Breast and Ovarian Cancer: A New Model For Educating Women

Hereditary

Beverly Mangerich, RN, MSN • Jaynelle F. Stichler, DNSc, RN, FACHE, FAAN

A New Model For Educating WomenA New Model For Educating Women

Ovarian Cancer

A New Model For Educating Women

Cancer

Hereditary

Imagine that a patient of yours, a 32-year-old woman named Susan, has just

been diagnosed with breast cancer. She shares with you that her mother died

of breast cancer when Susan was a teenager, and she wants to know if she’s also

going to die of breast cancer. She states she always “knew” she would get breast

cancer, because everyone in her mother’s family seemed to die of the disease.

Susan married young and had her family right away, with the haunting fear that

she would never live long enough to see her children grown. Susan isn’t alone

in her worries; many women with a family history of hereditary breast and/or

ovarian cancer (HBOC) worry about what a diagnosis could mean for them

and their families. They need supportive and comprehensive education on the

topic. This paper discusses one breast cancer center’s approach toward chang-

ing its model of education on HBOC.

&and

Breast

Rates of HBOCWhile breast cancer is the most prevalent form of cancer in

women (National Comprehensive Cancer Network [NCCN],

2007), approximately 5 percent to 10 percent or 18,000 cases

per year are associated with an identifi ed hereditary autosom-

al-dominate gene mutation or HBOC (Garber & Offi t, 2005).

Today, women with family histories of early onset breast can-

cers and/or ovarian cancers at any age have options to test for

a mutation in chromosome 17, referred to as BRCA1, and in

chromosome 13, referred to as BRCA2. Once tested and identi-

fi ed with a mutated gene, these women can be offered timely

and lifesaving medical options. Women diagnosed with HBOC

need education to help them make critical decisions, such as

whether to undergo prophylactic mastectomies. But what’s the

most effi cient way to deliver that education? This paper dis-

cusses a management change project that was initiated to de-

crease the amount of time spent on education for women with

a family history of early onset breast cancer without compro-

mising the quality of patients’ experiences.

Changing the Education ModelThis paper describes the development and implementation of

a quality HBOC management project at the Scripps Polster

Breast Care Center (SPBCC) in La Jolla, CA. The SPBCC is in

a separate building on the medical campus of Scripps Memo-

rial Hospital—La Jolla. The SPBCC is one of the leading breast

screening and diagnostic centers in the San Diego region. Be-

fore the project, all education for HBOC was done individu-

ally for each patient. While identifying, educating and testing

for HBOC is now considered the standard of care by several

organizations, including the American Society of Clinical On-

cology (ASCO) (Khatcheressian et al., 2006), U.S. Preventive

Services Task Force (2005), National Society of Genetic Coun-

selors (Trepanier et al., 2004) and the National Comprehensive

Cancer Network (NCCN, 2007), it’s important to consider the

cost-effectiveness of delivering these services. A preliminary

time analysis on individual patient appointments was com-

pleted and showed the need for a more effi cient delivery model

for the components associated with patient education and risk

assessment. A new program was designed using a conceptual

framework and a review of evidence-based literature to guide

the program design and educational content.

Conceptual FrameworkThe conceptual framework entitled “Nursing Administration

for Researchers and Administrators,” which was created by Bi-

ron, Richer, and Ezer (2007), was used to develop the HBOC

education class. The framework “links patient health care needs,

nursing resources and the nursing care process to the context

of the health care system, and the social, political and cultural

environments of care” (Biron et al., p. 188). This framework

links three important nursing administration concerns: (1)

providing evidence-based patient care, (2) maximizing nursing

resources and (3) using the nursing care process when making

decisions. At the core of the framework are patient- and nurse-

sensitive outcomes. Contributors to these outcomes are patient

health care needs, nursing care processes and nursing resources.

Nursing administration research must take into account the

dynamic needs of both the patient and nurse in the current

political, social, cultural and economic environment, as all of

these factors infl uence administration decision-making for the

HBOC management project. The HBOC management project

considered the need for patient education and risk assessment

before genetic testing, along with the limited nursing resources.

