1. The Nurse’s Role in Overcoming Barriers to Cancer Screening of African Americans An Integrative Review of the Literature Wendy Marie Clayton and Dr. Joseph Tariman MENP for Non-Nurse (MS), College of Sciences and Health, DePaul University
Background
Framework
Results
Patient
Nurse
Cues to Action
Cancer Screening Behaviors
Perceived Barriers
Perceived Threat
Perceived Benefit
Self-Efficacy
Cultural Care Preservation/Maintenance
Cultural Care Accommodation/Negotiations
Cultural Care Repatterning/Restructuring
Cancer mortality disadvantage experienced by African Americans increases as cancers become more amenable to medical interventions1
Not identifying cancer at an early stage can lead to advanced cancer stage, possible metastasis, and unfortunate death that has the potential to be avoided2
Nursing personnel have an opportunity and responsibility to impact the overall incidence and mortality of cancers3
Patient Education
Four of the studies (30%) focused on targeted patient education
Educational interventions reflected cultural care repatternning and restructuring’s effect on patient increased perceived benefits, increased self-efficacy, reduced perceived barriers, and reduced perceived threat
Continuing Nurse Education
Three of the studies (21%) suggest continuing nurse education
Educational intervention for the nurses was met with increasing knowledge of cancer screening of the providers themselves
Shared Decision Making
Three of the studies (21%) used decision aids and shared decision making
Provider and patient discussions surrounding cancer screening decisions would promote cues to action leading to cancer screening
Focus Groups
One of the studies (7%) incorporated focus groups to develop intervention
Recruitment of ethnically diverse populations for focus groups is important for research into cancer interventions
Engaging in Multidisciplinary Teams
Three studies (21%) involved multidisciplinary teams for outreach strategies
Outreach strategies are imperative to reach the African American population
Purpose
Purposes of this investigation into the literature were to:
identify various barriers to early cancer detection and screening behaviors among African Americans
Evaluate the nursing interventions and the nurse’s role in combating these barriers to improve on the health disparity associated with this population
Conclusions
Due to many factors such as personal, structural, and clinical barriers, African Americans face various obstacles to obtaining appropriate screening methods
Continuing nurse education, the use of specially selected focus groups, patient education, shared decision making, and involvement in multidisciplinary teams have the potentials to decrease morbidity and mortality rates associated with cancer screening disparities among American Americans
Methods
The following steps were followed: specifying the purpose of the review, systematic literature search process, data evaluation, data synthesis and analysis, and results presentation4
Conceptual framework for this integrative literature review, combining the Cultural Care Diversity and Universality Theory and the Health Belief Model. Through the use of Cultural Care Repatterning and Restructuring, Cultural Care Accommodation and Negotiations, and Cultural Care Preservation and Maintenance from the Cultural Care Diversity and Universality Theory, Nurses are able to impact the Patient’s Perceived Benefits and Self-Efficacy components of the Health Belief Model. Constructed Summer 2017 by Wendy Clayton.
Nursing Implications
CINAHL
PsychINFO
PubMed
Number of studies found using keywords 52 18 99
Number of studies meeting inclusion criteria 25 11 37
Number of studies after removing duplicates 21 12 20
Number of studies after using exclusion criteria 5 2 7
There should be encouragement through nurses to participate in clinical trials, and reliable interventions should be available regardless of income, lifestyle, and demographics
Nurses spend the most time with patients compared with other healthcare providers; hence, there is a responsibility and duty as a patient advocate to do everything within the scope of practice to combat the unnecessary morbidity and mortality associated with cancer screening disparities in African Americans
References
Tehranifar, P., Goyal, A., Phelan, J.C., Link, B.G., Liao, Y., Fan, X., …& Terry, M.B. (2016). Age at cancer diagnosis, amenability to medical interventions, and racial/ethnic disparities in cancer mortality. Cancer Cause & Issues, 27(4), doi: /s
Ryerson, A.B., Eheman, C.R., Altekruse, S.F., Ward, J.W., Jemal, A., Sherman, R.L., …& Kholer, B.A. (2016). Annual report to the nation on the status of cancer, , featuring the increasing incidence of liver cancer. Cancer, 112(9), doi: /cncr.29936
Ackerson, K., & Gretebeck, K. (2007). Factors influencing cancer screening practices of underserved women. Journal of the American Academy of Nurse Practitioners, 19(11), doi: /j x
Whittemore, R., & Knafl, K. (2005). The integrative review: Updated methodology. Journal of Advanced Nursing, 52(5), doi: /j x