PowerPoint Presentation

COMMUNITY INTERVENTION PLANChristina BookheimerMichelle RoweSandra SaylorJackie TiefenthalJoseph Urbanski

IntroductionKent County which includes the city of Grand Rapids, Michigan has a high prevalence of breast cancer. In reviewing the data provided to us it was apparent that this is an issue that requires public health attention.

Breast cancer is the second highest cause of cancer deaths among women in Michigan, as well as nationwide. Data supported this concern in relationship to poor air quality, lack of breast cancer screenings and the unemployment rate for this area. The area of our focus was narrowed to females age 50-74 for purposes of this project.2Community Problem StatementRisk of developing breast cancer among 50-74 year old residents of Kent County, Michigan related to poor air quality, lack of screenings, and high unemployment rate as evidenced by age specific rate of diagnosis of 343, lower than average mammography units available in area, high rates of carbon dioxide 0.277, particulate matter 9.44, nitrogen dioxide 11.6, and air quality indicator of 32.7 as well as high unemployment rate of 12.1%

A step further for this community problem statement would be to increase timely screenings for at risk women those with limited or no health coverage and those who avoid screenings in general which is the true focus of our community problem plan.3Supporting DataKent County cancer incidence trend 2003-2007 was 370.6 age-adjusted to 124.5State of Michigan cancer incidence trend 2003-2007 was 6939.4 age-adjusted to 122.11,320 deaths and 7,340 new cases of breast cancer were reported for the year 2010 in Michigan50-74 year olds in Kent County with age specific rate of 34350-74 year olds State of Michigan with age specific rate of 300.5

Michigan Department of Community Health, 2009Michigan Cancer Consortium, 2010

Breast cancer remains the second leading cause of cancer deaths for women in the United States4Supporting Data ScreeningsLowest rate for obtaining mammography in the United States is 50-59 years at 79.9%Relatively large amount of females in Michigan live within 30-45 miles of a mammography unitKent County is shown to have 23 mammography units but this is much lower than other counties comparatively

Centers for Disease Control and Prevention, 2010Michigan Cancer Consortium, 2010

One way to reduce breast cancer mortality is through screening.5Supporting Data Air PollutionAir quality in Kent County is rated at 32.7Air quality for the United States is 32.0Kent County/Grand Rapids is 45th of the Top 101 Counties with the highest lead air pollution and particulate matterKent County/Grand Rapids is 76th of the Top 101 with the highest nitrogen dioxide air pollutionKent County/Grand Rapids is 97th of the Top 101 with the highest carbon monoxide air pollution

City Data, 2010

Per the American Cancer Society certain changes in DNA can cause normal breast cells to become cancer. Breast cancer incidence was clearly higher in areas with increases levels of nitrogen dioxide and particulate matter as stated by the Breast Cancer Fund. 6Supporting Data UnemploymentOne-third of individuals who stopped working and left a job that previously provided them with employer-sponsored health insurance became uninsured for six consecutive months57% of all adults say they have put off some sort of needed medical care over the past 12 months because of costUnemployment rate for Kent County/Grand Rapids is 12.1 as of March, 2011Unemployment rate for State of Michigan 11%

Kaiser Commission, 2010City Data, 2010

It can be argued that losing a job or unemployment can be correlated with decreased health insurance which can be correlated with decreased ability to obtain health care.7Interventions for increasing timely screening for at risk women, women with limited or no health coverage and women who avoid screenings

Education on MammographyA mammogram is an x-ray picture of the breastThe National Cancer Institute recommends that women age 40 or older should have screening mammograms every 1 to 2 years

National cancer Institute, 2010

Say, for example, you feel a noticeable area of thickening in the upper area of your breast, next to your arm. If you've become familiar with how your breasts look and feel, you know your breast usually feels completely smooth in that area. Without a tactile memory from having done frequent breast exams, though, you might not notice this difference. Detecting such a change should prompt you to see your doctor.9DEVELOP OR SELECT EDUCATIONAL BROCHURES AND POSTERS WITH PHOTO IMAGES OF AGE-RELEVANT WOMENPosters and brochures on display/accessible on how to access advocacy services

Center for Disease Control and Intervention, & Prudential Center for Health Care Research. (n.d.).

To ensure that educational material is appropriate and relevant there is ongoing consultation with consumers, care givers and others regarding the planning, delivery, monitoring and evaluation of services10Education on self breast exams (sbe)A breast exam is a self-inspection of your breasts. During a breast exam, you use your eyes and hands to observe the appearance and feel of your breasts.Breast exams may help identify potential breast problems.

