The development of clinical breast examination by nurses for breast cancer screening at Ubon Ratchathani Cancer hospital

Abstract

              The purposes of this research and development were to study, develop, and evaluate a clinical breast examination (CBE) for breast cancer screening at the Ubon Ratchathani Cancer Hospital, Thailand. The study was divided into two phases. In the first phase, a situation analysis was conducted via two surgeons and 33 registered nurses by using questionnaires and a semi-structured interview. The second phase comprised developing the CBE prototype, implementation, and efficiency evaluation for the CBE model via 44 registered nurses, one physician. The CBE was performed with 44 female volunteers at the Hospital’s Outpatient Department. The data were collected using a questionnaire about the knowledge, attitude, skills, and satisfaction. Then, the data were analyzed by conducting content analysis, descriptive statistics, and a paired t test. In addition, a kappa statistic was used to test the diagnostic agreement, sensitivity, specificity, positive predictive value, and negative predictive value.

              The results of this research were as follows: In the first phase, the CBE model was unclear, and nurses did not have any competency about breast examination. Thus, this problem resulted in developing more details of the practice algorithms and reporting documentation. The CBE model consisted of five issues: 1) CBE training program, 2) CBE handbooks, 3) an innovative artificial breast model, 4) a video teaching how to conduct a breast examination, and 5) the format of the documentation of the interpretation and reporting of specific CBE findings. The results found that knowledge, attitudes, and skills of CBE practices scores were a statistically significant increased (p<0.05). The satisfaction of the service was at the highest level (mean=4.54). The quality of the CBE between the physician and specialist nurses was at a good agreement. (Cohen’s Kappa coefficient was 0.64 (95% CI= 0.19-1.00). The corresponding sensitivity values were 50% (95%CI=6.76-93.20), specificity values were 100% (95%CI=91.20-100.00), positive predictive value was 100% (95% CI=15.80-100.00), and the negative predictive value was 95.2% (95% CI=83.80-99.40), respectively.

             These findings suggested that a CBE model should be applied in the practice of screening for breast cancer in the health service system. Furthermore, this may enhance the nursing role in increasing the confidence of the competency and increasing the effectiveness of early breast cancer detection.