Retrospective analysis of communication with patients undergoing radiological breast biopsy
This study explored the perceptions of women after receiving breast biopsy results over the phone in order to determine patient preferences about the timing, setting, and provider they preferred when receiving biopsy results. Participants were recruited at a large university cancer center and surveyed by phone approximately 2 weeks after they received biopsy results. A 24-item survey was developed concerning how the biopsy results were communicated, the communication skills of the person reporting the diagnosis, and ways to improve the communication of results. The survey also asked about the relative importance of hearing the results quickly, from the most knowledgeable provider, from a primary care physician, or in person. We surveyed 59 patients (25 cancer, 34 benign). Patients from both groups were satisfied with the communication skills of the person who gave the results. However, patients with cancer and patients undergoing their first breast biopsy were more likely to need additional materials to understand their results (P = 0.018, P = 0.036, respectively). Both cancer and benign groups ranked hearing the results quickly as the most important aspect of communication and hearing the results in person as least important. This study suggests that patients value hearing cancer diagnoses quickly more than in person. Patients having their first biopsy or with a diagnosis of cancer would prefer to have additional materials to help them understand their diagnosis.
Correspondence to: Robert M. Arnold, MD, Division of General Internal Medicine, Section of Palliative Care and Medical Ethics, Montefiore University Hospital, 3459 Fifth Avenue Suite 932 West, Pittsburgh, PA 15213; telephone: (412) 692-4810; Fax: (412) 692-4892
| Receiving the results of the biopsy as soon as possible |
| Being told by a person who knows the most about what the results mean |
| Being told the results in person |
| Being told by your primary care provider |
Statistical Analysis
Survey statistics were analyzed using IBM SPSS Statistics software (SPSS, Inc., Chicago, IL). A one-sample Kolmogorov-Smirnov test was used to test variable normality. As all Likert-scaled survey variables were not normally distributed, a Mann-Whitney U-test was used to compare Likert scores between cancer and benign groups as well as first-time biopsy and repeat biopsy groups. Ordinal regression was used to evaluate the effects of age on Likert-scaled variables.
,Results
We screened 133 patients, and of these, 131 patients consented to participate in the study. Of these, 64 could not be reached during follow-up and one patient withdrew from the study, for a total of 66 patients completing the study. The overall response rate was 50.4%. Of the patients who completed the telephone interview, 39 had benign biopsies and 27 had cancer. Of the patients who did not complete the survey, 10 had cancer and 55 were benign (P = 0.004). Other demographic data from the survey cohort are illustrated in Table 2. As the vast majority of patients were white, a comparison between different races could not be performed. Age did not have any significant effect on any of study variables.
Communication Interactions
Of all patients in the study, 53 (80.3%) were contacted by a nurse from the breast center. The other patients were contacted by their primary care provider first (n = 5) or a radiologist (n = 3) or did not know who they were contacted by (n = 5). Forty-one patients (62.1%) recalled meeting the provider they spoke with, while 15 patients reported they did not meet the person who contacted them and 10 were not sure. Sixty-three patients (95.5%) were told their results over the phone, two were told in person, and one person did not respond.
Communication Skills
Mean Likert scales are reported in Table 3. There were no significant differences in the patients' assessments based on demographic or clinical variables. Overall, patients rated the communication skills of the person who gave their results very positively.
| SURVEY ITEM | MEAN LIKERT SCORE | STANDARD DEVIATION | % OF PATIENTS REPORTING “AGREE” OR “STRONGLY AGREE” |
|---|---|---|---|
| You were given the diagnosis in a timely fashion | 4.35 | 0.76 | 93.2% |
| The person who gave you the diagnosis was considerate and tactful | 4.60 | 0.63 | 93.2% |
| The person who told you the diagnosis was honest | 4.46 | 0.50 | 100% |
| The person told you the results in a way you could understand | 4.31 | 0.77 | 94.9% |
| The person who told you the results did not rush | 4.08 | 0.85 | 86.4% |
| The person who told you the results gave you the opportunity to ask questions | 4.13 | 0.77 | 87.9% |
| The person who told you the results was sensitive to your emotional reaction | 4.26 | 0.81 | 87.5% |
| You were satisfied with hearing your results by the method you did (eg, over the phone) | 3.98 | 0.98 | 79.7% |
| You were satisfied with hearing the results from the person you heard from | 4.11 | 0.95 | 86.4% |
Areas for Improvement
The proportions of patients responding “agree” or “strongly agree” to each item are reported in Figure 1 and are compared between several patient groups in Table 4. Patients were more likely to want additional materials to help them understand their diagnosis. This was significantly more common among patients having a first biopsy and patients who had cancer (P < 0.05). For example, 65.4% of cancer patients wanted more information versus 43.5% of benign patients. Also, 60.5% of patients having a first biopsy wanted additional information versus 37.0% of patients having a repeat biopsy. For all other items, less than 50% of patients answered “agree” or “strongly agree,” and there were no significant trends based on clinical or sociodemographic variables.
| SURVEY ITEM | MEAN LIKERTa ± SD | P | MEAN LIKERTa ± SD | P | ||
|---|---|---|---|---|---|---|
| CANCER | BENIGN | FIRST BIOPSY | NOT FIRST BIOPSY | |||
| You would have preferred additional materials to help you understand the diagnosis | 3.50 ± 0.99 | 2.82 ± 1.14 | 0.018
| 3.34 ± 1.05 | 2.74 ± 1.16 | 0.036
|
| You would have preferred to talk to someone beforehand to discuss how much you wanted to know about your results | 2.78 ± 1.09 | 2.77 ± 1.16 | 0.977 | 2.97 ± 1.08 | 2.50 ± 1.13 | 0.068 |
| You would have preferred more assistance making follow-up appointments | 2.19 ± 0.62 | 2.58 ± 1.22 | 0.370 | 2.57 ± 1.02 | 2.21 ± 1.03 | 0.088 |
| You would have preferred to choose who gave you the results | 2.54 ± 1.07 | 2.54 ± 1.07 | 0.896 | 2.55 ± 1.00 | 2.46 ± 1.07 | 0.618 |
| You would have preferred to receive the results faster | 2.85 ± 1.20 | 2.85 ± 1.20 | 0.428 | 3.00 ± 1.27 | 2.86 ± 1.17 | 0.638 |
a 1, strongly disagree; 2, disagree; 3, neutral; 4, agree; 5, strongly agree
