The Spirit of Inquiry Ignited
Cancer is a grave disease that is highly lethal and often delivers a slow and painful death at later stages. Statistically, in 2008 the mortality rate from cancer was at the level of 62% (Siegel et al., 2014). Breast cancer is one of the most dangerous kinds of cancer forming in ducts and lobules of the breast (in both men and women). In the United States, this type is the second leading cause of death from cancer (after lung cancer) and is found in one woman in eight (DeSantis et al., 2014). In 2017, 252,710 women have been diagnosed with breast cancer, for more than 40,000 of whom the disease is to be lethal (Donepudi, Kondapalli, Amos, & Venkanteshan, 2014). However, advances in mammogram screening and disease treatment have significantly increased survival rates during the last decades (there are now more than three million survivors living in the country).
Awareness of the symptoms is one of the most important factors in preventing deplorable consequences of breast cancer. Screening mammography is recommended to be performed annually for every woman aged between 40 and 55, especially if they are at increased risk owing to their family history of the disease. Some are advised to begin screenings earlier (approximately at 30) and continue undergoing them lifelong. Although in some cases breast cancer is detected due to the appearance of certain symptoms, it is not infrequent for it to be asymptomatic, which makes screening initiated by healthcare providers particularly important.
The PICOT Question Formulated
In a primary care setting, for women aged 40-55 (P), how effective is provider-initiated conversation regarding recommended screening guidelines and their benefits in detecting breast cancer (I) versus not initiating conversation (C) in increasing patient participation in mammogram screenings for breast cancer (O) over a 6-month period (T)?
Search Strategy Conducted
The search was conducted using numerous databases including Google Scholar, ProQuest, PubMed, and CINHAL. The MESH terms used for the project include: breast cancer, cancer, mammography, screening, cancer detection, and mammogram. After the all relevant studies had been selected, the evaluation for inclusion and exclusion criteria was conducted for them to exclude those that did not provide sufficient information, were not deeply grounded in evidence or outdated. In the advanced search, the timeframe indicated was 2015-2017. The search was narrowed by peer-reviewed and evidence-based studies, which were meant to increase accuracy and productivity of the project.
The acronyms utilized for searching include: BMC, NHS, ACOG, ACS, AHRQ, BCSC, BI-RADS, BSE, PTS, MMG, CBE, DCIS, EPC, LCIS, MRI, NCI, NNS, RR, WHI, WHO.
Critical Appraisal of the Evidence Performed
Several studies were chosen for the purpose of the project at hand. The choice was made based on the quality of evidence, its up-to-date character, and relevance to the intended research. All the selected materials were consistent with the hypothesis and proved the need for further investigation of the issue.
The study conducted by Rzepecki et al. (2017) was aimed to find out if patients pay attention to brochures in the changing room and follow the screening recommendations provided. The researchers also intended to investigate whether these patients made an appointment for an additional consultation after undergoing the screening. It was discovered that the majority of patients notices the information bulletins and more than 20% of them decided to check themselves for melanoma signs. Those who were informed about its symptoms booked a preemptive MMG exam in addition to visiting a dermatologist. This made the researchers conclude that knowledge of basic SSE techniques positively affects patients’ willingness to undergo cancer prevention and early detection procedures and may have an influence on MMG attendance.
Bayik, Daghan, Kaymakci, Ozturk, and Abaraci (2017) hypothesized that despite BSE and PST scores in Turkish women and teachers being traditionally low, training and awareness seemed to improve the results in three measured variables. The found out that providing breast cancer-related knowledge managed to improve awareness and MMG attendance in a region with traditionally low scores in BSE, MMG, and PST. This implies that that providing instruction and information in any way naturally improves a willingness to undergo the procedure.
Moshki, Taymoory, Khodamoradi, and Roshani (2016) aimed to test the strength of the connection between perceived risk of breast cancer in Iranian women and physician recommendation to perform the screening. The researchers discovered that a physician’s recommendation greatly enhanced chances of follow-up mammography attendance among patients. The mechanisms of influence revolved around inspiring fear through indirect means and making the patients want to conduct additional mammography tests in order to remain on the safe side.
Fisher, Wilkinson, and Valencia (2017) examined the willingness of women to receive additional knowledge on breast cancer. They found out that 93.7% reacted positively to the proposition. The study underlines the general receptiveness of the population towards acquiring new knowledge about breast cancer, which is directly related to MMG attendance rates.
Reder and Colip (2015) hypothesized that a decision aid rendered by a healthcare provider might improve an informed choice in breast cancer screening. They discovered that such an aid indeed increased patient knowledge about the procedure, reduced decisional conflicts, and improved MMG attendance rates. This proved the importance of physician recommendations and consultations in regards to MMG attendance rates.
Evidence Integrated with Clinical Expertise and Patient Preferences to Inform a Decision and Practice Change Implemented
The Purpose of the Project
All the studies reviewed showed that information provision is highly significant in detecting breast cancer. Thus, the project at hand is needed to expand the existing knowledge. That is why it will investigate whether provider-initiated conversation can improve the effect of screening guidelines. As an APRN, I am aware of my crucial role in the primary and secondary prevention of such diseases. The project will show whether my practical skills and theoretical knowledge of the problem are advanced enough to perform a successful intervention and convince even reluctant patients to perform the screening. This will allow me to initiate other screening programs in the future and influence patient preferences in making an informed decision. If the project is successful, it will contribute to the promotion of high-quality care and lead to a considerable practice change, making healthcare providers more involved in the problem (substituting the detached approach that consists in issuing guidelines without additional communication techniques).
Methods and Implementation Plan
The design of this PICOT research will feature a test group and a control group. The test group treatment will involve provider-initiated conversation regarded recommended screening guidelines. The control group will be treated without changes. It should provide a good comparison in order to determine the effectiveness of the approach. It will also show whether increased communication will patients may contribute to their decision-making capabilities and make them more aware of their health choices.
The intervention will last six months. The issue of time is appropriate for this PICOT question, as the effect of provider-initiated conversation does not happen over a short period of time. In order to see if non-intrusive conversations regarding breast cancer detection influence participation in mammogram screenings, a minimum of six months of observation are necessary. It will allow the researchers to detect any short-term and long-term influence patterns if there are any.
Outcomes Evaluated
In the event of a successful outcome of the project, the data analysis should reveal that the number of women deciding to undergo breast screenings increased among those who participated in a provider-initiated conversation in comparison to those who did not. Furthermore, to have validity and reliability, this study must be replicated to prove that its results can be generalized. Provided that all these conditions are met, the results of the project can be disseminated in the nursing community.
Evidence Synthesis
Evaluation Table
References
DeSantis, C., Ma, J., Bryan, L., & Jemal, A. (2014). Breast cancer statistics, 2013. CA: A cancer journal for clinicians, 64(1), 52-62.
Donepudi, M. S., Kondapalli, K., Amos, S. J., & Venkanteshan, P. (2014). Breast cancer statistics and markers. Journal of Cancer Research and Therapeutics, 10(3), 506-511.
Siegel, R., Ma, J., Zou, Z., & Jemal, A. (2014). Cancer statistics, 2014. CA: A Cancer Journal for Clinicians, 64(1), 9-29.