standards state that women between the ages of 40 and 69 should receive biannual mammography screenings (13). The Ministry of Health (MoH) assigns all Turkish citizens to a nearby family physician. The standards state that family physicians should identify eligible women assigned to their panels and invite them to designated facilities for free mammography screenings (13). These free mammography screenings are available at 68% of the 1,423 public general hospitals in Turkey (2). They can be obtained at Early Diagnosis Cancer Screening & Training Centers known as KETEMs. As of 2019, there are 218 KETEMs and 36 mobile cancer screening centers for a total of 254 centers in all 81 provinces in Turkey (13). Despite the availability of free, nationwide mammography screening services, the 2016 screening rate for Turkish women between the aged 40 to 69 during the prior two years has been found in different studies to be between 30 and 40% compared to the EU25 average of 58% (13-15). Numerous studies have shed light on Turkish women’s awareness, health beliefs, fear levels, and perceptions indicating that awareness levels are higher than compliance rates (16-20). This study was designed to understand the actual experiences of women age (...truncated)