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A Survey of the Awareness and Educational Needs of Nurses in Nagasaki Prefecture Regarding Hereditary Breast and Ovarian Cancer

A Survey of the Awareness and Educational Needs of Nurses in Nagasaki Prefecture Regarding... The aim of this study was to evaluate the knowledge and educational needs with regard to hereditary breast and ovarian cancer among nurses working in breast cancer care in the Nagasaki Prefecture. In breast cancer care, the identification of patients at risk for hereditary breast and ovarian cancer is necessary for the implementation of genetic testing and counseling. Nurses should be involved in this process, since they play a crucial role in the care of patients with breast cancer. However, the knowledge regarding hereditary breast and ovarian cancer among nurses working in oncology care in Japan has not been assessed. The design of this study is cross-sectional design. We distributed 597 surveys to nurses working in breast cancer care. The surveys assessed the nurses’ demographic data, their current knowledge and practices regarding cancer genetics and hereditary breast and ovarian cancer, and their attitude and preferences regarding learning about the condition. We received 317 valid replies. Nurses had limited knowledge about hereditary breast and ovarian cancer characteristics: 41.6% reported that they do not know about the condition, whereas less than 10% knew its characteristics. However, nurses were aware of hereditary breast and ovarian cancer significance and were willing to learn about it: 91% wished to learn about the condi- tion, and 88.6% wanted to participate in study group meetings. Further, nurses’ preferences regarding educational programs were clarified. Overall, our results show that educational programs should be implemented to advance nurses’ knowledge of hereditary breast and ovarian cancer characteristics. Keywords Educational program · Genetic screening · Hereditary breast and ovarian cancer · Oncology nurses Introduction 3]. The identification of patients with breast and/or ovarian cancer at high risk for HBOC is important to ensure appro- Breast cancer is one of the most prevalent cancer types priate genetic testing and counseling. Moreover, there is a worldwide [1]. Hereditary breast and ovarian cancer high burden of need for genetic testing in patients at risk (HBOC) syndrome is an inherited genetic condition asso- for HBOC [4]. To ensure adequate screening, genetic test- ciated with an increased risk of breast and ovarian cancer. ing, and counseling for HBOC, healthcare providers should Most cases of HBOC are caused by mutations in the breast have sufficient knowledge in the field of cancer genetics and cancer 1 (BRCA1) or breast cancer 2 (BRCA2) genes [2, genomics [5]. However, many healthcare professionals do not receive sufficient training in genetics and genetic testing, which increases the risk of errors [6, 7]. * Megumi Matsumoto Nurses play a critical role in the care of patients with mmatsumoto@nagasaki-u.ac.jp breast cancer; therefore, they should be closely involved in Department of Surgical Oncology, Nagasaki University screening for patients at high risk for HBOC. However, a Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, survey conducted with Turkish oncology nurses showed Nagasaki City, Nagasaki 852-8501, Japan that their knowledge of cancer genetics was only moder- Department of Reproductive Health, Institute ate [8, 9]. Similar findings were obtained in a Brazilian of Biomedical Science, Nagasaki University, Nagasaki City, study, which found that the majority of nurses had not Nagasaki 852-8501, Japan 3 identified or referred a patient for specialized risk assess- Department of Nursing, Nagasaki University Hospital, ment due to a genetic risk [10]. Only a few studies have Nagasaki City, Nagasaki 852-8501, Japan Vol.:(0123456789) 1 3 Journal of Cancer Education assessed the knowledge of healthcare providers in Japan Study Survey regarding HBOC screening, testing, and counseling, and none focused on nurses. A previous investigation found The survey was developed by the authors of this study and that although there was an awareness of the significance of included 14 questions. The first part of the survey (questions HBOC testing among Japanese healthcare providers, it was 1–4) gathered information about the participants’ age, sex, generally not sufficiently implemented in practice, and there professional qualifications, and current work situation. The was a need to further educate nurses. However, that study