CC BY
3
УДК 617.5
Eguruze K.G., PhD, chief assistant chief assistant Department of nursing care
Medical University Bulgaria, Varna
SAMPLE MODEL FOR TRAINING WOMEN AND CONTROL OF CONDUCTING PROPHYLAXIS OF BREAST CANCER
Abstract: Introduction: The high incidence of breast cancer and the comparatively low cost of the study make screening appropriate and economically justifiable. In the context of comprehensive screening programs at national level, the World Health Organization encourages breast cancer control. Demand for new ways and means in the fight against breast cancer should be a priority of any state policy. Aim: To present a Model for women's training and control of breast cancer prophylaxis to be applied to the personal ambulatory card of the adults. Material and methods: 1102 women living in the districts of Varna, Dobrich, Silistra and Shumen were interviewed, about 1/3 of the respondents living in the village. The opinion of260 nurses working in hospital and outpatient medical care in the regions concerned was also investigated. The surveys of both groups of respondents were completed in 2015. Sociological methods were used: documentary and survey methods, and statistical methods. The data is processed statistically through SPSS v. 20. Results and Discussion: Less than half of the women interviewed took part in the ongoing breast cancer prevention. Female respondents share a number of difficulties with a prophylactic review. Most of the women surveyed express the view that the proposed breast cancer prophylaxis model would significantly increase their awareness and help them to participate. This model is also supported by a large number of nurses surveyed. The presented model is, in its large part, author's work and aims to improve the awareness and participation of women in the prevention of breast cancer. Conclusion: Well-informed women with responsibility and concern for their own health are priorities of any healthcare system.
Key words: women, nurses, prevention, cancer, breast, model
Introduction: The high incidence of breast cancer (BC) and the comparatively low cost of the study make screening appropriate and economically justifiable. When the screening program is well-organized, it makes it possible to diagnose the disease at the earliest time and substantially reduce its mortality. The disease is completely curable if it is detected in time [1, 3]. Self-examination, clinical examination and mammography [1] are accepted for standard screening methods for BC.
Typically, the three methods combine because none of them is completely reliable. Each method has its advantages and disadvantages [3].
The highest sensitivity and specificity is mammography [1].
The recommendations of the American Center Society are useful:
• monthly self-examination of the breast after 20 years of age;
• annual clinical examination after 35 years;
• mammography every second year after 40 years and annually in the range of 50-69 years [1, 2, 9].
In the countries of the European Union, included Bulgaria, the mammography study was accepted for women aged 50-69 years at a two-year interval. A decision to include earlier in a screening program is taken if the woman is traced and belongs to a group with a high risk of developing a BC [8].
In the context of comprehensive national programs, the World Health Organization promotes the control of the BC. Specialized cancer control includes prevention, early detection, diagnosis and treatment, rehabilitation and palliative care. Key strategies are raising public awareness of the BC issue, control mechanisms, and the establishment of appropriate policies and programs. Demand for new ways and means in the fight against breast cancer should be a priority of any state policy.
Aim: To present a Model for women's training and control of breast cancer prophylaxis to be applied to the personal ambulatory card (PAC) of the adults.
Material and methods: 1102 women living in the districts of Varna, Dobrich, Silistra and Shumen were interviewed, about 1/3 of the respondents living in the village. The opinion of 260 nurses working in hospital and outpatient medical care in the regions concerned was also investigated. The surveys of both groups of respondents were completed in 2015. Sociological methods were used: documentary and survey methods, and statistical methods. Data is processed statistically through SPSS v. 20.
Results and discussion: In our sample of prevention of BC, 47.50% of the women performed, with a difference in the relative share of prophylactic examinations in different age groups (%2 = 37.38; p <0.001). The results show that after the age of 46, they are more often involved in breast prophylaxis.
