Breast cancer occurs in females worldwide. However, in the United States, it is among the leading causes of deaths associated with cancer. Despite the significant advancements in the detection of breast cancer, its diagnosis, and prevention, it was pointed out by the American Cancer Society (2018) that Black American women in the U.S. are unequally affected by breast cancer. The survival rate for White American women is 90 percent per five years, while African Americans’ have a seventy-nine percent rate. It is lower compared to other races and ethnic groups found in the U.S (Karcher et al. 2014). A new course of action, as well as methods for advocacy on breast cancer prevention, reduction in mortality, and enhancement of survival rates among the Black American women are needed. Therefore, it is vital to analyze the nursing interventions designed to improve the outcomes of Black American women who have breast cancer, the importance of quality improvement for these patients, and the use of nursing values for improvement in patient care.
There is a rise in mortality among African American females living in the U.S. as they are more vulnerable to breast cancer by 40 years than the Caucasian women . Surpassing four decades, the United States has experienced an increment in the five-year survival rate relative to breast cancer among white and Black American women. However, there is a significant racial distinction since new data has revealed that the 5-year survival rate among Black American as well as Caucasian women ranging between 79 percent and 92 percent respectively (Karcher et al. 2014). According to the comparison of these statistics, it is crucial to include African American women in developing goals and objectives for the program since they are the most affected by breast cancer mortality rates.
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The rationale for Health Disparities in Breast Cancer among Black American Women in Nursing
The reason for disparities in the rates of survival among Black American women living with breast cancer is that the diagnosis is made at a later stage and reduced stage-specific rates of survival among Black American females (Coughlin, 2015). It is alleged that biological and non-biological elements cause greater mortality rates among African American females. Biological factors comprise the treatment-resistant tumors and aggressive histology. Non-biological factors include access to care, as well as morale in seeking care (Daniel et al., 2018). Non-biological factors are perceived to be more mutable than biological factors. Consequently, the development of proactive measures for addressing the increased mortality rates in African American women is critical (Daniel et al., 2018).
Mechanisms for prevention of deaths related to breast cancer focuses on risk factors such as less alcohol consumption, promotion of physical activity, balanced diet and early detection by employing regular mammography . Recent data originating from a national survey carried out in the United States has shown that Black American women are less likely compared to white women to have carried out mammograms recently. However, several patient locations, as well as geographical localities, still experience Black-White disparities in rates of mammograms and referrals for evaluation and detection of breast cancer. They are as a result of socioeconomic factors such as educational attainment and family income (Coughlin, 2015).
Screening rates for breast cancer are low as a result of low-income, underinsured, together with uninsured families. As a result, there is increased mortality caused by breast cancer in such populations (Coughlin, 2015). Moreover, black American women have misconceptions regarding breast cancer etiology, breast cancer risk factors, and the barriers for receiving timely screening accompanied by treatment ( Yedjou et al., 2017 ). Black American women at risk of breast cancer are unaware of the present guidelines and recommendations relative to preventive measures, unlike their white counterparts (Coughlin, 2015).
The social cognitive theory is engaged in nursing to analyze African American females having breast cancer. It utilizes some concepts relative to behavioral change, such as the self-efficacy concept, which states that people have total control over their health; thus, they can do whatever they deem fit for them. Besides, we have the expectation theory, which is focused on the results of behavioral change. In any case, a patient must attend regular checkups to ensure that her health is in check and meets the required standard. Additionally, self-control is also a critical concept listed in the social cognitive theory. It gives patients autonomy and absolute control regarding their behavioral change. Notably, African American women, utilizing observational learning, observe and emulate whatever white women do for them to lengthen their survival rates.
Nursing Interventions and Out comes
Nurses work with harmony and equity at all levels of their profession; thus, their cognizance of breast cancer hazards is improved, precisely for African American females. The significant interventions for them include patient navigation base and case management intervention, which have a shorter time between diagnosis and the time of treatment (NBCCEDP, 2012). Interventions are developed to improve the quality and outcomes of treatment; however, it is essential for nurses to understand the challenges patients face during the treatment phase (Newman, 2014). Focus groups can be introduced among African American women who are patients of breast cancer and care providers to identify the factors that contribute to below the optimal care and outcomes.
