Staci T. Anderson, PhD, RN April 11, 2008

1. Knowledge, Cancer Fatalism and Spirituality as Predictors ofBreast Cancer Screening Practices forAfrican American and Caucasian Women Staci T. Anderson, PhD, RN April 11, 2008

2. Background • Breast cancer is the 2nd most frequently diagnosed cancer in women. • In 2007, an estimated 178,480 new cases of breast cancer will be diagnosed • African American (AA) women die from breast cancer more than any other racial group • Use of breast cancer screening practices influences mortality and survival rates

3. Breast Cancer IncidenceAge-Adjusted (per 100,000) (National Center for Health Statistics, 2006)

4. Survival Rates 5-Year Relative Survival Rates (National Center for Health Statistics, 2006) Percentage of Women

5. Trends in Mortality Rates Age-Adjusted Rates Per 100,000 (National Center for Health Statistics, 2006)

6. Louisiana Trends (per 100,000) Per 100,000 (NCI SEER State Cancer Profile, 2006)

7. Mammography Screening Trends (Centers for Disease Control and Prevention, 2005)

8. Breast Cancer Screening • Barriers • Structural Barriers • Organizational • Psychological • Facilitators • Health Insurance • Source of Health Care • Physician Recommendation

9. Problem Statement • Despite improvements in mammography screening rates, differences in breast cancer mortality and survival rates persist between AA and Caucasian women. Differences in utilization of breast cancer screening practices has been identified as a contributing factor to this phenomenon. Various complex and interrelated factors influence participation in breast cancer screening practices.

10. Purpose • To explore relationships between knowledge related to breast cancer screening and detection, cancer fatalism, spirituality and breast cancer screening practices in African American and Caucasian women. • To determine the ability of these variables to predict breast cancer screening practices in African American and Caucasian women.

11. Significance • Findings could be used to develop more culturally specific educational interventions. • Health care providers need to be aware of an individual’s knowledge, perceptions, beliefs, and attitudes about breast cancer.

12. Study Variables • Breast Cancer Knowledge • Cognitive information about breast cancer and breast cancer detection and screening practices • Breast Cancer Screening Practices • Methods used to detect breast cancer in persons who are asymptomatic. • BSE • CBE • Mammogram

13. Research Hypotheses H1 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in AA women. H2 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in Caucasian women.

14. Research Hypotheses H3 Breast cancer knowledge is a predictor of breast cancer screening practices in AA women. H4 Breast cancer knowledge is a predictor of breast cancer screening practices in Caucasian women.

15. Methodology • Study Design • Multicorrelational cross-sectional research design • Sampling • Non-probability convenience sample • Inclusion/exclusion criteria • Instruments

16. Measurements • Breast Cancer Knowledge Test (BCK) (McCance et al., 1990) • Measures knowledge of detection and screening practices • Higher scores associated with greater knowledge • Demographic Questionnaire

17. Demographic Characteristics • Race – 53.7% AA; 46.3% Caucasian • Age – 44.7 ± 12.8 • Marital Status – 48.8% Married • 63.6% Annual Income ≥ $50,000 • Education • 37.7% College Graduate • 18.5% Completed Graduate School

18. Demographic Characteristics • Health Resource Variables • Health Insurance Coverage - 94.4% • Usual Source of Care – 90.1% • Health History • Family history of BC diagnosis (n = 58) • 43.1% Participates in BCSP • Family history of BC death (n = 28) • 46.4% Participates in BCSP

19. Breast Cancer Screening Practices

20. Breast Cancer Knowledge

21. H1 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in AA women. X2 = 1.816; df = 1; p = .178

22. H2 There is a positive relationship between breast cancer knowledge and breast cancer screening practices in Caucasian women. X2 = .065; df = 1; p = .799

23. H3 Breast cancer knowledge is a predictor of breast cancer screening practices in AA women. Total variance explained = 6.0%; variance unexplained = 94.0%.

24. H4 Breast cancer knowledge is a predictor of breast cancer screening practices in Caucasian women. Total variance explained = 0.0%; variance unexplained = 100.0%.

25. Discussion/Conclusions • Breast Cancer Screening Practices • Breast Cancer Knowledge • No significant relationship found • Caucasian women had higher mean scores • Demographics • Income • Education • Health Resources

26. Implications • Nursing Research • Nursing Practice • Nursing Education • Health & Wellness Model • Health Policy • Policy Initiatives • Funding for Research

27. Limitations • Use of self-report data • Non-probability convenience sample • Recruitment settings • Variability of study participants

28. Recommendations • Study designed to determine breast cancer screening practices over time utilizing a larger and ethnically diverse sample • Secondary analysis to determine if there are relationships between demographic variables, spirituality, and each method of breast cancer early detection • Develop and test culturally specific interventions that focus on increasing breast health and breast cancer screening practices

29. THANK YOU! QUESTIONS?