Mayo Clinic, 2009

Screening mammograms are used to check for breast cancer in women who have no signs or symptoms of the disease. Diagnostic mammograms are used to check for breast cancer after a lump or other sign or symptom of the disease has been found

Early detection of breast cancer with screening mammography means that treatment can be started earlier in the course of the disease, possibly before it has spread. Results from randomized clinical trials and other studies show that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74, especially for those over age 50

11SAFETY OF MAMMOGRAM UNITSResults from randomized clinical trials and other studies show that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74Getting a high-quality screening mammogram and having a clinical breast exam (an exam done by a health care provider) on a regular basis are the most effective ways to detect breast cancer early

National cancer Institute, 2010

Screening mammography is also associated with potential harms, including false-negative results, false-positive results, the diagnosis and treatment of cancers and ductal carcinoma in situ lesions that would not have caused symptoms or threatened a womans life12Use Simple Educational messages and materialTarget less educated and low income women

Center for Disease Control and Intervention, & Prudential Center for Health Care Research. (n.d.).

Women who have less than a high school education are less likely to perform SBE, go to screenings and participitate in annual screenings due to lack of knowledge.13Preventative care for those with limited income or no health care coverageAvailable support systemsFunding available to cover the screeningsOrganizations that offer free screenings

Center for Disease Control and Intervention, & Prudential Center for Health Care Research. (n.d.).

The cost of screening mammograms varies by state and by facility, and can depend on insurance coverage. However, most states have laws that require health insurance companies to reimburse all or part of the cost of screening mammograms. Some state and local health programs and employers provide mammograms free or at low cost. For example, the Centers for Disease Control and Prevention (CDC) coordinates the National Breast and Cervical Cancer Early Detection Program. This program provides screening services, including clinical breast exams and mammograms, to low-income, uninsured women throughout the United States and in several U.S. territories14Refer women based on their ethicticity and geographic areaIdentify mammography units in particular areasUse females onlySame race and age

Center for Disease Control and Intervention, & Prudential Center for Health Care Research. (n.d.).

Women of racial and ethnic minorities will feel more comfortable being screening and examined by women of the same ethnic background15Hours screening are available for the publicOffer flexible weekend and evening hoursAssist women to identify the clinic and mammography sites most conveniently located to their home or jobs

Simi Valley Hospital, 2010

Convenient location and flexible hours make it easier for time constricted women to participate in mammogram screeningsFewer patients are required to come back for additional picturesLess anxiety as pictures are generated immediatelyLess time for appointments, as results are obtained fasterThe ability for physicians to magnify and optimize mammography results

16Transportation to screeningsIdentify pubic transportation and their geographic areaOrganizations that provide transportation to screening sites

Center for Disease Control and Intervention, & Prudential Center for Health Care Research. (n.d.).

BY IDENTIFYING TRANSPORTATION AND WOMEN IN THEIR GEOGRAPHIC AREAS, WOMEN WOULD BE MORE LIKELY TO GO TO SCREENINGS. REFERRALS THAT CAN ASSIST WITH TRANSPORTATION NEEDS WOULD GREATLY HELP THESE WOMEN WHO ARE FACING TRANSPORTATION ISSUES.17EVALUATION

Evaluation is the process of determining the value or worth of a program, course, or other initiative, toward the ultimate goal of making decisions about adopting, rejecting, or revising the innovation (Virginia Tech, 2011).

Virginia Tech. (2011). Retrieved from http://www.edtech.vt.edu/edtech/id/eval/eval.htm

lEvaluation is the process of determining the value or worth of a program, course, or other initiative, toward the ultimate goal of making decisions about adopting, rejecting, or revising the innovationOutcome Measures UtilizedKnowledgeBehaviors, skillsAttitudes, commitment to actionEmotional well-beingHealth status (epidemiologic measures)Presence of health care system services and componentsSatisfaction or acceptance regarding the program interventionsPresence of policy that allows, mandates, or fundsAltered relationship with physical environment

Maurer & Smith, 2009

Each of these variables can be used as a measure of the effectiveness of specific community/public health nursing interventions and have been incorporated into the evaluation portion of our project.19WAS THE MESSAGE UNDERSTOOD?Did the intervention include clear information on the importance of mammography screening and action to be taken by women?Was the intervention tailored to the unique needs of specific age/racial/ethnic/geographic or other subgroups?Were information and other educational methods available in other languages for non-English speaking women?

