Abstract: Comparisons Between Pediatricians’ and Nurses’ Evaluations and Implementation of a Training on Breast Cancer and the Environment

◆ Josephine K. Boumis, Michigan State University
◆ Brandon M. Walling, Michigan State Univeristy
◆ Brandon Thomas, Michigan State University
◆ Daniel Totzkay, West Virginia University
◆ Sandi W. Smith, Michigan State University
◆ Kami J. Silk, University of Delaware

Pediatricians and pediatric nurse practitioners are often referred to as gatekeepers of information, giving them the power to choose topics to discuss with young patients and their caregivers. One in eight women experience breast cancer at some point in their life, and recent findings establish the link between environmental and life style risk factors for young girls and their breast cancer risk across their lifespan. The Breast Cancer and Environment Research Program (BCERP) links environmental risk factors to breast cancer and communicates these findings to help pediatricians (Ps) and nurse practitioners (NPs) inform young women and their caregivers about environmental risks during critical periods in the young women’s lives. One way to reach providers is through continuing medical education (CME).

An interdisciplinary team of communication researchers, scientists, and advocates from the BCERP collaborated to create a CME training program for pediatric health care providers about environmental risk factors and communication strategies necessary to disseminate the information to young patients and their caregivers. Fifty Ps and 50 NPs evaluated the accredited CME training program.
Previous research indicates that there may be differences between how Ps and NPs approach diagnoses and care. Therefore, this paper aims to explore potential differences between the evaluation and implementation of the training between Ps and NPs. Quantitative and qualitative assessments of knowledge, attitudes, behavioral intentions, and behavior over multiple time periods were analyzed. All participants also answered open-ended questions concerning the changes they intend to make in their practices, the behaviors they integrated into their practice three weeks post training, any barriers they encountered in making the changes, three memorable takeaways, and feedback about the training.

The current study considered both the quantitative and qualitative measures to compare evaluations and implementation of the training between Ps and NPs. Overall, there was more knowledge gained over time for Ps compared to NPs, however, NPs scored higher than Ps in attitudes, intention, and behavior. Interestingly, the regression model predicting behavior from knowledge, attitudes, and intentions was statistically significant for Ps, but not for NPs.

Despite differences found in the quantitative measures, qualitative analyses of the open-ended items demonstrated that the two groups responded similarly to the training. Both groups reported that the biggest barriers to integrating the information in their practice was time with patients, however both also reported that they plan to discuss environmental exposures in well-child visits. When asked about memorable lessons from the training, both groups recalled information about risks for breast cancer, however more NPs specifically mentioned one key concept, “windows of susceptibility.” Both groups provided positive feedback about the training, mentioning that it was “very informative,” “well organized” and “easy to follow.” The findings from the current study exemplify that the differences and similarities between Ps and NPs are complex, however it is possible to create CME training programs that are beneficial and effective to both parties.