Self-confidence as a critical factor in breast self-examination

Can an instruction video or palpation aid improve the effectiveness of breast self-examination in detecting tumors? An experimental study

INTRODUCTION

Although large randomized trials have not shown benefits for breast self-examination (BSE), many organizations still endorse the practice. This study aimed to determine whether an instruction video or palpation aid improved the effectiveness of BSE.

METHODS

A total of 100 volunteers (50 men and 50 women) with no previous experience of BSE and/or clinical breast palpation were randomly assigned to the following intervention: instruction video seen versus not seen and use of palpation aids versus aids not used. Participants completed psychological trait and previous knowledge questionnaires before the intervention and/or breast examination. Examination was carried out on 24 different sized silicone breast forms, into 20 of which had been inserted tumor equivalents measuring 0.8-3.0 cm in diameter. The dependent variable was the rate of accurate tumor detection--the mean sum of correct positive hits (CPH)--defined as tumors detected within 20 s. Mean CPH values were then analyzed in relation to the interventions and other variables including gender and psychological measures (ANOVA and COVAR).

RESULTS

Neither the instruction video nor interaction effects between gender and the instruction video influenced the mean CPH value. Furthermore, the palpation aid was strongly and significantly associated with a reduced detection (p=0.00003).

CONCLUSION

Using an instruction video or palpation aid did not improve the effectiveness of breast examination in detecting tumors--a finding which supports results from large randomized studies. It is difficult to understand why BSE is still promoted by various groups.

Registered nurses' breast self-examination practice and teaching to female clients

Many registered nurses (RNs) do not regularly perform breast self-examination (BSE), and even fewer routinely teach the procedure. The aim of this descriptive survey was to investigate registered nurses' BSE practice and teaching to female clients. A systematic random sample of 171 female Australian RNs aged 20 to 65 who worked in acute or long-term care areas was surveyed. A questionnaire I developed and mailed to participants was used to collect the data, and descriptive statistics were used in data analysis. Ninety-three percent of participants reported performing BSE in the preceding 12 months. However, less than half (46%) had performed BSE monthly, and the major reason cited for not performing monthly BSE was "forgetting" (57%). Most participants (81%) stated they did not include the teaching of BSE in their nursing care; the major reason identified was "it was not relevant to their work context" (86%). However, 77% indicated feeling confident in teaching BSE, and most (94%) would teach BSE if they had the opportunity. Furthermore, participants were found to be more likely to teach BSE if they performed monthly BSE, felt confident with their BSE teaching skills, and had completed other nursing courses. The implications of this study are that nurses' teaching to clients may be increased if more emphasis on BSE occurs in the workplace and in undergraduate and postgraduate courses. Also, the provision of BSE educational programs is necessary to increase nurses' knowledge, confidence, performance, and teaching of BSE.

Self-efficacy of senior baccalaureate nursing students and preceptors

The purpose of this descriptive study was to investigate the effects of a senior clinical preceptorship experience on the self-efficacy levels of senior baccalaureate nursing students and their preceptors. Bandura's (1977, 1986) theoretical model of self-efficacy provided the conceptual framework. A non-probability convenience sample of 74 students and preceptors completed the self-efficacy pre-questionnaire; 47 the post-questionnaire. Students' overall self-efficacy scores increased significantly (M = 3.46/4.00; P < or = 0.01) following the 12-week preceptorship. Preceptors' post-scores, although not significantly increased, remained high, suggesting confidence in their role. Continuation of preceptorship programs is recommended.

A model for describing low-income African American women's participation in breast and cervical cancer early detection and screening

The article reports on data derived from two investigations. In one study, focus groups were used with low-income African American women to pilot test a teaching module developed to support the inclusion of culturally relevant content on breast and cervical health in teaching low-income African American women. A second study using individual interviews was undertaken to illuminate the lived experience of low-income African American women who participated in breast and cervical cancer early detection and screening services. Data analysis of group and individual interviews were performed using phenomenology as a methodological approach. Findings from the two studies, combined with information identified in the theoretical and literary contexts, supported the development of an Afrocentric model that describes the lived experience and decision making practices of low-income African American women's participation in breast and cervical cancer early detection and screening services.

