FACTORS DETERMINING COMPLIANCE WITH SCREENING MAMMOGRAPHY

Objective: To determine Factors affecting compliance with screening ma mmography prescribed by Family physicians. Design: Secondary analysis of a nonrandomized trial. Setting: University-affiliated family medici ne clinic in Montreal. Patients: Women aged 50 to 69 years who were gi ven a written prescription for a screening mammography during their vi sit at the clinic between Oct. 12, 1991, and May 31, 1992, and who had not undergone mammography in the preceding 2 years and had never been treated for breast cancer. Information on the potential factors was o btained through a telephone questionnaire 2 months after the visit. Ou tcome measures: Indicator of compliance: presence of result of screeni ng mammography in patient chart, potential factors influencing complia nce: age, level of education, marital status, socioeconomic level, smo king status, perceived health status, perceived psychological well-bei ng, risk factors For breast cancer, use of health services including f requency of Papanicolaou test, Health Belief Model variables. Results: Of the 171 eligible women 113 (66.1%) underwent the prescribed mammog raphy within 2 months after the visit to the clinic, and 149 (87.1%) r esponded to the questionnaire. The patients' socioeconomic characteris tics, perceived health status, health utilization indices and risk Fac tors For breast cancer were not found to be predictors of compliance. The strongest predictor of compliance was the number of previous mammo grams. Women who had undergone mammography previously were less likely to be noncompliant than those who had not (odds ratio [OR] 0.11, 95% confidence interval [CI] 0.02 to 0.51, p = 0.005). Women who did not c omply were less likely than those who did to believe that a prescripti on from their physician would convince them to, undergo mammography (O R 0.21, 95% CI 0.07 to 0.60, p = 0.004). Other factors associated with noncompliance were the expression of fear of mammography (OR 2.09, 95 % CI 1.08 to 4.02, p = 0.03) and the lack of time to lake the test (OR 3.07, 95% CI 1.21 to 7.80, p = 0.02). Being a smoker was negatively a ssociated with compliance (OR 0.43, 95% CI 0.22 to 0.86, p = 0.02). Th e stepwise logistic regression model accounted for 87.5% of the outcom e (chi(2) for goodness of fit = 164.4, p = 0.0001). Conclusion: Family physicians who prescribe screening mammography, even to women who con sult For other reasons, are likely to overcome some of the barriers ob served in association with population screening rates. However, physic ian-oriented approaches are not likely to reach the 30% to 40% of re l uctant women who appear to hold negative views toward physicians' reco mmendations. Further study is necessary to determine how better to rea ch these women.