Doctoral Project Defense: Evelyn Addo-Wallace

Candidate: Evelyn Addo-Wallace

Major: Doctor of Nursing Practice

Advisor: Carol Taylor, Ph.D.

Title: Impact of Education for Evidence-Based Screening Mammography in Black Women Aged 40-49

Breast cancer is the most commonly diagnosed carcinoma in the United States (U.S.), accounting for 30% of all cancers diagnosed in women. While the incidence of breast cancer in Black and White women is similar, 12.7% and 13.1%, respectively, Black women have a 41% higher mortality rate. The disparity is because Black women are diagnosed at younger ages, later stages, with more aggressive cancer types, and have 10% lower 5-year survival for every stage of the disease. Federally qualified health centers follow breast cancer screening guidelines that do not recommend mammography before age 50, which may put Black women at a disadvantage and lead to persistent disparities.

This quality improvement (Q.I.) project aimed to evaluate the impact of an educational presentation on providers’ mammogram referrals for Black women seen at a federally qualified health center in the northeast U.S. The Q.I. project also aimed to assess the providers’ beliefs and attitudes before and after the education about their intention to change their referral practices using the Continuing Professional Development-Reaction Questionnaire (CPD-RQ).

Data were collected over 24 weeks. During the 12-week pre-education period, 253 de-identified charts were reviewed, and there was a 12.3% missed opportunity rate to refer Black women between the ages of 40-49 for a mammogram. Two hundred twenty-nine charts were reviewed post-education, and the missed opportunity rate dropped significantly to 7.4% (z=1.79, p=0.037).

The participants included ten medical providers who completed an adapted CPD-RQ following a 60-minute educational presentation. Providers reported referring all low-risk women annually for mammograms 100% of the time, with the primary guideline being the American College of Obstetrics and Gynecology. The highest scoring constructs for referring Black women were “Intention,” “Moral norm,” “Beliefs about Capabilities,” and “Beliefs about Consequences,” all scoring 100% post-education.

The results suggested the educational module positively impacted referrals for screening mammograms for Black women aged 40-49. They did not appear to affect the providers’ attitudes and beliefs regarding disparities in breast cancer morbidity and mortality or their intent to change practice, as the data suggested they were already referring all women beginning at age 40.