0

No votes yet

Addressing the Support Needs of Women at High Risk for Breast Cancer: Evidence-Based Care by Advanced Practice Nurses

Dawn Stacey
Cathy DeGrasse
Lisa Johnston
ONF 2002, 29(6), E77-E84 DOI: 10.1188/02.ONF.E77-E84

Purpose/Objectives: To identify support needs of women at high risk for breast cancer and enhance an evidence-based service.

Design: Descriptive study.

Setting: A comprehensive, breast-health service for high-risk women.

Sample: 97 high-risk women with a 1.66% or greater five-year risk of breast cancer, atypical hyperplasia, lobular carcinoma in situ, or positive genetic screen.

Methods: A self-assessment questionnaire completed previsit and a satisfaction survey completed postvisit.

Main Research Variables: Women's perceived informational, emotional, and decisional support needs, current self-care practices, and satisfaction with the service provided.

Findings: Women under age 50 (n = 54) wanted information on breast cancer screening, risk of breast cancer, lifestyle options to lower risk, and hormone replacement therapy; older women (n = 43) wanted information on risk of breast cancer, lifestyle options, breast cancer screening, and chemoprevention. More than 75% of all women wanted information to help them make decisions on breast cancer prevention options, benefits, and risks. The satisfaction survey (N = 61) revealed that most women's needs were met.

Conclusions: Support needs were consistent with the literature that focused primarily on younger women seeking genetic counseling. Proactive planning assisted with addressing the needs of these women.

Implications for Nursing: A previsit questionnaire facilitates individualized proactive planning before the visit. However, further assessment of self-care practices and emotional needs is required. Interventions should evaluate outcomes, such as accurate risk perception, lifestyle changes, screening follow-through, and decision quality. Advanced practice nurses require specialized skills, including evidence-based risk communication, behavior modification, and decision support.

References 

American Cancer Society. (2001). <i>Breast cancer: Early detection.</i> Retrieved May 3, 2002, from <a target="_blank" href='http://www.cancer.org/eprise/main/docroot/CRI/content/CRI_2_6x_Breast_Ca...

American Institute for Cancer Research. (1997). <i>Food, nutrition, and the prevention of cancer: A global perspective.</i> Washington, DC: Author.

Armstrong, K., Eisen, A., & Weber, B. (2000). Assessing the risk of breast cancer. <i>New England Journal of Medicine</i>, <i>342</i>, 564-571.

Audrain, J., Rimer, B., Cella, D., Garber, J., Peshkin, N., Ellis, J., et al. (1998). Genetic counseling and testing for breast-ovarian cancer susceptibility: What do women want? <i>Journal of Clinical Oncology</i>, <i>16</i>, 133-138.

Bandura, A. (1997). <i>Self-efficacy: The exercise of control.</i> New York: W.H. Freeman.

Bernhardt, B.A., Geller, G., Doksum, T., & Metz, S.A. (2000). Evaluation of nurses and genetic counselors as providers of education about breast cancer susceptibility testing. <i>Oncology Nursing Forum</i>, <i>27</i>, 33-39.

Canadian Cancer Society. (2002). <i>Breast health.</i> Retrieved May 3, 2002, from <a target="_blank" href='http://www.cancer.ca/english/CI_S_BC_breasthealth.asp'>http://www.cancer...

Canadian Nurses Association. (2000). <i>Advanced nursing practice: A national framework.</i> Ottawa, Ontario: Author.

Chalmers, K., Thomson, K., & Degner, L.F. (1995). Information, support, and communication needs of women with a family history of breast cancer. <i>Cancer Nursing</i>, <i>19</i>, 204-213.

Chlebowski, R.T., & Collyar, D.E. (1999). <i>Technology assessment breast cancer risk reduction strategies: Tamoxifen and raloxifene.</i> Alexandria, VA: American Society of Clinical Oncology, Health Services Research Department.

Evans, D.G., Blair, V., Greenhalgh, R., Hopwood, P., & Howell, A. (1994). The impact of genetic counseling on risk perception in women with a family history of breast cancer. <i>British Journal of Cancer</i>, <i>70</i>, 934-938.

Fisher, B., Joseph, P., Costantino, D., Wickerham, D.L., Redmond, C.K., Kavanah, M., et al. (1998). Tamoxifen for prevention of breast cancer: Report of the National Surgical Adjuvant Breast and Bowel project P-1 study. <i>Journal of the National Cancer Institute</i>, <i>90</i>, 1371-1388.

Freudenheim, J. (2001, May). <i>Nutrition in the epidemiology of breast cancer.</i> Paper presented at the 2nd Scientific Conference of the Canadian Breast Cancer Research Initiative, Quebec City, Quebec.

