Nursing clinical trial of breast self-examination education in China

LIU C.-Y., XIA H.-O., ISAMAN D.M., DENG W. & OAKLEY D. (2010) Nursing clinical trial of breast self-examination education in China. International Nursing Review 57 , 128–134
Aim:  The aim of this study was to test community-based nursing education about breast self-examination to see whether self-examination frequency could be increased.
Background:  Breast cancer rates in China are rising rapidly, especially in cities. The majority of Chinese women does not know about breast self-examination, and the Chinese health care system cannot provide mammograms for the millions of at-risk women throughout China.
Method:  This study was a randomized clinical trial of nurse-provided, community-based teaching of breast self-examination in the urban and rural areas of Tianjin and urban and suburban areas of Shanghai. Women ( n  = 1510) never diagnosed with breast cancer and 40 years and older were randomized by community and stratified by urban vs. other residences.
Results:  At baseline, 9% of the intervention and 6% of the control groups did breast self-examination at least every other month. After 12 months, 34% of the intervention, but only 11% of the control, group did breast self-examination that often ( P  < 0.001). There was a significant impact in urban, suburban and rural areas, and intervention effects were stronger than any of the other influences tested.
Conclusion:  The clinical trial showed a statistically significant increase in breast self-examination after the nursing education intervention. As no other breast cancer screening method is available in most of China, this method is best suited for the masses of people currently at risk in China.     

Living With Genetic Test Results for Hereditary Breast and Ovarian Cancer

Purpose: To examine adaptation by nonsymptomatic individuals who knew the results of a genetic test for hereditary breast and ovarian cancer (HBOC) for at least 4 years.
Design: Longitudinal grounded theory study.
Methods: Follow-up interviews after a 3- to 4-year interval were conducted by telephone or e-mail with seven asymptomatic participants originally recruited for an earlier study of genetic testing experiences. A total of 14 interviews, 2 for each participant were conducted. Conceptual analysis on these 14 interviews focused on impact on daily life and health behavior decisions made in the intervening years.
Findings: Participants described the impact of the result and adaptations made in relationships, sexuality, outlook, and plans for the future. Participants accepted recommended surveillance and preventative measures to maximize a healthy lifestyle and reported both the benefits of knowing their mutation status as well as challenges they had encountered since testing.
Conclusions: Adaptation to living with genetic test results indicating a disease-related mutation is an ongoing process of balancing the knowledge of risk with living a normal life. Over time, awareness of genetic risk does not appear to diminish.
Clinical Relevance: Positive and negative long-term consequences of genetic testing for hereditary breast or ovarian cancer may influence many aspects of the personal lives and health care decisions of those tested.     

Breast cancer risk factors in Korean women: a literature review

Aim:  To compile a complete list of risk factors from the Korean breast cancer studies to obtain relevant predictor information essential in developing a predictive model for breast cancer.
Background:  Breast cancer is the most commonly diagnosed female cancer in Korea. However, the breast cancer-screening rate in Korea is relatively low compared with that in other countries. In order to promote early health screening, there is a need to identify those individuals who are most likely to develop breast cancer by using an accurate predictive model.
Methods:  Thirty-four breast cancer studies were selected from MEDLINE and two Korean literature databases. Two researchers summarized the risk factors and their effects in each article using a checklist.
Findings:  Most of the studies were case–control studies conducted after 2000. In 34 articles, a total of 84 risk factors for breast cancer in Korean women were identified; of these, 58 factors were determined as statistically significant factors. The factors identified most often were body mass index, menarche, menopause, family history, pregnancy and delivery, breastfeeding, alcohol use, smoking habits, diet, education and use of oral contraceptives. None of 34 studies looked at stress as a risk factor of which influence on cancer has been reported in other populations.
Conclusion:  The next steps will be to construct a questionnaire consisting of relevant variables based on these study results and to develop a predictive model. This would be used to encourage those Koreans who are more likely to develop breast cancer to have early check-ups.     

