The Effect of Mammography on Patients and their Perception of the Whole Experience - Book Report/Review Example

Breast cancer is the biggest killer cancer worldwide and need for preventive, and early diagnostic approach is a clear must. During the last few years, the use of mammography has widely helped to increase the detection of cancer in women at all stages, but early enough to make the therapeutic intervention a very credible approach. This method of screening may also have some harmful effects on the patients attending regular screening. The discomfort of the experience has been investigated through different studies and from different angles(Aro et al., 1996; Dullum et al., 2000). Poulos & Llewellyn, reported the effect of mammography on patients and their perception of the whole experience (Poulos & Llewellyn, 2005). The authors put women in the centre stage and infer the discomfort experience from a set of qualitative variables: before, during and after the mammography session. The study was conducted to give a holistic idea of the experience as perceived by women, hence the contrast to earlier studies. In most of the early studies, the discomfort was assessed during the mammography by looking at variables such as anxiety, beliefs, coping strategies and so forth; the samples were large and the mammogram is at the centre stage. In other studies, the investigators went to include seemingly less related factors to the experience such as the perception of the centre and privacy. These studies, unlike their first counterparts, do not address the "during" experience. In their report the authors aim to combine the two approaches and examine the experience: before the screening (just the thought of it), through screening (the day experience), and after screening. The authors have looked at the literature and describe it, but allowed evaluating the theoretical background of some studies such as the model used to establish the discomfort experience. In some studies, for example the number of patients and the questionnaires were both evaluated. Having said that, not all up to date literature was discussed. Sapir et al, for instance, has done a review of the mammography discomfort literature from 1988 to 2001 with quantitative results that would have been beneficial to the qualitative approach design. The study was conducted so that patients express their experience in their own words; this has the benefit of getting the exact effects of the experience, but has the difficulty of categorising and interpreting the data collected from the participants. This study approach however, is one of the first to get patients to express themselves, hence reflecting high qualitative value as the authors rightly suggested. To achieve this, the authors first recruited women from a breast screening centre, and using the theoretical framework explained above for the study design, chose their participants. Twelve women were selected based on characteristics that will infer a qualitative dimension to the study such as age, risk and discomfort perception, frequency of screening, and other factors contributing to the experience including social and cultural factors. The selective procedure was aimed at gathering information from patients till no more is needed and infer conclusions, in short theoretical saturation. The women chosen, can be argued, are less representative of the entire screening population at hand due to the selection procedure. For example, only around 70% of women in earlier studies have reported discomfort, and only few can be aligned with the criteria set by the investigators. It may be plausible to use other categories: those who do not subscribe to the selection procedure or those who show no discomfort, and be used as control samples for this study. The other two groups will have similar qualitative parameters to respond to before the experience as those selected for the study, but may have different personal outcomes, hence the authors would pinpoint the qualities needed for further improvement or research. These restrictions, somehow biased, are not well characterised or explicitly and quantitatively expressed, thus restricting further the generalisations made. To improve the data collection and analysis, the authors would have to quantify the parameters used such as age, and assess and evaluate factors expressively so the study could be replicated, reinforced, and generalised. The authors followed social interaction theories developed in the 1960s to achieve a comparative analysis by uncovering common issues and building a framework on which the data can be evaluated. These valuable procedures are independent of sample size and rely on strong categorisation of issues and would be best suited for this study. The data was gathered on tapes, transcripts and notes was categorised by means of comparison and contrast, the similarity within the same data group (the same woman) were compared as well as contrasted to other data groups, hence intra- and inter- analysis of the data. This procedure isolate the main categories of data so to be easily grouped and compared, what the authors termed categorising and coding. The investigators then grouped this information into concepts by clustering related issues forming 10 different concepts. And from those 10 categories, key concepts were defined, whereby some chronological clustering was involved by placing these key concepts, hence the three key concepts: beliefs about the experience, the day experience and the procedure. For beliefs, the author isolated three sub categories that contribute to the "before" experience: perception of risk, health lifestyle of patients (preventive medicine), benefits of mammography. During the day but prior to the procedure, the authors analysed the feelings, the effects of undressing and the power loss. As for the procedure itself, they concentrated on the technical support and the perception of the