Also considered in the planning was the effectiveness of

various patient education models. Calzone et al. (2005) studied

breast cancer and compared an individual-based genetic edu-

cation program with group-based education, and reported that

there were no signifi cant differences in knowledge scores be-

tween the individual or group methods of education (P=0.21).

Satisfaction scores also remained constant between the two

methods of genetic education. The study revealed that group

education allows for greater access to genetic information, risk

assessment and genetic testing and is more cost-effective than

individual education.

SPBCC elected to use a nurse educator to deliver education,

risk assessment and testing, working under the direction of the

medical director, because a genetic counselor was not available

nor was there enough volume to justify the cost of adding a ge-

netic counselor to the service. Traditionally, genetic counselors

deliver genetic counseling; however, the International Society

of Nurses in Genetics (2005) outlines the responsibilities and

competencies of nurses who may be involved in genetic coun-

492 © 2008, AWHONN http://nwh.awhonn.org

Beverly Mangerich, RN, MSN, is a liaison nurse for the Scripps Polster Breast Care Center in La Jolla, CA. Jaynelle F. Stichler, DNSc, RN, FACHE, FAAN, is an associate professor at San Diego State University in San Diego, CA. Address correspondence to: [email protected].

DOI: 10.1111/j.1751-486X.2008.00383.x

• Being diagnosed with or having a family history of hereditary breast or ovarian cancer can be emotionally draining for women.

• Women and their family members need support-ive, comprehensive education on the issue.

• Group classes can provide effective education that meets patients’ expectations while being more cost-effi cient than individual education.

Bottom Line

December 2008 January 2009 Nursing for Women’s Health 493

seling, including patient assessment, identifi cation, education,

care and support for genetics in health care. Nurses with exper-

tise in the clinical genetics aspect of health and illness can also

provide delivery of genetic information (Vogel, 2003), so the

SPBCC adopted an educational and informational program led

by a nurse educator. The SPBCC nurse educator has attended

local and national seminars on HBOC. The SPBCC also hosts a

quarterly meeting with other breast cancer genetic educators to

review cases. A genetic counselor leads these group discussions.

As professional nursing practice encompasses roles in patient

education, specifi c screening practices, patient advocacy and

counseling for health care choices, this seemed to be the most

appropriate and cost-effective model.

The Need to Save TimeAlthough genetic education and risk assessment are tradition-

ally conducted on an individual basis, the process is time-con-

suming. With the increasing need for HBOC patient education,

it was determined that a more time-effi cient education method

was needed in order to continue offering HBOC education.

Before the new program, patients made appointments free

of charge to meet with the nurse educator at SPBCC for an in-

dividual education session and risk assessment evaluation. The

hospital made a decision to offer the program without cost to

the patient because the education and counseling met the rec-

ommended standard of care for patients with a family history

of early breast cancer or ovarian cancer. After the individual pa-

tient session, a summary letter was written to the physician who

evaluated the patient for testing based on the risk assessment.

Physicians who wished their patient to continue with genetic

testing would write a prescription for genetic testing. The nurse

educator would then assist the patient with the genetic testing

process. Another patient appointment was made with the nurse

educator to give test results and to review the implication of

test results on medical options that were to be discussed with

their physician. Family members at risk for a positive BRCA

gene mutation were identifi ed and the patient’s responsibility

to inform identifi ed family members was discussed. The indi-

vidual education was time intensive and illustrated the need for

a more effi cient education.