Jordanian nurses' knowledge and practice of breast self-examination

Title.  Jordanian nurses' knowledge and practice of breast self-examination.
Aim.  This paper is a report of a study to evaluate the knowledge and practice of Jordanian nurses in relation to breast self-examination.
Background.  Studies have shown that women who have learned about breast self-examination have positive attitudes toward breast cancer and practise breast self-examination more frequently, and that nurses who teach their clients about methods of early detection and breast self-examination are more knowledgeable about breast cancer screening and breast self-examination techniques than those who do not. Therefore, it is important to understand nurses' knowledge about breast cancer and its early detection.
Methods.  A cross-sectional design was used, with a convenience sample of 347 Registered Nurses at three large cities in Jordan (response rate 95%). Data collection took place in 2005 using a self-administrated questionnaire with three parts and based on the American Cancer Society's guidelines: demographics, knowledge, and practice of breast self-examination.
Results.  Nurses reported high levels of knowledge of breast self-examination (M = 7·6, sd . 2·7). A high proportion of nurses reported doing breast self-examination in the past 12 months (85%), but only 17·7% reported doing so on a monthly basis. None of the demographic characteristics was found to be associated with the practice of breast self-examination.
Conclusion.  More health education about monthly breast self-examination and prevention strategies is needed for nurses and their women patients, especially for Arabic women.     

Effect of supportive care on the anxiety of women with suspected breast cancer

Title.  Effect of supportive care on the anxiety of women with suspected breast cancer.
Aim.  This paper is a report of a study of the effect of supportive care on anxiety levels of women with suspected breast cancer during the diagnostic period.
Background.  Informational and psychosocial support has been shown to improve care outcomes for women with breast cancer. However, little is known about the effect of supportive care on women's psychological status during the breast cancer diagnostic period.
Methods.  For this longitudinal quasi-experimental study, 122 participants were recruited from a large teaching hospital in Taiwan. The experimental group ( n  =   62) received a supportive care programme that included health education pamphlets about breast cancer diagnosis and treatment, three face-to-face sessions of informational and emotional support, and two follow-up telephone consultations. The control group ( n  =   60) received routine care. Data were collected from October 2006 to April 2007 using the State-Trait Anxiety Inventory at baseline (notification of need for breast biopsy), before biopsy, and after receiving biopsy result (diagnosis).
Findings.  After adjusting for covariance of breast discomfort, regular breast self-examination, and biopsy result, the anxiety levels of women receiving supportive care were significantly lower before biopsy ( P  =   0·017) and after diagnosis ( P  =   0·001) than those of women receiving routine care.
Conclusion.  Supportive care that incorporates informational and emotional support and follow-up telephone consultations can decrease anxiety levels of women with suspected breast cancer. These findings can serve as a reference for clinical nursing staff to improve care quality during the breast cancer diagnostic period by providing women with individualized and culturally sensitive care.     

Health Systems and Maternal and Child Survival in Central Asian Republics

Purpose: To describe the status of health care systems in five Central Asian Republics (CAR): Kyrgzstan, Kazakhstan, Uzbekistan, Turkmenistan, and Tajikistan, with particular attention to women's and children's health.
Organizing construct: Changing mortality profiles are investigated using the "protractedpolarized" model of epidemiologic transition.
Sources: Empirical evidence was drawn from the World Health Organization (WHO) database for the region, along with additional evidence presented at a maternal-child health conference held in Bishkek, Kyrgyzstan, on November 11–14, 1998. The conference was sponsored by the Albert Schweitzer Institute and the Soros Foundation. This evidence is evaluated for completeness, validity, and reliability. Trends are identified using the 1998 and 1999 World Health Reports and 1999/2000 World Bank Development Report.
Findings: Incomplete data prohibited comprehensive analysis. Available data indicated high but variable rates of maternal and child mortality and overall declines in health status and the health care infrastructure in the 1990s.
Conclusions: Data collection and analysis from this part of the world are often incomplete and unreliable. Future research should focus on improving maternal and child health indicators by enhancing resource sharing and opportunities for international collaboration.     

Creating case scenarios or vignettes using factorial study design methods

Title.  Creating case scenarios or vignettes using factorial study design methods.
Aim.  This paper is a report of a study conducted to develop clinical case vignettes using an adaptation of an incomplete factorial study design methodology.
Background.  In health care, vignettes or cases scenarios are core to problem-based learning, common in practice guideline development processes, and increasingly being used in patient or care-giver studies of chronic or life-threatening illnesses. A large number of behavioural, psycho-social and clinical factors can be relevant in such decision problems. Unbiased methods for choosing what factors to include are needed, when it is not possible to include all relevant combinations of factors in the vignettes.
Method.  The factors to be considered, number of levels or categories for each factor, and desired number of scenarios were decided in advance. An algorithm was used first to create the full factorial data set, and then a random subset of combinations was generated, according to predefined criteria, based on maximizing determinants. The subset of combinations was incorporated into written vignettes. The study was conducted in 2004–2005.
Findings.  Application of the method yielded diverse and balanced scenarios that covered the full range of factors to be considered for a project to elicit health providers' processes in diet counselling for dyslipidemia.
Conclusion.  The approach is flexible, decreases possible researcher bias in the creation of vignettes, and can improve statistical power in survey research. This novel application of study design methodology merits consideration when vignettes are being developed to elicit opinions or decisions in studies of complex health issues.     

