Why do patients decline screening mammography?

Physician recommendation may not be sufficient to motivate patients to comply with health maintenance activities. During a physician visit, female patients over age 50 were reminded to schedule mammography; more than 10% overtly refused. A telephone questionnaire of 20 age-matched refusers and compliers was performed to assess knowledge, attitudes, behavior, and demographics. Refusers and compliers were similar in many respects; there was no significant difference in how the groups perceived their current health. Paradoxically, refusers had less knowledge of bad experiences with mammograms (p < .01). Refusers were more likely not to know if their insurance covered screening (p < .01), and were less likely to recall their physicians recommending screening even though recommendation was documented in the chart (p < .05). Refusers were less likely to have ever had a mammogram (p < .05). This subgroup of patients does not obtain mammograms, finds physician recommendation an insufficient stimulus for mammography, and considers insurance coverage a concern without investigating it.