MODULE 1. Interprofessional working in early detection of breast cancer
7.2. Reaching out for clients
Women who are under the health professional´s radar
Some women are harder to reach than others. This may be due to their rural location or social exclusion, possibly because of their low income or other social challenges. Common, evidence based programs may not serve these women, as they do not participate in routine screenings etc. It is important to find ways to educate these women about early detection of breast cancer. Community nurses have a big role in this, as their knowledge and understanding of socially excluded patients is very valuable. These nurses can adapt their practices so that they fit to the patients they need to educate. (Leeman – Moore – Teal – Barrett – Leighton – Steckler 2013.)
Lee, Lim and Park (2010) have investigated in their study the socio-demographic factors, health behavioral risk factors and cognitive factors that affect participation in the breast cancer screening programs in Korea. This study revealed that women who had graduated from school were more likely to attend breast cancer screening compared to non-educated women. Women who had a positive attitude towards examinations were also more likely to attend breast screening compared to the women with a negative attitude or those who had not previously undergone a medical examination. |
Also, the nonsmokers were twice more likely to attend the screening compared to smokers. However, the household monthly income was not associated with the breast screening attendance rate.
Women in a rural location may miss their appointment more often than those living in cities where health care providers are within easy access. A long distance to the health center makes it more difficult to take part in screenings, possibly for transportation problems. A European study showed that more than half of the participants liked text message mammogram appointment reminders. Despite living in rural areas, most people have mobile phones and internet in daily use. (Kratzke – Wilson 2015) It has found to be very useful to arrange educational sessions to women in addition to other gatherings, such as regular meetings or hobby groups. It is important to know how to reach women in the rural area, and knowing their community helps when organizing breast cancer and screening education. In rural areas, church can offer good channels for reaching women. (Shackelford – Weyhenmeyer – Mabus 2014) |
Women with intellectual disability
Studies have shown that though breast cancer screening programs are aimed at all women within a specific age group, those with intellectual disabilities (id) have the participation rates much lower than others. Even with sufficient knowledge about breast cancer and screening programs, nurses fail to educate their id patients. (Kirby – Hegarty 2010)
Along with mental challenges, id patients are often outside the reach of screening programs as they live in care homes or other facilities. |
It is extremely important that professionals working with id patients are aware of breast screening programs and actively help their patients to attend. This must be done by enhancing knowledge and positive attitude towards screening among nurses. It is the responsibility of nurses to ensure that also id patients receive a proper screening and education. (Kirby – Hegarty 2010)
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The importance of early education
In a European study of positive attitude towards receiving cancer information, results showed that 38,3% of the participants had received information related to cancer within last six months. Among those participants, 31,5% expressed a negative attitude towards this information. This shows how important it is to promote a positive attitude towards breast cancer education and screening. (Sanz-Barbero – Prieto – Cambas 2015.)
The American Cancer Society has guidelines, where women from the age of 20 should be taught to be aware of breast symptoms and undergo a clinical breast examination every three years from 20 to 39 years and annually after 40 years. Mammography should be done annually after the age of 40. When breast cancer education has been started early enough, women are found to be more aware of early symptoms and irregularities during breast self-examination (BSE). |
In Turkey, a monthly BSE is recommended from the age of 20. This has also been written in the national guidelines on breast cancer screening. (Akpınar – Baykan – Naçar – Gün – Çetinkaya 2011)
In China, the importance of early education has been outlined, as younger patients, aged between 40 to 50 years have been diagnosed with breast cancer more often than before. Therefore, they have found that education on BSE and CBE should start before women are 20 years old. If done so, they would already be informed of the screening program and would attend more often than now. (Ouyang – Hu 2015) |
Communication tools for raising breast cancer awareness
The European guidelines for quality assurance in breast cancer screening and diagnosis offers guidance on breast cancer screening communication. Health care professionals should be aware of the role of the media in educating women on screening programs. The media has a strong influence on women deciding whether they attend medical interventions, such as screening, or not. Generally, the media paints a very positive picture of medicine and screenings in particular. This is both good and bad, as we want women to participate but we do not want them to believe that participating in regular screenings will guarantee that they will not have a chance of ever getting breast cancer. Internet offers a huge amount of information about cancer.
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Health care professionals should be able to inform patients about reliable sources of information. (Perry – Broeders – de Wolf – Törnberg – Holland – von Karsa 2006)
Television is found to be the most frequent source of information among the mass media. Magazines and internet are common too, newspapers not so much as people tend to use them for getting daily news quickly. Mobile devices are very common, and they offer an easy route for reaching women in wanted target group, despite them maybe living in rural areas. (Kratzke – Wilson 2015) |
Questions
1. What other ways to reach women living in rural areas or not seeking medical guidance could there be than those already mentioned? Be creative and try to think outside the box! Could we utilise the third sector more effectively? 2. Are we taking a full advantage of social media and nowadays technology in communicating and educating women on breast cancer awareness, early detection of breast cancer and breast cancer screening programmes? Do you have an example of an effective way to use them? Are there big differences between countries? |
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References
- Akpınar, Yeliz Yelen – Baykan, Zeynep – Naçar, Melis – Gün, İskender – Çetinkaya, Fevziye 2011. Knowledge, Attitude about Breast Cancer and Practice of Breast Cancer Screening among Female Health Care. Asian Pacific Journal of Cancer Prevention, Vol 12, 3063-3068
- Kirby, Siobhan – Hegarty, Josephine 2010. Breast awareness within an intellectual disability setting. European Journal of Oncology Nursing. Vol 14, No 4, pp. 328-336
- Kratzke, Cynthia – Wilson, Susan 2015. Ethnic Differences in Breast Cancer Prevention Information-Seeking Among Rural Women: Will Provider Mobile Messages Work? Journal of Cancer Education Vol 29, pp. 541-547
- Lee, Kiheon – Lim, Hyung Taek – Park, Sang Min 2010. Factors associated with use of breast cancer screening services, The Third Korea National Health and Nutrition Examination Survey 2005, BMC Cancer. Korea. http://www.biomedcentral.com/1471-2407/10/144
- Leeman, Jennifer – Moore, Alexis – Teal, Randall – Barrett, Nadine – Leighton, Ashely – Steckler, Allan 2013. Promoting community practitioners’ use of evidence-based approaches to increase breast cancer screening. Public Health Nursing. Vol 30, No 4, pp. 323-331
- Ouyang, Yan-Qiong – Hu, Xiaoyan 2015. The Effect of Breast Cancer Health Education on The Knowledge, Attitudes and Practise: A Community Health Center Catchment Area. Journal of Cancer Education 29, 375-381
- Perry, N. – Broeders, M. – de Wolf, C. – Törnberg, S. – Holland, R. – von Karsa, L. 2006. European guidelines for quality assurance in breast cancer screening and diagnosis, 4th Edition. Luxembourg: Office for Official Publications of the European Communities.
- Sanz-Barbero, Belén – Prieto, María Eugenia – Cambas, Naiara 2015. Factors associated with a positive attitude towards receiving cancer information: a population-based study in Spain. Health Expectations, 19, 288–298
- Shackelford, Judy A. – Weyhenmeyer, Diana P. – Mabus, Linda K. 2014. Fostering Early Breast Cancer Detection: Faith Community Nurses Reaching At-Risk Populations. Clinical Journal of Oncology Nursing Vol 18, No 6, pp 113-117