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Headline news creates need for patient education
Make sure education is consistent with media blitz
In November 2009, recommendations for changes in screening guidelines for breast cancer made headline news. Shortly thereafter, new guidelines for cervical cancer screening also became news.
The guidelines contradicted what was considered best practice by many health care institutions.
Such information can be confusing for both patients and professionals, says Joanne Lester, PhD, CRNP, ANP-BC, AOCN, a research scientist and oncology nurse practitioner at the James Cancer Hospital & Solove Research Institute in Columbus, OH.
Yet, when screening is news, there is an increased awareness and opportunity for education, she adds.
Any media coverage of a cancer-related topic will create questions on the part of the general public. As a result, a health care organization with any type of call-in or e-mail interface with the general public should be prepared with the facts, recommends Mary Szczepanik, RN, BSN,MS, a breast health specialist at the OhioHealth Breast Health Institute in Columbus, OH.
In the case of breast cancer screening, the U.S. Preventive Services Task Force of the Department of Health and Human Services in Washington, DC, recommended against routine screening mammography in women 40 to 49, with screening every other year for women 50 to 74 years of age. The task force counseled against teaching women to perform breast self-exams and questioned the usefulness of clinical breast exams. Also questioned was the usefulness of mammography for women 75 and older.
The recommendation that women should delay their first Pap test until age 21, regardless of sexual history, came from the American College of Obstetricians and Gynecologists (ACOG) based in Washington, DC. "Cervical cytology screening is recommended every two years for women between the ages of 21 years and 29 years. Evidence shows that screening women every year has little benefit over screening every other year," ACOG stated in a letter to its members.
When new guidelines for cancer screening become news, health care organizations need to have steps in place to make sure information from its staff is consistent, says Szczepanik.
"In the case of the recent announcements about mammography and Pap smears, it would be wise to research not only the full facts of the study and findings of the panel, but also to contact the leadership of the cancer program at your institution for an official statement," she advises.
According to Szczepanik, such an approach reduces the risk of associates expressing their personal opinions, and provides consistency and accuracy in all responses.
At M.D. Anderson Cancer Center in Houston, information was posted on its Cancerwise web site immediately after the news broke, advising women to get their first mammogram at age 40 and return every year for regular screenings. It stated that the guidelines would be assessed at the cancer center's annual evaluation in March 2010.
The web piece also stated that physicians needed to educate their patients on the risks and limitations of breast cancer screening, so their patients could participate in the decision-making.
Patients must be treated on an individual basis, agrees Lester. She explained that practitioners should look at each patient's individual risks and base what is done on the evidence, best practice, clinical intuitiveness, and patient preference.
"My first response to the news was that we had worked so hard to educate people, but it raised a lot of awareness and discussion, and it emphasizes again that you need to individualize your care for each person," says Lester.
Also important is education about the guidelines institutions choose to follow. Szczepanik says OhioHealth gets the word out via its web site, print materials made available to primary care physicians for use in their office, community education programs, and education of office staff, as needed.
Many institutions have a committee that reviews guidelines annually in order to establish policies for its practitioners to follow. OhioHealth follows the recommendations of the American Cancer Society, in Atlanta; American College of Surgeons in Chicago; and the National Cancer Center Network in Fort Washington, PA.
On the rare occasion when the medical staff committee identifies a difference in process, it creates a document indicating the exceptions to the standard, and that becomes part of the record via meeting minutes. If the difference is significant, then a letter to the medical staff would be sent, says Szczepanik.
Most of the physicians at OhioHealth are private practice physicians but are held to the standards set by the Medical Staff office, adds Szczepanik. "They are informed by section meetings , weekly Ground Rounds, cancer conferences, and at times in written form," she states.
At the James Cancer Hospital, guidelines issued by the ACS, the NCCN, and National Cancer Institute in Bethesda, MD, are used to form policy on screening. Also, the institution has disease-specific committees, including a breast disease committee, which discusses such issues as the new guidelines recommended by the task force.
Lester says it is important to discuss health information that has been on the news, because sometimes the information is misinterpreted. For example, ACOG recommended a Pap smear every two years, but women might assume that means they should have a pelvic exam every two years and therefore miss out on other important screenings, such as blood pressure and cholesterol.
Even if a screening test is not needed, it is important to educate women about seeing a physician on a regular basis, says Lester.
For more information about educating patients about health screenings following breaking news, contact:
Joanne Lester, PhD, CRNP, ANP-BC, AOCN, Research Scientist/Oncology Nurse Practitioner, James Cancer Hospital & Solove Research Institute, Clinical Assistant Professor, College of Nursing, The Ohio State University, Columbus, OH. Telephone: (614) 293-0010. E-mail: firstname.lastname@example.org.
Mary Szczepanik, RN, BSN, MS, Breast Health Specialist, OhioHealth Breast Health Institute, 376 Blenheim Road, Columbus, OH, 43214. Telephone: (614) 268-3547. E-mail: email@example.com.