Social Support and Cervical and Breast Cancer Screening in Argentinean Women From a Rural Population

ABSTRACT Objective: To examine whether emotional social support influences the use of 3 cancer screening tests in females.
Design: Cross-sectional study.
Sample: Data were collected via a household survey of a random sample of 200 Argentinean women.
Measurements: The questionnaire included self-reported data about the cancer screening tests (Papanicolaou [Pap] test for cervical cancer, breast self-examination, and clinical examination for breast cancer), and socioeconomic background information. Social support was measured by the Duke-UNC-11 questionnaire.
Analysis: Logistic models were used to investigate the association between social support and cancer screening tests.
Results: Emotional social support was associated with having participated in Pap screening within 3 years before this study, but a link between social support and self or clinical breast examination was not supported.
Conclusion: Emotional social support may play a role in early cervical cancer detection among Argentinean females, specifically by encouraging performance of the Pap test. The educational practices accomplished by nurses should include actions that involve the family and community; therefore, emphasizing the importance of social ties on health and promoting interactions between target women and existent social groups in the community.     

African American Women's Experiences with Breast Cancer Screening

Purpose: To describe the experience and meaning of breast cancer screening for African American women. Breast cancer screening offers the greatest hope of reducing breast cancer mortality and improving breast cancer outcomes. Despite the proliferation of initiatives targeting African American women, they continue to be first diagnosed only when they have late-stage disease.
Design and Methods: Using hermeneutic phenomenological research methods, 23 low-and middle-income African American women were interviewed to gain an understanding of their experiences with breast cancer screening.
Findings: Participants varied in their experiences with breast cancer screening. Women spoke of a desire for a holistic approach to health that did not separate the breast from the rest of the body. This desire is indicated in the theme of minding the body, self, and spirit, along with themes of relationships and spreading the word about breast health issues.
Conclusions: Interventions for African American women should include a focus on minding the body, self, and spirit to promote breast cancer screening, and should indicate the importance of relationships and spreading the word about breast cancer screening.     

A decision theory perspective on why women do or do not decide to have cancer screening: systematic review

Title.  A decision theory perspective on why women do or do not decide to have cancer screening: systematic review.
Aim.  This paper is a report of a review in which decision theory from economics and psychology was applied to understand why some women with access to care do not seek cancer screening.
Background.  Mammography and cervical smear testing are effective modes of cancer screening, yet many women choose not to be screened. Nurses need to understand the reasons behind women's choices to improve adherence.
Data sources.  Research papers published between January 1994 and November 2008 were identified using the Cumulative Index to Nursing and Allied Health Literature, MEDLINE and PsycINFO data bases. The search was performed using the following terms: cervical cancer screening, breast cancer screening, decision, choice, adherence and framing. Forty-seven papers were identified and reviewed for relevance to the search criteria.
Methods.  Nineteen papers met the search criteria. For each paper, reasons for obtaining or not obtaining cancer screening were recorded, and organized into four relevant decision theory principles: emotions, Prospect Theory, optimism bias and framing.
Findings.  All women have fears and uncertainty, but the sources of their fears differ, producing two main decision scenarios. Non-adherence results when women fear medical examinations, providers, tests and procedures, do not have/seek knowledge about risk and frame their current health as the status quo. Adherence is achieved when women fear cancer, but trust care providers, seek knowledge, understand risk and frame routine care as the status quo.
Conclusion.  Nurses need to address proactively women's perceptions and knowledge about screening by openly and uniformly discussing the importance and benefits.     

Taking decisions on expenditure for high‐cost drugs at the regional level: a model for evaluating the overall impact of Trastuzumab in the Veneto Region of Italy

Introduction Cost‐effectiveness analysis provides a ratio that indicates the value created per unit of money by a given therapy but says nothing about the total expected costs or net health and social impact of this therapy in a particular population of interest. Objective The main objective of this study is to define a methodology to calculate the effects of interventions from a local perspective. This will help determine parameters that provide information about resource planning and management to local decision makers. Methods The described methodology calculates four indicators using local demographic and epidemiological data and a Markovian decision tree approach. Results The method was applied to evaluate the economic, health and social impact of introducing a new cancer drug, Trastuzumab, for the early treatment of breast cancer in the Veneto Region of Italy. Discussion The indicators described in this study allow public policy makers to clearly understand the benefits and costs of a particular health intervention in a local population and to compare it with other strategies.     

