Breast Imaging for Patients with Hearing and Vision Loss Requires Individualized Approach

Although visual- and hearing-impaired individuals do not account for the majority of breast imaging patients, providers can anticipate encountering more such patients in the near future. And, knowing how to best communicate with these women – and meet their imaging needs – will be critical.

According to national statistics, approximately 30 million Americans over age 12 have hearing loss, and 26.9 million have some form of vision loss. These impairments can make providing screening and diagnostic breast imaging services a challenge, said a multi-institutional team of investigators. Consequently, radiologists must create protocols to ensure they are treating these patients with respect.

“Breast radiologists should critically analyze the types of communication required in every scenario and determine whether or not the current processes and available options can provide the appropriate level of communication,” said the team led by Claudia J. Kasales, M.D., a breast radiologist at Fox Chase Cancer Center at Temple Health in Philadelphia. “All members of the breast health team, from scheduling staff to front office personnel, technologist, and breast imaging radiologists, should understand how to respectfully communicate with and identify the needs of patients facing these challenges.”

The team published their findings in the Sept. 25 Journal of Breast Imaging.

Although these encounters can be stressful and emotionally charged for patients, the team said, there has been little focus given to educating breast health providers about how to effectively interact with these patients. Overall, they said, it is important to remember that every patient’s circumstances and experiences will be unique.

“The key is to determine what level of service or aid is required to communicate effectively and to understand how to respectfully incorporate it into practice,” the team said. “But, to make such a determination, a breast imaging provider must better understand the needs of their patients facing communication challenges."

Hard-of-Hearing Patients

To most effectively treat these patients, the team said, there are several factors to consider.

1. Identify the patient’s preferred form of communication. Some patients prefer American Sign Language while others opt for written communication or to read lips. Be sure to determine which way the patient most comfortably communicates prior to the appointment.
2. Develop scripted protocols so schedulers can identify patients who might need assistive services, such as “Will communication assistance, such as a translator, be required during the appointment?’
3. Provide an official interpreter if one is requested, and ask the patient if she has a preference on the gender of the interpreter. Family members should not be used as interpreters as they may not fully understand medical information. If interpreters are used, breast imaging providers must be sure to look at and address all comments to the patient during the visit.
4. Providers should keep the exam rooms well lighted and sit where the patient can see his or her face, as well as the interpreter's, directly. Do not multitask during the appointment
5. Include any pertinent information or questions about imaging exams in written materials. If digital tools are used, include computer-assisted real-time captioning and telecommunication relay services. Be sure to keep instructions simple.

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Vision-Impaired Patients

Just like patients who have hearing loss, those who have low vision will also need individualized care, the team said.

1. Keep pathways and walkways clear, and use contrasting colors on doorways, floors, and walls to improve their perception.
2. Upon arrival, address the patient in a normal voice and offer any navigational assistance if it is needed. Only provide assistance if it is requested.
3. Provide verbal cues that can alert patients to approaching doorways, steps, ramps, or other obstacles, and describe the orientation of any new exam rooms. Breast imaging providers should verbally greet the patient upon entering the room, sharing their name and title.
4. Offer different communication formats – braille or large-print documents that provide information about various imaging studies can be helpful in giving a patient a better understanding of what to expect from a mammogram or ultrasound. Audio recordings can also be useful when providing complicated details
5. Breast imaging providers should describe what they are doing with a patient every step of the way so the patient can feel comfortable. In many instances, it can be helpful to have the patient touch the equipment, such as the ultrasound transducer or the mammography paddle.

Educating Staff

It is imperative, the team said, for all breast imaging staff to be trained in how to best care for patients who have communication challenges due to hearing and vision loss.

“Every breast cancer team member needs to understand the heterogeneity and varying needs of the patient population and how their interactions with the patient can dramatically affect the overall experience,” they said.

To reach this goal, they said, breast imaging providers can organize educational opportunities through in-service lectures, lunch-and-learn talks, or by sharing educational articles with their colleagues, including scheduling staff, front office personnel, aides, technologists, navigators, and trainees.

“It is vitally important that breast center providers understand the requirements…for interactions with the patient, as well as their family members and partner,” the team concluded.