Purpose: The purpose of this study is to test whether patient and radiologist demographics influence perceptions of screening mammogram reports and the interpreting radiologist.
Materials and Methods: Patients presenting for breast imaging were invited to participate. Demographic questions included age, race, ethnicity, education (pre-college, any college, post-college), and insurance status. Each participant was shown five mock screening mammogram reports with BI-RADS 2 findings, each with a recommendation for one year screening. Each mammogram report included a picture of the interpreting radiologist and each set of five reports contained at least one example of Black men, Black women, white men, and white women. For each report, participants were asked seven Likert questions about understanding, satisfaction, and trust in the report and radiologist. Multivariate modeling compared responses based on participant and radiologist demographics.
Results: There were 178 women who participated in the study with a mean age of 55.2 ± 10.2 years. Most participants self-identified as white (71%) or Black (22%) and non-Hispanic (98%). There was broad educational representation, most commonly with a Bachelor’s (28%) or Master’s degree (28%). Almost everyone had insurance (99%) and most women had read a prior screening mammogram report (85%). The results of the multivariate logistic regression models are as follows. Pre-college educated participants had significantly lower agreement (p=0.04) that they understood the report recommendations. Higher agreement in the quality of the report was reported for post-college educated (p < 0.001) and white (p=0.009) participants. Black participants were significantly more likely to recommend the radiologist to family and friends if the radiologist was Black (p=0.011) than were other racial permutations (Figure 1). Similarly, there was greater trust in the report findings for Black participants and Black radiologists (p=0.021) than other racial permutations (Figure 2). Finally, participants with post-college education (p < 0.001) reported greater agreement that the radiologist cares about his/her patients.
Conclusion: Patient and radiologist demographics influences perceptions of mammogram reports and the interpreting radiologists. Specifically, Black patients reported greater trust in the radiology report and a higher likelihood of recommending the radiologist to friends and family if the radiologist was Black. Additionally, participant education notably influenced understanding of the content and quality of the report as well as perceptions of whether the radiologists cares about his/her patients.
Clinical Relevance Statement: Efforts to diversify breast radiology may benefit Black patients. Furthermore, practices should tailor the language of their reports to patients with a broad educational background.
