Impact of Physician Attitudes on Mammography Screening Rates

Institution: University of California, San Francisco
Investigator(s): Miriam Komaromy, M.D. -
Award Cycle: 1995 (Cycle I) Grant #: 1KB-0157 Award: $13,746
Award Type: New Investigator Awards
Research Priorities
Detection, Prognosis and Treatment>Imaging, Biomarkers, and Molecular Pathology: improving detection and diagnosis

Final Report (1998)
This project examines the possible role of physician attitudes and practice style in explaining the observed racial/ethnic and socioeconomic differences in breast cancer screening and early detection rates. The goals of this study are to determine whether individual physicians differ in their attitude toward breast cancer screening or the likelihood that they would recommend breast cancer screening in minority and poor patients compared with wealthier, non-minority patients. Understanding physicians' role, if any, in contributing to disparity in breast cancer screening rates will allow us to design interventions to improve access to breast cancer screening and reduce breast cancer morbidity and mortality for poor and minority women.

There will be two major components to this study. The first is a series of focus groups with California physicians who provide primary care for women. In the focus groups we will explore how physician attitudes and practice style may vary when physicians are evaluating patients of different racial/ethnic or socioeconomic backgrounds. We will perform eight focus groups with 8-10 physicians. The second study component will be a survey of a random sample of 720 California primary care physicians, sampled so as to increase the representation of physicians practicing in areas with large numbers of poor and minority patients. The survey will reflect the physician attitudes and practice styles revealed during the focus groups, and will be used to test the generalizability of these findings. It will also assess the relationship of physician attitudes regarding breast cancer screening in poor and minority populations, and physicians' knowledge and usual practice with regard to breast cancer screening. Finally the survey will include a measure of physicians' degree of cultural sensitivity, i.e., their attitudes toward the care for minority patients and degree of competence in caring for special problems of minority patients. Results will be analyzed to determine the frequency with which physicians perceive they are less able to communicate adequately about breast cancer screening with poor and minority patients, and the reasons for and consequences of communication barriers. We will also compare the frequency with which physicians who care for large poor and minority populations report that they recommend mammography with the frequency reported by physicians who care for few poor and minority patients.

Results will be used to design targeted educational interventions for physicians to improve their cross-cultural communication skills, and reinforce the awareness of the need for breast cancer screening in poor and minority patients.