Feasibility Pilot Outcomes of a Mammography Decision Support and Navigation Intervention for Women With Serious Mental Illness Living in Supportive Housing Settings

Abstract

Objective: People with serious mental illness (SMI) experience significant disparities in morbidity and mortality from preventable and treatable medical conditions. Women with SMI have low mammography screening rates. SMI, poverty, and poor access to care can have a significant effect on a woman’s opportunity to learn about and discuss breast cancer screening with health care providers. This study examines the feasibility pilot outcomes of mammography decision support and patient navigation intervention (DSNI) for women with SMI living in supportive housing settings. The primary research question was: Does the DSNI increase knowledge, promote favorable attitudes, and decrease decisional conflict relating to screening mammography? Methods: We developed the intervention with the community using participatory methods. Women (n = 21) with SMI who had not undergone screening mammography in the past year participated in an educational module and decision counseling session and received patient navigation over a 6-month period. We conducted surveys and interviews at baseline and follow-ups to assess mammography decisional conflict. Results: Among study participants, 67% received a mammogram. The mammogram DSNI was feasible and acceptable to women with SMI living in supportive housing settings. From baseline to 1-month follow-up, decisional conflict decreased significantly ( P = .01). The patient navigation process resulted in 270 attempted contacts ( M = 12.86, SD = 10.61) by study staff (phone calls and emails with patient and/or case manager) and 165 navigation conversations ( M = 7.86, SD = 4.84). A barrier to navigation was phone communication, with in-person navigation being more successful. Participants reported they found the intervention helpful and made suggestions for further improvement. Conclusions: The process and outcomes evaluation support the feasibility and acceptability of the mammography DSNI. This project provides initial evidence that an intervention developed with participatory methods can improve cancer screening outcomes in supportive housing programs for people with SMI.

‘We can bear it!’ Unpacking barriers to hepatocellular carcinoma screening among patients with hepatitis B: A qualitative study

“…The identified barriers, such as hepatitis B stigma, HCC taboo and social norms of enduring hardship, provide new insights for future inspections in other regions. Second, the study also mapped findings based on the PHM, which has been effectively verified in different cultures to predict cancer screening utilisation and may increase the generalisability of the current findings (Weinstein et al, 2019).…”

“…• Insights have important implications for diminishing the global burden of hepatocellular carcinoma from late diagnosis, and progress towards the World Health Assembly endorsed global hepatitis targets for improving survival in hepatitis B. fatalism and stigma) and sociostructural (limited health resources) levels for breast, cervical and colorectal cancer (Huhmann, 2020;Weinstein et al, 2019). Conversely, HCC screening targets a population with chronic diseases and the liver ultrasound screening modality is more accepted than the colonoscopy, mammography and the Papanicolaou test, which have an invasive or sensitive nature (Omata et al, 2017).…”

“…Thus, intervention components have largely been limited to clinical reminders, radiology‐led recall and quality improvements, which have only achieved uptake rates of ≤50% for HCC screening (Wolf et al, 2021). In contrast, barriers to screening were fully explored at individual (cancer worry and screening knowledge), cultural (cancer fatalism and stigma) and sociostructural (limited health resources) levels for breast, cervical and colorectal cancer (Huhmann, 2020; Weinstein et al, 2019). Conversely, HCC screening targets a population with chronic diseases and the liver ultrasound screening modality is more accepted than the colonoscopy, mammography and the Papanicolaou test, which have an invasive or sensitive nature (Omata et al, 2017).…”

“…Drawing on self‐regulation and preventive health behaviour theories, the preventive health model (PHM) has been advanced and extensively verified to explain participation in screening for breast, cervical, colorectal and prostate cancer (Christy et al, 2019; Myers, 2003; Weinstein et al, 2019). Based on the PHM, individual's sociocultural background (e.g.…”

Encouraging participation in colorectal cancer screening for people with schizophrenia: A randomized controlled trial

“…A previous meta‐analysis showed that patient navigation was effective for increasing cancer screening rates among populations adversely affected by healthcare disparities, although people with severe mental illness were not included in this previous research 26 . In a study of patient navigation to encourage participation in breast cancer screening, Weinstein et al reported preliminary efficacy for women with serious mental illness living in a supportive housing setting 27 . Given that the present randomized controlled trial confirmed efficacy among people with schizophrenia, patient navigation may be an important component of the intervention to encourage participation in cancer screening.…”