Not only was the process for education and testing time-in-

tensive, but during 2007 the company with the patent on testing

for the BRCA1 and 2 mutations initiated a marketing cam-

paign to obstetricians and gynecologists in San Diego, which

signifi cantly increased the number of referrals for HBOC risk

assessment and testing. Referrals from physicians for HBOC

education and assessment grew from 11 percent in 2006 to 20

percent in 2007. Currently, physicians utilize the HBOC indi-

vidual patient education services due to the number of patient

concerns that resulted from the expanded marketing of the

BRCA test. The patients had many questions, emotional reac-

tions and concerns, which were presented to physicians, but

with competing priorities in the offi ce to see patients in an ex-

pedient manner, physicians had less time to spend in address-

ing individual patient concerns (Tai-Seale, McGuire, & Zhang,

2007). Individual genetic education and testing takes anywhere

from 1 to 2.5 hours (Calzone et al., 2005). Physicians were un-

able to devote the needed time during an offi ce visit, and the

increase in referrals to SPBCC made it costly and ineffi cient for

the nurse educator to spend time addressing individual con-

cerns and education instruction one patient at a time. At the

same time, the information and education was critical for pa-

tients to use as a basis for crucial medical care decisions.

What Are Women’s Concerns?The content for the new HBOC education class was based on

a review of evidence-based literature on fi ve factors of concern

for patients regarding their potential risk and possible treat-

ment alternatives: (1) risk factors, (2) interpretation of test

results, (3) medical intervention for HBOC, (4) psychosocial

concerns and (5) health insurance issues.

Risk FactorsOne of the most important features in HBOC is the increased

incidence of breast cancer at an early age. A personal or family

history of premenopausal breast cancer indicates the possibil-

ity of a genetic mutation (Frank et al., 2002). Other indicators

of an inherited mutated gene are male breast cancer, multiple

primary breast cancer, epithelial ovarian cancer at any age and

specifi c ethnicities associated with increase mutations in the

BRCA genes, such as Ashkenazi Jewish and Icelandic.

The majority of women with a BRCA gene mutation will

develop breast and/or ovarian cancer. Although genetic infor-

mation is not deterministic, mutation in the BRCA genes are

Group education allows for greater access to genetic information, risk assessment and genetic testing and

is more cost-effective than individual education

494 Nursing for Women’s Health Volume 12 Issue 6

associated with a lifetime risk of 45 percent to 78 percent for

breast cancer (Antoniou et al., 2003). The lifetime cumulative

risks in BRCA1-mutation carriers are 65 percent for breast

cancer and 39 percent for ovarian cancer (Antoniou et al.).

BRCA2-mutation carriers had a 45 percent risk of breast cancer

and 11 percent risk of ovarian cancer.

Women diagnosed with breast cancer with an inherited

BRCA1 and 2 gene also have an increased risk of developing

a second primary breast cancer. Risk of a contralateral breast

cancer, within 5 years of the initial diagnosis, ranges from 23

percent to 27 percent, according to Metcalfe et al. (2004). Risk

of a contralateral breast cancer increases between 50 percent

and 64 percent by the time a women reaches age 70.

Interpreting Test ResultsThere are categories for test results regarding BRCA1 and 2.

The fi rst category is positive for a deleterious mutation. A

deleterious mutation in either the BRCA1 or 2 gene prevents

translation of the full-sized protein (Peshkin, DeMarco, Bro-

gan, Lerman, & Isaacs, 2001). When proteins fail to decrease

cell replication, the increased percentages of accruing breast/

ovarian cancer apply to the individual testing positive.

The second category is negative results or results in which

no mutation is detected. They have two different interpreta-

tions. The fi rst interpretation is considered a true negative

when a mutation has been found previously in a family mem-

ber. A negative result in a subsequent family member reverts

the family members’ breast and ovarian cancer risk back to the

general population (Ponder, 1997). The second negative inter-

pretation is considered “indeterminate” and takes place when

there are no known mutations in the family. Women with in-

determinate test results may still be considered high-risk and

should choose treatment based on their family history (Lan-

caster et al., 2007).

The last category of test results is a genetic variant of un-

certain signifi cance labeled as inconclusive, according to the

NCCN (2007). Sequence analysis may identify changes in the

gene that have not been identifi ed previously. The signifi cance

of these variants for breast and ovarian cancer is unknown

(Peshkin et al., 2001). Other family members can be tested for

the variant to acquire more information on which to base deci-

sion-making. Management of patients with uncertain variance

should be based on personal and family history (NCCN).

