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Knowledge, Cancer Fatalism and Spirituality as Predictors of Breast Cancer Screening Practices for African American and Caucasian Women. Staci T. Anderson, PhD, RN April 11, 2008. Background. Breast cancer is the 2 nd most frequently diagnosed cancer in women.

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Knowledge, Cancer Fatalism and Spirituality as Predictors ofBreast Cancer Screening Practices forAfrican American and Caucasian Women

Staci T. Anderson, PhD, RN

April 11, 2008


Background
Background

  • Breast cancer is the 2nd most frequently diagnosed cancer in women.

  • In 2007, an estimated 178,480 new cases of breast cancer will be diagnosed

  • African American (AA) women die from breast cancer more than any other racial group

  • Use of breast cancer screening practices influences mortality and survival rates


Breast cancer incidence age adjusted per 100 000
Breast Cancer IncidenceAge-Adjusted (per 100,000)

(National Center for Health Statistics, 2006)


Survival rates
Survival Rates

5-Year Relative Survival Rates

(National Center for Health Statistics, 2006)

Percentage of Women


Trends in mortality rates
Trends in Mortality Rates

Age-Adjusted Rates

Per 100,000

(National Center for Health Statistics, 2006)


Louisiana trends
Louisiana Trends

(per 100,000)

Per 100,000

(NCI SEER State Cancer Profile, 2006)


Mammography screening trends
Mammography Screening Trends

(Centers for Disease Control and Prevention, 2005)


Breast cancer screening
Breast Cancer Screening

  • Barriers

    • Structural Barriers

    • Organizational

    • Psychological

  • Facilitators

    • Health Insurance

    • Source of Health Care

    • Physician Recommendation


Problem statement
Problem Statement

  • Despite improvements in mammography screening rates, differences in breast cancer mortality and survival rates persist between AA and Caucasian women. Differences in utilization of breast cancer screening practices has been identified as a contributing factor to this phenomenon. Various complex and interrelated factors influence participation in breast cancer screening practices.


Purpose
Purpose

  • To explore relationships between knowledge related to breast cancer screening and detection, cancer fatalism, spirituality and breast cancer screening practices in African American and Caucasian women.

  • To determine the ability of these variables to predict breast cancer screening practices in African American and Caucasian women.


Significance
Significance

  • Findings could be used to develop more culturally specific educational interventions.

  • Health care providers need to be aware of an individual’s knowledge, perceptions, beliefs, and attitudes about breast cancer.


Study variables
Study Variables

  • Breast Cancer Knowledge

    • Cognitive information about breast cancer and breast cancer detection and screening practices

  • Breast Cancer Screening Practices

    • Methods used to detect breast cancer in persons who are asymptomatic.

      • BSE

      • CBE

      • Mammogram


Research hypotheses
Research Hypotheses

H1 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in AA women.

H2 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in Caucasian women.


Research hypotheses1
Research Hypotheses

H3 Breast cancer knowledge is a predictor of breast cancer screening practices in AA women.

H4 Breast cancer knowledge is a predictor of breast cancer screening practices in Caucasian women.


Methodology
Methodology

  • Study Design

    • Multicorrelational cross-sectional research design

  • Sampling

    • Non-probability convenience sample

    • Inclusion/exclusion criteria

  • Instruments


Measurements
Measurements

  • Breast Cancer Knowledge Test (BCK) (McCance et al., 1990)

    • Measures knowledge of detection and screening practices

    • Higher scores associated with greater knowledge

  • Demographic Questionnaire


Demographic characteristics
Demographic Characteristics

  • Race – 53.7% AA; 46.3% Caucasian

  • Age – 44.7 ± 12.8

  • Marital Status – 48.8% Married

  • 63.6% Annual Income ≥ $50,000

  • Education

    • 37.7% College Graduate

    • 18.5% Completed Graduate School


Demographic characteristics1
Demographic Characteristics

  • Health Resource Variables

    • Health Insurance Coverage - 94.4%

    • Usual Source of Care – 90.1%

  • Health History

    • Family history of BC diagnosis (n = 58)

      • 43.1% Participates in BCSP

    • Family history of BC death (n = 28)

      • 46.4% Participates in BCSP




H1 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in AA women.

X2 = 1.816; df = 1; p = .178


H2 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in Caucasian women.

X2 = .065; df = 1; p = .799


H 3 breast cancer knowledge is a predictor of breast cancer screening practices in aa women
H3 Breast cancer knowledge is a predictor of breast cancer screening practices in AA women.

Total variance explained = 6.0%; variance unexplained = 94.0%.


H 4 breast cancer knowledge is a predictor of breast cancer screening practices in caucasian women
H4 Breast cancer knowledge is a predictor of breast cancer screening practices in Caucasian women.

Total variance explained = 0.0%; variance unexplained = 100.0%.


Discussion conclusions
Discussion/Conclusions

  • Breast Cancer Screening Practices

  • Breast Cancer Knowledge

    • No significant relationship found

    • Caucasian women had higher mean scores

  • Demographics

    • Income

    • Education

    • Health Resources


Implications
Implications

  • Nursing Research

  • Nursing Practice

  • Nursing Education

    • Health & Wellness Model

  • Health Policy

    • Policy Initiatives

    • Funding for Research


Limitations
Limitations

  • Use of self-report data

  • Non-probability convenience sample

  • Recruitment settings

  • Variability of study participants


Recommendations
Recommendations

  • Study designed to determine breast cancer screening practices over time utilizing a larger and ethnically diverse sample

  • Secondary analysis to determine if there are relationships between demographic variables, spirituality, and each method of breast cancer early detection

  • Develop and test culturally specific interventions that focus on increasing breast health and breast cancer screening practices


THANK YOU!

QUESTIONS?


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