AJR September 2017

Rajni Natesan Corresponding Author University of Texas, Anderson Cancer Center Houston, TX

“Patient Demographics Reveal Preferences for Breast Imaging Providers”

Patient preferences for breast imaging care and location vary and are correlated with specific demographic characteristics, according to an article in the September issue of the American Journal of Roentgenology. The authors suggest that a greater understanding of these population characteristics can shape organizational strategies for improving patient-centered care and outcomes.

In the AJR article, titled “The Impact of Patient Demographics on the Selection of Breast Imaging Centers,” Rajni Natesan, of the UT- MD Anderson Department of Radiology, and coauthors, used an 18-question survey to gather information on patient demographics and preferences for breast imaging center location and radiologist training level. Their analysis of the 1682 responses identified four distinct cohorts:

• “Convenience optimizers” based their choice of breast imaging care primarily on location convenience, and showed a preference for non-medical-center settings. Those in this cohort also had a lower rate of cancer history and traveled, on average, 10 miles to get to their breast cancer imaging locations.
• “Ambivalent patients” showed the greatest degree of ambivalence about all preferences relative to the other cohorts, and did not show a significant trend with regard to the rate of patient cancer history or personal education level.
• “Medical center seekers,” who strongly favored a particular medical center (MC) location, also expressed a strong preference for completing all imaging studies at the same site.
• “Expertise seekers,” who expressed a stronger preference for physician training over location, and in particular sought radiologists with additional breast imaging training regardless of location.

Across the cohorts, there were no significant differences in age, marital status, insurance, income, and other demographic factors, the study authors reported.

“Breast imaging center location and radiologist training level, in addition to patient ethnicity, education level, and cancer history, have a significant impact on patient decision-making in breast imaging care,” the article said. “This information may prove helpful to health care delivery organizations as they establish and grow patient-centered breast imaging care practices.

“For example, health care organizations may want to choose a distributed location model to effectively serve the convenience optimizers cohort who prefer a relatively nearby community location over a more distant main MC. With sensitivity to the distinct needs and preferences of patient subpopulations, institutions can provide service and expand in meaningful ways to positively impact early detection of breast cancer and outcomes,” the authors stated.

The first preference was for care in an MC versus non-MC location, reflecting geographic distinction, the authors said. The low personal cancer history rate among the convenience optimizers may have driven a preference for locations that were closer to the patient’s home. This indicates a strong convenience preference linked to limited cancer history and indicates that breast care institutions should focus on providing convenient access to their centers for this population of patients, the article stated.

The second preference involved the training level of the radiologist, a less tangible and less transparent branding factor. Other studies reported that younger, more educated patients, particularly white female patients, desire greater involvement in their health care choices. Still other studies have indicated that race, language, and education can be barriers to information and can therefore hinder an individual’s access to choices.

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