Nearly half (49.60%) of the women surveyed indicated that they had difficulty in conducting prophylactic check-ups. The main problem is the lack of information in 17.90% of the respondents, followed by the lost waiting time of 14.20%. A total of 12.90% of women said they live in a village remote from the city and that their personal physician comes on certain days, making it difficult for them to participate in BC prevention (fig. 1):
Others (n = 42)
When I go for prophylactic examination I wait for a long time because my GP examines other patients at the same time (n... I don't know, when, where and who should execute the prophylactic examination (n = 197) I don't know, that I should visit such examination and I am waiting for invitation (n = 121)
I am living in village, which is far from the city (n = 63) I am not insured and I have no GP (n = 22) I live in village and my GP work in fix days (n = 79)
17,90%
0,00%
4,00%
8,00°%
12,00°%
16,00%
20,00%
Fig. 1. Difficulties encountered by women in conducting a prophylactic
examination
Looking for new ways and means to improve BC prevention, women's opinion on offering a training model was important to us. One of the steps was to establish whether the presence of a schedule and timetable in a PAC would facilitate BC prevention.
For a total of 76.20% of women, the proposal would facilitate them and increase their participation in ongoing prophylaxis (fig. 2). The personal ambulatory card is a medical documentation that is mandatory for every citizen of the Republic of Bulgaria. It must be certified by General practitioner (GP) and kept by the person to whom it was issued. We believe that the availability of BC information in PAC would make it easier for women to have a self-study report and the time for a prophylactic examination.
50,00% 40,00% 30,00% 20,00% 10,00% 0,00%
44,80%
I am not sure (n = 261)
Yes, probabily (n = 344)
Yes, I'm sure (n = 491)
Fig. 2. Opinion of women on the existence of a schedule and calendar in PAC for the prevention of breast cancer
We also sought the opinion of the nurses by proposing the new tool, namely to introduce a breast self-examination scheme in PAC and a timetable indicating the time to visit the planned prophylactic review.
A large percentage (44.60%) of the surveyed nurses support the idea and believe that this would have a positive effect on BC prevention. They also express an opinion on the use of visual materials for training, lecturers and practitioners,
who are very popular with BC prevention (fig. 3).
In the PAC there should be a scheme with all the steps for a proper self-examination of the breast (n=116)
1%
Preparation of brochures and other visual materials accessible to all women (n = 129)
49,60%
Arrangement of lectures and practical lessons with them (n = 132)
50,80%
Training women by discussing specific cases (n = 71)
0,00°% 10,00°% 20,00°% 30,00°% 40,00°% 50,00°% 60,00°%
Fig. 3. Nurses' suggestions on training women for self-examination of
the chest
The proposed model for training women and controlling breast cancer prophylaxis includes: breast self-examination scheme and instructions; Women's calendar for prophylaxis for breast cancer and History of preventive breast cancer
prevention.
SAMPLE MODEL FOR WOMEN TRAINING AND CONTROL OF CONDUCTING PROPHYLAXIS OF BREAST CANCER
On the basis of the breast self-control scheme as well as its explanatory notes, which are derived from Annex 15 of the 2002 National Framework Agreement (NFA) and Annex 13 to the NFA for 2015 [6, 7], are presented adapted to female consumers "Breast Self-Examination Scheme and Guidelines". For clarity and ease of execution by our users, we have allowed to reformulate some of the self-examination steps.
The women's calendar for the prevention of breast cancer and the history of breast cancer prophylaxis for women are entirely author's work.
1. Chest self-examination scheme and instructions
Dear ladies,
It is important to know that chest self-testing should be done once a month, after 20 years of age, from the 3rd to the 5th day after the end of the menstrual period (if you are in the menopause - it is done in the first days of each month). For the success of this study it is necessary to observe strictly defined rules and sequence of its conduct (fig. 4).
Fig. 4. Breast self-examination scheme
Please, follow the following instructions as the following:
Step 1: Take-off your dresses down to your waist. Stand in front of the mirror first with the arms slack, then with the hands on the hip as shown in (fig. 4.1). Look around your two breasts and watch for a change in the appearance of the chest; changes in the position of the nipples; wrinkling of the skin.
Step 2: Raise your hands and repeat the same view as shown in (fig. 4.2).
Step 3: Lie on a harder bed, place a folded towel or pillow under your left shoulder and put your left hand under your head as shown in (fig. 4.3). Start to feel your breasts in parts, start from the upper inside of the breast. Your fingers should move out of the breast to the nipple. Look for a lump regardless of its size.
Step 4: Repeat the same action for the top outer part (fig. 4.4), the lower outer part (fig. 4.5) and the lower inner part of your breast.
Step 5: Remove your left hand and with your right hand touch your left armpit as shown in (fig. 4.6).