second part (questions 5–10) inquired about nurses’ current primarily assessed the knowledge and educational needs of knowledge and practices regarding cancer genetics and HBOC. clinical geneticists, other physicians, and genetic counse- These questions clarified whether the nurses had been involved lors, whereas only 2.4% of the respondents were nurses [11]. in breast cancer care and for how long, whether and to what Moreover, in a study limited to physicians, genetics training extent they had collected the family history of patients with and continuing medical education were associated with bet- breast cancer, whether and to what extent they were aware ter knowledge of HBOC risk assessment [12]. of HBOC, and whether they had received a question or con- The authors’ institution has the capacity to construct sultation request regarding genetics by a patient with breast a medical care system for HBOC primary screening and cancer. The third part of the survey (questions 11–14) assessed identification, risk assessment, genetic counseling, genetic whether nurses had had the opportunity to learn about HBOC, testing, surveillance, and management of risk-reducing sur- whether they wanted to learn about it, what their motivation gery. However, even though it is the only institution capable for learning was, and what their preferred learning format was. of providing HBOC care in the prefecture, there have been few cases of genetic counseling (47 cases between 2014 and Statistical Analysis 2016). Hospitals in the prefecture, including this institution, have not yet succeeded in placing appropriate cases on the The multiple-choice questions included in the survey were care flow as HBOC cases. assessed with descriptive statistics, whereas the open-ended In addition to their knowledge of HBOC, the educational questions were evaluated using content analysis. needs of nurses working in breast cancer care should also be assessed. The necessity for further genetic education has Results previously been described among nurses in other settings [13]. However, the knowledge and specific educational needs Participants’ Characteristics of nurses working in cancer care in Japan have not been analyzed. The majority of the participants were women (97%). More The aim of this study was to gain insight into the level nurses worked in a ward (70%) than in an outpatient setting of understanding, interest, and educational needs of nurses (27%). The most prevalent duration of experience working regarding HBOC by conducting a survey among nurses with breast care was 1–5 years (47% of nurses working in working in the field of breast cancer care in Nagasaki wards and 59% of nurses working in outpatient units) (Sup- Prefecture. plementary Table S1). Nurses’ Practices with Respect to Family History Assessment Materials and Methods Slightly more than half of the nurses (52%) participating in Study Design and Participants the study reported that they were aware of the family history of patients with cancer. Moreover, 63% responded that they Nurses working in the field of breast cancer care at 23 insti- asked patients with cancer about their family history. However, tutions in Nagasaki Prefecture were contacted for participa- only 23% of nurses who recorded a family history also asked tion in this descriptive study. The study was approved by about the family history of extended family members up to the Ethics Committee of the Nagasaki University Hospital. third-degree relatives (Table 1). It was conducted between June 1, 2016 and November 30, 2016. A questionnaire was distributed via physicians at each Nurses’ Knowledge and Practices with Respect institution, and answers were collected from each respondent to HBOC and Its Screening by mail. By mailing in their replies, the respondents were deemed to have provided consent. The total number of dis- When the nurses were asked whether they knew about tributed questionnaires was 597, while the number of valid HBOC, 41.6% reported that they did not know about it, responses was 317 (53.1%). 