Feasibility of Using Technology to Disseminate Evidence to Rural Nurses and Improve Patient Outcomes

Background: Rural African American women receive less frequent mammography screening and die of breast cancer at a higher rate than is seen in the general population. To overcome this disparity, it is necessary to assist rural providers in their efforts to influence women to obtain screening. Method: This study examined the feasibility of using distance education to disseminate knowledge about timely and appropriate mammography screening to rural nurses, using patient outcome data to evaluate the effectiveness of this intervention. Results: Overall, there was a decline in referrals and mammography screening, but the intervention group centers showed a smaller decline after the educational intervention than did the control group. Conclusion: The findings show the effect of dissemination of information and the feasibility of using patient outcome data for educational evaluation. Neighboring academic health centers and nursing schools should include in their mission the provision of educational programs for relatively isolated rural nurses.health technology, rural health

Options for early breast cancer follow-up in primary and secondary care : a systematic review

Background Both incidence of breast cancer and survival have increased in recent years and there is a need to review follow up strategies. This study aims to assess the evidence for benefits of follow-up in different settings for women who have had treatment for early breast cancer. Method A systematic review to identify key criteria for follow up and then address research questions. Key criteria were: 1) Risk of second breast cancer over time - incidence compared to general population. 2) Incidence and method of detection of local recurrence and second ipsi and contra-lateral breast cancer. 3) Level 1–4 evidence of the benefits of hospital or alternative setting follow-up for survival and well-being. Data sources to identify criteria were MEDLINE, EMBASE, AMED, CINAHL, PSYCHINFO, ZETOC, Health Management Information Consortium, Science Direct. For the systematic review to address research questions searches were performed using MEDLINE (2011). Studies included were population studies using cancer registry data for incidence of new cancers, cohort studies with long term follow up for recurrence and detection of new primaries and RCTs not restricted to special populations for trials of alternative follow up and lifestyle interventions. Results Women who have had breast cancer have an increased risk of a second primary breast cancer for at least 20 years compared to the general population. Mammographically detected local recurrences or those detected by women themselves gave better survival than those detected by clinical examination. Follow up in alternative settings to the specialist clinic is acceptable to women but trials are underpowered for survival. Conclusions Long term support, surveillance mammography and fast access to medical treatment at point of need may be better than hospital based surveillance limited to five years but further large, randomised controlled trials are needed

Mammography

In this volume, the topics are constructed from a variety of contents: the bases of mammography systems, optimization of screening mammography with reference to evidence-based research, new technologies of image acquisition and its surrounding systems, and case reports with reference to up-to-date multimodality images of breast cancer. Mammography has been lagged in the transition to digital imaging systems because of the necessity of high resolution for diagnosis. However, in the past ten years, technical improvement has resolved the difficulties and boosted new diagnostic systems. We hope that the reader will learn the essentials of mammography and will be forward-looking for the new technologies. We want to express our sincere gratitude and appreciation?to all the co-authors who have contributed their work to this volume

An Evaluation of Mammography Rates for Women, 50-74 Years Old, at the San Francisco Department of Public Health

