Abstract B86: “The doctor supported me by telling me exactly what she was doing”: Health care experiences of African American women following an abnormal mammogram
Authors: Molina Yamile , Hohl Sarah H. , Hempstead Bridgette , Thompson-Dodd Jacci , Malen Rachel C. , Thompson Beti , Ceballos Rachel M. 
Published: May 2015

Purpose. The diagnostic and therapeutic delays African American women experience following an abnormal mammogram are well-documented and may partially contribute to racial disparities in late stage diagnosis and survival. Previous literature has suggested inadequate provider-patient communication may contribute to delayed care and subsequent attitudes and behaviors regarding breast cancer care. Nevertheless, little research has characterized the specific communication needs African American women have following an abnormal mammogram experience.

Objective. We describe themes regarding positive and challenging healthcare experiences following an abnormal mammogram result among a small sample of African American women.

Methods. Through multiple clinics and community advocates, we recruited a convenience sample of 30 African American women who had received an abnormal mammogram within the previous four years. Qualitative, semi-structured interviews focused on challenging and positive aspects of healthcare interactions following the abnormal mammogram experience (e.g., “What were some ways you felt the doctor and staff supported you?”). Data were analyzed using principles of grounded theory.

Results. Several salient themes concerning health communication emerged from our exploratory study.

African American women often emphasized their confidence in their ability to act on health information during the abnormal mammogram experience (“When you do the follow-up, you get to ask”). Staff responses to proactive approaches were negative and positive for different women. Negative social interactions with staff included perceived disrespect (“I was actually disappointed with the receptionist…she had a little attitude”) and healthcare distrust concerning withheld information (“I would call them on the phone and…fuss at them about different things that I had found out that were not true or that were available that they did not tell me.”). African American women with positive experiences noted direct communication (“They didn't try to hide anything. They were out front.”; “I feel the doctor supported me by telling me exactly what she was doing.”) and detailed information (“They told me what they were going to do. They told me how to prepare.”).

Additionally, women noted the importance of personalism. Women who were less satisfied with follow-up care noted lack of empathy (“They were robots…They're like a tape recording. It's not individualized or personal.”). Conversely, satisfied women mentioned familiarity with patients (“Well they knew my history, so that really made me feel comfortable”) and empathy (“I have doctors who care. They are concerned about this, so they want me to follow-up”; “They talked to you, comforted you.”).

Conclusions: Our findings parallel a broader body of literature concerning inadequate patient-provider interactions and culturally specific communication needs of African American populations. The current study further suggests the importance of providing African Americans an active role during care, including direct, professional, and comprehensive communicative styles. Interpersonal support and “whole patient” approaches are also highly valued for this patient population. Emergent themes from this study have direct implications for clinicians and future interventions to increase early breast cancer detection for African American women.

Citation Format: Yamile Molina, Sarah H. Hohl, Bridgette Hempstead, Jacci Thompson-Dodd, Rachel C. Malen, Beti Thompson, Rachel M. Ceballos. “The doctor supported me by telling me exactly what she was doing”: Health care experiences of African American women following an abnormal mammogram. [abstract]. In: Proceedings of the Sixth AACR Conference: The Science of Cancer Health Disparities; Dec 6–9, 2013; Atlanta, GA. Philadelphia (PA): AACR; Cancer Epidemiol Biomarkers Prev 2014;23(11 Suppl):Abstract nr B86. doi:10.1158/1538-7755.DISP13-B86