Step 6: Thoroughly squeeze your left chest with your thumb and forefinger. Look for unusual secretion or bleeding (milk secretion, greenish secretion, bloody secretion).
Step 7: Move the folded towel or pillow under your right shoulder and repeat all steps with your right breast, armpit and nipple [5, 6, 7].
The proposed scheme and description are intended for women aged 20 to 69 and is scheduled to be placed on the personal ambulatory card (PAC). The purpose of this model is to help each woman perform self-examination of her breasts. Knowing her with the steps she has to follow, explaining and illustrating the self-control method of the breast, every woman is given the opportunity to be trained and constantly self-educated. This would, to a great extent, guarantee the quality of the method, as well as the formation of habits to make it happen to become automatism.
2. Women's calendar for prophylaxis for breast cancer
On the basis of an Ordinance No. 39 of the Ministry of Health of 2004 on the organization and conduct of preventive examinations and dispensaries in Bulgaria in Art. 4, para. 8 [4], Annex 1a to Art. 4, para. 8, as well as in the NFA for medical activities, Annex 13/2015, indicating the type and frequency of preventive examinations and studies in persons over the age of 18, a calendar was designed to
be placed in PAC for an adult. So prepared, the calendar aims at informing and reminding of the planned prophylactic procedures for BC according to the age of the woman. From the conducted study in women it was proved that one of the reasons for not realizing the planned prophylaxis is their poor awareness of the time, place and type of the examination (Table 1).
Tab. 1. Women's calendar for prophylaxis for breast cancer
Self-examination of the chest -every month Clinical examination of the breast by the GP - every year Mammography of the breast - once every two years
Women after 20 years +
Women over 30 years old + +
Women aged 50-69 including + + +
Legend
Mandatory:
• Self-examination of the chest should be done after 20 years of age, from the 3rd to the 5th day after the end of menstruation, if you are in menopause - is done in the first days of each calendar month;
• Clinical examination of the breast is performed after 30 years of age, once a year by your GP during the planned prophylactic examination;
• Mammography of the breast is performed from 50 to 69 years of age, once every 2 years or every year at the discretion of your doctor. Over 69 years of age are at the discretion of a doctor.
3. History of breast cancer prophylaxis for women
A history of breast cancer prophylaxis for women is a form that is scheduled to be placed in the PAC and should be completed by the GP or specialist in the appropriate prophylaxis. For this purpose, against the respective year with a / + / positive or / - / negative sign, the BC prophylaxis is noted, and in the case of the findings and results, any health problems and findings are noted. Thus, on the one hand, this would help the GP to inform the woman about a subsequent visit and would improve the statistical information on the BC preventive examinations. By knowing the BC prevention periods, each woman could monitor for the time of her next prophylaxis. The history will allow timely prevention as well as documentation of all findings and follow-up events, if any, related to the diagnosis and treatment of BC (Table 2).
Tab. 2. History of breast cancer prophylaxis for women
Year Clinical examination of the breast Finding Mammography of the breast Result of mammography study
20 г.
20 г.
20 г.
Legend:
Mark / - / negative - no clinical examination and / or mammography has been performed.
Mark / + / positive - clinical examination and / or mammography. In the "Find" and "Score" columns, it is necessary to state the findings. Currently, GP completes an ambulatory sheet and applies it to the person's health record when conducting a prophylactic examination of health insured persons over 18 years of age. Conclusions:
1. Difficulties in participating in the prophylaxis of BC, which have a large proportion of women (49.60%), are mainly due to their poor awareness and poor organization of preventive examinations.
2. The majority of women believe that the proposed "Model for women's training and control of rrophylaxis of BC" in PAC would facilitate them and increase their awareness and participation in the prevention of BC.
3. A large percentage (44.60%) of the surveyed nurses support the idea and believe that the availability of a learning scheme and schedule in PAC would have a positive effect on BC prevention.
4. The proposed "Model for women's training and control of prophylaxis of BC" in PAC would stimulate and enhance self-examination.
Conclusion: Thus, the proposed model applied in PAC will help raise awareness among women and their involvement in the prevention of breast carcinoma. Finding new means to improve prophylactics against cancer is a major task for every member of the European Union. Well-informed women with responsibility and concern for their well-being are priorities of every healthcare system.
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