title: Online support: Impact on anxiety in women who experience an abnormal screening mammogram.
abstract: OBJECTIVE
  To determine whether an online support tool can impact anxiety in women experiencing an abnormal mammogram.
  
  
  METHODS
  We developed an online support system using the Comprehensive Health Enhancement Support System (CHESS) designed for women experiencing an abnormal mammogram as a model. Our trial randomized 130 of these women to online support (the intervention group) or to a list of five commonly used Internet sites (the comparison group). Surveys assessed anxiety and breast cancer worry, and patient satisfaction at three important clinical time points: when women were notified of their abnormal mammogram, at the time of diagnostic imaging, and at the time of biopsy (if biopsy was recommended).
  
  
  RESULTS
  Study participants in the intervention group showed a significant decrease in anxiety at the time of biopsy compared to the comparison group (p = 0.017). However, there was no significant difference in anxiety between the intervention group and the comparison group at the time of diagnostic work-up. We discontinued assessment of patient satisfaction after finding that many women had substantial difficulty answering the questions that referenced their physician, because they did not understand who their physician was for this process of care.
  
  
  CONCLUSIONS
  The combination of the inability to identify the physician providing care during the mammography work-up and anxiety effects seen only after an interaction with the breast imaging team may indicate that online support only decreases the anxiety of women in concert with direct interpersonal support from the healthcare team.
authors.affiliation: Department of Radiology, Johns Hopkins University, Baltimore, MD, United States.
authors.forename: Eniola T
authors.initials: ET
authors.lastname: Obadina
authors.affiliation: Center for Health Enhancement System Studies (CHESS), United States.
authors.forename: Lori L
authors.initials: LL
authors.lastname: Dubenske
authors.affiliation: Center for Health Enhancement System Studies (CHESS), United States.
authors.forename: Helene E
authors.initials: HE
authors.lastname: McDowell
authors.affiliation: Center for Health Enhancement System Studies (CHESS), United States.
authors.forename: Amy K
authors.initials: AK
authors.lastname: Atwood
authors.affiliation: School of Nursing, University of North Carolina, Chapel Hill, NC, United States.
authors.forename: Deborah K
authors.initials: DK
authors.lastname: Mayer
authors.affiliation: Department of Radiology, University of Wisconsin, Madison, WI, United States.
authors.forename: Ryan W
authors.initials: RW
authors.lastname: Woods
authors.affiliation: Center for Health Enhancement System Studies (CHESS), United States.
authors.forename: David H
authors.initials: DH
authors.lastname: Gustafson
authors.affiliation: Department of Radiology, University of Wisconsin, Madison, WI, United States. Electronic address: EBurnside@uwhealth.org.
authors.forename: Elizabeth S
authors.initials: ES
authors.lastname: Burnside
mesh_terms: D001007:Anxiety / Q000523:psychology*; D001706:Biopsy; D001943:Breast Neoplasms / Q000175:diagnosis* / Q000523:psychology; D055088:Early Detection of Cancer / Q000523:psychology*; D005260:Female; D006801:Humans; D020407:Internet; D008327:Mammography / Q000523:psychology*; D017060:Patient Satisfaction; D010865:Pilot Projects; D012657:Self-Help Groups; D012944:Social Support
keywords: Anxiety; Mammography; Screening