Factors influencing registered nurses teaching breast self-examination to female clients

A university hospital-based study was conducted to explore factors that influence nurses teaching breast self-examination (BSE) to female clients, using the PRECEDE (Predisposing, Reinforcing, and Enabling factors in Educational Diagnosis and Evaluation) model as an organizing framework. Female registered nurses (N = 140) from adult inpatient and outpatient units completed a questionnaire that included items about frequency of BSE, knowledge of breast cancer screening and BSE technique, health motivation, confidence and competence in performing BSE, and teaching BSE. Data analysis compared the characteristics of nurses who reported teaching BSE with nurses who did not teach. Nurses in the teaching group had more work experience in nursing and were more likely to have a friend with breast cancer than were those in the nonteaching group. The teaching group had more knowledge about breast cancer screening and BSE technique and reported more confidence and competence in performing BSE.

Young women's breast self-examination knowledge and practice

A descriptive survey was conducted to identify and describe breast self-examination (BSE) knowledge and practices of young women (< 45 years). The sample consisted of 65 female university nursing students, whose ages ranged between 17 and 45 years (M = 19). Data were collected using a self-administered questionnaire and analyzed using descriptive statistics. The results of the study were that 99% of the sample had performed BSE in the previous 12 months. Fewer than half (44%) of these participants indicated that they would classify their BSEs as regular; only 27% of the participants reported they had examined their breasts from 9 to 12 times in the previous 12 months, which would normally be considered regular BSE. No significant relation was found between a family history of breast cancer and regular BSE (r = .262). A large percentage of the sample (77%) correctly identified the recommended time for BSE in relation to their menstrual cycle, although only 37% of the participants performed BSE at this time. Significant differences were found between the recommended times for performing BSE and the days of the menstrual cycle on which the participants performed BSE, chi 2(16, N = 64) = 35.330, p < .01. Forty percent of participants indicated they would ask their doctor to obtain more information about BSE. A further 36% of participants indicated they would go to a community health center. The most commonly cited community resource stated by the participants for obtaining BSE information was a doctor.

Effectiveness of a comprehensive breast cancer-screening class for women residing in rural areas

The purpose of this study was to investigate the effectiveness of two different educational methods on the variables of knowledge gains of breast self-examination as a cancer-screening device and the subsequent frequency of breast self-examination for women living in rural areas. Two educational methods were used: (A) a comprehensive class and (B) an information session using a brochure. The experimental group attended a comprehensive class on breast cancer screening that included a presentation where one of the investigators used American Cancer Society materials and modeled breast self-examination. The comparison group attended an information session in which a brochure by the American Cancer Society was given to the women as the educational modality. The sample was one of convenience and was comprised of 103 women living in rural areas. The experimental group included 50 women and the comparison group was made up of 53 women. The findings indicated that each group made significant gains in knowledge from the pretest to the posttest with the teaching method used. Each group retained approximately the same amount of knowledge at the 3-month follow-up test, and each group had an increased frequency of performing breast self-examination.

A theory of care-seeking behavior

Although much research has focused upon why people do and do not engage in recommended health behaviors, there is a need to develop more accurate theories to explain and predict engagement in health behaviors. Because health behaviors differ in important ways, it could be most fruitful to understand one type of health behavior, such as secondary prevention behavior. This paper proposes a theory of care-seeking behavior (CSB), based on a theory of general behavior by Triandis. Other popular theories about health behavior (i.e., Health Belief Model and Theory of Reasoned Action) also are reviewed. Empirical support for the variables identified in the theory of CSB is presented, drawing from the literature on secondary prevention for cancer. The theory of CSB is applied to the situation of seeking care for cancer symptoms. Directions for future research based upon this theory are delineated.

Breast self-examination

A review of publications on breast self-examination (BSE) up to the middle of 1991 showed that evidence supporting BSE has strengthened since 1989. BSE is associated with a smaller size of tumor at diagnosis and has the potential to reduce breast cancer mortality. Mortality reduction is likely to be achieved only if BSE is competently performed and if appropriate diagnostic follow-up is accessible. Because screening is justified when preclinical disease is prevalent, BSE practice is important for women 40 years of age and older.