Mary Alice Trapp

A Program to Increase Breast and Cervical Cancer Screening for Cambodian Women in a Midwestern Community

OBJECTIVE To determine local screening rates for breast and cervical cancer screening among Cambodian women older than 50 years of age who had used the health-care system, to compare these rates with those for non-Cambodian women, to identify barriers to screening among Cambodians, and to implement community screening. MATERIAL AND METHODS From review of medical records, cancer screening rates for 1 year among Cambodians (N = 57) were compared with rates for a matched non-Cambodian sample (N = 57). Southeast Asian focus groups identified barriers to screening as a basis for intervention. The intervention included community informational programs in the Cambodian language, group screening appointments, provision of transportation, use of female physicians and interpreters, and an informal clinic setting. Cancer screening rates were compared before and after the intervention. RESULTS Initial screening rates for Cambodians were significantly lower than for the non-Cambodians. Expressed barriers included lack of knowledge about cancer, shyness at physical examination, lack of transportation, fear of a large, technical medical center, and individual appointments. After the intervention, community screening rates were almost 5 times higher than at baseline. CONCLUSION The intervention was successful in overcoming organizational, economic, and cultural barriers to cancer screening among older Cambodian women in this setting.

The quality of Pap test specimens collected by nurses in a breast and cervical cancer screening clinic.

BACKGROUND It is possible that nurses can help close the gap between the Healthy People 2000 clinical preventive services goals and current cancer screening rates by collecting Pap test specimens in clinical practices. The purpose of this analysis was to determine whether nurses can collect high-quality Pap tests. DESIGN Retrospective cohort analysis of all Pap tests submitted to a commercial pathology laboratory between January 1, 1996 and July 31, 1996. Pap tests collected by the nurses at Rosebud Hospital (N = 404) were compared to the Pap tests collected by other providers at the Rosebud Hospital (N = 118) and the Pap tests collected by providers from all other sites (N = 22,696). SETTING The Indian Health Service Hospital, Rosebud, South Dakota. SUBJECTS Eight nurses who had been trained to collect Pap test specimens. MAIN OUTCOME MEASURES The proportion of Pap test specimens that were wholly satisfactory and the proportion of Pap test specimens collected from nonpregnant patients that lacked endocervical cells. RESULTS The proportion of specimens that were wholly satisfactory was 79.8% (95% CI = 75.9-83.7) for the nurses, 65.3% (95% CI = 56.7-73.9) for other Rosebud providers, and 81.7% (95% CI = 81.2-82.2) for non-Rosebud providers. The proportion of specimens that lacked endocervical cells and were from nonpregnant patients was 6.4% (95% CI = 4.0-8.8) for Rosebud nurses, 8.5% for other Rosebud providers (95% CI = 3.5-13.5), and 7.9% for non-Rosebud providers (95% CI = 7.6-8.2). CONCLUSIONS After one week of training, nurses can collect Pap test specimens that are of the same quality as the specimens collected by physicians, nurse practitioners, and physician assistants. The widespread availability of female nurses and the high quality of their work suggest that they can contribute to the Healthy People 2000 goals by collecting Pap test specimens.

Evaluation of a program to train nurses to screen for breast and cervical cancer among native American women

BACKGROUND Routine screening for breast and cervical cancers lowers mortality from these diseases, but the benefit has not permeated to Native American women, for whom the five-year survival rate is the lowest of any population group in the United States. To help address this problem, an educational/training program was designed to enhance the skills of nurses and other health service providers and develop clinic support systems to better recruit, screen, and follow clients for breast and cervical cancer screening services. METHODS A total of 131 nurses participated in the training program at 33 different sites between 1995 and 2000. Prior to and following training, each participant was given a questionnaire to determine knowledge of breast and cervical cancer screening techniques and recommendations, cancer survival and risk factors, and situational scenarios. RESULTS The average score for the pretest was 54% correct. The posttest average was 89% correct. The percent correct increased 35% from pre- to posttest (p < 0.001). CONCLUSION The knowledge to implement a successful screening program can be acquired through the current curriculum.

