Impact of an educational intervention on provider knowledge, attitudes, and comfort level regarding counseling women ages 40–49 about breast cancer screening

Abstract

BackgroundMammography screening for women under the age of 50 is controversial. Groups such as the US Preventive Services Task Force recommend counseling women 40–49 years of age about mammography risks and benefits in order to incorporate the individual patient’s values in decisions regarding screening. We assessed the impact of a brief educational intervention on the knowledge and attitudes of clinicians regarding breast cancer screening.MethodsThe educational intervention included a review of the risks and benefits of screening, individual risk assessment, and counseling methods. Sessions were led by a physician expert in breast cancer screening. Participants were physicians and nurses in 13 US Department of Veterans Affairs primary care clinics in Alabama. Outcomes were as follows: 1) knowledge assessment of mammogram screening recommendations; 2) counseling practices on the risks and benefits of screening; and 3) comfort level with counseling about screening. Outcomes were assessed by survey before and after the intervention.ResultsAfter the intervention, significant changes in attitudes about breast cancer screening were seen. There was a decrease in the percentage of participants who reported that they would screen all women ages 40–49 years (82% before the intervention, 9% afterward). There was an increase in the percentage of participants who reported that they would wait until the patient was 50 years old before beginning to screen (12% before the intervention, 38% afterward). More participants (5% before, 53% after; P<0.001) said that they would discuss the patient’s preferences. Attitudes favoring discussion of screening benefits increased, though not significantly, from 94% to 99% (P=0.076). Attitudes favoring discussion of screening risks increased from 34% to 90% (P<0.001). The comfort level with discussing benefits increased from a mean of 3.8 to a mean of 4.5 (P<0.001); the comfort level with discussing screening risks increased from 2.7 to 4.3 (P<0.001); and the comfort level with discussing cancer risks and screening preferences with patients increased from 3.2 to 4.3 (P<0.001). (The comfort levels measurements were assessed by using a Likert scale, for which 1= not comfortable and 5= very comfortable.)ConclusionMost clinicians in the US Department of Veterans Affairs ambulatory practices in Alabama reported that they routinely discuss mammography benefits but not potential harms with patients. An educational intervention detailing recommendations and counseling methods affected the knowledge and attitudes about breast cancer screening. Participants expressed greater likelihood of discussing screening options in the future.

Educational Study to Increase Breast Cancer Knowledge Level and Scanning Participation among Women Working at a University

“…After the program, the knowledge levels of the women about BC screening methods were reported to increase when compared with the scores prior to the training as in the present study, and it was found that their attitudes toward screening methods had taken a positive turn (18). Studies in Turkey have also reported that women's knowledge levels about BC increased after an educational program in a similar way to our research (7,18,19).…”

“…The present study showed that intervention via training was effective in increasing women's knowledge levels about BC (p=.001). Working with 40-to-49-year-old women in a study conducted in Alabama, Bryan et al (18) provided the women with an educational program designed to extend their information and change their attitudes about BC screening methods. After the program, the knowledge levels of the women about BC screening methods were reported to increase when compared with the scores prior to the training as in the present study, and it was found that their attitudes toward screening methods had taken a positive turn (18).…”

“…Working with 40-to-49-year-old women in a study conducted in Alabama, Bryan et al (18) provided the women with an educational program designed to extend their information and change their attitudes about BC screening methods. After the program, the knowledge levels of the women about BC screening methods were reported to increase when compared with the scores prior to the training as in the present study, and it was found that their attitudes toward screening methods had taken a positive turn (18). Studies in Turkey have also reported that women's knowledge levels about BC increased after an educational program in a similar way to our research (7,18,19).…”

The WISDOM Study: breaking the deadlock in the breast cancer screening debate

“… 37 Similarly, primary care physicians, key influencers in a woman’s screening decisions, are far less willing to refer patients 40–49 for screening when fully educated about the potential risks/benefits of screening. 38 …”

Determining the effect of an educational intervention on medical support personnel's knowledge to administer a standardized developmental screening tool.

“…Educational training programs were predominately delivered to staff working in residential care facilities and hospitals, and were aimed at physicians, nurse practitioners, nurses, and nursing assistants/aides. In the most recent years, only a handful of manuscripts were found that could be analyzed using Kirkpatrick's framework; these include the following trainees and topics: increasing physicians', nurse practitioners', and nurses' knowledge of the HPV vaccine (Berenson, Rahman, Hirth, Rupp, & Sarpong, 2015); increasing physicians' and nurses' knowledge and comfort levels regarding counseling about breast cancer screening (Bryan, Estrada, Castiglioni, & Snyder, 2015); increasing nurses' comfort level using tele-ultrasound (Douglas et al, 2019); increasing nurses' knowledge of and response to deteriorating patients (Liaw et al, 2016); determining knowledge and attitudes of nursing assistants about chronic pain in long-term care (Long, 2013); evaluating nurses' attitudes and beliefs about familycentered bedside rounds (Montgomery, Benzies, & Barnard, 2016); increasing nursing assistants' knowledge of challenging behaviors associated with dementia (Pfeifer, Vandenhouten, Purvis, & Zupanc, 2018); and improving the ability of nurses to recognize child abuse in the emergency department (Smeekens et al, 2011). A breakdown of the evaluation of these studies using Kirkpatrick's framework is provided below: Knowledge and Understanding (Berenson et al, 2015;Bryan et al, 2015;Douglas et al, 2019;Liaw et al, 2016;Long, 2013;Montgomery et al, 2016;Pfeifer et al, 2018) Attitudes and Beliefs (Bryan et al, 2015;Long, 2013;Montgomery et al, (Liaw et al, 2016;Pfeifer et al, 2018).…”