Friedenreich, C.M., Thune, I., Brinton, L.A., & Albanes, D. (1998). Epidemiologic issues related to the association between physical activity and breast cancer. <i>Cancer Supplement</i>, <i>83</i>, 600-610.

Gail, M.H., Brinton, L.A., Gyar, D.P., Corle, D.K., Green, S.B., Scharirer, C., et al. (1989). Projecting individualized probabilities of developing breast cancer for white females who are being examined annually. <i>Journal of the National Cancer Institute</i>, <i>81</i>, 1879-1886.

Gandini, S., Merzenich, H., Robertson, C., & Boyle, P. (2000). Meta-analysis of studies on breast cancer risk and diet: The role of fruit and vegetable consumption and the intake of associated micronutrients. <i>European Journal of Cancer</i>, <i>36</i>, 636-646.

Gross, R.E. (2000). Breast cancer: Risk factors, screening, and prevention. <i>Seminars in Oncology Nursing</i>, <i>16</i>, 176-184.

Hallowell, N., Murton, F., Statham, H., Green, J.M., Richards, M.P.M. (1997). Women's need for information before attending genetic counseling for familial breast or ovarian cancer: A questionnaire, interview, and observational study. <i>British Medical Journal</i>, <i>314</i>, 281-283.

Hamric, A.B., & Spross, J.A. (1989). <i>The clinical nurse specialist in theory and practice.</i> Philadelphia: Saunders.

Hartmann, L.C., Schaid, D.J., Woods, J.E., Crotty, T.P., Myers, J.L., Arnold, P.G., et al. (1999). Efficacy of bilateral prophylactic mastectomy in women with a family history of breast cancer. <i>New England Journal of Medicine</i>, <i>340</i>, 77-84.

Hopwood, P., Keeling, F., Long, A., Pool, C., Evans, G., & Howell, A. (1998). Psychological support needs for women at high genetic risk of breast cancer: Some preliminary indicators. <i>Psycho-oncology</i>, <i>7</i>, 402-412.

Kash, K.M., Holland, J.C., Halper, M.S., & Miller, D.G. (1992). Psychological distress and surveillance behaviors of women with a family history of breast cancer. <i>Journal of the National Cancer Institute</i>, <i>84</i>, 24-30.

Kash, K.M., Holland, J.C., Osborne, M.P., & Miller, D.G. (1995). Psychological counseling strategies for women at risk of breast cancer. <i>Journal of the National Cancer Institute Monographs</i>, <i>17</i>, 73-79.

Kerlikowske, K. (1997). Efficacy of screening mammography among women aged 40 to 49 and 50 to 69 years: Comparison of relative and absolute benefit. <i>Journal of the National Cancer Institute Monographs</i>, <i>22</i>, 79-86.

Klijn, J.G., Janin, N., Cortes-Funes, H., & Colomer, R. (1997). Should prophylactic surgery be used in women with at high risk of breast cancer? <i>European Journal of Cancer</i>, <i>33</i>, 2149-2159.

Lerman, C., Kash, K., & Stefanek, M. (1994). Younger women at increased risk for breast cancer: Perceived risk, psychological well-being, and surveillance behavior. <i>Journal of the National Cancer Institute Monographs</i>, <i>16</i>, 171-176.

Lerman, C., Schwartz, M.D., Miller, S.M., Daly, M., Sands, C., & Rimer, B. (1996). A randomized trial of breast cancer risk counseling: Interacting effects of counseling, education level, and coping style. <i>Health Psychology</i>, <i>15</i>(2), 75-83.

Lev, E.L. (1997). Bandura's theory of self-efficacy: Applications to oncology. <i>Scholarly Inquiry for Nursing Practice</i>, <i>11</i>(1), 21-37.

Lloyd, S., Watson, M., Waites, B., Meyer, L., Eeles, R., Ebbs, S., et al. (1996). Familial breast cancer: A controlled study of risk perception, psychological morbidity and health beliefs in women attending for genetic counseling. <i>British Journal of Cancer</i>, <i>74</i>, 482-487.

Longnecker, M.P. (1994). Alcoholic beverage consumption in relation to risk of breast cancer: Meta-analysis and review. <i>Cancer Causes and Control</i>, <i>5</i>(1), 73-82.

MacDonald, D.J. (1997). The oncology nurse's role in cancer risk assessment and counseling. <i>Seminars in Oncology Nursing</i>, <i>13</i>, 123-128.

