Abstract
The study has been designed to measure the effectiveness of breast cancer decision aids (DAs) in improving mammography screening intentions in African-American women 65 years and older. The importance of the project is underscored by a large body of evidence pointing to the fact that older African-American women are not adequately informed about the benefits of the procedure, which exposes them to a high risk of breast cancer.
In addition, the population is disproportionately targeted by the disease, which necessitates an effective intervention. The pre-test-post-test trial will be conducted in Florida Hospital between January 1, 2018, and January 1, 2019. Eligible participants who have scheduled physician visits will be recruited via phone calls. The informational output of the study will be assessed with the help of the Wilcoxon signed-rank test and bivariable statistics.
Mammography Screening Reduces Breast Cancer Mortality
It has been long established that the mortality burden of breast cancer can be substantially reduced by timely mammography screening. Age is the key risk factor in breast cancer, which means that chances of developing the disease rise with advancing age (Walter & Schonberg, 2014). The need for the procedure is especially pressing in women 65 years and older because they comprise a considerable portion of the US population—11.4 million (Walter & Schonberg, 2014). Furthermore, African-American women are disproportionately affected by the disease; therefore, it is necessary to increase their mammography intention rates, thereby reducing their breast cancer mortality.
The aim of this paper is to detail a research proposal that can serve as a basis for an improvement project. The proposed research will assess the effectiveness of DAs in increasing mammography screening intentions in African-American women 65 years and older.
Problem Statement
When compared to their White counterparts, African-American women have substantially lower rates of breast cancer survival (Checka, Chun, Schnabel, Lee, & Toth, 2012). Despite comprehensive media campaigns and other efforts exerted by governmental and non-governmental agencies, the excess mortality among African American women is still at high levels. The group has selected the project to develop effective methods for improving the population’s adherence to regular mammography screening, thereby detecting early malignancies. Taking into consideration the fact that the risk of breast cancer increases with age, the project will focus on women 65 years and older who are especially vulnerable to the disease (Checka et al., 2012).
Literature Review
A study by DeSantis, Naishadham, and Jemal (2013) shows that African American Females are disproportionately targeted by all types of cancer, in general, and breast cancer, in particular, with the latter accounting for 19 percent of deaths. The disparities are particularly striking for older women. According to Hall, Rim, Johnson-Turbes, Vanderpool, and Kamalu (2015), African American women 65 years and older are 40 percent more likely to die from breast cancer than white women. The importance of the issue is underscored by the fact that each year approximately 41, 000 women do not survive the disease (Hall et al., 2015).
The adherence to a regular mammography screening regimen is central to reducing mortality from breast cancer. Fair, Monahan, Russel, Zhao, and Champion (2012) maintain that the perceived benefits of the procedure are the best predictor of adherence rates. It follows that by improving women’s knowledge of mammography, it is possible to diminish breast cancer mortality.
Thematic evaluation of the extant literature on the topic shows that while women’s perceptions of the screening are extremely diverse, the following themes can be traced: fear, pain, and discomfort (Clark & Reeves, 2015). The study indicates that women’s perceptions of the procedure prevent them from regularly undergoing examinations to avoid discomfort and pain (Clark & Reeves, 2015). A corollary is that to decrease the healthcare disparity, it is necessary to improve women’s knowledge of mammography screening.
Clinical PICOT Question
A PICOT question for the project is formulated as follows:
- P In a primary care setting, for African American women 65 years and older,
- I how effective is the provision of DAs
- C versus not providing DAs
- O in increasing mammography screening intentions
- T over a one-year period?
Purpose
To evaluate the effectiveness of the use of DAs for increasing mammography screening intentions in the primary care setting.
Methods
For the evaluation of the effectiveness of DAs in increasing screening intentions, a pre-test-post-test trial will be used. Prior to a physician visit, participants will be provided with DAs discussing the pros and cons of mammography screening, health outcomes, mortality risks, and scientific uncertainties associated with breast cancer (Stacey et al., 2014). The women will complete a survey after the visit. The participants of the study will be divided into two groups with the help of random sampling. The intervention group (50 percent) will receive DAs, whereas the control group (50 percent) will not be provided with information concerning mammography.
Study Sample
Women at Florida Hospital who had not had a mammography screening in at least two years prior to the study will be included in the sample. Other eligibility criteria: a lack of dementia, no history of breast cancer, and ages between 65 and 89 years. To identify appropriate participants, primary care physician appointment schedules will be used. To detect a moderate effect, at least 40 patients will be recruited.