This paper explores the efforts of the San Francisco Department of Public Health (SFDPH) and San Francisco General Hospital (SFGH) to increase their overall mammogram screening rate to 76.7% by June 2015 in order to receive funding from the federal government. The target population is women within SF DPH’s primary care program, 50-74 years old, and overdue for a mammogram. The literature reports there are health disparities among women who receive mammograms and how breast cancer affects them. African American women have the highest mortality rates and women of color are more likely to be diagnosed at a later stage, when treatment options are limited (National Cancer Institute, 2014). There were disparities found within the mammogram rates at SFDPH which varied by ethnicity, insurance type, and socioeconomic status. The literature also supports this finding with The National Cancer Institute (2014) stating that lower screening rates are associated with lower education levels and incomes, the uninsured, and women of color. A pilot study was conducted at the SFGH Avon Breast Center, which included extending evening hours and opening a Saturday clinic for mammograms, from February to June 2014, to increase appointment accessibility for patients. The overall mammogram rate was calculated using data from just over 13,000 eligible women in the SFDPH system. After the pilot study ended, the mammogram rate for every ethnicity group had increased and the overall rate had increased by 5%. Using a chi-square test, this increase was shown to be statistically significant. The appoinment show rate also increased by 16% during the pilot study, as compared to the regular hour appointments, and this increase was shown to be statistically significant as well. Patient and staff surveys were distributed to obtain quantitative and qualitative feedback directly from involved stakeholders. It was noted that women enjoyed the pilot study hours and were especially interested in having other services offered on Saturdays as well. By offering evening and Saturday hours, the mammogram and show rates experienced a significant increase, and the patients awarded high satisfaction scores for their experience during the pilot study. SFDPH and SFGH are collaborating together to address this issue in addition to discovering other methods to educate women on the importance of getting screened for breast cancer and to make mammograms more accessible to women from diverse backgrounds

Comparison of breast and bowel cancer screening uptake patterns in a common cohort of South Asian women in England

Background: Inequalities in uptake of cancer screening by ethnic minority populations are well documented in a number of international studies. However, most studies to date have explored screening uptake for a single cancer only. This paper compares breast and bowel cancer screening uptake for a cohort of South Asian women invited to undertake both, and similarly investigates these women's breast cancer screening behaviour over a period of fifteen years. Methods: Screening data for rounds 1, 2 and 5 (1989-2004) of the NHS breast cancer screening programme and for round 1 of the NHS bowel screening pilot (2000-2002) were obtained for women aged 50-69 resident in the English bowel screening pilot site, Coventry and Warwickshire, who had been invited to undertake breast and bowel cancer screening in the period 2000-2002. Breast and bowel cancer screening uptake levels were calculated and compared using the chi-squared test. Results: 72,566 women were invited to breast and bowel cancer screening after exclusions. Of these, 3,539 were South Asian and 69,027 non-Asian; 18,730 had been invited to mammography over the previous fifteen years (rounds 1 to 5). South Asian women were significantly less likely to undertake both breast and bowel cancer screening; 29.9% (n = 1,057) compared to 59.4% (n = 40,969) for non-Asians (p < 0.001). Women in both groups who consistently chose to undertake breast cancer screening in rounds 1, 2 and 5 were more likely to complete round 1 bowel cancer screening. However, the likelihood of completion of bowel cancer screening was still significantly lower for South Asians; 49.5% vs. 82.3% for non-Asians, p < 0.001. South Asian women who undertook breast cancer screening in only one round were no more likely to complete bowel cancer screening than those who decided against breast cancer screening in all three rounds. In contrast, similar women in the non-Asian population had an increased likelihood of completing the new bowel cancer screening test. The likelihood of continued uptake of mammography after undertaking screening in round 1 differed between South Asian religio-linguistic groups. Noticeably, women in the Muslim population were less likely to continue to participate in mammography than those in other South Asian groups. Conclusions: Culturally appropriate targeted interventions are required to reduce observed disparities in cancer screening uptakes

Retrospective Analysis of a Breast Health Program on Routine Annual Mammography in Low-Income, Uninsured Women