Medical InterventionsThe NCCN has recommended that women identifi ed with a

mutated BRCA1 and 2 gene receive a semiannual clinical breast

exam, annual mammography and magnetic resonance imag-

ing starting at age 25 or individualized based on the earliest

age of onset of breast cancer in their families (Hartman et al.,

2004). The most invasive but effective management is prophy-

lactic mastectomies, which have been shown to reduce the risk

of breast cancer by more than 91 percent (van Sprundel et al.,

2005).

Unlike breast cancer screening, surveillance for ovarian

cancer is often ineffective, according to the NCCN. Although

less than an ideal surveillance, the NCCN (2007) recommends

the combination of the CA-125 blood test, ultrasound of the

ovaries and bimanual pelvic exam as the most effective way to

screen for ovarian cancer. More effective than surveillance for

ovarian cancer is prophylactic salpingo-oophorectomy. Reb-

beck et al. (2002) and Kauff et al. (2002) both found a signifi -

cant reduction in both ovarian and breast cancer following a

prophylactic salpingo-oophorectomy and recommended the

procedure in patients who screen positive for the BRCA mu-

tation. Recommendations from these studies included a pro-

phylactic salpingo-oophorectomy as soon as possible after

childbearing is complete or by age 35 (McEwen et al., 2004).

It’s important to explore a patient’s past experiences and perception regarding the subject of cancer, her family history of cancer and her family’s perceptions regarding genetic testing


The New Education ModelBased on the conceptual framework and the evidence-based

literature review of the fi ve educational areas, a new method of

providing patient education was explored for its effectiveness

and cost benefi ts.

Planning for the program included the need for develop-

ing a HBOC education class process and for garnering support

from physicians for the class. It was determined that new edu-

cation slides and handouts needed to be developed in addition

to assessment tools to measure participants’ acquired knowl-

edge and satisfaction with the new class format. A demographic

questionnaire describing the characteristics of the group was

Psychosocial ConcernsThe NCCN Guidelines (2007) recommend psychological as-

sessment and support for individuals seeking genetic testing.

Education on HBOC includes considerations of the worry of

cancer, potential diffi culty communicating within families, at-

titudes toward prevention and surveillance options, and the

need for support (Hamilton, Bowers, & Williams, 2005). Im-

plications of testing affect not only the individual but also her

family members. Effective family communication is stressed,

as it’s the individual’s responsibility to communicate positive

genetic testing results to family members who may or may not

choose to be tested.

It’s important to explore a patient’s past ex-

periences and perception regarding the subject

of cancer, her family history of cancer and her

family’s perceptions regarding genetic testing.

Patients having diffi culty coping with the risk

of breast or ovarian cancer may need profes-

sional intervention with a psychologist or other

mental health professional.

Health Insurance ConcernsWomen may not only fear positive results and

how they will affect their relationships, but they

may also be concerned with how test results will

affect their ability to obtain health insurance.

So while genetic testing has the great potential

to enhance patient care, this testing also carries

the concern of potential discrimination in em-

ployment and health care benefi ts. The Health

Insurance Portability and Accountability Act

(HIPAA) of 1996 is one federal policy that ad-

dresses genetic discrimination. HIPAA affords

some protection to group markets by prohibit-

ing insurers from charging different premiums

within a group plan. HIPAA also mandates

that genetic information cannot be used to de-

termine insurance eligibility or be viewed as a

preexisting condition when a diagnosis is not

present. The Genetic Information Nondiscrim-

ination Act, which provides protection against

discrimination based on an individual’s genetic

information for health insurance coverage and

employment, was signed into law by President

Bush on May 21, 2008. Many states also have

laws that prohibit the use of genetic informa-

tion for insurance coverage and employment

(Hall & Rick, 2000), and, therefore, genetic and

nurse counselors should familiarize themselves

with their state regulations.

