Mammography Adherence: Creation of a Process Change Plan to Increase Usage Rates

Clin J Oncol Nurs. 2019 Jun 1;23(3):281-287. doi: 10.1188/19.CJON.281-287.


Background: Mammography is the optimal tool to mitigate breast cancer morbidity and mortality; however, in many healthcare settings, mammography adherence rates are decreasing.

Objectives: This nurse-led quality improvement project was conducted to improve patient adherence to annual mammography screening.

Methods: Data collection included clinical information from the electronic health record, chart reviews, tracking documentation used by the clinic's social worker, interviews with staff, observation of the clinical setting, creation of a process flow map to identify barriers, and identification of internal and external resources. Strategies to reduce barriers included communication with staff about problems, a streamlined referral process, a scripted message about mammography, an up-front assessment of financial and social barriers to adherence, and an early referral to resources.

Findings: A pre-process change chart audit showed a 22% mammography adherence rate. The post-process change rate was 51%, representing a statistically significant difference in adherence.

Keywords: adherence; breast screening; mammography; process improvement.

MeSH terms

  • Adult
  • Aged
  • Ambulatory Care / organization & administration
  • Ambulatory Care Facilities / organization & administration
  • Breast Neoplasms / diagnostic imaging*
  • Breast Neoplasms / ethnology
  • Breast Neoplasms / pathology
  • Early Detection of Cancer / standards*
  • Electronic Health Records / statistics & numerical data
  • Female
  • Guideline Adherence
  • Health Behavior / ethnology*
  • Health Literacy
  • Health Planning / standards
  • Humans
  • Mammography / methods*
  • Mammography / statistics & numerical data*
  • Middle Aged
  • Monitoring, Physiologic / methods
  • Oncology Nursing / organization & administration
  • Patient Compliance / statistics & numerical data*
  • Practice Guidelines as Topic
  • Practice Patterns, Nurses' / organization & administration
  • Quality Improvement
  • Risk Assessment
  • United States