Improving nurse education critical to improving control of breast cancer worldwide

The most significant need worldwide is to improve nurse education in breast cancer patient care, management, and clinical research, results of a consensus study among international leaders in breast cancer have found.

While medical advances have greatly reduced breast cancer morbidity and mortality in developed nations, the majority of the world's women—nearly 90% who live in low and middle income nations—still lack access to breast cancer prevention, screening, and treatment, noted Lillie Shockney, RN, BS, MAS, director of the Johns Hopkins Avon Foundation Breast Center, Johns Hopkins University, Baltimore, Maryland, and colleagues from institutions in Saudi Arabia, Brazil, Taiwan, Korea, and the United States. An acute lack of research and reliable epidemiologic data also exists in these countries.

The consensus study was conducted to identify emerging needs and challenges observed by breast cancer thought leaders in diverse international settings representing the majority of women in the developing world, and to identify strategies for improving breast cancer control, Shockney told colleagues attending the Oncology Nursing Society 36th Annual Congress.

A total of 225 breast cancer medical, advocacy, and policy leaders from 30 countries in Latin America, Asia, the Middle East/North and South Africa, Canada, and Australia representing 59% of women in the world participated in this study. The study sample included breast cancer specialists (n=203), patient advocates (n=12) and policy makers (n=10). Experts participated in face-to-face or telephone interviews  averaging 1 hour that were conducted in English or the respondent's primary language. Although the survey questionnaire was structured, respondents were encouraged to express their thoughts and concerns in an open format. The answers were analyzed and 122 individual variables were identified across all answers and were then coded.

According to Shockney, the most salient needs identified were to train nurses in patient and family care, management, education, and clinical research (48%); individualize therapy (47%); and improve understanding of the reasons for apparently higher proportions of younger women presenting with more aggressive tumors among nonwhite populations (45%). They also identified the need to increase public education, including for younger women (40%) and to detect and screen younger women earlier (38%).

Analysis of these and other needs identified evolved into four key themes to improve overall breast cancer control: capacity, research, advocacy, and access. Study results were used to create taxonomy of key themes and dimensions within each theme that may be useful to governments and societies in evaluating opportunities to improve breast cancer control. Within the dimensions, the most significant need identified was to improve nurse education in breast cancer patient care, management, and clinical research.

Most respondents recognized nurses as pivotal to breast cancer patient care and outcomes. However, in addition to an acute shortage of qualified oncology nurses in most countries, those involved in breast cancer care require further education in patient and family member communications and education; in familial and other risk assessment and monitoring; in clinical research; and in multidisciplinary team participation, she concluded.

“There is a significant opportunity for ONS to play a critical role in the development of oncology and breast cancer nurse specialists internationally,” Shockney concluded during the presentation.
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