BOX 1 Questionnaire Used at SPBCC

Please indicate whether you think each item is True or False or if you don’t know. This is not a test. This information will help us evaluate our educa-tion program.

True False Don’t Know

A father can pass down an altered BRCA gene to his daughter.

All people who have an altered BRCA gene will get breast cancer.

A person who does not have an altered BRCA gene can still get breast cancer.

A woman who has an altered BRCA gene has a 100% chance of passing it to her daughter.

Most breast cancer is inherited.

My doctor will tell my family if they need to test for the BRCA gene mutation.

A woman who has a sister with an altered BRCA gene has a 50% chance of also hav-ing an altered BRCA gene.

If there are 4 siblings in a family and 2 already have breast cancer, then the other 2 don’t have the gene mutation.

A bilateral mastectomy eliminates the risk of breast cancer.

A woman whose gene mutation test is negative does not need to have regular mammograms.

California laws prohibit health insurance to discriminate based on genetic results.


would be required to make an individual appointment with the

nurse. During the appointment a three-generation pedigree is

obtained and the patient’s risk assessed using the BRCAPRO

tool (the computer program that determines risk for the BRCA

1 and 2 gene) (Parmigianni et al., 2007). Although the IES isn’t

administered formally as in Calzone (2005) research, patients

are assessed verbally by the nurse educator using the IES as a

guide. A letter summarizing the patients’ risk is sent to the phy-

sician, and the physician decides if the patient is to be tested for

the BRCA gene mutation. If the physician decided to proceed

with patient testing, a prescription is forwarded to the SPBCC

nurse educator, who assists the patient with the testing process.

Educational ContentEducation material covered in the class was developed from

the review of the literature on selected core content for patient

education and approved by the medical director of the SPBCC.

The class includes information on the following: (1) identifying

factors of HBOC, (2) possible test results, (3) elevated risks of

breast and ovarian cancer, (4) available medical interventions,

(5) psychosocial concerns and (6) insurance discrimination.

The learning objectives of the class are shown in Box 2.

The education class begins with breast cancer facts and iden-

tifying factors in a family history that alert the physician, nurse

and participants of possible HBOC. Pedigrees are reviewed

with the mutated gene inherited from the paternal side and the

maternal side of the family. When HBOC factors are identi-

fi ed, testing is performed with a possibility of various results.

When test results are indeterminate or inconclusive, patients

created. Knowledge of HBOC would be assessed using an 11-

item, true/false scale modifi ed from the work of Calzone et al.

(2005). The Calzone questionnaire, modifi ed from a tool devel-

oped by the National Human Genome Research Institute Can-

cer Genetics Studies Consortium, has reported psychometric

properties (Cronbach’s alpha of ≥0.75). The instrument was

modifi ed because during the pilot testing some items were un-

clear to participants, and, therefore, they were either eliminated

or revised to be appropriate for the setting and were reviewed

by a panel of experts at the SPBCC. Reliability testing of the

modifi ed Calzone instrument will be conducted once there is

a suffi cient number for statistical analysis. See Box 1 for the

modifi ed Calzone instrument used at SPBCC. All other re-

sources needed for the new education delivery method were

already available at the center, including handout materials,

laptop computer, projector and conference room.

Participants, who were either self-referred or referred by

their physicians, would register ahead of time for the class. Fam-

ily members were encouraged to attend. Classes were offered

twice a month during the day and scheduled for approximately

1 to 1.5 hours of educational content, including questions and

answers. The class length varied depending on the size of the

class. More participants would generate more questions and

increase the length of the class.

The class began with participants fi lling out a demograph-

ic questionnaire and the 11-item pretest. Introductions were

made by the nurse educator, including a disclaimer that the in-

structor is not a genetic counselor but that she holds a master’s

degree in nursing and has years of experience in the breast and

ovarian cancer fi eld. Participants were invited to share as much

personal history as they were comfortable sharing. The edu-

cation component was presented via a lecture method using

slides and handouts. The nurse educator would address ques-

tions from the participants during the presentation for imme-

diate clarifi cation. Following the presentation, the participants’

satisfaction of the class would be assessed by a questionnaire

using a 5-point Likert scale. The 11-item post-test using a true/

false scale was repeated at the conclusion of the class to assess

knowledge gained from the educational content. Although

Calzone’s (2005) research included the Impact of Events Scale

(IES), this wasn’t included in the educational session since it

wasn’t the focus for this program.