BREAST SELF EXAMBreastcancer.org still believes that BSE is a useful and essential screening strategy, especially when used in combination with regular physical exams by a doctor and mammography. About 20% of the time, breast cancers are found by physical examination rather than by mammography. It is recommended that all women routinely perform breast self-exams as part of their overall breast cancer screening strategy (Breastcancer.org, 2008). Evaluation: Do women know how to perform a breast self-exam?http://www.breastcancer.org/symptoms/testing/types/self_exam/MAMMOGRAPHYResults from randomized clinical trials and other studies show that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74, especially for those over age 50

National Cancer Institute. (2011) Retrieved from http://www.cancer.gov/cancertopics/factsheet/detection/mammogramsResults from randomized clinical trials and other studies show that screening mammography can help reduce the number of deaths from breast cancer among women ages 40 to 74, especially for those over age 50

EVALUATING FACILITIESAre radiation facilities conveniently located in the community?Are radiation facilities user friendly?Mammography Centers in Grand Rapids Michigan (MI)

DMI Clinic - Carl J. Kubek847 Parchment SEGrand Rapids, MI 49546 Kent Radiology P.C. - Northwest933 Three Mile Rd, N.W. Ste. 106Grand Rapids, MI 49544 Spectrum Hlth Hospitals Lemmen-Holton Cancer Pavilion145 Michigan NE Ste 4200Grand Rapids, MI 49503 East Beltline Advantage Health St. Mary's X-Ray1471 East Beltline NE Ste. 103Grand Rapids, MI 49525 MMPC Womens Imaging Center4069 Lake Drive SE Ste. 116Grand Rapids, MI 49546

2011 UCompareHealthCare.com & UCompare Holdings, LLC http://www.ucomparehealthcare.com/mammography/mammogram_mi/Grand_Rapids.htmlMammography Centers in Grand Rapids (continued)Spectrum Hlth Hospitals Women's Hlth Center555 Mid Towne NE Ste 101Grand Rapids, MI 49503 Grand Valley Surgical and Diagnostic Ctr2680 Leonard N.E.Grand Rapids, MI 49525 Spectrum Health Hospitals-Betty Ford Breast Care Service550 Cherry Street SEGrand Rapids, MI 49503 Spectrum Hlth-South Campus - Betty Ford Breast Care Servs.80 - 68th Street S.E.Grand Rapids, MI 49548 Kent Radiology P.C.4340 Callander Dr SE Ste.102Grand Rapids, MI 49508 Spectrum Hlth Hosp Betty Ford Breast Care1840 Wealthy St. S.E.Grand Rapids, MI 49506 The Lacks Cancer Center at Saint Mary's Breast Services250 Cherry St. SEGrand Rapids, MI 49503

Evaluation of Screening HoursWomen in the age group of 40+ will be able to identify at least two different facilities near their home and the hours they offer clients to have mammograms performed. Patients will follow The National Cancer Institute recommendation that women of the age 40 or older should have screening mammograms every 1 to 2 yearsWomen Who are being regularly screened will identify their knowledge of radiation exposure from mammograms and notify their health care provider when needing other tests involving radiation.

Evaluation: Preventative care for those with limited coverage or no health care coverageWomen in the community will be able to identify at least one support system available to them in their community or surrounding area.Identify factors that increase a womans risk of breast cancer.Personal History Women who have had breast cancer are more likely to develop a second breast cancer.Family History A womans chance of developing breast cancer increases if her mother, sister, and/or daughter have been diagnosed with the disease, especially if they were diagnosed before age 50.Genetic Alterations: Inherited changes in certain genes increase the risk of breast cancer.Breast Density: Women who have a high percentage of dense breast tissue have a higher risk of breast cancer than women of similar age who have little or no dense tissue in their breasts.

