Teaching is a must for mammography callbacks

Explain with as much detail as possible

Education can help ease anxiety when a problem is detected on a screening mammogram. That is why all imaging centers within the OhioHealth system have a breast health nurse call patients who need additional views.

During the telephone conversation, patients are told what is showing up on the mammogram, what will be done to try and rule out whether there is a problem, and that they can expect to be met by a breast health nurse on their return appointment, says Pam Rudmose, RN, BSN, a breast health nurse and coordinator of the multi-specialty Second Opinion Breast Cancer Clinic at OhioHealth in Columbus.

On the return visit, the breast health nurse again explains what the radiologist saw on the mammogram or ultrasound and what will be done that day. The nurse also explains that the radiologist will look at the films as soon as they are processed and provide an answer about the particular issue before the woman leaves the center that day.

For example, if an area of calcification were detected on the right breast in the mammogram, the patient would be told that these are not unusual and they form all over the body as part of the aging process. To determine if further evaluation is required, the calcification needs to be magnified.

"I try to make sure that they understand that we will be able to tell when we magnify [the image] what needs further follow-up and what doesn’t," says Rudmose.

If a radiologist determines that follow-up is needed, the breast health nurse calls the referring physician to ask what surgeon he or she wants the patient to schedule an appointment with and then works with the patient to set it up.

Quick calls, quality care

The goal is to determine if there is a problem or not by biopsy within five days from the moment that the phone call about the abnormality is made. Therefore, most surgeons will try to schedule an appointment within 24-48 hours when the breast health nurse makes the call, says Rudmose.

"If it is something that needs further work-up, the patient is very worried at that point, so we try to get them in quickly to the surgeon and get the abnormality evaluated," she says.

At Inland Imaging in Spokane, WA, patients are given a slip of paper when they have a screening mammogram that helps prepare them for a follow-up visit should one be required. The note, which is printed on tear-off tablets for easy distribution, reads:

"A screening mammogram is a procedure used to screen for potential problems in the breast due to the denseness and complexity of breast tissue. Additional tailored imaging may be needed in order for the radiologist to complete the interpretation of your exam. If additional imaging is required, you will be informed by phone or letter at which time you need to contact our office to schedule another appointment. The need for additional imaging does not necessarily mean there is a problem just that more information is needed to complete the interpretation of your breast exam. There will be a charge for additional imaging, but it is generally covered by insurance."

The people who make the follow-up calls are given guidelines on what information to provide and appropriate language, says Jan Robbins, RT (RM), mammography coordinator at Inland Imaging. For example, they are not to say that there is a mass in the breast, because that term frightens women.

The person making the phone call has the report and simply provides information on why the patient is being asked to return. For example, there may be an area that is denser than the surrounding tissue and needs to be compressed.

"I try not to have [representatives] on the phone tell patients too much. If a patient is asking too many questions they are to get a technologist to answer the questions," says Robbins.

About 10% of the women who are screened for breast cancer at Inland Imaging must return for a diagnostic mammogram.

Education along the continuum

At OhioHealth, when a diagnostic mammogram reveals that further evaluation is needed by a breast surgeon, Rudmose lets patients know that 80% of the time it is nothing. However, if there is a problem, a breast health nurse is involved with the patient’s care all along the continuum.

Should a woman need surgery, she is referred to an inpatient breast health nurse who completes pre-op teaching and post-op discharge instructions. The nurse also follows up at home making calls to be sure that the patient is OK and is following discharge instructions.

Women who are diagnosed with breast cancer also can go to the Second Opinion Breast Cancer Clinic to see all the different specialists who treat breast cancer. Specialties include surgeons, plastic surgeons, medical oncologists, radiation oncologists, pathologists, and radiologists.

At the time of her appointment, the patient is assigned a lead physician based on the reason for her evaluation. If she were coming to the clinic to decide what type of surgery she wants, her lead physician would be a surgeon.

The lead physician does an initial history and exam and then meets with the group of specialists to present the case and review the patient’s imaging studies. When the team reaches a consensus, they meet with the patient who asks questions. The lead physician facilitates the discussion pulling each specialist into the conversation so the patient knows how this specialty relates to her.

Once the doctors formulate the patient’s treatment recommendation, it is sent to her referring physician and she receives some education from the breast health nurse depending upon her need at the time.

There are all different types of teaching sheets available for various procedures, in addition to a pre-op surgery class for women undergoing breast surgery, says Rudmose.

"We don’t want to overwhelm patients by giving them all the information at once. We take it step-by-step depending on where the patient is and how much they are ready to learn. The role of the breast health nurse is to provide education and support to both the patient and family through this whole process," says Rudmose.

Sources

For more information about educating patients when further follow-up is needed after a screening mammogram, contact:

  • Jan Robbins, RT, Mammography Coordinator, Inland Imaging, 12420 E. Mission, Spokane, WA 99216. E-mail: jrobbins@inland-imaging.com.
  • Pam Rudmose, RN, BSN, Breast Health Nurse and Coordinator for the Multispecialty Second-Opinion Breast Cancer Clinic, Breast Health Program, OhioHealth. Grant/ Riverside North East Health Center, 6200 Cleveland Ave., Columbus, OH 43231. Telephone: (614) 566-0569. E-mail: prudmose@ohiohealth.com.