Suggestions for Breast Screening - Mammographers and Breast Screening Nurses

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Breast screening is often recommended for women between the ages of 50 and 69 as a preventive health strategy. Breast examination and mammography procedures can be experienced as intimate and intrusive and can influence a woman survivor's experience and perception of this screening process.

Mammographers occupy different roles from physicians and nurses in diagnostic testing and screening. Usually, they see a patient only once, and have almost no information beyond what is specified by a physician on a requisition form. The interviews indicated that most mammographers regularly encountered patients with severe anxieties who were unable to proceed with certain invasive tests, sometimes to the detriment of a needed diagnosis. It is often difficult to secure an accurate mammogram without the patient being in a somewhat relaxed state. Some background information about patients may be helpful to have before examinations and procedures. This would allow for specific provisions for people who need it (e.g., increased support and time, allowing the patient to apply compression on their own). The challenge is to make patients feel more relaxed in a relatively short period of time, knowing almost nothing about them. The following are ways to help survivors of abuse.

  1. Practitioners in our study suggested an approach of "Universal precautions"
    • Routinely ask patients how you could help them feel more comfortable with the examination, procedure, or test, and if there is anything they think you should know before proceeding. Consider a possible abuse history if patients show signs of anxiety or tension. A "universal precautions" approach indicates an awareness of the prevalence of abuse, and sensitivity to any signals that may suggest an abuse history. It also demonstrates respect for the patient and offers them control and input into the test, examination, or procedure without necessarily needing to disclose their history.
  2. Become more informed about childhood abuse
  3. Make your clinical setting more client-friendly
    • Most medical environments are intimidating rather than accommodating to patients. Provide a comfortable office environment for patients, particularly if they choose to disclose an abuse history.
    • Making small changes to the physical environment (e.g., cartoons, artwork, adjustable lighting, music, and informational posters on walls) can ensure a safe and welcoming environment to anxious clients.
    • Pamphlets or articles in waiting areas should describe what patients can expect from medical examinations. Materials that mention abuse and that it can be a part of a patient's history may also help.
  4. Approaching patients
    • Use a gentle touch, it is less frightening.
    • Use relaxation techniques with women who have difficulty with certain examinations.
    • Be aware of cultural and/or other differences where women have disabilities, are immigrants or visible minorities from diverse cultural backgrounds, are aboriginal, have literacy challenges, or are lesbians.
  5. Respect boundaries
    • Use curtains, ample cloth gowns appropriate for all sized women, knock or gently announce before entering the examining room, and discuss sensitive information only when women are sitting and dressed.
    • Ask patients beforehand if they would mind somebody in training being involved in the examination or procedure. Include a description of the sex and status of the person, and ask this question ahead of time without the person standing there, so patients are given the option, without having to say in front of somebody, "No I don't want you there."
  6. Find ways to provide patients with a greater sense of control and comfort over procedures
    • Offer an initial appointment just to talk.
    • Involve the survivor in care and plan treatment together.
    • Provide a checklist that helps women identify which concerns they have about the health care encounter (e.g., discomfort with certain procedures, boundary issues and others).
    • Ask patients for ideas to make the examination or procedure more comfortable (e.g., specific signals to stop or have a time out)
    • Start with a straightforward procedure with patients who require a lot of time and are fearful. Also, suggest the patient come back another day.
  7. Use interdisciplinary team meetings, hold case conferences, debrief with others, and share ideas and strategies for different ways of improving care for women survivors of abuse.
  8. Help patients stay in the present and avoid dissociating
    • Use the patient's name.
    • Help them to stay connected by asking for example, "Are you able to hear me? Is this okay?"
    • Engage the patient in what is being done in each part of the examination, test or procedure (e.g., what you are doing and why), rather than in talk that distracts from what you are doing.
  9. Integrate survivors' suggestions into your work situation

    The women interviewed with histories of CSA made suggestions for providing care to make things easier for them.

    • Having a support person with them
    • Being asked before any examination what might make it easier
    • Having examinations or procedures fully explained
    • More privacy in terms of gowns/drapes
    • Dimmer lights or brighter rooms
    • Being able to see a practitioner of a specified gender to perform certain procedures
  10. Let the patient know that she can stop the procedure or exam at any time if she finds it too uncomfortable and that you will respect her wishes and limitations.

    The voluntary nature of breast screening clinics may be a deterrent for many women with backgrounds of abuse. Recruiting letters should inform women that finding a cancer early improves the chances for full recovery. Patient fear may be reduced by advising in the letter that the visit will be one on one, confidential and private.

    Make pre-screening educational sessions available to women. Include a discussion of why women may not wish to attend breast screening and how the staff could be available for support.

    During examinations be aware that for many women, the nipple area may be sensitive; prepare her for this before touching. If possible, use positioning of the body rather than manipulation of the breast to achieve the proper location of the breast for Xray.

    To allow for a greater sense of control, some women may feel more comfortable if they are given the option of positioning their breast themselves for Xray with the help of the mamographer.