Addressing Health Disparities to Improve the Care of African-American Women Affected by Breast Cancer Moderator: Patricia K. Bradley, PhD, RN, FAAN Associate Professor, Villanova University College of Nursing Panelists: Tiffany P. Avery, MD Assistant Professor, Department of Medical Oncology, Jefferson University Dianne L. Hyman, RN, MSN, OCN Oncology Nurse, Cooper Cancer Institute, Cooper University Hospital Jeanne Chavious, MSW Former Manager of Patient Services, Temple University Hospital Cancer Center
Objectives Describe current health and outcome disparity issues for African American women Describe barriers African-American woman face in screening, diagnosis, treatment adherence, and continuing oncology care Explain how understanding barriers to screening and care has the potential to improve provider-patient relationships and health outcomes. Describe best practices in overcoming barriers to care and treatment adherence.
Understanding barriers to screening and care can improve provider-patient relationships and health outcomes.
Breast Cancer Disparities Breast cancer is the second leading cause of cancer deaths among women in the United States. Breast cancer deaths are going down fastest among white women. Black women have the highest breast cancer death rates of all racial and ethnic groups and are 40% more likely to die of breast cancer than white women.
Black women often have cancers that grow faster and are harder to treat. Black women often have fewer social and economic resources than other women. Black women are less likely to get prompt followup care when their mammogram shows something that is not normal. Black women are less likely to get high-quality treatment if they have cancer.
Barriers to Screening and Diagnosis Fear of cancer, perceived cost of care, and lack of physician referral are common barriers to cancer screening and other preventive services. Health care providers play a critical role in recommending and increasing use of preventive services. Research shows that physician recommendation is a major predictor of receipt of screening. http://www.cdc.gov/cancer/healthdisparities/basic_info/dis parities.htm
PRIMARY TOOLS OF BREAST CANCER SCREENING Breast Self Checks Clinical Breast Exam Mammography
Barriers to Care Social: child and eldercare concerns, culture of silence around health concerns Medical: co-morbidities, mistrust of health care system, access to quality healthcare coverage Cultural/Spiritual: role of faith and fate in understanding health status and interventions Economic: single-income households, ease of taking time away from work, financial burden of co-pays or co-insurance, ease of transportation to care
SURVIVORSHIP ISSUES Mortality and morbidity Clinical Presentation Access Trust Fear Communication Disconnection
Best Practices Patient-provider communication: building trust, encouraging note-taking and repetition of key points, dispelling myths around treatment and outcomes Communication with patient s family and friends: understanding family history, explaining diagnosis and treatment Psycho-social support: involving spiritual leaders in psycho-social care, accessing culturally-relevant resources, tailored support groups and support programs
PERCEPTIONS OF BREAST CANCER The perception of breast cancer as a death sentence has often been attributed to African Americans. Not all African Americans perceive breast cancer as an automatic death sentence.
Getting Connected Table of Contents Ch 1: Surviving First Reactions to Diagnosis Reasons to Seek Medical Treatment Taking the Next Steps Ch 2: Making Decisions Managing Information Finding Out Your Beliefs about Breast Cancer Getting the Best Care Understanding Treatment Choices Deciding About Breast Reconstruction Dealing With Side Effects Understanding Emotions Ch 3: Getting Support Seek Positive People and Help Messages to Family and Friends You and Support Groups Ch 4: Staying Connected When Active Treatment Ends Follow-up Care Ch 5: Living Loving Yourself and Others You and Your Partner Living Single You and Your Children Living Beyond Breast Cancer Some of Our Stories Resources
OVERCOMING BARRIERS Acknowledgement of past abuses Provide education about rights Use of established collaborative relationships Use of established referral networks
How Health Care Providers Can Help Their Patients Get Breast Cancer Screening and Care Remind patients of their appointments. Have the office staff remind your patients of their upcoming appointments. Track the progress of patients who need followup tests or treatment to make sure they get the care they need. If possible, assign a patient navigator.
How Health Care Providers Can Help Their Patients Get Breast Cancer Screening and Care Talk with each patient about her risk of breast cancer, the benefits and risks of mammograms, and the right age to start getting mammograms. Tell her where she can get a mammogram done. Don t forget some women may not be able to afford a mammogram. If the mammogram shows something that is not normal, explain the next set of tests. Find out if there are other questions.
How Health Care Providers Can Help Their Patients Get Breast Cancer Screening and Care Get test results quickly and call your patients right away. If needed, refer them to the next test or doctor right away.
Creating Programs Include community from beginning Collaborate with other organizations Do it together (practice what you preach) Look for teachable moments Include humor Don t forget the food