Preparing African American women for breast biopsy.

Breast cancer, the second leading cause of cancer deaths among African American women,1-3 is commonly diagnosed as a result of a biopsy procedure performed as follow-up to an abnormal mammography result.4,5 Lack of knowledge, anxiety about undergoing breast biopsy, and inadequate social support have been associated with delay in screening and follow-up.6-9 There have been a number of calls for interventions that would help to address psychosocial issues related to breast biopsy and to minimize delay in diagnosis.10-13 However, little research has been reported on the development of effective, theory-based methods for addressing these issues. In this paper we present results of a pilot study, Breast Biopsy Education Study, which was intended to develop and test methods to prepare African American women for the breast biopsy experience. Specific aims of the Breast Biopsy Education Study were (1) to test the feasibility of enrolling African American women in an educational counseling intervention, (2) to develop a brief educational counseling intervention that involves a trained nurse educator and an African American woman who has been recommended to have a breast biopsy, and (3) to assess intervention effects on biopsy-related knowledge, affective moods, and perceived social support among participating women. The pilot study was designed as a one-group, pretest/posttest study. Eligibility criteria for participation included being an African American woman aged 40 to 74 years with no personal history of breast cancer and having a recommendation to undergo a breast biopsy to follow up an abnormal mammography result. Study participants were patients identified at the Breast Imaging Center of a university hospital located in an urban area of the northeastern United States. The educational intervention was developed using the preventive health model, which is based on selfregulation theory.14 Self-regulation theory asserts that cognitive and psychological representations (ie, mental images) affect personal anticipatory reactions to a pending experience.15,16 Intervention materials developed and pretested for acceptability, relevancy, usefulness, understandability, and ease of administration17 included a 20-page informational booklet, Having a Breast Biopsy: Plain Talk for Women Who Have Been Advised to Have a Breast Biopsy, and a brief in-person educational counseling session conducted by a nurse educator. Consistent with self-regulation theory, the booklet, written at an 8th-grade reading level, provides concrete objective information about steps involved in preparing for a breast biopsy experience. It also includes descriptions of major types of breast biopsy procedures and information intended to acknowledge and address affective representations about the breast biopsy experience. The counseling session engaged patients in considering how to manage personal informational, emotional, and support needs.