Women’s satisfaction with information at breast biopsy in breast cancer screening
Introduction
As breast cancer screening is set up for finding cancer, some women need to go through further examinations after mammography and some reach the stage of breast biopsy. Even if less than one percent (0.62% in 1991) of the women (age 50–59) who participate in the Finnish nationwide screening programme are referred for surgical biopsy, this equals to 700–800 women a year [1]. In less than half of them a breast cancer diagnosis is confirmed.
Previous studies have shown that breast biopsy is associated with considerable distress [2], [3], [4], [5], [6], [7], [8]. The referral for biopsy after routine screening comes as a surprise to an a-symptomatic woman and it may raise fear of serious disease. In breast biopsy a tissue sample is removed from the breast while the patient is in hospital. This procedure may be unfamiliar and painful to the woman. The uncertainty experienced prior to having the results is considered particularly distressing [3], [4], [6], therefore breast biopsy can be a stressful event regardless of the finding. Among those with a benign diagnosis the effect may not be severe or long-lasting [9], but a subgroup of women may still require professional counselling [10].
Provision of information is a central component in preparing patients for surgery and in combination with other factors (e.g. supportive contact) it seems to have positive outcomes on clinically and economically important measures such as psychological distress and length of hospital stay [11]. Studies from various settings have shown that breast biopsy patients should be given more information about the impending surgery in order to reduce uncertainty and distress [4], [7], [12], [13] and to promote continued screening adherence [13].
Not only the amount of information, but also the quality and timing of information were important to women with false positive results in ovarian cancer screening [14]. Increased satisfaction with care and decreased distress followed provision of written information among women who were recalled for further examinations after breast cancer screening [15].
As far as we know previous studies on information needs at breast biopsy are either from mixed clinical and screening settings or they focus only on one diagnostic group. The screening setting is special in that the woman may consider mammography as a routine check, but being referred for biopsy is something extraordinary. In this study we include all women referred for biopsy in mammography screening regardless if the diagnosis is malignant or benign, because up to the point of diagnosis all women remain in a similar state of uncertainty. Furthermore, we considered it important to study informational matters not only using fixed-choice questions, but qualitative methods as well starting from the women’s own words. The aim of this study is to evaluate the service provided at hospital to women referred for biopsy in mammography screening by describing their information needs, satisfaction with information and information sources.
Section snippets
Subjects and procedures
Questions on biopsy experiences were presented in the follow-up phase of a survey study evaluating psychological impact of invitation-based mammography screening in Finland (N=16,886; age 50 in 1992–94). Of the screening participants 98 (0.65%) were referred for biopsy; 44% had a benign diagnosis and 56% had breast cancer.
A baseline questionnaire was sent to all women one month before screening invitation. The response rate was 65% among the 98 women later referred for biopsy. Because response
Satisfaction with information
The amount of information at the hospital was regarded adequate by a majority of the women (Table 2, question 1). In listing the three most supporting factors information was mentioned the third most often (14/67 mentions) close after support from significant others (21/67) and support from the staff (15/67), e.g. in the following way: “Sufficient information (B)”, “The sharing of matter of fact information at every stage has been the best thing (B)”.
Four women had considered the information at
Discussion
The women undergoing breast biopsy expressed satisfaction with the amount and comprehensibility of information at the hospital. Information had been reassuring to many women. According to the fixed-choice questions, the Finnish health care system seems to provide information that has a potential of reducing distress associated with the biopsy – a result differing from studies in other settings [7]. The general satisfaction may also reflect the women’s thankfulness [16] that was expressed by a
Acknowledgements
This study was supported by the Cancer Society of Finland.
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