title: Processes of care in cervical and breast cancer screening and follow-up--the importance of communication.
abstract: BACKGROUND
  Given limited research, we investigated patient reports of processes of care related to screening follow-up, timing of result notification, communication issues, and adherence following an abnormal mammogram or Pap test.
  
  
  METHODS
  Women age 50 and over with an abnormal screening mammogram and women age 18 and above with an abnormal Pap test result completed surveys. The mammogram and Pap survey instruments had similar items except pertaining to measures specific to mammography or Pap tests. Bivariate associations between processes of care variables (test results, result receipt, recommendation adherence, receipt of confusing/conflicting information) and global satisfaction were explored using chi-square contingency table analysis. Multivariable logistic regression modeling was conducted.
  
  
  RESULTS
  One thousand one hundred thirty-four women (79.1%) completed the mammogram survey and 1087 women (69.7%) completed the Pap survey. The majority of women received test results quickly. High compliance was reported with recommendations for short-term follow-up. Conflicting/confusing information was reported by a minority of women, but was significantly and positively related to reporting that "care could be better". Patient's lack of understanding about equivocal findings was evident.
  
  
  CONCLUSIONS
  This study confirms that patients need clear messages about recommendations, especially when findings are equivocal and where multiple providers are involved in the process of making clinical decisions.
authors.affiliation: Division of Preventive and Behavioral Medicine, University of Massachusetts Medical School, Worcester, MA 01655, USA. Jane.Zapka@umassmed.edu
authors.forename: Jane G
authors.initials: JG
authors.lastname: Zapka
authors.forename: Elaine
authors.initials: E
authors.lastname: Puleo
authors.forename: Stephen H
authors.initials: SH
authors.lastname: Taplin
authors.forename: Karin Valentine
authors.initials: KV
authors.lastname: Goins
authors.forename: Marianne
authors.initials: M
authors.lastname: Ulcickas Yood
authors.forename: Judy
authors.initials: J
authors.lastname: Mouchawar
authors.forename: Carol
authors.initials: C
authors.lastname: Somkin
authors.forename: M Michele
authors.initials: MM
authors.lastname: Manos
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000175:diagnosis*; D003142:Communication; D003625:Data Collection; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D016015:Logistic Models; D008327:Mammography / Q000706:statistics & numerical data*; D008875:Middle Aged; D013997:Time Factors; D002583:Uterine Cervical Neoplasms / Q000175:diagnosis*; D014626:Vaginal Smears / Q000706:statistics & numerical data*