1 3 Journal of Cancer Education Table 1 Current practices of the Questions Possible answers Rates nurses with respect to family history Do you ask about the family history of patients? (n = 317) Yes 63% No 36% Unknown 1% Do you ask about the family history of the extended family members up to the Yes 23% third-degree relatives? (If the answer to the previous question is yes, n = 199) No 75% Unknown 2% When you see a cancer patient, are you aware of their family history? (n = 317) I am aware 52% I am not aware 48% questioned (86.6%) or to implement it in nursing (53.4%) (Table 2). The topics nurses wanted to learn about included the pathology of HBOC (76%), basic information about inher- itance (68.5%), the reality of HBOC care (61.5%), genetic testing (47.6%), and genetic counseling (33.1%). The major- ity of nurses were interested in hour-long study sessions. The internet (85.5%) and journals (70.3%) were the most frequently used sources for learning (Table 2). Discussion Fig. 1 The degree of nurses’ knowledge regarding hereditary breast The current study found that knowledge regarding HBOC and ovarian cancer among Japanese nurses working in the field of breast cancer care is limited, whereas their interest in learning more about whereas 58.4% reported that they did. However, fewer than it is pronounced. In this study, the nurses had limited knowledge of HBOC 10% of the respondents knew about the characteristics of HBOC or the characteristics leading to suspicion of HBOC inheritance. These findings agree with previous publications, which showed limited knowledge of hereditary breast can- (Fig. 1). Open-ended questions were also asked about the knowl- cer/HBOC among nurses in Brazil and Turkey, especially with respect to genetic counseling [9, 10]. Our study was edge and practices of nurses with respect to questions or consultation requests concerning genetics by breast cancer based on self-assessment of HBOC knowledge among nurses. However, the utilization of objective assessment patients (Supplementary Table  S2). The most frequently asked question was “Can my close relatives (especially my tools may provide more reliable information. Such tools should focus on examining nurses’ knowledge of cancer daughter) inherit the cancer from me?” The most common answer to this question was “I recommended a self-exami- genetics and HBOC. A range of factors should be assessed, including knowledge of the risk factors, epidemiology, nation and a breast cancer screening test.” inheritance patterns, screening, diagnosis, and treatment for HBOC. Similar questionnaires have been developed and Attitudes of Nurses Regarding Learning About have been successfully implemented to assess the knowl- edge of nurses regarding hereditary breast cancer [9, 10]. HBOC Moreover, future studies should compare HBOC awareness between nurses from cancer centers that have and have not Ninety-one percent of the participants in the survey were willing to learn about HBOC; furthermore, 88.6% of the implemented HBOC educational programs. The nurses were aware of the significance of HBOC respondents wished to participate in HBOC study group meetings. However, before the survey, the majority of awareness and screening. A previous study showed that involving nurses in screening for HBOC could help iden- respondents had had the opportunity to learn only about breast cancer (62%) but not about heritability (3%). The tify patients who required further testing [14]. Moreover, nurses’ knowledge regarding pharmacogenetics and phar- most important reasons for wishing to learn were wanting to utilize this knowledge to provide information when being macogenomics in general may improve patient outcomes 1 3 Journal of Cancer Education Table 2 Nurses’ attitudes regarding learning about inheritance and hereditary breast and ovarian cancer (HBOC) Questions Answers Rates Have you had an opportunity to learn about cancer and inherit- I only had an opportunity to learn about breast cancer 62% ance? (n = 317) I only had an opportunity to learn about inheritance 3% I had an opportunity to learn about both 9% I have had neither learning opportunity 26% Do you wish to learn about HBOC? (n = 317) Yes 91% No 8% Unknown 1% Reasons for wishing to learn (n = 281) I would like to utilize what I learn to provide information when 86.6% being questioned I would like to implement what I learn in nursing 53.4% It is useful for me and people close to me, such as relatives 31.4% It is a hot topic these days 15.2% Reasons for not wishing to learn (n = 26) I do not feel a particular need to learn 11 I am not interested 9 There is no established system yet, etc 6 Topics nurses want to learn about (n = 281) HBOC pathology (incidence rates of cancer, inheritance, etc.) 76.0% Basic information about inheritance 68.5% The reality of HBOC care (identifying patients, asking about the 61.5% family history, etc.) Genetic testing 47.6% Genetic counseling 33.1% Do you wish to participate in a study group meeting on HBOC? I wish to participate 88.6% (n = 317) I do not wish to participate 7.9% Unknown 3.5% How long should the study group meeting