Preventative Care ContinuedAlso included are; Reproductive and menstrual history, long-term use of menopausal hormone therapy, radiation therapy, alcohol, DES, body weight, and physical activity level (National Cancer Institute).Identify available funding information for various screenings. The Centers for Disease Control and Prevention (CDC) coordinates the National Breast and Cervical Cancer Early Detection Program. This Program provides screening services, including clinical breast exam and mammograms, to low-income, uninsured women through the Unites States (National Cancer Institute).Transportation EvaluationHow many people had access to necessary transportation services and were they used effectivelyIdentification of at least one transportation mode to and from screening facilities along with rates and times available for appropriate transportation.Grand Rapids TrolleyMetro CabKent County Bus Use of available resources such as www.accesskent.com to locate screening locations and services

Safety EvaluationWomen will identify potential benefits of mammograms along with potential harms from screening. (False-Negative and False-Positive results)Early detection of patients who do have breast cancerBeginning of treatment as early as possible in the course of the disease processReduction in number of breast cancer deaths in women ages 40 to 74Regular screening average increased in area being studied.Understanding radiation dosing and its involvement with other testing such as x-raysSafety ContinuedNational Breast and Cervical Cancer Early Detection Program (NBCCEDP).Provides high quality screenings and diagnostic services for;Breast CancerCervical CancerWomen ages 40-64Treatment Referals

ConclusionIn conclusion this community intervention plan was developed related to breast cancer incidence in the target community of Kent County, Michigan. The group chosen was 50-74 year old female residents of this community. It was established that the risk of developing breast cancer for this group is above the state average. The core problems identified were related to air pollution/quality, access and knowledge of screenings available, and unemployment rate that could impact insurance coverage and cost of this diagnosis. An intervention plan with evaluation methods have been identified and supported with appropriate data.

32ReferencesAccesskent. (2011). Womens health network/breast & cervical cancer control program. As retrieved from http://www.Accesskent.Com/health/healthdepartment/health_promotion/womens_health.HtmAmerican Cancer Society (2011). Learn about breast cancer. Retrieved from http://www.cancer.org/cancer/breastcancer/overviewguide/breast-cancer.Breast Cancer. (2008). Breast self exam. Retrieved from http://www.breastcancer.org/breastcancersymptoms/testing/types/self_exam/Breast Cancer Fund. Chemicals in air and water. Retrieved from http://www.breastcancerfund.org/clear-science/chemicals-linked-to-breast-cancer.Center for disease control and prevention. (2008). Breast cancer screening services provided. As retrieved from http://www.Cdc.Gov/features/dsbreastcancer/Centers for Disease Control and Prevention. (2010). Vital signs: breast cancer screeningamong women aged 50-74 years, United States, 2008. Retrieved from http://www.cdc.gov/mmwrhtml/mm59e0706a2.htm on June 14, 2011.Center for disease control and intervention, & prudential center for health care research. (N.D.). The manual of intervention strategies to increase mammography rates [data file]. Retrieved from http://www.Cdc.Gov/cancer/nbccedp/pdf/prumanual.PdfCity-Data. (2010). Kent County, Michigan. Retrieved from http://www.city-data.com/county/Kent_County-MI.html on June 16, 2011.Kaiser Commission. (2010). Assessing the risk of becoming uninsured after leaving a job: a look at the data. Retrieved from http://www.kff.org/uninsured/8056.cfm

ReferencesMaurer, F. A., & Smith, C.M. (2009). Community/Public health nursing practice: Health for families and populations. St. Louis, MO: Saunders Elsevier.Mayo Clinic. (2009). Breast exam. As retrieved from http://www.mayoclinic.com/health/breast-exam/my00743/dsection+why-its-doneMichigan Cancer Consortium. (2010). The cancer burden in Michigan: selected statistics_1992-2010. Retrieved from www.michigancancer.org/WhatWeDo/TheCancerBurdenMichiganSelectedStatistics.cfm on June 15, 2011.Michigan Department of Community Health. (2010). Cancer tables: Kent County female 1985-2007. Retrieved from http://www.mdch.state.mi.us/pha/osr/chi/cancer/frame.html on June 15, 2011.Michigan Department of Community Health. (2009). Michigan critical health indicators: 2007. Retrieved from http://www.mdch.state.mi.us/.National Cancer Institute. (2010). Mammograms. As retrieved from http://www.cancer/gov/cancertopics/factsheet/detection/mammogramsSimi Valley Hospital. (2010). Cancer services. As retrieved from http://www.simivalleyhospital.com/services/cancer/nancy_reagan.phpUcompareHealthCare and UcompareHolding. (2011). Mammography Centers in Grand Rapids Michigan. Retrieved from http://www.ucomparehealthcare.com/msmmography/mammogram_mi/grand_rapids.htmlVirginia Tech. (2011). Retrieved from http://www.edtech.vt.edu/edtech/id/eval/eval.html