Patients wishing to proceed with a personal risk assessment

BOX 2 Learning Objectives for the HBOC Group Class

At the conclusion of the presentation participants will be able to identify the following:

• Risk factors associated with hereditary breast and ovarian cancer

• Breast and ovarian cancer risks associated with BRCA mutations

• Medical intervention options for women test-ing positive for BRCA mutation

• Implications of positive and negative BRCA test results for family members

• Potential psychosocial implications with ge-netic testing

• Relevant health insurance issues

Testing is done in the context of the patient’s psychological well-being and her individual family dynamics


tient sessions versus group education. The total time expendi-

ture for individual education is approximately 125 minutes per

patient. By expanding the number of participants to two partic-

ipants per class, the total time expenditure was reduced to 114

minutes per patient. There is further incremental reduction in

time spent with each additional class participant. Further gains

resulted when after the class participants realized their family

history of breast cancer did not put them in a high-risk cat-

egory for HBOC and they didn’t need to test for the BRCA gene

mutation. The HBOC class has resulted in the ability to use less

of the nurse educator’s time with a natural “self screening” for

patients away from unnecessary testing.

Box 4 shows the conversion of time expended into salary

expenses for individual education compared with group edu-

cation. Cost per individual patient education using $40/hour

salary cost was approximately $80 per patient. By providing edu-

cation in a class setting, even with as few as two participants, the

cost per patient was reduced to $73 per patient. Six participants

in a class reduced the cost per patient to $46.66. Because SPBCC

already had the other educational materials and the equipment,

no other expenses were incurred in the change from individual

to group education. Marketing of the program was an existing

role expectation of the nurse educator, so no incremental costs

were incurred as a result of the program change and marketing

to physicians who were already referring patients.

Class ParticipationThe fi rst three group classes enrolled a total of 15 participants.

The age range of the participants was 30 to 66 with a mean

of 50 years and a median of 49 years. All of the participants

reported having some college education, with fi ve participants

completing a baccalaureate degree, four a master’s degree and

are counseled to base their medical decisions on their personal

and family history. Positive results, however, give the patient

additional options of surgical medical management. A positive

result, indicating a mutated gene, signifi cantly increases the

risk of breast (86 percent) and ovarian cancer (44 percent) and

increases the risk of a second primary breast cancer in the con-

tralateral breast (64 percent).

Testing is done in the context of the patient’s psychological

well-being and her individual family dynamics. Patients are of-

ten concerned about their family members’ cancer risks as well

as their own. Along with family risk concerns, patients are also

concerned about health insurance eligibility following positive

test results. Federal and California nondiscriminatory laws are

included in the content of the class as well as the challenges of

obtaining health insurance after a cancer diagnosis.

Marketing the ProgramThe program was marketed to ensure its success. The free class

was marketed to Scripps physicians and to the public. Fliers

were also developed for the class by the marketing department

and distributed by marketing personnel and the SPBCC nurse

educator during visits to physicians’ offi ces. Pamphlets were

also distributed to patients at the SPBCC and community edu-

cation events. News articles and marketing in the community

will be planned as the program develops.

ResultsTime AnalysisAn analysis was completed to evaluate the time and cost dif-

ference between individual appointments and the HBOC class.