sessions be? Less than 30 min 12.5% 1 h 62.1% 2 h 12.8% Over 2 h 1% Unknown 11.6% Wishes for the study group meetings (open-ended) Short duration/multiple times/serialization e-Learning/on-demand/live Inclusion of physicians Provision of documents Q&A of frequently asked questions Held on weekends/in the evenings after work How do you check on what you do not know during nursing work? Internet 85.5% (n = 317) Journals (nursing journals, academic journals, etc.) 70.3% Questioning an acquaintance 36.0% [15]. Therefore, the results of the present and previous The development of web-based educational interven- studies indicate that genetics and genomics knowledge is tions in the fields of genetics and genomics is an area of critical for oncology nurses [16]. active research [17]. Standards for the core competencies The current study found that nurses are motivated of healthcare professionals in the field of genomic medicine to learn about HBOC characteristics, mainly to answer have been established to serve as a basis for the development patients’ questions and to implement the newly acquired of educational programs [18]. These standards relate to the knowledge in nursing. Previous studies also found that the domains of knowledge, attitudes, and abilities [5]. Educa- majority of nurses are motivated to continue their educa- tional genetics interventions, including interactive work- tion in the field of cancer genetics [9 , 10]. shops and PowerPoint modules, have also been developed 1 3 Journal of Cancer Education Takeshi Nagayasu: Supervision and have shown to be effective in educating primary health- care providers [19]. In this survey, the nurses reported that Data Availability All data generated or analyzed during this study are they used the internet as a primary source of learning. In included in this published article (and its supplementary information Nagasaki Prefecture, there are many minor islands, and files). interactive study group meetings via e-learning and internet are being considered by our team and institution, including Code Availability Not applicable. in remote areas. Promoting nurses’ knowledge of cancer genetics will also Declarations have beneficial effects on patient education. For example, Ethics Approval Nurses working in the field of breast cancer care at 23 education for breast self-examination of women and BRCA1 institutions in Nagasaki Prefecture were contacted for participation in or BRCA2 mutations has been proven to be feasible [20]. this descriptive study. The study was approved by the Ethics Committee This study has several limitations. First, it used self-report of the Nagasaki University Hospital. measures to assess nurses’ awareness of HBOC. These find- Consent to Participate A questionnaire was distributed via physicians ings should be confirmed through more objective assess- at each institution, and answers were collected from each respondent ments. Second, it did not directly evaluate the effect of by mail. By mailing in their replies, the respondents were deemed to nurses’ knowledge regarding HBOC on the effectiveness of have provided consent. patient screening and the identification of patients at high Consent for Publication The consent for publication was not required risk for HBOC. Third, even though it assessed nurses’ pref- as no intervention occurred. erences regarding the development of an educational pro- gram, further studies should determine the optimal design Conflict of Interest The authors declare no competing interests. of the program. Open Access This article is licensed under a Creative Commons Attri- bution 4.0 International License, which permits use, sharing, adapta- tion, distribution and reproduction in any medium or format, as long Conclusion as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes The results of this awareness survey among nurses work- were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated ing in breast cancer care institutions in Nagasaki Prefecture otherwise in a credit line to the material. If material is not included in indicate that most nurses do not know about the disease the article’s Creative Commons licence and your intended use is not characteristics and inheritance patterns of HBOC but are permitted by statutory regulation or exceeds the permitted use, you will eager to learn about them. Therefore, further focused learn- need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. ing opportunities should be provided to nurses working in breast cancer care. Supplementary Information The online version contains supplemen- References tary material available at https://doi. or g/10. 