Self-Report and Primary Care Medical Record Documentation of Mammography
INTRODUCTION
Regular screening for breast and cervical cancer reduces cancer morbidity and mortality through early detection and treatment. Yet, many women are not receiving these screening tests in accordance with recommended guidelines. For example, poor, uneducated women are less likely to receive mammography and Pap smears compared to women of greater socioeconomic status. Similarly, Latinas are less likely to receive screening in accordance with recommended guidelines than non-Latinas. Minority women continue to have lower incidence rates but higher mortality rates compared to white women.
Primary care offices provide an opportunity to incorporate timely and consistent delivery of preventive services, particularly among low-income minority women. For example, continuity of care offered through primary care offices has been shown to increase cancer screening. However, the use of preventive services remains difficult to monitor and maintain in the context of complex healthcare systems, busy primary care offices and competing healthcare demands. Many preventive services are implemented by specialists and are not recorded in the primary care medical record. Due to competing demands, particularly among high-risk populations, preventive care may not be offered at any given visit. Patients may experience acute healthcare needs that take priority, may have cultural beliefs regarding screening that are not addressed or may not follow provider recommendations for screening. Provider beliefs and attitudes may also present a bias in the delivery of preventive services.
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Various interventions have been implemented to improve cancer screening rates in the primary care setting. These include personalized letters to patients and prompts to providers. These interventions may not be effective in all practices due to cost and staffing constraints. Can patient self-report provide adequate information to mike screening decisions? In general, studies have found a range of agreement (49-74%) between self-report and chart review for Pap smear and mammography. Agreement increases with the recentness of the test. However, self-report has been shown to overestimate actual receipt of preventive services. These studies have been conducted in the community setting and have included women both with and without access to primary care health services. Few community studies include a large number of both African-American and Latina women.
This study adds to the literature by reporting the use of mammography and Pap smears among low-income African-American, Latina and non-Hispanic white women seen in two primary care settings. Specifically, two research questions were addressed: 1) Were self-report of mammography and Pap smear utilization accurate? and 2) Were there racial/ethnic differences in the validity of self-report of mammography and Pap smear utilization? It is hypothesized that recall of screening exams would be lower among Puerto Rican women than African-American and non-Latina white women due to cultural acceptance of the exams by the women and their male partners. cheap prescription drugs online
