Improving Breast Cancer Screening and Education through an Advanced Practice Nurse-Led Evening Clinic

• Main Author: Robles-Rodriguez, Evelyn
• Format: Dissertation
• Language: English
• Published: ProQuest Dissertations & Theses 01.01.2018
• Subjects: Nursing
• ISBN: 0355888130; 9780355888133

Breast cancer continues to be the most commonly occurring cancer in women in the United States and the second most common cause of cancer death (American Cancer Society, 2016). Screening with mammography has been shown to effectively find early breast cancers when they have higher potential for cure (American Cancer Society, 2016). Women who reside in Camden County, NJ have lower screening rates, higher incidence rates, higher late-stage diagnosis rates, and higher mortality rates for breast cancer than women in surrounding counties, the State of New Jersey and the nation (Baker Tilly, 2016 and Susan G. Komen Central and South Jersey and Philadelphia Affiliates, 2015). Camden city, where the project took place, is thought to have even lower screening rates than the County, as a community needs assessment report found that three of the four Camden County zip codes with the highest health disparities were in Camden city (Baker Tilly, 2016). Barriers to screening include decreased access to screening sites, lack of transportation, mistrust of the health care system and cultural and socioeconomic concerns (Baker Tilly, 2016). This DNP project sought to provide access to an APN-led evening clinic to educate and encourage Camden city Latina and Black women 40 years of age and older who had never been screened, or whose last mammogram was greater than 24 months ago, to obtain a screening mammogram. The Self-Efficacy Mammography Scale (SEMS) was utilized to measure self-efficacy pre-clinic interventions and understand barriers to screening, as higher self-efficacy has been shown to increase the likelihood to get screened (Jerome-D’Emilia & Suplee, 2014). SEMS results and screening rates were compared to women who received care at Cooper primary care provider offices that care for insured women, and the Camden County Cancer Screening Project which cares for uninsured women, both during day hours. Results were evaluated through a comparison of self-efficacy and mammography screening rates, ethnicity, age, and clinic location utilizing One Way ANOVA, Chi square testing and Intendent T Test. Logistic regression was also utilized to analyze the association of outcome variables to screening rates. This project hypothesized that addressing barriers to screening in Camden city Black and Latina women who were never or seldom screened through culturally and linguistically sensitive APN-led interventions during evening clinics, would help increase breast cancer screening rates and improve adherence to regular screening, in order to help decrease the risk of late-stage diagnosis in the future.