Mahon, S.M. (1995). Prevention and early detection of cancer in women. <i>Seminars in Oncology Nursing</i>, <i>11</i>, 88-102.

National Cancer Institute. (2000). <i>Breast cancer risk assessment tool.</i> Retrieved April 30, 2002, from <a target="_blank" href='http://bcra.nci.nih.gov/brc/'>http://bcra.nci.nih.gov/brc/</a>

National Cancer Institute. (2001). <i>Breast cancer.</i> Retrieved April 30, 2002, from <a target="_blank" href='http://www.cancer.gov/cancer_information/cancer_type/breast'>http://www....

O'Connor A.M., Tugwell P., Wells G.A., Elmslie, T., Jolly, E., Holling-worth, G., et al. (1998). A decision aid for women considering hormone therapy after menopause: Decision support framework and evaluation. <i>Patient Education and Counseling</i>, <i>33</i>, 267-279.

Oncology Nursing Society. (2001). <i>The role of the advanced practice nurse in oncology care.</i> Retrieved May 3, 2002, from <a target="_blank" href='http://www.ons.org/xp6/ONS/Information.xml/Journals_and_Positions.xml/ON...

Ontario Cancer Genetics Network. (1999). <i>Ontario Cancer Genetics Network consensus recommendations for breast cancer risk management in familial breast/ovarian cancer.</i> Toronto: Author.

Pender, N.J. (1996). <i>Health promotion in nursing practice.</i> Stanford, CT: Appleton & Lange.

Picker Institute. (2000). <i>Surveys.</i> Boston: Author. Retrieved April 3, 2000, from <a target="_blank" href='http://www.picker.org'>http://www.picker.org</a>

Picker Institute Europe. (2002). <i>Sample questions.</i> Retrieved May 3, 2002, from <a target="_blank" href='http://www.pickereurope.ac.uk/surveys/sample.htm'>http://www.pickereurop...

Richardson, J.L., Mondrus, G.T., Deapen, D., & Mack, T.M. (1994). Future challenges in secondary prevention of breast cancer for women at high risk. <i>Cancer Supplement</i>, <i>74</i>, 1474-1481.

Spross, J.A., & Heaney, C.A. (2000). Shaping advanced nursing practice in the new millennium. <i>Seminars in Oncology Nursing</i>, <i>16</i>, 12-24.

Stacey, C.D. (2000). <i>Development and evaluation of a breast cancer prevention decision aid to address the needs of women aged 50 and older at high risk for breast cancer.</i> Unpublished master's thesis, University of Ottawa, Ontario, Canada.

Stacey, C.D., Jacobsen, M.J., & O'Connor, A.M. (1999). Nurses guiding breast cancer-related decisions: A decision support framework. <i>Innovations in Breast Cancer Care</i>, <i>4</i>(3), 71-81.

Stewart, M.J. (1995). Social support, coping, and self-care: Public participation concepts. In M.J. Stewart (Ed.), <i>Community nursing</i> (pp. 89-124). Philadelphia: Saunders.

Swedish Cancer Society & Swedish National Board of Health and Welfare. (1996). Breast-cancer screening with mammography in women aged 40-49 years. <i>International Journal of Cancer</i>, <i>68</i>, 693-699.

Tessaro, I., Borstelmann, N., Regan, K., Rimer, B.K., & Winer, E. (1997). Genetic testing for susceptibility to breast cancer: Findings from women's focus groups. <i>Journal of Women's Health</i>, <i>6</i>, 317-327.

Thomas, D.B., Gao, D.L., Self, S.G., Allison, C.J., Tao, Y., Mahloch, J., et al. (1997). Randomized trial of breast self-examination in Shanghai: Methodology and preliminary results. <i>Journal of the National Cancer Institute</i>, <i>89</i>, 355-365.

Trentham-Dietz, A., Newcomb, P.A., Storer, B.E., Longnecker, M.P., Baron, J., Greenberg, E.R., et al. (1997). Body size and risk of breast cancer. <i>American Journal of Epidemiology</i>, <i>145</i>, 1011-1019.

Verloop, J., Rookus, M.A., van der Kooy, K., & van Leeuwen, F.E. (2000). Physical activity and breast cancer risk in women aged 20-54 years. <i>Journal of the National Cancer Institute</i>, <i>92</i>, 128-135.

Vogel, V.G. (2000). Breast cancer prevention: A review of current evidence. <i>CA: A Cancer Journal for Clinicians</i>, <i>50</i>, 156-170.

Zimmerman, R.S., & Connor, C. (1989). Health promotion in context: The effects of significant others on health behaviour change. <i>Health Education Quarterly</i>, <i>16</i>(1), 57-75.