New surgical breast cancer patient education program: A joint quality improvement initiative

Breast cancer is the second most common cancer in American women, according to the American Cancer Society, with 13 percent of women developing breast cancer in their lifetime. Although extensive education materials are available on breast cancer, the American College of Surgeons (ACS) Division of Education’s Surgical Patient Education Program found a gap in materials available for the surgical community to use to educate and enable surgical decision-making for women with breast cancer.

A literature review on informed consent and breast cancer surgery found that only 47 percent of lumpectomy and 67 percent of mastectomy patients felt fully informed and felt an urgency to plan for their operation. A recent ACS survey confirmed that only 15 percent of surgeons and nurses include all ACS-recommended guidelines in their print materials. Although education on breast cancer is available, it is often accompanied by fundraising efforts and provides limited information on the preparation, diagnostic tests, surgical procedures, new targeted therapy agents, hospital treatment course, or discharge education.

Your Breast Cancer Surgery Program uses scientifically derived skill development techniques, engaging instructional media, and checklists to carefully coach patients into becoming fully informed and active participants in their care and best recovery. The program was developed with input from the American Society of Breast Surgeons, the Commission on Cancer (CoC), the National Accreditation Program for Breast Centers (NAPBC), the American Society of Plastic Surgeons, and The American Physical Therapy Association and reviewed by NAPBC patient support groups, plus a trial group of 50 laypersons. The program is in a convenient digital format, easily accessible on tablets and smartphones. It offers information on preoperative prep, cancer staging, targeted immunotherapy options, procedure overview, potential risks, discharge, home care, and survivorship plans.

Surgeons are committed to providing the best education for their patients and meeting all the standards and guidelines from the various accreditation bodies. The Health Information National Trends Survey identified the trust patients have in their physicians, and since 2018, 94.2 percent of Americans have reported that they trust information provided by their physician versus 70 percent who say they trust government agencies and 64 percent who trust the Internet.

One of the goals of this program was to provide surgeons with accessible content that met the Affordable Care Act requirements for Info Button-enabled information integrated into the electronic medical record and that could be printed or e-mailed to the patient at the point of care. It also meets NAPBC Standard 2.17 for providing culturally appropriate educational resources for patients along with a process to provide them. The program includes education on nearly every standard, such as breast cancer staging, the pathology report, needle biopsy, genetic treatments, clinical trials, and surgical procedures. All materials meet the guidelines for health literacy, informed consent, and surgical safety.

From a hospital perspective, patient-centered education increases patient and physician satisfaction, improves clinical outcomes, and decreases the likelihood of litigation. Ensuring safe and seamless transitions starts before hospital discharge, according to research included in Advances in Patient Safety: From Research to Implementation (Volume 1: Research Findings). Transitioning patients from the hospital to other care settings is a dynamic, multifaceted process in which health care systems, hospitals, providers, patients, and their families share increasing responsibility. Better-informed patients and caretakers are less likely to experience medical errors by offering another layer of protection.

The surgical community is receptive to offering comprehensive education and desires to go beyond binders stuffed with a plethora of materials. In a recent ACS survey, 98 percent of surgeons and nurses requested help from the ACS to develop quality multimedia patient education and skills training materials that meet the needs of all levels of learners. Development of a print copy of the Patient Guide is under way, along with a plan to translate the program into Spanish. Broadcast rights also are available for hospital networks. The ACS Your Breast Cancer Surgery Program will be distributed throughout the Commission on Cancer and used as a credentialed course model for surgical professionals to educate patients with breast cancer. Evaluation data will include behavioral outcomes (preoperative prep, activity score, home care compliance); affective outcomes (confidence, patient satisfaction); and clinical outcome data (complication rate, length of stay, frequency of use of additional services postoperatively).

The ACS has recognized through its successful skills series of programs, which include Ostomy, Feeding Tube, Central Line, Wound Care, and Lung Surgery, that safety is enhanced when patients and families can anticipate what is likely to happen and have the knowledge and skills needed for decision-making and full participation in care during hospitalization and their recovery. Allowing patients to review disease and procedure information with images in advance of meeting with a surgeon supports effective communication and is associated with greater participation, increased satisfaction, and higher rates of compliance.

The program can be viewed here. For information about other skills programs, click here, or contact Nancy Strand MPH, RN, at [email protected].