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Introduction

Breast cancer poses a great threat to human health globally. This has necessitated the need for awareness a bout the disease and how   it can be prevented inn due time. Breast cancer affect both men and women however more cases have been registered on women than men. Mammography is one of the preferred checks up which is normally used to detect strains of cancer virus in the body. This paper takes a critical evaluation, the aims, methods, analysis strategies and potential application only in the journal mammography decision making in older women with a breast cancer family history.

According to McCarthy, Burns, Freund, et al (2000) “in the year 2000, 51% of the estimated 3.8 million community-dwelling women aged 80 and older residing in the United States had received breast cancer screening with mammography in the previous 2 years”. Chu, Smart and Tarone, (1988) illustrates that “even among the 1.3 million oldest-old women with probable life expectancies of less than 5 years, 39% received screening mammograms despite little chance of benefit”. McCarthy, Burns, Freund, et al (2000) states that, “screening mammography has gone along way in the society and is popular among elderly women since Medicare first began paying for them in 1991”. The uncertainty that surrounds the importance of mammography screening for women aged 80 and above is depicted in practitioners’ guidelines. Most guidelines mammography screenings do not specify when one can stop going for screening.

Mammography Decision Making in Older Women with a Breast Cancer Family History Journal critical Analysis

Main Aim: The main aim of the study   is to describe and explain how women 55 years of age and older with a family history of breast cancer make screening mammography decisions.

Design: “A qualitative design based on grounded theory. This purposeful sample consisted of 23 women 55 years of age or older with one more first-degree relative diagnosed with breast cancer” (Greco,  Nail,  Kendall, Cartwright,  and Messecar, 2010). The qualitative design used in the study was applicable and relevant for this research. The choice was appropriate since some of the decision issues cannot be quantified.

Method and Strategy: “Open-ended interviews were conducted with 23 women 55 years of age and older with a family history of breast cancer using a semi-structured interview guide” (Greco,  Nail,  Kendall, Cartwright,  and Messecar, 2010).Opened ended interview was appropriate since it does not limit the scope of information gathered and the decision to semis-tructured the interview was excellent since it ensures that the interviewer does not go outside the topic. Data analysis using constant comparative analysis is good since it identifies conditions, actions, and consequences associated with participant's screening mammography decision making.

Findings: The study’s results that women continue to be aware of their breast cancer risk is  triggered by event such as having a family member diagnosed with breast cancer, resulting in women preventing cancer. This is true since the outcome alludes to Chu, Smart and Tarone, (1988) study findings.

 Clinical Relevance: “Women 55 years of age and older with a breast cancer family history need timely mammogram results, mammography reminders, and psychosocial support when undergoing a mammography recall or other follow-up tests” (Greco, Nail, Kendall, Cartwright, and Messecar, 2010).The clinical relevance of women aged 55 and above for mammography screening is 99.5% relevant this shows that the reach was done good since similar results within marginal error have also been achieved in other cases of mammography screening.

Merits associated with screening women aged 80 and over

 Mammography screenings is important to women aged 80 or older. This is because the process increase longevity and decrease morbidity caused by metastases from advanced breast cancers. According to (McCarthy, Burns, Freund, et al 2000) “anxiety related to false-positive mammograms, complications from follow-up procedures, finding breast cancers that might never have become clinically significant during a patient's lifetime, and morbidity associated with treating breast cancer among frail elderly women”.

Chu, Smart and Tarone, (1988) illustrates that, “even though there are difficulties associated with decision making around mammography screening for the oldest-old, little is documented about how these old women decide on screening, what risks and benefits they consider in their decisions and what role their physicians play”.

According to Chu, Smart and Tarone, (1988) “a family history of breast cancer is recognized as a strong risk factor for the disease”. “guidelines recommend that women with multiple affected close relatives, or with one first degree relative affected under the age of 40 years, should be offered annual screening by mammography” (Chu, Smart and Tarone, 1988).