Implementing Nurse-Based Systems to Provide American Indian Women With Breast and Cervical Cancer Screening

OBJECTIVE To describe the factors critical to implementation of a nurse-based system to increase access for American Indian women to breast and cervical cancer screening. MATERIAL AND METHODS We report the experience of 103 nurses at 40 clinics who were trained to use the nurse-based screening system. In addition, the critical elements are discussed in the context of one particularly successful site. RESULTS Fifteen factors were identified as critical to the implementation of a nurse-based cancer screening process once a nurse had been trained to perform clinical breast examinations and collect Papanicolaou (Pap) test specimens: knowledge of benefit, skills, organization, adequate return, perceived patient demand, perceived effectiveness, legitimacy, confidence, commitment, adequate resources, a data-driven iterative approach to program implementation, an objective measure of quality, leadership, the passage of time, and a focus on delivering the service to the patient. For example, in one site that was particularly successful, the nurses, administrators, and other key health-care professionals contributed their respective resources to implement the screening program. The program was also supported by the lay community, the state board of nursing, and the state health department breast and cervical cancer control program. During the 3-year study period, the 103 nurses performed screening tests on 2,483 women, and only 18 of the Pap test specimens were unsatisfactory. CONCLUSION Nurse-based systems designed to collect high-quality Pap test specimens and perform detailed clinical breast examinations can be implemented if the factors that are critical to implementation are identified and addressed.

The Pine Ridge-Mayo National Aeronautics and Space Administration Telemedicine Project: Program Activities and Participant Reactions

OBJECTIVE To determine the response of participants to the Pine Ridge-Mayo National Aeronautics and Space Administration telemedicine project. DESIGN We describe a 3-month demonstration project of medical education and clinical consultations conducted by means of satellite transmission. Postparticipation questionnaires and a postproject survey were used to assess the success of the activity. MATERIAL AND METHODS Patients and employees at the Pine Ridge Indian Health Service Hospital in southwestern South Dakota and employees at Mayo Clinic Rochester participated in a telemedicine project, after which they completed exit surveys and a postproject questionnaire to ascertain the acceptability of this mode of health care. RESULTS Almost all Pine Ridge and Mayo Clinic participants viewed the project as beneficial. The educational sessions received favorable evaluations, and almost two-thirds of the patients who completed evaluations thought the consultation had contributed to their medical care. More than 90% of the respondents from Pine Ridge and more than 85% of the respondents from Mayo Clinic Rochester said that they would recommend participation in this project to others. More than 90% of respondents from Pine Ridge and 80% of Mayo respondents agreed with the statement that the project should continue. CONCLUSION These data suggest that a program of clinical consultation services, professional education, and patient education available by telemedicine might be viewed as beneficial.

Outcomes of Training Nurses To Conduct Breast and Cervical Cancer Screening of Native American Women

Native WEB (Women Enjoying the Benefit) is a unique training program for nurses employed by the Indian Health Service (IHS), tribal clinics, and other clinics with large, underserved populations. It teaches nurses breast and cervix cancer screening techniques and trains them to administer and maintain high-quality screening programs that include patient outreach, education, and training. We review American Indian (AI)/Alaska Native (AN) womens need for screening services, identify some of the obstacles to screening, and present our evaluation of the Native WEBs impact on clinics, nurses, and patients. Findings show that Native WEB training is associated with increased screening activity at all three levels.

Erratum to: Development and Pilot Evaluation of a Cancer-Focused Summer Research Education Program for Navajo Undergraduate Students

This paper describes the development and pilot testing of a 10-week cancer research education program for Navajo undergraduate students. The program was piloted at Diné College with 22 undergraduates (7 men, 15 women) in 2007 and 2008. Students completed a pre–post program survey assessing attitudes, opinions, and knowledge about research and about cancer. The program was found to be culturally acceptable and resulted in statistically significant changes in some of the attitudes and opinions about research and cancer. Combining all 13 knowledge items, there was a significant (p = 0.002) change in the mean total correct percent from baseline [70.3 (SD = 15.9)] to post-program [82.1 (SD = 13.1)]. The curriculum was adapted for a new cancer prevention and control course now offered at Diné College, enhancing sustainability. Ultimately, these efforts may serve to build capacity in communities by developing a cadre of future Native American scientists to develop and implement cancer research.