Chinese Breast Cancer Screening Beliefs Questionnaire: development and psychometric testing with Chinese-Australian women

Title.  Chinese Breast Cancer Screening Beliefs Questionnaire: development andpsychometric testing with Chinese-Australian women.
Aim.  This paper is a report of the development and psychometric testing of the Chinese Breast Cancer Screening Beliefs Questionnaire, a culturally sensitive questionnaire for measuring Chinese-Australian women's beliefs, knowledge and attitudes towards breast cancer and breast screening practices.
Background.  Breast cancer is the leading cause of cancer morbidity among Chinese-Australian women. They are, however, 50% less likely to participate in all types of breast examination. A valid and reliable instrument to explore the breast cancer beliefs is essential for the development of interventions to promote breast cancer screening practices.
Method.  Items for the questionnaire were drawn from a literature review and in-depth interviews. A panel of professional experts and lay women evaluated face and content validity. The instrument was translated from English to Chinese using back-translation. In 2008, a total of 292 Chinese-Australian women aged 22–78 years who were resident of Australia were included in testing the instrument. Multi-trait analysis and Cronbach's alpha were used to assess internal consistency reliability and exploratory factor analysis assessed construct validity.
Results.  The final 13-item questionnaire had satisfactory validity and internal consistency. Cronbach's alpha for the total scale was 0·76, and for the three subscales ranged from 0·70 to 0·79. Exploratory factor analysis showed that the scale reduced to three factors.
Conclusion.  Preliminary data suggest that the Chinese Breast Cancer Screening Beliefs Questionnaire is a valid, reliable and culturally sensitive instrument for the measurement of Chinese-Australian women's beliefs, knowledge and attitudes about breast cancer and breast cancer screening.     

Effects of a Cognition-Oriented Breast Self-Examination Intervention for Korean Women and Their Spouses

ABSTRACT Objective: This study evaluated the effectiveness of a cognition-oriented breast self-examination (BSE) intervention program that is based on the Transtheoretical Model and reflects individual characteristics according to BSE stage among Korean women and their spouses.
Design: A time-series nonequivalent control group design was used.
Sample and Measurement: Twenty-four couples in each of 2 groups completed a preintervention test and were evaluated 1, 3, and 6 months later for their knowledge of breast cancer and BSE, spousal encouragement for BSE, perceived confidence in BSE methods, change in BSE stage, and perceived benefits and barriers to BSE. The intervention involved husbands as well as women, and consisted of lectures on breast cancer and BSE, demonstrations and practice with models while being videotaped, and feedback.
Results: There were significant differences between the control and experimental groups for all variables. Change of BSE stage in experimental group showed significantly advancement over time.
Conclusions: This intervention program was effective in promoting regular BSE practice and in enhancing confidence in BSE. The intervention also raised awareness among husbands of the importance of breast health for their wives. Educational interventions for breast cancer prevention should be specified to an individual's stage of BSE.     

Correlates of recent and regular mammography screening among Asian-American women

Title.  Correlates of recent and regular mammography screening among Asian-American women.
Aim.  This paper is a report of a study of the health beliefs, knowledge and selected demographic variables that influence mammography utilization among Asian-American women.
Background.  Breast cancer is the most frequently occurring cancer in Asian-American women and its incidence is increasing at a greater rate than for other racial and ethnic groups in the United States of America (USA). Compared to White women, breast cancer also is more likely to be diagnosed at a later stage with larger tumours in Asian-Americans.
Method.  A self-administered questionnaire was used with Asian-American women residing in the USA. Data were collected in 2005 and 315 women participated in the study.
Results.  Fifty-five per cent of participants reported having their last mammogram within the past 13 months, and 33% reported having annual mammograms in each of the past 5 years. Based on multivariate logistic regression analyses, clinical breast examination, barriers and knowledge of recommendations of the frequency of mammography screening were associated with both recent and regular mammography practice after controlling for all other demographic, psychosocial and behavioural variables in the model.
Conclusion.  Intervention strategies tailored to knowledge, language and cultural factors associated with mammography use should target at-risk subgroups, particularly those who are recent immigrants and those with limited English language ability. Culturally appropriate strategies should be developed to promote lifelong mammography screening for this rapidly growing and diverse population.     