1007/ s13187- 022- 02132-4 . 1. Harbeck N, Penault-Llorca F, Cortes J, Gnant M, Houssami N, Acknowledgements We thank the institutions that participated in this Poortmans P, Ruddy K, Tsang J, Cardoso F (2019) Breast cancer. study: Imamura Women’s Clinic, Inoue Hospital, Isahaya General Hos- Nat Rev Dis Primers 5(1):66 pital, Itoyanagi Breast Clinic, Izumikawa Hospital, Kobayashi Hospi- 2. Petrucelli N, Daly MB, Pal T (1998) [updated 2016 Dec 15]. tal, Kouseikai Hospital, Menoto Clinics, Nagasaki Ekisaikai Hospital, BRCA1- and BRCA2-associated hereditary breast and ovarian Nagasaki Genbaku Hospital, Nagasaki Harbor Medical Center, Naga- cancer. In: Adam MP, Ardinger HH, Pagon RA, Wallace SE, Bean saki Kamigoto Hospital, Nagasaki Kawatana Medical Center, Nagasaki LJH, Mirzaa G, Amemiya A (eds) GeneReviews® [Internet]. Uni- Medical Center, Nagasaki Rosai Hospital, Nagasaki University Hos- versity of Washington, Seattle; pp: 1993–2021 pital, Nijigaoka Hospital, Sasebo City General Hospital, Sasebo Chuo 3. Yoshida R (2020) Hereditary breast and ovarian cancer (HBOC): Hospital, Saiseikai Nagasaki Hospital, St. Francis Hospital, Uga Surgi- review of its molecular characteristics, screening, treat- cal Clinic, and Yutaka Fukuda Clinic. Editorial support, in the form of ment, and prognosis. Breast Cancer. https:// doi. or g/ 10. 1007/ medical writing, table assembly, and creation of high-resolution images s12282- 020- 01148-2 based on the authors’ detailed directions, collation of author comments, 4. Singh N, Shukla S, Agrawal S, Singh U, Kumar V (2019) Assess- copyediting, fact checking, and referencing, was provided by Editage, ment of high risk of hereditary breast and ovarian cancer (HBOC) Cactus Communications. and acceptance for genetic testing among cases of ovarian and breast cancer in Indian set-up. Indian J Gynecol Oncol 17:35 Author Contribution Megumi Matsumoto: Conceptualization and for- 5. Tognetto A, Michelazzo MB, Ricciardi W, Federici A, Boccia S mal analysis (2019) Core competencies in genetics for healthcare professionals: Noriko Sasaki: Methodology and formal analysis results from a literature review and a Delphi method. BMC Med Yayoi Tsukigawa: Investigation and data curation Educ 19(1):19 Hiroshi Yano: Investigation Ryota Otsubo: Investigation 1 3 Journal of Cancer Education 6. Brierley KL, Blouch E, Cogswell W, Homer JP, Pencarinha D, care nurse navigation at mammography and imaging centers. J Stanislaw CL, Matloff ET (2012) Adverse events in cancer genetic Natl Black Nurses Assoc 26(2):17–26 testing: medical, ethical, legal, and financial implications. Cancer 15. Dodson CH (2017) Pharmacogenomics: principles and relevance J 18(4):303–309 to oncology nursing. Clin J Oncol Nurs 21(6):739–745 7. Nair N, Bellcross C, Haddad L, Martin M, Matthews R, Gabram- 16. Eggert J (2017) Genetics and genomics in oncology nursing: what Mendola S, Crane B, Meaney-Delman D (2017) Georgia primary does every nurse need to know? Nurs Clin N Am 52(1):1–25 care providers’ knowledge of hereditary breast and ovarian cancer 17. Dumo AM, Laing B, Lim AG, Palaganas E, Abad PJ, Valdehueza syndrome. J Cancer Educ 32(1):119–124 O, Palovaara M, Saunders H, Estola M, Mandysova P, Maguire 8. Seven M, Akyüz A, Elbüken B, Skirton H, Öztürk H (2015) J, Ward LD, Carlberg C, Vehviläinen-Julkunen K (2020) Rand- Nurses’ knowledge and educational needs regarding genetics. omized controlled trial on the effectiveness of web-based Genom- Nurse Educ Today 35(3):444–449 ics Nursing Education Intervention for undergraduate nursing stu- 9. Seven M, Pasalak SI, Guvenc G, Kok G (2017) Knowledge level dents: a study protocol. J Adv Nurs 76(11):3136–3146 and educational needs of Turkish oncology nurses regarding the 18. Skirton H, Lewis C, Kent A, Coviello D (2010) Genetic education genetics of hereditary breast and ovarian cancer. J Contin Educ and the challenge of genomic medicine: development of core com- Nurs 48(12):570–576 petences to support preparation of health professionals in Europe. 