Community Pharmacist s Role in Breast Cancer Health Promotion Disclosure I have no real or potential conflict to disclose Continuing Pharmacy Professional Development (CPPD) Program May 11 2010 Dr Maguy El Hajj, BScPharm, PharmD Assistant Professor Clinical Pharmacy and Practice Group Qatar University 2 Outline Community Pharmacist s role in breast cancer health promotion Study objectives Study methods Study results Study conclusions Breast Cancer Epidemiology Breast cancer is by far the most frequent cancer of women in the world (23% of all cancers) and it is the leading cause of cancer mortality in women (14% of female cancer deaths) 3 Parkin M, Bray F, Ferlay J, Pisani P.Global Cancer Statistics, 2002. CA Cancer J Clin 2005 April/March;55:74-108. 4 MH 1
Breast Cancer Early Screening Appropriate early screening for breast cancer allows early stage detection of this fatal disease this will save patients' breast and will improve their chances of cure Breast Cancer Early Screening Consequently, cancer societies or organizations around the globe have published breast cancer early detection and screening guidelines http://www.cancer.org/docroot/cri/content/cri_2_6x_breast_cancer_early _Detection.asp 5 6 Breast Cancer Early Screening Despite of these guidelines, in many countries some patients with breast cancer present for the first time at advanced stages of the disease public education about breast cancer and about the importance of early breast cancer-screening is warranted Community Pharmacist and Health Promotion Community pharmacists are the most frequently accessible health care providers for all segments of the population Pharmacists have became increasingly interested in broadening their roles beyond the product-oriented functions of dispensing medications community pharmacists are in an ideal position to direct patients to appropriate care and to improve public health Khatib O, Modjtabai A. Guidelines for the early detection and screening of breast cancer. Cairo: World Health Organization; 2006. 7 8 MH 2
Community Pharmacist and Health Promotion Pharmacists' code of ethics encompasses a public health perspective, stating that the pharmacist should serve individual, community and societal needs Among the myriad of public health related aspects of pharmacy practice, the most common pertain to health promotion activities Community Pharmacist and Health Promotion Health promotion activities can cover a variety of health care conditions including cardiovascular diseases, Diabetes Mellitus, cancer and others The pharmacists' role as cancer health promoters is now emerging www.pharmacist.com/am/template.cfm?section=code_of_ethics _for_pharmacists&template=/cm/htmldisplay.cfm&contentid=5420. 9 Ciardulli LM, Goode JR. Using health observances to promote wellness in 10 community pharmacies. J Am Pharm Assoc 2003 Feb 4;43(1):61-68. Community Pharmacist and Breast Cancer Health Promotion Community pharmacists have the chance to advocate, facilitate and or provide cancer related health promotion activities to patients: they can play a significant role in increasing breast cancer awareness among women Community Pharmacist and Breast Cancer Health Promotion Community pharmacists can advocate breast cancer early screening and detection by: Dropping flyers into prescription bags Giving educational pamphlets or self-risk assessment quizzes at the pharmacy counter or during counseling Displaying l i posters and showing videos Giles JT, Kennedy DT, Dunn EC, Wallace WL, Meadows SL, Cafiero AC. Results of a community pharmacy based breast cancer risk-assessment and education program. 11 Pharmacotherapy 2001;21:243 253. Ciardulli LM, Goode JR. Using health observances to promote wellness in community pharmacies. J Am Pharm Assoc 2003 Feb 4;43(1):61-68. 12 MH 3
Community Pharmacist and Breast Cancer Health Promotion Community pharmacists can facilitate breast cancer promotional activities by inviting other health care professionals or breast cancer societies to provide these activities in the pharmacy to the public or by referring patients to special breast cancer screening programmes Community Pharmacist and Breast Cancer Health Promotion Community pharmacists themselves can provide breast cancer individualized counseling or organize community-based educational programs They can assess women's breast cancer risk using validated breast cancer risk-assessment tools and provide them with enough knowledge to take appropriate decisions about breast cancer screening Ciardulli LM, Goode JR. Using health observances to promote wellness in community pharmacies. J Am Pharm Assoc 2003 Feb 4;43(1):61-68. 13 Ciardulli LM, Goode JR. Using health observances to promote wellness in community pharmacies. J Am Pharm Assoc 2003 Feb 4;43(1):61-68. 14 Breast Cancer in Qatar Breast cancer is the most common cancer in women in Qatar accounting for 30% of all women cancers Qatar's cancer societies and hospitals are trying to increase breast cancer public awareness via breast cancer awareness campaigns and public screening programmes Breast Cancer in Qatar A substantial number of women in Qatar do not have adequate knowledge about breast cancer early detection and their breast cancer early screening rate is low More breast cancer public education efforts are warranted in Qatar Bener A, Ayub H, Kakil R, Ibrahim W. Patterns of cancer incidence among the population of Qatar: a worldwide comparative study. Asian Pac J Cancer Prev 2007;8(9):19-24. 15 Bener A, El Ayoubi HR, Moore MA, Basha B, Joseph S, Chouchane L. Do we need to maximise the breast cancer screening awareness? Experience with an endogamous society with high fertility. Asian Pac J Cancer Prev 2009;10(4):599-604. 16 MH 4
