Enhancing Patient Education Through the Use of a Breast Biopsy Education Booklet

1. Enhancing Patient Education Through the Use of a Breast Biopsy Education Booklet Amy Singer, MSN, RN Nursing Program Manager Patient Education

2. The Ohio State University Comprehensive Cancer Center-James Cancer Hospital and Solove Research Institute • Located in Columbus, Ohio and 1st dedicated cancer hospital in the Midwest. • One of 10 freestanding cancer hospitals in the nation. • Designated as a Comprehensive Cancer Center by the National Cancer Institute (NCI). • Member of the National Comprehensive Cancer Network (NCCN). • A 228 bed hospital; 24 bed blood and marrow transplant unit; 26 research labs and multiple ambulatory clinics on campus and through out the community. • Designated as a Magnet Hospital in 2013 • Future growth - a new 21 level James Cancer Hospital will open in December 2014. Columbus, Ohio

3. The Stefanie Spielman Comprehensive Breast Center • Offers a full continuum of breast cancer care from prevention and screening through detection, diagnosis, treatment and survivorship. • Services include: • Breast Imaging • Medical and Surgical Oncology • Reconstructive Surgery • Chemotherapy • Radiation Oncology • Laboratory / Phlebotomy • Diagnostic and Nuclear Imaging • Oncology Rehabilitation • Survivorship Classes • Hope’s Boutique

4. Why develop a Breast Biopsy Booklet? Factors influencing the need for a customized booklet: • New facility, expanding services and new nursing role in Breast Imaging Department • Gaps identified in the consistency of education provided for pre and post procedure care • Nurses identified a need for more print materials specific to a breast biopsy procedure and self care education • Calls from patients inquiring about various process and procedure questions

5. Project Goal • Develop a comprehensive educational booklet (teaching tool) to enhance one-on-one teaching sessions for patients needing a breast biopsy. • Provide an organized and easy to use booklet that serves as a take away resource for patients • Improve the delivery, consistency and continuity of education • Improve patient preparedness and knowledge of what to expect before, during and after a breast biopsy

6. Booklet Development • Collaboration between Breast Imaging staff and the Patient Education Department to develop customized booklet • Multidisciplinary approach (e.g. Nursing, Imaging Technologist, Radiologist, Patient Education, Hospital Patient Education Liaison Committee) • Content developed was based on current practice guidelines and standards of care • Booklet addressed the major areas of concern and trajectory of care for breast biopsy

7. Developing Print Materials Basic principles for print material development: • Readability / low literacy levels • Written in plain language • Clear and Simple Format (e.g. headings, ample white space, bullet points,14 font size) • Conversation style / Active voice • Easy step by step instructions • “Need to Know” information • Use of illustrations • Institutional policy, logo and branding

8. Final Booklet • Final Product “ Breast Biopsy” education booklet: • Spiral Bound booklet • 5 sections with a total of 17 separate documents • Plastic pocket for additional educational materials

9. Breast Biopsy Booklet Table of Contents Tab 4: Patient and Visitor Information • Places to Stay: Patient and Visitor Information • Driving Directions to The Stefanie Spielman Comprehensive Breast Center Tab 5: Resources and Notes • Cancer Screening for Women • Cancer Genetics Consultation • Lifestyle and Nutrition Recommendations • Managing Symptoms of Menopause • Osteoporosis • Breast Biopsy Internet Resources • Notes and Questions Tab 1: Breast Imaging • Questions and Answers About Having a Mammogram • Breast Ultrasound • Common Breast Changes Tab 2: Preparing for Your Breast Biopsy • Questions to Ask Before Having a Breast Biopsy • Breast Biopsy Methods • Preparing for Your Breast Biopsy • Breast Marker Clips • Herbal Use Before Surgery Tab 3: After Your Breast Biopsy • After Your Breast Biopsy

10. Booklet Implementation How was the booklet used in practice? • Patient referred from screening mammogram to a diagnostic mammogram • Diagnostic imaging performed • Radiologist recommends further evaluation by breast biopsy • Nurse provides one-on-one teaching to prepare patient and uses booklet to enhance teaching sessions.

11. Booklet Evaluation • A product evaluation occurredto determine if the delivery method and content was effective in meeting patient’s learning needs. • Method • Short online survey performed over a 3-month period. • Survey consisted of 7 Likert scale questions and an open comment area. • After the biopsy teaching session, patients were invited to participate in online survey. Hard copy survey was also an option. • Results • 44 patients agreed to participate. Actual response rate of 61% (n=27). Total of 26 online and 1 hard copy

13. Survey Results 1. The information given to me was helpful. 2. The information prepared me for what to expect before, during and after breast biopsy. 22% Agree 78% Strongly Agree 15% Neutral 3. The information helped decrease my concerns about having a breast biopsy. 48% Agree 37% Strongly Agree 4. The patient education materials were easy-to-read and understand. 22% Agree 78% Strongly Agree

14. Survey Results 5. The amount of patient education materials given to me was helpful. 8% Neutral 6. The patient education materials were organized in a way that was useful. 22% Agree 70% Strongly Agree 7. Overall, I found the patient education materials to be helpful. 30% Agree 70% Strongly Agree

15. Discussion Project Strengths • Successful collaboration resulted in developing an effective educational tool. • Customized booklet enhanced nurse-led teaching sessions. • Aided consistency of education / information being provided. • Booklet provided answers to questions and concerns thereby reducing calls to the clinic. • Empowered patients to be actively involved in their care. • Findings consistent with the literature. Providing clear and effective patient education in a supportive environment promotes patient learning, satisfaction and quality outcomes.

16. Lessons Learned • Question 3 showed variance. In the future, the question will be reworded to focus more on educational content vs. psychosocial impact. • Question 6 showed variance regarding the organization of materials. Patients suggested using tabs due to vast amount of content. • Future booklet revisions: • Re-evaluate needed content • Add tabs to help direct patients to desired sections

17. Future Opportunities • The booklet was well received for providing adequate education to prepare for biopsy. • However, results showed patients had concern with the associated uncertainty of receiving a breast cancer diagnosis. • An opportunity exists to further investigate the impact of education and emotional support on the anxiety and uncertainty associated breast biopsy.

18. Acknowledgments Thank You to Our Project Workgroup Megan Oroszi, BSN, RN, CBCN Joyce Hendershott, MSW, LISW, ACSW Grazia Sorice, BSN, RN, CCRN Janine Overcash, PhD, GNP-BC Staff of the SSCBC Imaging Department

19. References • Bastable, S.B., (2006). Essentials of Patient Education. Sudbury, MA: Jones & Bartlett Publishers. • Centers for Disease Control and Prevention (2009). Simply Put: A Guide to Creating Easy-to-Understand Materials (3rd ed) Atlanta, GA. Retrieved from http://www.cdc.gov/healthliteracy • Mahon, S.M (Ed.). (2011). Site-specific cancer series: Breast cancer (2nd ed.). Pittsburgh, PA: Oncology Nursing Society. • National Cancer Institute (2003). Clear and Simple: Developing Effective Print Materials for Low Literate Readers: Retrieved from http://www.cancer.gov/cancertopics/cancerlibrary/clear-and-simple

20. Thank You To learn more about Ohio State’s cancer program, please visit cancer.osu.edu or follow us in social media:

21. Contact Information Amy Singer, MSN, RN OSU-CCC James Cancer Hospital Patient Education Department 614-293-2010 / amy.singer@osumc.edu Megan Oroszi, BSN, RN, CBCN Stefanie Spielman Comprehensive Breast Center Breast Imaging Department 614-366-9212 / megan.oroszi@osumc.edu