10. Prolla CM, da Silva PS, Netto CB, Goldim JR, Ashton-Prolla P Eur J Hum Genet 18(9):972–977 (2015) Knowledge about breast cancer and hereditary breast can- 19. Carroll JC, Rideout AL, Wilson BJ, Allanson JM, Blaine SM, cer among nurses in a public hospital. Rev Lat Am Enfermagem Esplen MJ, Farrell SA, Graham GE, MacKenzie J, Meschino W, 23(1):90–97 Miller F, Prakash P, Shuman C, Summers A, Taylor S (2009) 11. Terui-Kohbata H, Yoshida M (2017) Current condition of Genetics education for primary-care providers: improving atti- genetic medicine for hereditary breast cancer. Mol Clin Oncol tudes knowledge and confidence. Can Fam Physician 55:e92-99 7(1):98–102 20. Visser A, Bos WC, Prins JB, Hoogerbrugge N, van Laarhoven 12. Cohn J, Blazey W, Tegay D, Harper B, Koehler S, Laurent B, HW (2015) Breast self-examination education for BRCA mutation Chan V, Jung MK, Krishnamachari B (2015) Physician risk carriers by clinical nurse specialists. Clin Nurse Spec 29(3):E1-7 assessment knowledge regarding BRCA genetics testing. J Cancer Educ 30(3):573–579 Publisher’s Note Springer Nature remains neutral with regard to 13. Chair SY, Waye MMY, Calzone K, Chan CWH (2019) Genomics jurisdictional claims in published maps and institutional affiliations. education in nursing in Hong Kong, Taiwan and Mainland China. Int Nurs Rev 66(4):459–466 14. Appel SJ, Cleiment RJ (2015) Identifying women at risk for hereditary breast and ovarian cancer syndrome utilizing breast 1 3 http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png Journal of Cancer Education Springer Journals

A Survey of the Awareness and Educational Needs of Nurses in Nagasaki Prefecture Regarding Hereditary Breast and Ovarian Cancer

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Abstract

The aim of this study was to evaluate the knowledge and educational needs with regard to hereditary breast and ovarian cancer among nurses working in breast cancer care in the Nagasaki Prefecture. In breast cancer care, the identification of patients at risk for hereditary breast and ovarian cancer is necessary for the implementation of genetic testing and counseling. Nurses should be involved in this process, since they play a crucial role in the care of patients with breast cancer. However, the knowledge regarding hereditary breast and ovarian cancer among nurses working in oncology care in Japan has not been assessed. The design of this study is cross-sectional design. We distributed 597 surveys to nurses working in breast cancer care. The surveys assessed the nurses’ demographic data, their current knowledge and practices regarding cancer genetics and hereditary breast and ovarian cancer, and their attitude and preferences regarding learning about the condition. We received 317 valid replies. Nurses had limited knowledge about hereditary breast and ovarian cancer characteristics: 41.6% reported that they do not know about the condition, whereas less than 10% knew its characteristics. However, nurses were aware of hereditary breast and ovarian cancer significance and were willing to learn about it: 91% wished to learn about the condi- tion, and 88.6% wanted to participate in study group meetings. Further, nurses’ preferences regarding educational programs were clarified. Overall, our results show that educational programs should be implemented to advance nurses’ knowledge of hereditary breast and ovarian cancer characteristics. Keywords Educational program · Genetic screening · Hereditary breast and ovarian cancer · Oncology nurses Introduction 3]. The identification of patients with breast and/or ovarian cancer at high risk for HBOC is important to ensure appro- Breast cancer is one of the most prevalent cancer types priate genetic testing and counseling. Moreover, there is a worldwide [1]. Hereditary breast and ovarian cancer high burden of need for genetic testing in patients at risk (HBOC) syndrome is an inherited genetic condition asso- for HBOC [4]. To ensure adequate screening, genetic test- ciated with an increased risk of breast and ovarian cancer. ing, and counseling for HBOC, healthcare providers should Most cases of HBOC are caused by mutations in the breast have sufficient knowledge in the field of cancer genetics and cancer 1 (BRCA1) or breast cancer 2 (BRCA2) genes [2, genomics [5]. However, many healthcare professionals do not receive sufficient training in genetics and genetic testing, which increases the risk of errors [6, 7]. * Megumi Matsumoto Nurses play a critical role in the care of patients with mmatsumoto@nagasaki-u.ac.jp breast cancer; therefore, they should be closely involved in Department of Surgical Oncology, Nagasaki University screening for patients at high risk for HBOC. However, a Graduate School of Biomedical Sciences, 1-7-1 Sakamoto, survey conducted with Turkish oncology nurses showed Nagasaki City, Nagasaki 852-8501, Japan that their knowledge of cancer genetics was only moder- Department of Reproductive Health, Institute ate [8, 9]. Similar findings were obtained in a Brazilian of Biomedical Science, Nagasaki University, Nagasaki City, study, which found that the