machine, as well as the interaction between patient and machine and how patients depersonalised their breasts, and finally women's talk. Though similar data emerged from other studies, this study has place more emphasis on subjective view of women and the raw emotional behaviour towards the experience while others would have concentrated or regrouped the key concepts differently. One study published in august 2005, though concentrating on quantitative approaches, set different selection criteria and concentrated on factors during the experience, the human-machine ,or human-human interactions (Papas and Klassen, 2005). The authors, however, shied from this emphasis as they think it has been very well reported, nevertheless, qualitative studies were never reported before covering this issue. The results from this study, further illustrate the point. The women showed anxiety towards the risk of developing breast cancer as a function of their age, or their personal experiences with friends or family, but also anxieties towards the technical aspects of the procedure such as the competence of the radiographer and their medical training is also questioned. These risk factors put under the umbrella of beliefs as a key concept, would have been of much more value if correlated with age or education levels. The same applies when the authors examined preventive medicine or the benefits of screening. One positive result is that women who engage in healthy lifestyle activities, screen themselves as a reassurance or to achieve treatment at the earliest stages which, has not been reported in the literature examined. The three concepts were not analysed or linked in great detail and a link is surely existent between the three factors as earlier described by others (Bruyninckx et al., 1999; Sapir et al., 2003). The second concept focused on the day experience of mammography. Women showed a diverse range of emotional behaviours, some were feeling happy for different reasons; others, however, were affected by the results of other patients, giving more plausibility to separate the waiting room from the main screening room. The women also showed a mixed response to the effect of undressing, and the authors tried to link it to age but with no quantifiable measurements, nevertheless, this corroborate earlier studies (Kashikar-Zuck et al., 1997). The last concept in this category is quite novel in such studies, showing that women would like to contribute to the process more, and may be to regulate compression of breast or reduce embarrassment (Poulos et al., 2003). This suggests a need for more user friendly mammogram that would curtail the discomfort experienced on the day. In the final category, the authors found the procedure important but fail to establish it as a critical component of the discomfort experience. The women expressed trauma to the compression of their breast and describe them as non-personal entities, and this should have been correlated with certain variables such as breast size to appreciate its full importance. The women expressed concerns about the machine itself, and that it was not made and designed to deal with humans. This is crucial information as it corroborates both earlier results relating to the lack of power and suggests a need for more "feminine-aware" machine. This, however, can be further complicated by the technical competence of the radiographer. Sometimes, the radiographer is friendly making the women feel comfortable dealing with the machine, and conversely, the training of these professionals is brought into question as in earlier studies(Van Goethem et al., 2003). The final concept the authors explored is women's talk. The women do talk about their experience to others and build their beliefs from such discussions; hence the first concept is further enforced. To conclude, the paper established some qualitative factors that should be analysed in new studies and that the personal experiences of women, amid supporting quantitative studies, do suggest more specific and essential improvements that cannot be derived from the quantitative studies alone. The study shows a need for better awareness of the procedure, better training for radiographers, perception of the day experience irrespective of beliefs, and the role of human-machine interaction in influencing the design of machines. The study should be replicated at it evaluates the role of each part of the experience and offers improvements, but quantifiable data is needed to support it so the changes can be enforced for the benefit of the whole community. Aro, A. R., Absetz-Ylostalo, P., Eerola, T., Pamilo, M., and Lonnqvist, J. (1996). Pain and discomfort during mammography. Eur J Cancer 32A, 1674-1679. Bruyninckx, E., Mortelmans, D., Van Goethem, M., and Van Hove, E. (1999). Risk factors of pain in mammographic screening. Soc Sci Med 49, 933-941. Dullum, J. R., Lewis, E. C., and Mayer, J. A. (2000). Rates and correlates of discomfort associated with mammography. Radiology 214, 547-552. Kashikar-Zuck, S., Keefe, F. J., Kornguth, P., Beaupre, P., Holzberg, A., and Delong, D. (1997). Pain coping and the pain experience during mammography: a preliminary study. Pain 73, 165-172. Papas, M. A., and Klassen, A. C. (2005). Pain and discomfort associated with mammography among urban low-income African-American women. J Community Health 30, 253-267. Poulos, A., McLean, D., Rickard, M., and Heard, R. (2003). Breast compression in mammography: how much is enough Australas Radiol 47, 121-126. Sapir, R., Patlas, M., Strano, S. D., Hadas-Halpern, I., and Cherny, N. I. (2003). Does mammography hurt J Pain Symptom Manage 25, 53-63. Van Goethem, M., Mortelmans, D., Bruyninckx, E., Verslegers, I., Biltjes, I., Van Hove, E., and De Schepper, A. (2003). Influence of the radiographer on the pain felt during mammography. Eur Radiol 13, 2384-2389. The paper analysed: Poulos, A. Llewellyn, G. (2005)Radiology 11, 17-25. Read More