Cultural Competence Education for Healthcare Providers to Increase Knowledge of Breast Cancer Screening Recommendation in

Filipino-American Women

Dr. Michelle Modina, DNP, ANP-C, GNP, RN

January 17, 2015

Researcher’s Background

Proud to be a nurse for over 20 years Adult/Geriatric NP since 2001 specializing in breast

cancer screening and education Assistant Professor of Nursing at West Coast University Adjunct Professor at Chamberlain University Independent Contractor for White Memorial Medical

Center’s Breast Cancer Screening and Education Program

Learning Objectives/Outcomes

Increase cultural awareness about FA culture, healthcare beliefs and practices

Recognize and describe cultural issues and barriers to obtaining a screening mammogram and offer suggestions for practice

Value the importance of HCP screening mammogram recommendation as one of the strongest indicators of mammogram utilization in FA women

Increased knowledge will change practice to incorporate culturally appropriate breast CA screening recommendation

Statement of the problem

With breast cancer as the #1 killer of Filipino-American women, studies have shown that mammograms are underutilized by Filipino-American women and that a healthcare provider recommendation is an important reason why they obtain screening mammography.

Research question

Does cultural competence education change a healthcare provider’s knowledge of breast cancer screening recommendations appropriate for Filipino-American women?

Methodology

Design: One-group pretest-posttest quasi-experimental Instrument: Paired-sample t test using SPSS software Intervention: 30-min Cultural Competence Education IV: comparison of pre-intervention and post-intervention

trials DV: percent of correct score on the T/F objective test Setting: St. Vincent Medical Center Cancer Tumor Board

Meeting in Downtown Los Angeles Participants: 25 HCPs measured immediately before and

after cultural competence education

Percentage of Providers with Accurate Knowledge

Why it matters?

Breast CA leading cause of cancer deaths in Fil-Am women

Highest mortality rate but do not have highest incidence of breast cancer

Evidence shows that FA women likely to obtain mammogram if HCPs recommended it

30-60% Asian Americans report no prior mammogram compared to 10-21% of White women

In 2012, CDC and NCI report Asian Americans have lowest cancer screening rates

Why it matters?

US-born Filipino women younger than 55 had higher rates than White women of same age

When Asian women migrate to the US, risk of developing BC increases up to six-fold

Asian women living in the US for as little as a decade had an 80% higher risk of breast CA than new immigrants

LA County with highest incidence of breast cancer cases in California, 23.8% never received a mammogram

Study shows beliefs and perceptions of HCPs matter

Current Guidelines

USPSTF- biennial, 50-74 years oldACS- 40 years old, no specific age for stoppingACOG- every one to two years from 40-50

years old, annually after 50, no specific age for stopping

ACR, SBI (Society of Breast Imaging)- support ACOG recommendations

NCI- 40 years old, every 1-2 yearsCDP: EWC- 40 years old, every year

Filipino Culture

Religion and faith“God’s will”

Include family in decision making process

Care for aging family

Principle of balance

HCPs most trusted source of health info

Reasons to hesitate

Concern over cost and immigration status Only needed in the presence of symptoms, wait until

severely ill Low perceived need Inconvenience and difficulty getting to mammo facility Language barrier esp. 1st gen immigrants

Reasons to hesitate

Acculturation Embarrassment Belief that breast cancer caused by factors beyond

human control such as spiritual forces, fate, and predestination

Don’t know where to go

HCP Barriers

Differ in breast cancer screening guideline adherence

Mid-level practitioners more likely than MDs or DOs to adhere to guidelines

Physician age, gender, & specialty area associated with breast cancer screening practices

OB-GYNs favor aggressive breast cancer screening

Variations not fully understood Not enough evidence available

EBP Suggestions for Practice

HCP recommendation works- most trusted Provision of culturally sensitive care Discussion of BC and mammography in

churches, senior, and community centers- weekends preferred

Female HCP if possible Follow-up phone calls

EBP Suggestions for Practice

Brochures/handouts in TagalogSmall group discussion of FA womenCommunity liaisons/ social supportEmphasis on lifestyle, diet, exercise Word of mouth through friends and relatives is

effective

But… who pays?

Affordable Care Act aka “Obamacare”PPO and HMO usually100% coveredNo co-pay after August 1, 2012CA- CDP: Every Woman Counts

Private health plans, Medicaid, Medicare in CA:

baseline for ages 35-39, every 2 years for 40s, each year or physician recommendation

CDP:EWC State Program

are 40 years old or older are low income have medical insurance that does not cover breast

cancer screening have a high insurance deductible or co- payment are not getting these services through Medi-Cal or

another government-sponsored program live in California

Benefits to Stakeholders

Increased preventive health care visitsIncreased knowledge Increased adherence to screening mammoCultural sensitivity careEarly detection reduces morbidity and mortality

Potential Problems

If they don’t come, no screening mammogram recommendation

Lack of engagement Non-adherence despite intervention Strong and persistent cultural factors Guideline confusion

“ An ounce of prevention is worth a pound of cure.”

~ Ben Franklin

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