Problem Statement
Given the significance of the problem of breast cancer, it is important to promote awareness and self-care behaviors in high-risk populations (Best, Spencer, Hall, Friedman, & Billings, 2014; Percac-Lima, Ashburner, McCarthy, Piawah, & Atlas, 2015). In particular, the use of mammography by the patients who are at risk of developing cancer is a healthy behavior to foster (Best et al., 2014; Gray et al., 2017). However, it has been found that women tend to be underinformed about mammography and are likely to have incorrect beliefs about it (Henriksen, Guassora, & Brodersen, 2015; Waller, Whitaker, Winstanley, Power, & Wardle, 2014). This issue can limit the appropriate use of screening by women who are at risk of developing cancer.
Nurses, including advanced registered nurse practitioners (ARNPs), are directly responsible for educating high-risk groups (Gray et al., 2017). However, a preliminary investigation does not find any recent sources that would test the effectiveness of any form of nurse-provided consultations or other nurse-led efforts in educating patients on mammography. Also, a few suggestions on the development of such interventions are provided in the recent literature. Therefore, it can be suggested that the subject of ARNP-led educational efforts related to mammography is understudied, which leaves ARNPs with little evidence for their practice. The proposed study will attempt to address the problem.
Purpose, Objective, or Hypotheses
The purpose of the study is to test the effect of ARNP-conducted consultations concerning mammography on patients’ intent to engage in the procedure. Additionally, the changes in patients’ understanding of mammography, including the related benefits, risks, and rationale for using it, can be checked. The study has no direct objective. Regarding a hypothesis, it could be offered based on the fact that provider recommendations are among the factors that may affect screening participation (Donovan, Urquhart, Hopkins, Knight, & Moore, 2014; Haas et al., 2017; Percac-Lima et al., 2015). However, no recent direct evidence regarding the effectiveness of consultations was found yet. As a result, no hypothesis is proposed for the time being.
Aim of the Project/Outcomes to Achieve
Since little information is available about the activities that ARNPs can undertake to educate their patients about breast cancer screening opportunities, the proposed project intends to contribute some data on the topic. Therefore, the project aims to provide evidence indicating the effectiveness of ARNP-conducted consultations in affecting the willingness to use mammography in the groups of women who are at high risk of developing cancer. Consequently, the desired outcome is the contribution of information on the topic.
PICOT Question
The population that will be considered are the women for whom mammography should be recommended based on a high risk of developing breast cancer. Some of the factors that increase the risks include age, ethnicity, and relatives with breast cancer (Best et al., 2014; Nattinger & Mitchell, 2016). For the project, the eligible women will be identified and offered recruitment materials by their care providers. The intervention will be a culturally-appropriate consultation meant to deliver all the pertinent information on the risks, benefits, and other significant aspects of mammography. It will be conducted by ARNPs. Regarding the comparison, the project will be a pre-test and post-test study: the women will be provided with data collection questionnaires before and after the intervention
The outcome that will be measured is the willingness to use mammography for monitoring one’s health. Additionally, it may be helpful to gather the data regarding the patients’ understanding of the risks and benefits of mammography. The desired outcome is the improvement of patients’ knowledge and awareness and the adjustment of their willingness to use mammography depending on personal risks. Since a high-risk population is going to be recruited, the increase in willingness seems to be the desired outcome.
For the time being, it is proposed to use the Champion’s health beliefs survey for data collection. The tool has been proven to be reliable, and it can be employed in mammography-related studies. For example, Hasnain, Menon, Ferrans, and Szalacha (2014) demonstrate the way the survey can be adapted to include culturally sensitive items. It is noteworthy that the tool inquires about multiple circumstances that can affect screening intent. This fact is beneficial for the study since the willingness to use mammography is the result of the interaction of several factors (Haas et al., 2017). The scale would help to rule out external variables, including, for example, insufficient income.
Finally, regarding the timing, it appears necessary to consider both short-term and long-term effectiveness. As a result, it is proposed to gather the data immediately after the consultation and ten weeks after it. This timeframe is feasible and will offer an improved understanding of the effects of the intervention since long-term outcomes will also be taken into consideration. In summary, the following PICOT question is proposed for the project.
In women at high risk of developing breast cancer (P), how does an ARPN-conducted consultation (I) affect their willingness to use mammography (O) right after the consultation and ten weeks after it (T) as compared to the willingness to use mammography before the consultation (C)?
References
Best, A., Spencer, M., Hall, I., Friedman, D., & Billings, D. (2014). Developing spiritually framed breast cancer screening messages in consultation with African American women. Health Communication, 30(3), 290-300. Web.
Donovan, D., Urquhart, L., Hopkins, U., Knight, S., & Moore, L. (2014). Oncology nursing support for safe and effective use of eribulin in metastatic breast cancer. Clinical Medicine Insights: Oncology, 8, 1-6. Web.
Gray, T., Cudjoe, J., Murphy, J., Thorpe, R., Wenzel, J., & Han, H. (2017). Disparities in cancer screening practices among minority and underrepresented populations. Seminars in Oncology Nursing, 33(2), 184-198. Web.
Haas, J. S., Barlow, W. E., Schapira, M. M., MacLean, C. D., Klabunde, C. N., Sprague, B. L.,… Harris, K. (2017). Primary care providers’ beliefs and recommendations and use of screening mammography by their patients. Journal of General Internal Medicine, 32(4), 449-457. Web.
Hasnain, M., Menon, U., Ferrans, C., & Szalacha, L. (2014). Breast cancer screening practices among first-generation immigrant Muslim women. Journal of Women’s Health, 23(7), 602-612. Web.
Henriksen, M., Guassora, A., & Brodersen, J. (2015). Preconceptions influence women’s perceptions of information on breast cancer screening: A qualitative study. BMC Research Notes, 8(1). Web.
Nattinger, A., & Mitchell, J. (2016). Breast cancer screening and prevention. Annals of Internal Medicine, 164(11), ITC81. Web.
Percac-Lima, S., Ashburner, J., McCarthy, A., Piawah, S., & Atlas, S. (2015). Patient Navigation to improve follow-up of abnormal mammograms among disadvantaged women. Journal of Women’s Health, 24(2), 138-143. Web.
Waller, J., Whitaker, K., Winstanley, K., Power, E., & Wardle, J. (2014). A survey study of women’s responses to information about overdiagnosis in breast cancer screening in Britain. British Journal of Cancer, 111(9), 1831-1835. Web.