Nursing uses case management and patient navigation models to increase screen mammography use especially among women of forty years or more and African American women who are a high risk through the use of educational sessions, client reminders, or small media such posters, brochures, videos or even via newspapers (NBCCEDP, 2012). The mammography used can also be increased by minimizing the overhead costs that affect the client, and also by reducing the structural barriers in care provision (Newman, 2014). These barriers could be screening locations, inconvenient hours, complex administrative framework and the need for several clinic visits. Education and partnerships with the care providers and public health programs are required to realize an effective reduction of these structural barriers.
Quality Improvement Initiative and Patient Care
Increased support for patient navigation helps in minimizing the disparities in the care of breast cancer patients which are present among African Americans. Case management amid African American females is helpful in the lessening of the risk issues allied to breast cancer. One of the factors includes obesity, which is more widespread among African American females compared to the Caucasian females. Awareness on the need to maintain physical fitness and right uptake of healthy foods, in workplaces, schools, and so forth. Improves the quality initiative and ensures breast cancer patients care risk is avoided among African Americans. Long term smoking can also be avoided by the use of mass awareness on African Americans because they have difficulties in ceasing smoking behavior more than white women (American Cancer Society, 2018). Increasing the continuum of care among African Americans has proved to be an effective quality initiative in ensuring better patient care. It is essential for nursing to be involved in the quality initiative since nursing has a direct link with the care of patients and coordination of all activities that are included in the medical care of the patient, as well as the well-being of patients.
Nursing, Quality, and Outcomes
Nursing is involved in quality initiatives through professional nursing values like human dignity where nurses are expected to provide privacy, confidentiality, sensitivity to individual needs, together with competent communication skills to Black American women who have breast cancer. Through human dignity, patients will be able to open up to nurses to have their problems solved, including financial burdens since human dignity entails the respect for the inherent worth and exclusivity of individuals and populations. Altruism involves having a concern for the welfare and well-being of others. Through this value, nurses will be able to take care of Black American women with breast cancer and be able to encourage and educate others on the significance of having initial tests.
Conclusion
Nursing is critical in quality care provision to African American women who have a higher risk of contracting breast cancer. It can be attained using the intervention of case management and patient navigation. Nursing and care coordination is also essential in providing morale to patients towards better and improved well-being and coming up with responses that ensure increased quality initiative care. Throughout the healing journey of patients, from diagnosis to treatment and eventual care provision after the treatment or during radiation treatments, chemotherapies and screening are difficult without nursing. Hence, nursing is vital in ensuring the continuum of care in African American patients. Nursing is also crucial in providing faster awareness and education to patients since they are closest care providers to patients and the populations with a high risk of acquiring breast cancer, which in this case is African American women. This awareness is essential in ensuring the breast cancer risk factors are reduced through self-awareness to maintain a healthy lifestyle. Nursing impacts care provision to African American patients of breast cancer. To achieve this, nurses ought to have human dignity and altruism to ensure better care for Black American Women who have breast cancer.
References
American Cancer Society, (2018). Disparities in Breast Cancer: African American Women. Washington, DC.
Newman, L (2014). Breast cancer disparities: high-risk breast cancer and African ancestry. Surgical Oncology clinics of North America . 23 (3), 579-592.
Yedjou, C. G., Tchounwou, P. B., Payton, M., Miele, L., Fonseca, D. D., Lowe, L., & Alo, R. A. (2017). Assessing racial and ethnic disparities in breast cancer mortality in the United States. International Journal of Environmental Research and Public Health, 14 (486), 1-14. Retrieved from https://doi.org/10.3390/ijerph14050486
Coughlin, S. S., (2015). Intervention approaches for addressing breast cancer disparities among African American women. Annals of Translational Medicine & Epidemiology, 1(1), 1-12. Retrieved from https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4283773/
Daniel, J. B., Gaddis, C. L., Legros, J. R., Bennett, M. D., & Turner, N. C. (2018). Breast Cancer Knowledge, Beliefs and Screening Practices among African American Women in a Rural Setting: A Pilot Study. International Journal of Health Sciences , 6 (1), 29-38. DOI: 10.15640/ijhs.v6n1a3
Karcher, R., Fitzpatrick, D. C., Leonard, D. J., & Weber, S. (2014). A community-based collaborative approach to improve breast cancer screening in underserved African American women. Journal of Cancer Education , 29 (3), 482–487. Doi: 10.1007/s13187-014-0608-z.
NBCCEDP. (2012). National Breast & Cervical Cancer Early Detection Program Guidance Manual. Retrieved from https://azdhs.gov/documents/prevention/tobacco-chronic-disease/cancer-prevention-control/data-manuals-forms/book-3-screening-diagnostic-services-development-education-outreach.pdf
