Textbook of Medical-Surgical Nursing 3e

234

Unit 3   Applying concepts from the nursing process

Nurs ing Research Prof ile : Evidence -based practice Factors associated with mammographic decisions of Chinese-Australians

Diagnosis of cancer A cancer diagnosis is based on assessment of physiological and functional changes and results of the diagnostic evaluation. Patients with suspected cancer undergo extensive testing to: (1) determine the presence of tumour and its extent; (2) identify possible spread (metastasis) of disease or invasion of other body tissues; (3) evaluate the function of involved and uninvolved body systems and organs; and (4) obtain tissue and cells for analysis, including evaluation of tumour stage and grade. The diagnostic evaluation is guided by infor- mation obtained through a complete history and physical examination. Knowledge of suspicious symptoms and of the behaviour of particular types of cancer assists in determining which diagnostic tests are most appropriate (Table 11-4). A patient undergoing extensive testing is usually fearful of the procedures and anxious about the possible test results. The nurse can help relieve fear and anxiety by explaining the tests to be performed, the sensations likely to be experienced and the patient’s role in the test procedures. The nurse encourages the patient and family to voice their fears about the test results, supports the patient and family throughout the test period, and reinforces and clari­fies information conveyed by the doctor. The nurse also encourages the patient and family members to communicate and share their concerns and to discuss their questions and concerns with each other. Tumour staging and grading A complete diagnostic evaluation includes identifying the stage and grade of the tumour. This is accomplished before treatment begins to provide baseline data for evaluating outcomes of therapy and to maintain a systematic and consis- tent approach to ongoing diagnosis and treatment. Treatment

CHART 11-2

Summary In Australia, a National Screening Program (BreastScreen) has been in place since 1991 providing free mammograms for all women over the age of 50 (NHMRC National Breast Cancer Centre, 1998). Given that Australia is a multicultural nation, breast screening promotional efforts have also been targeted at women whose first language is not English. Relevant printed material is available in 19 languages including Chinese. Nevertheless, non-English-speaking background (NESB) women have had markedly lower screening rates (48.9%) than English-speaking women (58.5%). The purpose of the study by Kwok, Cant and Sullivan (2005) is to explore and investigate the factors associated with mammographic decisions of Chinese- Australian women. Nursing implications The results of this study indicate the need to consider the beliefs and concerns of NESB women when promoting developing and implementing screening programs. Further, healthcare professionals need to have an understanding of the cultural, educational, and socio-economic factors that influence NESB women attending breast screening. In addition, this study also yields several health education and policy implications for designing and providing culturally sensitive screening services by specifically addressing the identified barriers. For more information on this study, see Nursing research profile 11-2 in the related ancillary file for this chapter.

Table 11-3  RECOMMENDATIONS FOR EARLY DETECTION OF CANCER IN ASYMPTOMATIC, AVERAGE-RISK PEOPLE Site Gender Age Evaluation

Every 3 years Every month Every year Every month Every year Every 2 years Frequency

Breast

F

20–39

Clinical breast examination (CBE) Breast self-examination (BSE) Clinical breast examination (CBE) Breast self-examination (BSE) Mammogram Faecal occult blood test and Flexible sigmoidoscopy or Colonoscopy Prostate-specific antigen and digital   rectal examination (DRE) Papanicolaou (Pap) test* Pelvic examination

$ 40

50–59 $ 50

Colon/rectum

M/F

Every 5 years

Every 10 years Not recommended;   patient discretion

Prostate

M

$ 50 (or , 50 if at   high risk) 20–69

Cervix

F

Every 2 years Every 2 years Every 3 years

Cancer-related checkups

M/F

$ 20–39

Checkup that includes examination for   cancers of the thyroid, testicles, ovaries,   lymph nodes, oral cavity and skin as well   as counselling about health practices and   risk factors

40 1

Every year

*After three or more consecutive satisfactory normal examinations, the Pap test may be performed less frequently at the discretion of the doctor. Adapted from the National Health and Medical Research Council (NHMRC). (2009). Cancer: Clinical Practice Guidelines . Available at: www.nhmrc.gov.au/publications/subjects/ cancer.htm.