Improving Mammography Adherence and Volume with Text Messaging

It is well understood that breast cancer screening with mammography saves lives. Unfortunately, many women do not receive the regular, recommended screening tests needed to identify breast cancer early.^1,2

Text messaging is one way to enhance mammography screening rates. A well-designed, well-executed texting campaign can not only grow an organization's number of scheduled mammograms, it can also boost the number and percentage of completed screenings. For those patients who have opted in to receive text messaging, consider sending texts at the following points in their breast cancer screening journey.

Scheduling. Your initial text can inform patients that it is time to schedule their screening. Within this message, one can explain how patients can choose a date and time that works well for them. This can be done by accessing a scheduling system through a patient portal and/or by calling your organization. Including a link to the portal and the phone number patients can call in the text can help make scheduling easier.

If you use two-way texting, which enables the recipient of the text to reply to a message, you can ask if the patient would prefer a call from your organization to help with scheduling. If the patient prefers a call, send a follow-up text identifying the phone number that will be calling them and the time/time of day the patients should expect the call. Doing so helps improve the likelihood that the patient will answer the call.

For patients who will be undergoing their first screening, the text can note that guidelines recommend they start receiving mammograms. For patients who have already received a mammogram, a recall text message can remind patients about the importance of adhering to the recommended screening schedule.

To help improve scheduling success rates, communicate with patients in their preferred languages. Some text messaging systems will enable you to easily choose a patient's preferred language and ensure that outgoing messages to the patient are in this language.

(Editor’s note: For related content, see “Mammography Study: AI Software Predicts One-Third of Breast Cancer Cases Up to Two Years Prior to Diagnosis.”)

Referral scheduling. It's also worthwhile to send a scheduling prompt text as soon as you receive a referral. This can help get patients booked before they consider scheduling their screening at another facility.

Scheduling reminder. For patients who receive the initial scheduling text message but do not take an action, a follow-up text(s) can further remind them about the importance of scheduling their screening (i.e., early detection of breast cancer). This text can also remind patients that most health plans cover the full cost of a screening mammogram, which can help address a top screening barrier.

This text should also remind patients that they can speak with someone at your organization to receive help with scheduling and get any questions answered. Provide a number they should call and the hours when calls will be answered.

Appointment details. Once patients have scheduled their screening, send a text that provides the details about their appointment, including date, time, and location. You may also want to note what patients should do if any of the confirmed information is incorrect or if patients need to choose a different date/time/location.

Preparation instructions. As the appointment approaches, send a text summarizing what patients should do to prepare for their mammogram.3 This information may be longer than you will want to summarize in a text message. You can include a link in the text that directs people to this information, which may be posted to your website or accessible within your portal.

Appointment confirmation. A few days prior to the screening appointment, send a text asking patients to confirm that they still intend to make it to their screening and what they should do if they need to reschedule. If you use two-way texting, you can ask patients to confirm by responding to the text (e.g., Y/N).

Appointment reminder. A day before the patient's screening appointment, send a text reminding them about their appointment details. This is also a good time to share information like arrival time, directions, parking, what patients should bring with them, and what patients should and should not wear (e.g., deodorant, jewelry). Here's another instance where a link to a web page with these details can help you include all the information you believe will help ensure patients arrive on time and prepare appropriately.

Canceled or missed appointment. If patients cancel or fail to show up for their appointment, a subsequent text can encourage them to reschedule their screening, emphasizing the importance of following the recommended scheduling guidelines.

Results reminder. A text sent the morning after a completed screening can remind patients not to call the facility for the results of their screening as these will be provided by their physician. This proactive message will help cut down on unnecessary inbound phone calls.

Post-appointment survey. After patients undergo their screening, texting can be used to conduct an experience survey. A two-way text message can ask patients questions about their experience or to rank their experience, or the text could provide a link to an online survey. Information gathered from this survey can help organizations improve their mammography screening program.

For patients who identify in a survey that they had a positive experience, a text can ask them to provide an online review and include a link(s) to where patients can provide their review (e.g., Google, Facebook). In a competitive market, providers with a strong, positive online presence are likely to find themselves at an advantage with attracting patients and staff.

Why Texting is Highly Effective

Despite its simplicity, text messaging can be a game changer for improving adherence to breast cancer screening rate as well as mammography volume in one’s practice. People have become accustomed to receiving and interacting with text messages from familiar organizations, like health plans, financial institutions, airlines, and numerous service providers. A text from you will likely not be a surprise and be welcomed by many.

While people are increasingly ignoring phone calls, especially from numbers they don't recognize, your organization is not likely to ignore inbound calls. On a cell phone, initiating an inbound call to your organization only requires patients to click your number included in the text message. As I like to say, "If you want someone to call you, send them a text."

Text messaging can be heavily automated so you can schedule messages to go out to patients in advance. Some text messaging solutions can allow to you use "trigger" texts, which are messages that will go out based upon actions taken by recipients. An example is the series of confirmation, reminder, instruction, and survey texts you may send after a patient schedules an appointment. When texting is automated, you reduce the likelihood of falling behind — and your patients falling behind — and developing a backlog of outreach efforts.

At a time when organizations are facing staff shortages and work overload, texting reduces manual labor and frees up personnel to focus on other work critical to the success of an organization. Text messaging can also help with reducing expenses, including those associated with overtime or part-time work.

One final benefit is the ability to perform ongoing evaluation of your program's performance. Texting is powered through a technology platform, which should enable an organization to run analytics and track metrics such as:

• the number of patients subscribed to your screening program;

• how many patients you have mobile numbers for and can reach via text, which you can work to update and increase;

• how many patients received and responded to texts; and

• how many patients scheduled and kept their appointments.

By incorporating or further leveraging text messaging, organizations can improve mammography adherence, help ensure more patients get their timely screenings, and grow patient and screening volume.

Brandon Daniell is co-founder and chief revenue officer of Dialog Health, a provider of a HIPAA-compliant, conversational two-way texting platform to organizations which they can leverage as a communication and engagement channel.