Recruitment
The eligible candidates will receive phone calls, which will invite them to participate in the study before their scheduled physician visits. After the verbal consent is obtained, the eligible African-American women will be included in the study.
DA
The DA has been developed by the Canadian Breast Cancer Screening Initiative (CBSCI). The aid facilitates women’s decision-making process concerning mammography by providing them with information on the procedure, its purposes, follow-up tests, and treatment (CBSCI, 2009). The aid takes the form of a booklet with infographics, statistics, and age-appropriate language. References provided at the end of the DA provide justification for the information featured in the booklet. A table of contents makes it easier to navigate the DA.
Data Collection and Analysis
Demographic data (education, health insurance, marital status, and age) of the study’s participants will be assessed with the help of the physician’s logs. Pre-test and post-test surveys will help to assess the outcomes of the intervention. The surveys will measure screening intentions on a 0 to 100 scale, where 0 is ‘does not intend to get a screening,’ and 100 is ‘intend to get a screening.’ The scale used in the study will be the Decisional Conflict Scale (DCS), the validity of which has been confirmed by multiple independent lines of investigation (Turcotte et al., 2015). Data will be analyzed with the help of the Wilcoxon signed-rank test and bivariable statistics. The analyses will be performed in the SAS statistical software package v. 9.3.
Proposed Change
Nurses working in the primary care setting will influence screening decisions of women who have scheduled a primary care physician visit by providing them with DAs. The purpose of the change is to increase mammography screening intentions among African-American women 65 years and older.
Implementation Strategies and Evaluation
The intervention will be implemented at Florida Hospital between January 1, 2018, and January 1, 2019. Medical records will be used to evaluate whether the participants of the study received a mammography screening following the intervention. A member of the research group will review the hospital’s medical records at the end of the year to capture mammograms completed by the participants. The analysis of the records will show the effectiveness of the intervention.
Discussion and Findings
The findings of the study will be used to understand the magnitude of the intervention’s impact on African-American women’s intentions to get a mammography screening. The discovery of a positive link between the administration of DAs and the women’s screening intentions will mean that the intervention has been effective in bringing about a meaningful change.
Implications
The study has the potential to improve African-American women’s breast cancer screening intentions. The implications of the research are far-reaching and important in equal measure considering poor knowledge on the mortality benefit among the population.
Conclusion
The paper has outlined the research proposal that can help African-American women to make more informed decisions with respect to their health. The proposed research seeks to measure the effectiveness of DAs in increasing mammography screening intentions among African-American women 65 years and older. The population choice is informed by numerous studies suggesting that the groups are especially vulnerable to the disease.
References
CBSCI. (2009). Information on mammography for women aged 40 and older: A decision aid for breast cancer screening in Canada. Web.
Checka, C. M., Chun, J. E., Schnabel, F. R., Lee, J., & Toth, H. (2012). The relationship of mammographic density and age: Implications for breast cancer screening. Women’s Imaging, 198(3), 292-295.
Clark, S., & Reeves, P. J. (2015). Women’s experiences of mammography: A thematic evaluation of the literature. Radiography, 21(1), 84-88.
DeSantis, C., Naishadham, D., & Jemal, A. (2013). Cancer statistics for African Americans, 2013. CA: A Cancer Journal for Clinicians, 63(3), 151-166.
Fair, A. M., Monahan, P. O., Russel, K., Zhao, Q., & Champion, V. L. (2012). The interaction of perceived risk and benefits and its relationship to predicting mammography adherence in African-American women. Oncology Nursing Forum, 39(1), 53-60.
Hall, I. J., Rim, S. H., Johnson-Turbes, C. A., Vanderpool, R., & Kamalu, N. K. (2015). The African American women and mass media campaign: A CDC breast cancer screening project. Journal of Women’s Health, 21(11), 1107-1113.
Stacey, D., Legare, F., Col, N. F., Bennett, C. L., Barry, M. J., Eden, K. B.,.. Wu, J. H. (2014). Decision aids for people facing health treatment or screening decisions. Cochrane Database Systematic Reviews, 28(1), 124-129.
Turcotte, S., Guerrier, M., Labrecque, M., Robitaille, H., Rivest, L. P., Hess, B., & Leqare, F. (2015). Dyadic validity of the Decisional Conflict Scale: common patient/physician measures of patient uncertainty were identified. Journal of Clinical Epidemiology, 68(8), 920-927.
Walter, L. C., & Schonberg, M. A. (2014). Screening mammography in older women: A review. JAMA, 311(3), 1336-1347.