Screening Mammograms: How to Teach Patients & Promote Compliance

What Is Patient Teaching about Breast Cancer Screening – Mammography?

  • Patient teaching about breast cancer screening mammography (SM)  can defined in simple terms as the process of providing helpful information to patients before, during, and after mammography. This is to increase their knowledge of the procedure and enhance their ability to cope with the procedure and related results.
    • What Patients need to know about screening mammograms:

      screening mammogramPatient teaching about Screening Mammogram involve: –

      • Teaching patients about the purpose of breast cancer screening
      • The risks involved and benefits of screening mammograms
      • How to prepare for mammography
      • What to expect during the procedure
      • Strategies for coping with the screening mammogram procedure and findings.
      • Screening mammogram is the single most effective method for early breast cancer detection because it can identify breast cancer several years before physical signs and symptoms are apparent.
      • Lack of screening mammograms and infrequent  screening mammogram are widely recognized as major factors contributing to increased breast cancer mortality
    • How to teach patients about screening mammograms:

      First time experience can be uncomfortable to many women but with correct teaching, compliance can be achieved. Teaching and motivational activities like face-to-face instruction, written materials, video presentations and pre-visit tours can be utilized to teach and support patients in learning about mammography and breast cancer screening

      • Make teaching and learning an ongoing process by using combination strategies like sending a reminder letter, providing a pamphlet about screening mammograms & discussing concerns about discomfort during mammography. This has been shown to be more beneficial than face-to-face instruction only
      • Use of informed decision-making process is important when promoting health screening such as screening mammogram. In educated population, research has shown that use of leaflets with decision aids appear to increase knowledge and participation in breast screening and have a positive impact on reducing decisional conflict.
    • Where does teaching about screening mammograms occur?

      Patient teaching about breast cancer screening mammograms typically begins in primary care, but can also be introduced at any time of clinic or hospital visit. Public education has shown to yield the best results about screening mammograms.

      • Every possible effort should be made to promote seamless delivery of patient teaching throughout the course of care and after screening mammogram.
      • Conflicting information about breast cancer screening mammograms should be avoided to reduce frustration and confusion and increase
    • Who is the best to teach about breast cancer screening mammograms:

      Patient teaching about breast cancer screening mammogram can be given by healthcare professionals like physicians and nurses and should not be delegated to assistive clinical staff or none clinical staff.

      • Research has shown that the most effective educators of women undergoing mammography are those who individualize information to specifically address their learning needs – women just like them

Nursing a Breast Cancer Patient: Pain Kills

Breast cancer patient in both physical and emotional pain

I choose to give this story because it still bothers me 4 years down the road. My name is Linda and I am a critical care nurse in a big city in America. Breast cancer patient hurts both physically and emotionally, something we deal with everyday especially being a cancer center hospital.

Four years ago I took care of a young 35 years old lady with end stage metastatic breast cancer. This day still remains fresh as if it happened yesterday. For those of you who are in healthcare, I beg you to stand firm and advocate for your patients as if you are fighting for one of your own.

dehiscedMy 35 years old had been fighting breast cancer well over five years. This time, her best ever fighting spirit was on all time high. Her breasts were scarred, full of flaps and patches. Some of the scars show they had dehisced and repaired leaving heartbreaking scars. But that was not the toughest battle yet.

On this night, she was transferred from oncology unit to ICU after a round of Chemo.  For those familiar with inpatient healthcare protocols, a patient whose oxygen saturation drops below 90%, change in mentation, heart rate in 130’s meets the criteria of being admitted to intensive care unit (ICU). On top of that her liver profile looked really bad. Her skin color was yellow due to liver failure secondary to metastasis. Excuse me if I sound too much like a text book nurse.

Series of radiological tests were performed to make sure she didn’t have a collapsed lung or pulmonary embolism. These tests showed nothing way out of normal and the oncologist together with intensivist gave me orders to continue watching the patient. The patient vision had been taken away by chemo and the only good special sense she had was hearing. She could easily recognize me because of a foreign accent.

Supraventricular tachycardiaThe heart rate kept on going up and orders to give her fluids and Morphine were executed. My eyes could not hold tears anymore and I became a bitter empathetic nurse taking care of a near helpless patient. Few hours later, I sent a specimen for complete blood count to the lab and her white cells count was near ZERO. We put the patient on neutropenic precautions, simply meaning anyone is a danger to the patient as she had no immune defense left in her system.

My patient had no family close to her, just a few friends that came to see her, one of them, a Briton. Now in neutropenic precautions, no one was allowed to stay in that room for long and a safe distance from the patient was enforced. The heart rate kept going up and up and now it’s almost 0200 AM. This time, I am dealing with heart rate of 160-180 beats per minute. The heart cannot withstand this rhythm/rate for too long before it gives up and so I had to act and act fast.

Numerous calls had been placed to the oncologist as the patient kept complaining and crying of pain. The dose I had initially was for morphine 2 mg every hour as needed. The second call I placed, the dose was doubled to 4 mg every hour as needed for pain. This did not make a difference,

The oncologist was getting irritated because of my endless calls at late hours of the night, but I was not going to give up on this lovely lady. The oncologist argument was that the patient oxygenation was poor and may potentially have lungs related problem. He was also concerned that due to liver involvement, the metabolism of opiates may be poor and this could further compromise breathing and oxygenation.