Box 3 demonstrates the expenditure of time for individual pa-

BOX 3 Comparison of Time Spent on Individual Versus Group Education

Number of participants per class 1 2 3 4 5 6

Class registration 5 6 9 12 15 18

Class set up 1x expenditure 0 15 15 15 15 15

Class time 1x expenditure 70 90 90 90 90 90

Data analysis 1x expenditure 0 15 15 15 15 15

Individual risk assessment 30 minutes/pt 30 60 90 120 150 180

Explanation of results 20 minutes/pt 20 40 60 80 100 120

Total minutes 125 226 294 352 405 468

Time per patient 125 113 93 83 77 73

Cost per patient at $40/hour employee $80 $73 $60 $53.33 $49.33 $46.66


Pre- and Post-Test ResultsParticipants’ baseline knowledge of breast cancer genetics was

assessed using an 11-item pretest. Results from the pretest

showed an average of 63 percent of the questions answered cor-

rectly with 37 percent answered incorrectly or with a response

of “I don’t know.” The mean score was 6.92 with a standard

deviation of 2.67. The same 11-item questionnaire was used

for the post-test. The post-test showed an increase in correct

responses when compared with the baseline scores. The post-

test showed 95 percent of the questions answered correctly by

the participants. The mean score of the post-test was 10.3 with

a standard deviation of 0.89, demonstrating an improvement

in participants’ content knowledge.

Patient SatisfactionA satisfaction survey was also given to the participants to deter-

mine their level of satisfaction with the new HBOC education

program. All participants “strongly agreed” or “agreed” that the

education method provided suffi cient information to increase

their knowledge of HBOC. The majority of the participants felt

the class helped them make a decision whether or not to test

for the BRCA gene mutation. Most participants were “strongly

satisfi ed” or “satisfi ed” with the class setting, handouts and time

to ask questions.

ConclusionAlthough women with HBOC comprise a small proportion of

breast cancer cases, HBOC education and risk assessment is the

standard of care according to numerous medical organizations

and is an important component in patient medical decision-

making. Although this education is important to patients, when

done on an individual basis it’s a labor-intensive process. A cost-

effective process was needed that considered patient outcomes,

nursing resources and nursing process. The change project

developed an education process in which education would be

delivered in a classroom setting without compromising the

quality of patients’ education. Test scores revealed a signifi cant

improvement between pretest and post-test education. Partici-

pants in the classes were engaged and asked questions that the

whole group benefi ted from. Class participants were supportive

of each of the individual situations that participants shared.

Patient education and health risk assessment conducted on

an individual basis remains a labor intensive process during a

time when administration directives are to provide cost-effec-

tive care. Analysis of the class versus individual appointments

has shown a marked decrease in the nurse educator’s time. A

decrease in the nurse’s time allows a cost benefi t to the center.

One limitation to the twice-monthly class offerings has been

that newly diagnosed patients need to have the testing as soon as

possible in order to make decisions regarding surgery for their

breast cancer and this time between classes is diffi cult for some

one a doctorate degree. This fi nding was refl ective of the type

of patients seen at SPBCC and the surrounding community,

which includes two universities, high-tech industries and re-

search centers and a population of upper-class, highly educated

individuals. The majority of participants were women (n=11)

with four men attending to support their partners. Eight par-

ticipants came to the class because their physician had recom-

mended the class. Six participants had been diagnosed with

breast cancer and three were diagnosed in the last year.

Motivation for attending the class varied among the group.

Seven attendees were concerned about the potential genetic

mutation that they may have passed on to their children. Six

participants had a family member newly diagnosed with breast

or ovarian cancer and another six were concerned about their

family history of breast/ovarian cancer being inherited. Eight

participants had a family member diagnosed with breast cancer

under the age of 50 years. Only three participants had a family

member diagnosed with ovarian cancer.

BOX 4 Patient Cost for HBOC Education

Sala

ry C

ost

Number of patients educated

Cost per patient with classCost if individual appointmentsTotal cost of class


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patients. Therefore, in order to accommodate the patient’s need,

these patients are seen individually for education and testing.

This project considered patient outcomes, nursing resourc-

es and the nursing process in developing and implementing a

group education class that was effective in its goals of decreas-

ing the amount of the nurse educator’s time spent on educa-

tion, while still providing an effective class to patients. NWH

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Breast and Ovarian Cancer: A New Model For Educating Women