The effect of cancer on women with a family history of breast cancer

A number of factors are affecting cost effectiveness of a service for women with a family history of breast cancer; these include psychological and financial. According to Chu, Smart and Tarone, (1988), “investigations carried out on patients, number of breast cancers detected, pathological stages of these cancers, cumulative costs of treatment and outcomes account for the burden felt by the patients and their families”.

Methodology

The methodology applied on the study included collection of patient-specific data from Tayside medical research ethics committee. During the study, “46 breast cancers were diagnosed among 42 women enrolled in the Tayside breast cancer family clinic surveillance programme” (McCarthy, Burns, Freund, et al 2000). The mean age at analysis and diagnosis was 48 years. In comparison, “it is identified that a consecutive series of 40 women diagnosed with breast cancer under the age of 50, in the same hospital, since 1995” (Greco,  Nail,  Kendall, Cartwright,  and Messecar, 2010).

In most instances, “the relative’s diagnosis had been recorded at first clinic attendance of our patient, confirmed in the course of family risk assessment and updated at subsequent annual clinic visits” (Greco,  Nail,  Kendall, Cartwright,  and Messecar, 2010).

 Data on result from the study are published for guidline. The findings in Greco, and Cartwright study “were compared with the much larger dataset compiled from several collaborating USA and European Cancer Family centres” (Greco,  Nail,  Kendall, Cartwright,  and Messecar, 2010).

Greco,  Nail,  Kendall, Cartwright,  and Messecar, (2010) , illustrates that,“the poor prognosis for breast cancer among young women unscreened and unselected for family history is well recognized 25 out of 27 and there substantial evidence that premenopausal women with a family history of breast cancer, enrolled in an annual screening programme, can expect a much better outcome”. “Our figures of 75% of breast cancers in such women being screen detected and 77% as small node negative tumours are conservative in comparison with recently published experience from one large clinic” (Greco,  Nail,  Kendall, Cartwright,  and Messecar, 2010).

Greco, Nail, Kendall, Cartwright, and Messecar, ( 2010), highlights that, “breast cancers in women with a family history of the disease tend to be of lower grade and to have a better predicted prognosis than sporadic tumours”

Greco, Nail, Kendall, Cartwright, and Messecar, ( 2010), illustrates that,

There are also data supporting the view that screening of women fewer than 50 irrespective of family history can achieve a stage shift in breast cancers at diagnosis. Our analysis of the outcomes for unscreened affected young relatives of our cohort with comparable familial risk shows that screening has a large beneficial effect. Of course the comparison is far from ideal.

 It is noted that, “Introduction of magnetic resonance imaging (MRI) scanning may change the evidence of survival benefit is awaited. Despite detection of their cancers at an apparently early stage small, node negative primary recurrence rate is noted to be very high” (Greco, Nail, Kendall, Cartwright, and Messecar, 2010)

In addition, chemotherapy method of treatment for BRCA1 which is linked to breast cancer depicts that observation of benefit of survival and may alter prognosis significantly.

Andersson, Aspegren, Janzon, et al (988) argues that, “the emotional price of annual screening, with attendant reminders of breast cancer risk and the anxiety that accompanies the wait for results, applies to all women enrolled in a family history surveillance programme”. “It is difficult to quantify the emotional and psychological cost but recent reviews conclude that the impact on general anxiety or cancer specific worry is broadly neutral and it is clear that women aware of their possible familial risk of reast cancer strongly favour access to regular mammography, regarding it as a comfort rather than a source of anxiety” (McCarthy, Burns, Freund, et al 2000).

McCarthy, Burns, Freund, et al (2000) highlights that, “health insurance charges to measure costs of screening, and assumed a 75% cure rate for women who developed breast cancers while in a surveillance programme— not very different from what has subsequently been observed”.

McCarthy, Burns, Freund, et al (2000) states that, “Two Canadian studies undertaken a decade ago alludes to the fact that costs of management of advanced breast cancer are much higher than at the onset of the disease”.