For those in healthcare, especially nurses and doctors, I am sure you can follow me on this and agree it is a true prudent rationale from the oncologist. The oncologist consulted the cardiologist and he ordered adenosine push to correct supraventricular tachycardia (heart rate above 150).

Before I could even fax the order to the pharmacy, the patient called. She could barely talk. She said “Linda, I want you to get lethal injection and kill me or get a baseball butt and hit my head so I won’t have to feel this.

Angry-DoctorMy courage, empathy and bitterness rose to the threshold that I could not hold anymore. I placed another call to the already upset oncologist, this time with demands, not requests. A frustrated voice answered the phone and I started…

“I need better pain control for this patient from you right now, or else, you come in and take care of her. I need strong medications for pain and if she cannot support her airway, better be on a ventilator (life support machine) that suffer like this. I need dilaudid (hydromorphone) drip in Patient Controlled Analgesia (PCA)”.

The oncologist had never heard someone come that strong to a point of demanding which drug they want. He replied…calm down. Go ahead and start dilaudid PCA …..” Give the patient 2 mg push now before starting the drip….”. In 2 minutes, I pushed the 2 mg and the heart rate dropped quickly from 180, 150, 110, 80 and before it got to 60, the whole team was at the door with crash cart. We all thought the patient heart had given up.

At heart rate of 70, the patient stabilized. Blood pressure improved. Breathing rate lowered from 40’s to low 20’s. Her oxygen saturation went up to above 95%. We changed her from 100% non-rebreather mast to 2 liter nasal canula. She was in pain and now her pain is under control.

15 minutes later, she asked for ice water. She drank. She then requested extra blankets and off she slept. She was in pain but no one thought of pain as the reason why all her vital signs were off the limits. No adenosine for her.

Good night sunshine. You are my hero. 3 days later when her white count was starting to come back up, she passed on. She came to an end of her pain. I attended her burial and to this day, I still feel it like my own family.

Again, Good night sunshine and rest in peace.

rip

Fungating Breast Cancer

Summary:

fungating Breast Cancer

A middle aged woman in Kenya with fungating stage 4 breast cancer.

Breast cancer mortality in Kenya and most of sub-Saharan Africa is about 75% compared to 10% in developed countries according to World Health Organization (WHO). Majority of women in Kenya do not know anything about breast cancer and those who do, they have no means of getting screened. There is acute shortage of healthcare professionals to take care of breast cancer cases. The country of 43 million has a total of 10 mammogram machines as of 2012 according to report published by ministry of health – Kenya. There are only 4 oncologists in Kenya and total of 7 in East Africa.

Introduction:

Meet Janet a breast cancer victim in Kenya. For the purposes of privacy, we’ll call her Janet from Nairobi, Kenya. Janet presented to the hospital with a stage 4 breast cancer. The problem started few years back but she thought it was mastitis and would go away. Janet visited local clinic where she got antibiotics but the problem never resolved.  On seeking second opinion from a different clinic, she was referred to a referral hospital miles away where she was diagnosed with Stage 4 fungating breast cancer.

Diagnosis:

Janet breast cancer diagnosis came 2 years too late from when she noted her first signs and symptoms. Janet did try to get medical help but it is obvious that the medical personnel Janet went to was under-informed about breast cancer. Janet recalls giving her signs and symptoms as:-

  • Inverted nipple
  •  Pain
  • Swollen armpit glands
  • Bloody discharge
  • Discoloration
  • Weight loss

Despite the fact that Janet went to seek medical help after the signs and symptoms were obvious, her prognosis was worsened by the fact that the clinician or the nurse that saw her in a field clinic misdiagnosed her.

On referral to a bigger hospital, a mammogram was not necessary as the cancer had grown to a point of penetrating the skin to form what is called “Fungating” breast cancer. Simple histological biopsies revealed that Janet had a metastatic breast cancer. A CT-Scan revealed involvement of the lungs and the liver. She remains admitted in a hospital waiting for treatment.

 

Treatment:

Obviously, Janet needs surgery to remove the fungating breast cancer mass. She needs chemotherapy and radiation therapy to increase her chances of survival. Janet requires high calorie nutrition, something she cannot afford, let alone other treatment. Janet is a Mom and a bread winner for her family. She requires support for her family financially, spiritually and emotionally.

None of the treatments have been started because there is no money to fund her treatment. Her fate depends on good Samaritans that may come through for her and giver a second chance to live.

 

Prognosis:

The longer Janet waits for treatment, the poorer her prognosis gets. While stage 4 breast cancers has poor prognosis in developing countries, Janet still stands a chance to see another day. Tens of thousands women like Janet are in similar situation in Kenya alone. Millions more women across Sub-Saharan Africa are suffering like Janet.

How you can help:

Janet breast cancer may have happened for a reason. Reading this article may have happened for a reason.  For those who are Christians, Roman 8:28 says, “all things happen together for good for those who trust God”. Janet needs help. Besides Janet, hundreds of thousands of women can benefit from a simple mammogram.

Learn how you can help