title: Breast self-examination education for BRCA mutation carriers by clinical nurse specialists.
abstract: OBJECTIVE
  Breast self-examination (BSE) may be beneficial for women with a BRCA1 or BRCA2 mutation. Therefore, these women are often advised to perform BSE. However, only 20% to 35% is performing BSE monthly, and proficiency levels are low. Recently diagnosed carriers are educated by a specially trained clinical nurse specialist (CNS) on how to perform BSE, as part of the yearly surveillance. Clinical nurse specialists are already commonly involved in breast cancer care. However, CNSs are not yet involved in the counseling of BRCA mutation carriers. The aim of this RCT was 2-fold: (1) to evaluate the feasibility of CNS-led BSE education (based on the Health Belief Model) as part of BRCA surveillance and (2) to evaluate the effects and feasibility of additional written information leaflets concerning BSE.
  
  
  METHODS
  Thirty-seven female BRCA1 or BRCA2 mutation carriers were randomized into the intervention or control group. Women in both groups were educated about BSE by a specially trained CNS during the yearly visit to the outpatient clinic. The intervention group received additional written BSE instructions. After 3 months, 29 patients filled out a questionnaire, covering demographic characteristics, BSE behavior, and patient satisfaction.
  
  
  RESULTS
  The BSE frequencies did not significantly differ between both groups. A significant increase in the self-reported frequency of BSE after CNS-led education (P < .001) was shown. Before the education, the main reason for not performing BSE was that women had felt unable to perform BSE (42.9%). Patient satisfaction with the CNS-led education was high.
  
  
  CONCLUSIONS
  CNS-led BSE education is feasible for the yearly breast surveillance of BRCA mutation carriers. In addition, a leaflet was shown to be useful as an additional source of information for patients.
  
  
  CONCLUSIONS
  These results indicate that it is feasible to involve a CNS in the yearly surveillance of BRCA mutation carriers, which could be a solution for the continuous increased demand for care, while providing continuing high-quality care.
authors: Author Affiliations: PhD Student (Ms Visser), and Professor in Psychosocial Oncology, Clinical Psychologist, and Head of Department (Dr Prins), Department of Medical Psychology; Clinical Nurse Specialist (Ms Bos) and Medical Oncologist (Dr Laarhoven), Department of Medical Oncology; Professor in Hereditary Cancer, Medical Specialist for Internal Medicine, and Head of Outpatient Clinic for Hereditary Cancer (Dr Hoogerbrugge), Department of Genetics, Radboud university medical center Nijmegen; Professor in Translational Oncology and Medical Oncologist (Dr Laarhoven), Academic Medical Center, University of Amsterdam, Amsterdam, the Netherlands.
authors: Annemiek
authors: A
authors: Visser
authors: Wilmy C A M
authors: WC
authors: Bos
authors: Judith B
authors: JB
authors: Prins
authors: Nicoline
authors: N
authors: Hoogerbrugge
authors: Hanneke W M
authors: HW
authors: van Laarhoven
mesh_terms: D001943:Breast Neoplasms / Q000235:genetics* / Q000517:prevention & control; D016504:Breast Self-Examination / Q000706:statistics & numerical data; D005240:Feasibility Studies; D005260:Female; D005500:Follow-Up Studies; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D020022:Genetic Predisposition to Disease; D006579:Heterozygote; D006801:Humans; D009154:Mutation; D009720:Nurse Clinicians; D009723:Nurse-Patient Relations; D015403:Nursing Evaluation Research; D010353:Patient Education as Topic / Q000379:methods*; D017060:Patient Satisfaction / Q000706:statistics & numerical data; D057832:Watchful Waiting