Problem: Detection of breast cancer in women of low socioeconomic status, lacking health insurance, can be improved by increasing annual mammography rates, yet little is known about their screening behavior. Purpose: A retrospective subject-controlled study of an ongoing Breast Health Program, at a not-for-profit, non-government assisted, volunteer clinic, was undertaken to examine mammography usage and discovery variables. Design and Methods: English and Spanish speaking women 40 years old and over who viewed in a 7-minute breast health DVD and were offered free mammography were eligible for the study (N= 223). The Health Belief Model (HBM) (Becker, 1974) provided the study framework that utilized radiology billing records for mammography completion and a dual-language self-administered survey. Data retrieval was from March 2004 to July 2009, with DVD viewing beginning in December 2006. Recruitment occurred between July 2009 and September 2009. Results: Results revealed that 214 (96%) women had a mammography after viewing the DVD. Of the 120 subjects that had time to complete an annual mammography, 28 (23%) completed it in the 12th month, 48 (40%) completed it within 15 months, and 91 (75%) completed even if late. Only 37 subjects had time to complete a third mammography and of those only 8 completed a fourth. Significant findings found: (1) a greater proportion of women who received a reminder postcard participated in their annual mammography in the 12th month, Χ2(1) = 3.98, p = .046; (2) perceptions of breast cancer susceptibility scores were significantly lower (M = 6.89, SD = 3.18), in those who completed their annual mammography in the 12th month, t(118) = 2.03, p = .045; (3) a greater proportion of women who were knowledgeable about screening recommendations completed annual mammography, even if late, Χ2(1) = 4.736, p = .030 and; (4) Hispanic women completed at a significantly higher rate (n= 69; 81.2%) even if late, Χ2(2) = 6.450, p = .04. Implications: Longitudinal studies utilizing radiology billing records for mammography completion present real findings of mammography usage. This study\u27s findings enhance the understanding of low-income, working uninsured women and identify new variables not found in comparative research findings

HOW DO MARKET AND ORGANIZATIONAL FACTORS AFFECT QUALITY OF CARE: MAMMOGRAPHY FOLLOW-UP RATE

A mammogram follow-up rate investigates the rate of initial mammograms that require a follow-up visit to confirm breast cancer. The ideal mammogram follow-up rate for an organization is 10%. Rates below mean organizations are underperforming the scan and missing possible cancer cases; above means that hospitals are overdoing mammograms. Previous research examined the problem in a micro-level approach focusing on patient and provider level factors. Open systems theory views the problem from a macro-level approach showing the components and how they interact with each other and their environments. The objectives of this study include reviewing how open systems theory can be used to understand the components affecting hospitals mammography follow-up rates, and examining market and organizational factors are associated with hospitals or counties meeting the recommendation, and understand how the guarantor in open systems theory changed the system between 2010 and 2016. We merged three datasets: Centers for Medicare & Medicaid Services, Area Health Resource File, and the Healthcare Cost and Utilization Project. We performed multinomial logistic regressions to analyze what market and organizational factors affect the follow-up rate. We conducted t-tests and sign tests to provide a profile of hospitals that changed recommended meeting status between 2010 and 2016. Our results showed that open systems theory is underutilized and has the capability to be included in future research on public health problems. Our findings showed that counties were less likely to meet the recommendation if they had more deaths per 100,000 population, more radiologists per 100,000 population, a higher percentage of screening hospitals, and higher percent of African Americans. Organization level factors that affected quality of care included hospital ownership and region where hospitals that were private/not-for-profit, government funded, or in the Western region were more likely to meet the recommendation compared to hospitals that were for-profit or in the Northeast. The guarantor results showed no significant findings between 2010 and 2016 for organizational and market level factors. Future research should focus on open systems and viewing the problem in a macro-level approach in market and organization level factors in relation to their effect on quality of care

A novel therapy for breast cancer: implications for treatment access

In 2016, there were 250,000 new cases of invasive cancer and 60,000 of ductal carcinoma in situ. Mammograms are used to screen for cases of disease, but the literature shows that mammograms are highly dependent on patient characteristics and do not majorly impact mortality rates from invasive cancer. Additionally, they are prone to false-positives, false-negatives, and overdiagnosis in cases of in situ cancer, with overdiagnosis exposing patients to the side effects of treatment. Better screening tests are needed, and a potential solution can be to extend molecular screening methods often used in advanced stage 1 and higher cancers to stage 0 ductal carcinoma in situ cases. This new test would prevent overdiagnosis, be more accurate, and prevent unnecessary screening as well as be in line with the future of cancer care in the US