Perceptions of internal marketing and organizational commitment by nurses

Title.  Perceptions of internal marketing and organizational commitment by nurses.
Aim.  This paper is a report of a study to determine whether a favourable perception of internal marketing is associated with increased organizational commitment.
Background.  The role of nurses in healthcare treatment is expanding, and becoming more important as time progresses. Therefore, the primary concern of business of health care is to use internal marketing strategies effectively to enhance and develop nurses' organizational commitment and reduce turnover to promote competitive advantages for the organization.
Methods.  A cross-sectional design was used. Questionnaires were distributed in 2006 to a convenience sample of 450 Registered Nurses in two teaching hospitals in Taiwan, and 318 questionnaires were returned. Eighteen were excluded because of incomplete answers, which left 300 usable questionnaires (response rate 66·7%). Validity and reliability testing of the questionnaire proved satisfactory and Structural Equation Modeling was used to analyse the data.
Results.  A favourable perception of internal marketing was associated with increased organizational commitment. Communication management had the greatest influence on organizational commitment and external activity had the smallest impact.
Conclusion.  Hospital managers need to recognize the importance of internal marketing for staff retention and the survival of their organizations as competitive pressure increases. As a great deal of time and costs are involved in educating nurses, the best way to retain outstanding nurses and reduce turnover costs and personnel problems is for employers to understand the needs and expectations of their nursing staff.     

Reinforcement Learning Methods in Public Health

PurposeReinforcement learning (RL) is the subfield of machine learning focused on optimal sequential decision making under uncertainty. An optimal RL strategy maximizes cumulative utility by experimenting only if and when the information generated by experimentation is likely to outweigh associated short-term costs. RL represents a holistic approach to decision making that evaluates the impact of every action (ie, data collection, allocation of resources, and treatment assignment) in terms of short-term and long-term utility to stakeholders. Thus, RL is an ideal model for a number of complex decision problems that arise in public health, including resource allocation in a pandemic, monitoring or testing, and adaptive sampling for hidden populations. Nevertheless, although RL has been applied successfully in a wide range of domains, including precision medicine, it has not been widely adopted in public health. The purposes of this review are to introduce key ideas in RL and to identify challenges and opportunities associated with the application of RL in public health.MethodsWe provide a nontechnical review of the theoretical and methodologic underpinnings of RL. A running example of RL for the management of an infectious disease is used to illustrate ideas.FindingsRL has the potential to make a transformative impact in a range of sequential decision problems in public health. By allocating resources if, when, and where they are most impactful, RL can improve health outcomes while reducing resource consumption.ImplicationsPublic health researchers and stakeholders should consider RL as a means of efficiently using data to inform optimal evidence-based decision making.     

Factors influencing women in seeking help from a health care professional on self discovery of a breast symptom,in an Irish context

Aim. To identify the extent of delay and the factors influencing women in seeking help from a health care professional on self discovery of a breast symptom, in an Irish context. Background. Breast cancer is the most common malignancy among women in the developed world. In Ireland, 2700 women are diagnosed with breast cancer and over 900 die from it annually. A longer delay in presenting with breast symptoms is associated with a lower rate of survival from breast cancer. However, many women wait for longer than three months before presenting to a health care professional on self discovery of a breast symptom. Design. A quantitative correlational design was used. Methods. Data were collected using the ‘Women’s help seeking for breast symptoms’ questionnaire. Women were recruited in the breast clinic prior to their visit with the consultant. Results. A total of 100 women participated, 99 of whom fully completed the questionnaire. Mean age was 40 years. It was found that 72·7% (n = 73) of women visited their GP within one month, 14·1% (n = 14) within one to three months and 10% (n = 12) after three months. Delay time was significantly related to women’s knowledge and beliefs and social issues. Conversely, help seeking also correlated to women’s knowledge and beliefs about the symptom and the anxiety surrounding the initial symptom discovery period. Conclusion. Despite breast health promotion campaigns, many women delay for one month or more, in seeking help from a health care professional for self discovered breast symptoms. Prolonged delay has potential to impact on survival from breast cancer. This highlights the need for continued education and breast health promotion for women. Relevance to clinical practice. Health care professionals need to be aware of possible reasons for delay in seeking help for self discovered breast symptoms and explore new ways to address these barriers.