title: A qualitative analysis of staff-client interactions within a breast cancer assessment clinic.
abstract: OBJECTIVE
  Breast screening clients recalled to an assessment clinic experience high levels of anxiety. The culture of the assessment clinic may impact upon client experience, which may influence their future re-engagement in screening. This study aimed to explore the culture of staff-client interactions within a breast cancer assessment clinic.
  
  
  METHODS
  Following an ethnographic approach, twenty-three client journeys were observed, followed by semi-structured interviews with the clients. The observation and interview data were analysed to produce research themes, which were then explored within two focus groups to add a practitioner perspective.
  
  
  RESULTS
  Multiple staff-client interaction events were observed over a period of several weeks. Client interview feedback was overwhelmingly positive. Three recurrent and sequential themes emerged: breaking down barriers, preparing the ground and sign-posting. These themes outline the changing focus of staff-client interactions during the client's clinic journey, encompassing how anxieties were expressed by clients, and responded to by practitioners.
  
  
  CONCLUSIONS
  This study was the first to explore in depth the staff-client interaction culture within a breast assessment clinic using an ethnographic approach. A new perspective on professional values and behaviours has been demonstrated via a model of staff-client interaction. The model documents the process of guiding the client from initial confusion and distress to an enhanced clarity of understanding. A recommendation most likely to have a positive impact on the client experience is the introduction of a client navigator role to guide the clients through what is often a lengthy, stressful and confusing process.
authors.affiliation: University of Salford, United Kingdom. Electronic address: J.Nightingale@salford.ac.uk.
authors.forename: J M
authors.initials: JM
authors.lastname: Nightingale
authors.affiliation: University of Salford, United Kingdom.
authors.forename: F
authors.initials: F
authors.lastname: Murphy
authors.affiliation: University of Salford, United Kingdom.
authors.forename: C
authors.initials: C
authors.lastname: Eaton
authors.affiliation: East Lancashire Hospitals NHS Trust, United Kingdom.
authors.forename: R
authors.initials: R
authors.lastname: Borgen
mesh_terms: D000554:Ambulatory Care Facilities; D001943:Breast Neoplasms / Q000000981:diagnostic imaging*; D005260:Female; D017144:Focus Groups; D006801:Humans; D007407:Interviews as Topic; D015279:Organizational Culture; D062526:Patient Navigation; D011369:Professional-Patient Relations
keywords: Breast assessment; Breast screening; Culture; Ethnography; Patient experience; Qualitative research