The successful design, development and implementation of management decisions are very complex and at times daunting tasks for many managers, more so in the provision of health care insurance program, (McCarthy, Burns, Freund, 2000)

Usually, managers will be faced with daily problems that require the application of tools that will ensure for the successful operations irrespective of the sectors they manage such as the identification of the objectives of the organization, alternative means of achieving the stated objectives and the selection of the means that accomplish the objectives in the most efficient manner. Towards this the application of probability concepts in decision making is inevitable. This paper takes a succinct analysis of the decision a medical health care provider takes in a situation where the cost of health care provision or insurance is rising. 

Today, due to the national decline in health status and increase in health care costs, employers have been forced to implement worksite wellness and health promotion programs with more clinical rigor. The focus is anchored on the platform of deflating high costs and is structured towards overall wellbeing, with ‘financial bearings never far behind” (Steel, 1998). Steel, (1998) illustrates that, “the existence of these programs reflects the gradual shift in responsibility for health care from government to employer and from the health care industry to its consumers over the last 25 years”. “Industry’s burden is multifaceted, placing most businesses in a quandary when it comes to providing health care to its employees” (Steel, 1998).

The changes in lifestyle have particularly impacted the health of workers and the entire population at large. Poor nutrition, lack of exercise, stresses in the work place, and drug and substance abuse, to name a few issues, predisposes the population to a higher risk of developing complications that may require health care interventions. “The sum of a more immobile population, a variable in fitness climate, a more complex disease base, and an increase in health care expenditure have equaled to a heavier financial burden for employers” (Steel, 1998). Steel, (1998) States that, “the interest in the health and wellness of Americans may therefore be grounded in financial incentives.” There is the belief that potential improvement to personal wellness and organizational finance can be realized through these initiatives (McPherson, Swenson, Lee, 2002).

A number of researchers are on the view  that, early provisions of worksite wellness and health promotion programs as an intervention strategy that can be used to change the behavior of those struggling with common conditions such as asthma, diabetes, heart failure and coronary heart diseases, towards positive outcomes. As has been noted by McCarthy, Burns, Freund, (2000) many employees are “known to engage in behaviors that puts their health at risk.” For instance, McCarthy, Burns, Freund, (2000) have compiled statistics indicating that 9 percent of adults do not engage in any leisure-time physical activity; 11.8 percent of adults engage in vigorous leisure-time physical activity at least five times per week; nearly 6 in 10 adults are overweight, with 23 percent considered obese; and current adult smokers comprise 21.5 percent of the population, and an additional 22 percent are former smokers. 

 McCarthy, Burns, Freund, (2000) observes that, “the findings got suggest the need for health education, early detection and appropriate interventions and health programs in order to maximize returns on investments in wellness programs”. As McCarthy, Burns, Freund, (2000) observes, “many companies now conduct health screenings at the office or plant site while others reimburse employees for the cost of annual exams”. “This has been brought about by the realization that while early detection may cost $15,000 in surgical costs, the health care costs for acute disease are much higher averaging $40,000 per incidence” (McCarthy, Burns, Freund, 2000).A general concurrence on the need to improve health and wellness programs abides. The initiatives towards health care and wellness programs arises from the backdrop that preventive health care can act as a cornerstone on the basis of which efforts to reduce expenditures on health, enhance employees performance and improve company profits con be congregated.

Factors which affect and influence decision making among aged women to go for Mammography screenings

The decision to embrace mammography among aged women with family history of breast cancer is full of mixed reaction. A number of issues are suggested to be at centre stage in influencing the decision of old women to go for mammography. These reasons include; the need to increase ones life expectancy, advice from close relatives, advice from doctors among others.

Conclusion

Cancer disease is a big threat to human life and calls for greater attention to all stakeholders. Older women are always faced with challenging task of detecting, managing and curing of the disease. The paper discusses some of the challenges faced by older women in deciding whether to embrace mammography or not. In addition, the essay further examines the methodology used in collecting data, counseling, data analysis and interpretation. Towards this it is prudent to note that all people in the society are required to take a bold step towards cancer awareness and eradication.

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