Qatar s Community Pharmacist and Breast Cancer Health Promotion More than 320 community pharmacists practice in more than 140 pharmacies in Qatar Involvement of these community pharmacists in the communication and distribution of health information related to breast cancer screening and early detection can have a significant effect Qatar s Community Pharmacist and Breast Cancer Health Promotion Are community pharmacists in Qatar already engaged in breast cancer health promotion activities? Are they interested, prepared and able to take the role of breast cancer health promoters? 17 18 Community Pharmacists in the State of Qatar: a Survey of Their Interests and Needs in Relation to Breast Cancer Health Promotion Project Team Yousra Hamid (QU CPH-3 rd Year Student) Maguy El Hajj 20 MH 5
Study Objectives To determine the frequency of community pharmacists' participation in breast cancer health promotion activities in Qatar To describe their attitudes related to serving as breast cancer health promoters Study Objectives To assess their breast cancer knowledge and their interest in receiving breast cancer continuous education To illustrate their perceived barriers for including breast cancer promotion into their daily practice 21 22 Study Methods The study objectives were addressed in a crosssectional survey of community pharmacists in Qatar A multipart pretested survey was used to solicit community pharmacists anonymous responses Study Methods The survey contained questions that addressed the study objectives and collected data on the participants' sociodemographic and practice characteristics Eligible participants were all pharmacists practicing in community pharmacies in Qatar 23 24 MH 6
Study Methods An initial phone call explaining the objectives of the study and requesting participation p were made to all community pharmacists Consenting pharmacists were given the option to complete the survey either online using userfriendly survey software or as paper-based in Arabic or in English Study Methods Electronic mails (Emails) containing the survey URL were sent to the participants p who wanted to complete the survey online The paper-based survey was faxed to the other participants After anonymously completing the faxed survey, the participants were asked to fax the survey back to QU College of Pharmacy 25 26 Study Methods Survey reminders were sent to all community pharmacists via email/fax or telephone thanking those who have already responded and asking those who have not responded to complete the survey After 3 months of data collection, survey was closed, data was entered into the online survey software then downloaded d d to an Excel spreadsheet then imported into SPSS version 17 for analysis Over a 12-week period, we collected 195 surveys (approximately 60% of the population of community pharmacists in Qatar) 65% of respondents were male and 80% were less than 40 years old 27 28 MH 7
% of respondents 40 35 30 25 20 15 10 5 81% reported graduating at least 5 years prior to the survey 95% held a pharmacy baccalaureate degree as their highest degree 0 Egypt India Philippines Jordan Other Middle Eastern countries Country of origin Sudan Other South Asian countries 29 30 % of respondents 45 40 35 30 25 20 15 10 97% reported previous practice experience in at least one other country and 75% had practiced for at least 2 years in Qatar 59% practiced in a chain community pharmacy 85% practiced in a community pharmacy located in Doha 5 0 Egypt India Philippines Jordan Sudan Other countries Country awarding highest degree Pakistan 31 32 MH 8
% of respondents 70 60 50 40 30 20 10 Average % of daily respondents prescription volume <50 34 50-99 29 100-199 16 Number of % of adult respondents patients seen daily <20 4 20-49 24 50-100 43 0 40-59 60-79 20-39 >80 <20 >200 21 >100 29 Number of hours worked per week 33 34 % of female patients % of respondents seen daily <25 33 25-50 41 51-75 20 76-100 6 Number of pharmacists at any one shift 1 77 2 19 >2 4 % of respondents 61% indicated that they are professionally satisfied 35 36 MH 9
Current Involvement in Breast Cancer Health Promotion Activities 37 MH Dec 22 2009 38 % of respondents % of respondents 23% 10% 67% Interest in Provision of Breast Cancer Health Promotion High Medium Low 28% 12% 60% Comfort in Provision of Breast Cancer Health Promotion High Medium Low Breast cancer knowledge was evaluated using 12 true/false questions 48% of participants scored less than 60% The mean percent score was 63 plus or minus 15% Scores were particularly low for the questions related to breast cancer risk factors and screening recommendations 39 40 MH 10
Despite of this low breast cancer knowledge level, 77% expressed their interest in receiving breast cancer continuous education 41 MH Dec 22 2009 42 Attitudes and Believes about Breast Cancer Health Promotion MH Dec 22 2009 43 44 MH 11
MH Dec 22 2009 45 MH Dec 22 2009 46 Pharmacists perceived many barriers for integrating breast cancer health promotion including: Lack of breast cancer educational materials (79% of respondents) Lack of recognition of this pharmacist role by the public (61%) Lack of personnel (59%) Lack of enough time (51%) Conclusions This study represents the first known attempt to assess current practices of and willingness to provide breast cancer education by community pharmacists in Qatar Although most community pharmacists surveyed are not currently involved in breast cancer health promotion, the majority were interested in educating patients about breast cancer 47 48 MH 12
Conclusions Low breast cancer knowledge level in addition to other identified barriers can prevent actualizing pharmacist role in breast cancer education Conclusions Further work should focus on providing these pharmacists with breast cancer continuous education opportunities and on overcoming all identified barriers as pharmacists are well situated to make an important contribution to breast cancer education in this country 49 50 Acknowledgement This presentation was made possible by a grant from the Qatar National Research Fund under its Undergraduate Research Experience Program and by Qatar University Undergraduate Student Research grant 51 MH Dec 22 2009 52 MH 13
Questions MH Dec 22 2009 53 54 MH 14