Barriers and Facilitators to Breast Cancer Screening for Women With Severe Mental Illness

Abstract

Background: Women with severe mental illness (SMI) are diagnosed with breast cancer at later stages, with greater mortality rates than the general population. Although breast cancer screening is an acknowledged strategy for early breast cancer detection, women with SMI are 32% to 50% less likely to have regular mammography screenings, yet the specific factors related to the disparity in this population have not been determined. Aim: The purpose of this study was to identify the barriers and facilitators toward breast cancer screening in women diagnosed with SMI. Method: In collaboration with a community-based mental health services agency, women aged 40 and older, diagnosed with SMI, and treated at that agency, were identified and asked if they were willing to participate. Fifteen women agreed to be interviewed. An interpretive descriptive approach was utilized to analyze the qualitative data. Results: The themes elicited included barriers and facilitators to screening. Barriers found were: Psychiatric Symptoms, Fear, Distrust in the Health care System, and Not my Priority. Among the facilitators were Support, Good Health care Experiences, Make it Easy, Integrated Care, and Self-Care. Conclusion: Unique to this study was the understanding by participants that physical health needed to be integrated into their mental health care services through direct support and education, primarily because the process of recovery from mental illness itself entailed the increasing ability for self-care, encompassing a focus on both mental and physical health needs and preventive care.

Barriers and facilitators for people with severe mental illness accessing cancer screening: A systematic review

“…After de-duplication and title and abstract sifting, 114 full papers were assessed. In total, 20 papers met the inclusion criteria and were included in the review [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49][50][51][52][53][54] (Figure 1).…”

“…The characteristics from the 20 included papers are presented in Table 2. Most papers (n = 11) focused on multiple cancer screening programmes (i.e., cervical and breast) within the same study, [35][36][37][38][44][45][46][47][48]51,53 four on breast cancer screening, 42,43,49,54 three on cervical cancer screening, 39,41,50 and two on colorectal cancer screening. 40,52 In total, 3,594,891 PwSMI were included as participants across the studies.…”

“…45 People with severe mental illness felt that their relationship with health professionals was poor (for example poor engagement and/or communication) and were concerned about attending cancer screening. 45,53,54 Having good communication was not only needed between the person attending the appointment, and the screening staff, but for care systems to communicate with each other. 36,45,54 Specifically, there was a concern that a lack of integration between services (for example mental health/hospital in-patient and screening services) and using different computer systems may cause problems, for example, the screening staff had no way of knowing if the person had any specific needs or when they were due for cancer screening.…”

“…36 Similarly, if the individual had personal experiences of trauma and stigma, lacked motivation, and/or was fearful of having a positive test result, these all contributed to their decision not to attend cancer screening. 36,53,54 A barrier found to impede participation was stigmatisation and cancer screening staff's negative attitudes towards SMI. 36,45,53,54 PwSMI felt some screening staff were unaware of individuals mental health diagnosis and did not understand the effects that this had upon their physical health; while others felt, some screening staff were supportive and understanding.…”

“…36,53,54 A barrier found to impede participation was stigmatisation and cancer screening staff's negative attitudes towards SMI. 36,45,53,54 PwSMI felt some screening staff were unaware of individuals mental health diagnosis and did not understand the effects that this had upon their physical health; while others felt, some screening staff were supportive and understanding. It was also found that nonmental health professionals, including doctors, held stigmatising views, 45 for example, doubting whether cancer screening is needed for PwSMI.…”