Eija Metsälä

Breast cancer worry in further examination of mammography screening – a systematic review

AIMS In this systematic review, we explored which factors are associated with breast cancer (BC) worry in further examination (FE) of mammography screening and for how long women experience BC worry associated with FE. METHODS Medline, Cochrane, Cinahl and the International Network of Agencies for Health Technology Assessment databases were used in the search. In addition to this, reference lists of the selected articles were inspected. The subject headings and keywords searched included breast screening, mammography screening, BC worry, distress or anxiety, additional test, further examination and recall. These were used separately and in combination. The databases gave 598 references. From the selected titles, 83 abstracts were read; from these, 23 publications were selected for full-text review. On the basis of full texts, 15 articles were chosen. FINDINGS There were very few studies about the associations between FE and BC worry. In those found, the amount of measured variables was limited. BC worry in FE of breast screening was associated with several sociodemographic and psychosocial factors of recalled women, as well as those related to the FE process. About half of the recalled women were quite or very anxious in the prediagnostic phase. CONCLUSIONS The review gave implications for interventions in the FE process of mammography screening. These interventions should predominantly be made in the preclinical phase and should differ according to the type of recall visit and characteristics of recalled women. In communicating the diagnosis to the women, the time from the examination process to diagnosis should be as short as possible, and in addition to physicians being present, other health care professionals should also be there to ensure the necessary emotional and practical support a woman needs in such a situation.

Reducing psychological distress in patients undergoing chemotherapy

Psychological distress is a common problem among patients with cancer, yet it mostly goes unreported and untreated. This study examined the association of a psycho-educational intervention with the psychological distress levels of breast cancer and cervical cancer patients undergoing chemotherapy. The design of the study was quasi-experimental, pretest-posttest design with a comparison group. One hundred patients at a cancer hospital in Jakarta, Indonesia, completed Distress Thermometer screening before and after chemotherapy. Fifty patients in the intervention group were given a psycho-educational video with positive reappraisal, education and relaxation contents, while receiving chemotherapy. Patients who received the psycho-educational intervention had significantly lower distress levels compared with those in the control group. Routine distress screening, followed by distress management and outcome assessment, is needed to improve the wellbeing of cancer patients.

European radiographers’ challenges from mammography education and clinical practice : an integrative review

ObjectivesThis study aims to identify European radiographers’ challenges in clinical performance in mammography and the main areas of mammography that require more and better training.MethodsAn extensive search was performed to identify relevant studies focused on clinical practice, education and training in mammography published between January 2010 and December 2015 in the English language. The data were analysed by using deductive thematic analysis.ResultsA total of 27 full text articles were read, evaluating their quality. Sixteen articles out of 27 were finally selected for this integrative review. The main challenges of radiographers’ mammography education/training can be divided into three groups: training needs, challenges related to radiographers, and challenges related to the organization of education. The most common challenges of clinical performance in mammography among European radiographers involved technical performance, the quality of practices, and patient-centeredness.ConclusionsThe introduction of harmonized mammography guidelines across Europe may serve as an evidence-based tool to be implemented in practice and education. However, the variability in human and material resources as well as the different cultural contexts should be considered during this process.Teaching Points• Radiographers’ awareness of their professional identity and enhancing multiprofessional cooperation in mammography.• Radiographers’ responsibilities regarding image quality (IQ) and optimal breast imaging performance.• Patient-centred mammography services focusing on the psychosocial needs of the patient.• Challenges: positioning, QC-testing, IQ-assessment, optimization of breast compression, communication, teamwork, and patient-centred care.• Introduction of evidence-based guidelines in Europe to harmonize mammography practice and education.

Characterization of breast imaging education and insights from students, radiographers and teaching staff about its strengths, difficulties and needs

INTRODUCTION The study aimed to characterize breast imaging education and identify its strengths, difficulties and needs across five European countries according to student, radiographer and teaching staff perspectives. METHODS An observation grid was used to collect data regarding breast imaging education and three questionnaires targeted to key-participants were developed/applied to collect data on strengths, difficulties and needs. Descriptive statistics and thematic analysis were performed according to the nature of the questions. RESULTS Breast imaging curricula varied within and between countries. Response rate for questionnaires also varied (13-100%). More than one-third of the teaching staff (37.5%) was involved in breast research projects. This was identified as the main strength in breast imaging education followed by collaborations between hospitals and academia. Difficulties with their education program identified by the 97 students surveyed included teaching issues (45), breast positioning (18), variety of image evaluation strategies (10) and human interaction (6). The need to provide an explanation to the patient about the role of the student in the mammography setting, and performing exams and teaching at the same time (22.6%) was identified as difficult by radiographers. The need for education and training in communication, practice and technological developments was identified. CONCLUSIONS A bridge between academia and clinical practice is extremely important in order to overcome recognized gaps between theory and practice. The development of a European education program covering the needs identified by the participants could be a possible solution to improve knowledge and access, and also to harmonize education and training across Europe.

Correction to: European radiographers’ challenges from mammography education and clinical practice—an integrative review

Affiliation number 2 was rendered incorrectly.

Auditor recommendations resulting from three clinical audit rounds in Finnish radiology units

Background The purpose of clinical audits performed in radiology units is to reduce the radiation dose of patients and staff and to implement evidence-based best practices. Purpose To describe auditor recommendations in three Finnish clinical audit rounds performed in 2002–2014, and to determine if auditor recommendations have had any impact on improving medical imaging practice. Material and Methods The retrospective observational study was performed in radiology units holding a radiation safety license issued by the Finnish Radiation and Nuclear Safety Authority. The data comprised a systematic sample (n = 120) of auditor reports produced in three auditing rounds in these units during the years 2002–2014. The data were analyzed by descriptive methods and by using the Friedman two-way ANOVA test. Results The number of auditor recommendations given varied between clinical audit rounds and according to the type of imaging unit, as well as according to calculation method. Proportionally, the most recommendations in all three clinical audit rounds were given about defining and using quality assurance functions and about guidelines and practices for carrying out procedures involving radiation exposure. Demanding radiology units improved their practices more than basic imaging units towards the third round. Conclusion Auditor recommendations help to address the deficiencies in imaging practices. There is a need to develop uniform guidelines and to provide tutoring for clinical auditors in order to produce comparable clinical audit results.