Mammographic screening programs are essential in timely detection and effective treatment of breast cancer. Since 2006, Croatia implemented a national MSP which asks for a regular biannual mammography for all women 50 - 69 years of age. First-visit screening attendance in the country is estimated at 58.3% with the trend of gradually decreasing re-attendance rates. Since patient satisfaction with the screening procedure may influence subsequent adherence, this study aimed to assess patient satisfaction in order to predict and improve patient re-attendance rate, a first-time effort of such kind in Croatia. 201 random patients undergoing mammography screening procedure at four facilities in Croatia were asked to complete an anonymous questionnaire which specifically evaluated the following aspects of patient experience: patient attitude, facility surroundings, staff attitude and pre-examination information transfer, associated physical pain, psychological discomfort, and finally overall patient impressions and satisfaction. The majority of our examinees expressed high satisfaction with MSP and an intention to re-screen; patient attitude, facility environment and staff attitude were deemed overly positive, whereas the majority of patients estimated the physical and psychological pain associated tolerable. These results suggest that patient satisfaction is not a critical factor influencing future adherence rate in MSP, and other components of the program should be evaluated and improved.
Mammography (MG) plays a central role in the diagnosis of breast cancer (BC), the 2nd leading cause of cancer-related death in women. Mammographic screening programs (MSP) are of essential importance in timely detection and effective treatment of BC [
The series consists of a sample of 201 women undergoing regular MSP in the period from January to May 2014, aged 50 - 69 (average 58) years. Ten women per day undergoing screening MG procedure were randomly chosen to be surveyed at 4 university hospitals, 1 county hospital and 1 secondary healthcare facility (Dom zdravlja) using an anonymous questionnaire completed immediately after the examination with the authors’ assistance. Informed consent was obtained from the patients and approved by the ethics committee of the MSP. The questionnaire consisted of 40 questions covering the following specific categories: general patient profile, level of information before MG, ease of accessibility and comfortableness of the mammography facility, staff attitude towards the patient, patient impressions of the mammographer, physical discomfort and pain of the examination, associated psychological discomfort, post-examination impressions and general patient satisfaction with MG. Questions assessing patient attitudes utilized Likert’s Scale of 5 possible answers (1-strongly agree, 2-partially agree, 3-neither agree nor disagree, 4-mostly disagree, 5-strongly disagree). Pain level was assessed by the Visual Analogue Scale (VAS) (0 = no pain, 10 = severe pain) [
Success of national MSP depends highly on patient adherence rate, which is closely associated with the experiences related to the screening procedure. Assessment of general and specific factors influencing patient experience helps recognize potential areas for improving patient satisfaction and future adherence. Specifically, this study evaluated patient attitude, facility surroundings, staff attitude and pre-examination information transfer, associated physical pain, psychological discomfort, and finally overall patient impressions and satisfaction.
Positive patient attitude before the examination contributes to later patient satisfaction with the process [
The environment of the mammographic screening facility is a contributing factor in decreasing patient anxiety. Great majority (93.5%, 188) of our examinees found the environment of the waiting rooms pleasant, 57.2% (115) agrees that the examination room is pleasant, but 30.3% (61) of patients completely disagree about adequacy of privacy during the procedure. Pleasant and welcoming environment of the waiting and examination room positively affects patient satisfaction [
Positive staff attitude and pre-examination information transfer are important contributing factors to patient satisfaction. Negative experience regarding staff attitude has been shown to decrease overall patient satisfaction with the procedure [
Subjective patient assessment of mammographer’s professional skills could have an impact on patient satisfaction, considering that the women have been invited to the procedure and expect a high service quality and professional courtesy. More than a half (51.3%, 103) of the patients had an impression that the person who performed the examination was insufficiently trained and professionally skilled for such a task. Some studies [
Physical breast pain and discomfort during MG is a significant factor that may cause anxiety and dissatisfaction with the procedure, and various strategies for pain relief could be attempted. 60% (120) of our patients found the procedure mildly painful or even completely painless (scores 1 - 3 on a 10-point Visual Analog Scale (VAS)), a highly satisfactory result considering the age of participants, and limited technical skills of mammographers in some facilities. The usual breast compression force of 12 daN was comfortable for 46.3% (93) of the patients, whereas others would ask to decrease the compression force. Great majority of patients (88.5%, 178) claim that they completely understand the reasons why breast compression is required to achieve proper quality of images and to reduce breast radiation dose, whereas (19.4%, 39) of patients think that MG is an inherently painful examination; 8% (16) of patients consider the reason being was the too small size of their breasts, and 7.5% (15) the too large size of their breasts.
In one study [
Psychological impressions associated to MG procedure are related to the imaging technique itself (getting undressed, compression) and to the mammographer’s social skills and communication ability, and significantly influences patient satisfaction. Majority of women in our series (87.6%, 176) have not experienced the procedure psychologically embarrassing or unpleasant, 74.6% (150) of women agrees that the personnel acted supportively and reassuring, and 85.1% (171) states that the staff approach was encouraging them for future rescreening. The possibility of recall for further testing after basic MG screening has been confirmed to increase patient anxiety [
Overall satisfaction with the MSP was good in the vast majority of examinees (“completely satisfied” 65.6% (132), “satisfied” 26.9% (54)), and 87.6% (176) of them found the associated discomfort negligible compared to possible benefits of MG. Only 6.9% (14) of women found the overall experience more taxing than they expected. The most (93.1%, 187) of women claim their examination experience encourages them to re-screen, and would recommend other women to participate in MSP.
There are some limitations of the study concerning sample patient characteristics, influence of social desirability bias and non-assessment of some factors. Most of the patients have previously undergone MG has found them tolerable: 7.5% (15) underwent MG for the first time, 7.9% (16) previously underwent screening MG once, 17.4% (35) twice, and 64.2% (129) three or more times. A more appropriate assessment of screening experience would involve a greater number of first-time participants. The survey was completed in the examination facility, which could have the results affected by social desirability bias [
In conclusion, in this first quality assurance survey in Croatian MSP the majority of our examinees expressed high satisfaction with MSP and an intention to re-screen. More specifically, patient attitude, facility environment and staff attitude were deemed overly positive, whereas the majority of patients estimated the physical and psychological pain associated tolerable. The results of this study suggest that patient satisfaction would not be a critical factor influencing future adherence rate in MSP, and other components of the program should be improved to maintain satisfactory participation.
All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.
Informed consent was obtained from all individual participants included in the study.
Brnić, Z., Kašnik, K., Kašnik, K., Brnić, V., Borojević, N., Ljubešić, L., Schmidt, S. and Krpan, T. (2017) Patient Satisfaction in Croatian Nationwide Mammography Screening Pro- gram. International Journal of Clinical Me- dicine, 8, 159-166. https://doi.org/10.4236/ijcm.2017.83016