majority of nurses had not Nagasaki 852-8501, Japan 3 identified or referred a patient for specialized risk assess- Department of Nursing, Nagasaki University Hospital, ment due to a genetic risk [10]. Only a few studies have Nagasaki City, Nagasaki 852-8501, Japan Vol.:(0123456789) 1 3 Journal of Cancer Education assessed the knowledge of healthcare providers in Japan Study Survey regarding HBOC screening, testing, and counseling, and none focused on nurses. A previous investigation found The survey was developed by the authors of this study and that although there was an awareness of the significance of included 14 questions. The first part of the survey (questions HBOC testing among Japanese healthcare providers, it was 1–4) gathered information about the participants’ age, sex, generally not sufficiently implemented in practice, and there professional qualifications, and current work situation. The was a need to further educate nurses. However, that study second part (questions 5–10) inquired about nurses’ current primarily assessed the knowledge and educational needs of knowledge and practices regarding cancer genetics and HBOC. clinical geneticists, other physicians, and genetic counse- These questions clarified whether the nurses had been involved lors, whereas only 2.4% of the respondents were nurses [11]. in breast cancer care and for how long, whether and to what Moreover, in a study limited to physicians, genetics training extent they had collected the family history of patients with and continuing medical education were associated with bet- breast cancer, whether and to what extent they were aware ter knowledge of HBOC risk assessment [12]. of HBOC, and whether they had received a question or con- The authors’ institution has the capacity to construct sultation request regarding genetics by a patient with breast a medical care system for HBOC primary screening and cancer. The third part of the survey (questions 11–14) assessed identification, risk assessment, genetic counseling, genetic whether nurses had had the opportunity to learn about HBOC, testing, surveillance, and management of risk-reducing sur- whether they wanted to learn about it, what their motivation gery. However, even though it is the only institution capable for learning was, and what their preferred learning format was. of providing HBOC care in the prefecture, there have been few cases of genetic counseling (47 cases between 2014 and Statistical Analysis 2016). Hospitals in the prefecture, including this institution, have not yet succeeded in placing appropriate cases on the The multiple-choice questions included in the survey were care flow as HBOC cases. assessed with descriptive statistics, whereas the open-ended In addition to their knowledge of HBOC, the educational questions were evaluated using content analysis. needs of nurses working in breast cancer care should also be assessed. The necessity for further genetic education has Results previously been described among nurses in other settings [13]. However, the knowledge and specific educational needs Participants’ Characteristics of nurses working in cancer care in Japan have not been analyzed. The majority of the participants were women (97%). More The aim of this study was to gain insight into the level nurses worked in a ward (70%) than in an outpatient setting of understanding, interest, and educational needs of nurses (27%). The most prevalent duration of experience working regarding HBOC by conducting a survey among nurses with breast care was 1–5 years (47% of nurses working in working in the field of breast cancer care in Nagasaki wards and 59% of nurses working in outpatient units) (Sup- Prefecture. plementary Table S1). Nurses’ Practices with Respect to Family History Assessment Materials and Methods Slightly more than half of the nurses (52%) participating in Study Design and Participants the study reported that they were aware of the family history of patients with cancer. Moreover, 63% responded that they Nurses working in the field of breast cancer care at 23 insti- asked patients with cancer about their family history. However, tutions in Nagasaki Prefecture were contacted for participa- only 23% of nurses who recorded a family history also asked tion in this descriptive study. The study was approved by about the family history of extended family members up to the Ethics Committee of the Nagasaki University Hospital. third-degree relatives (Table 1). It was conducted between June 1, 2016 and November 30, 2016. A questionnaire was distributed via physicians at each Nurses’ Knowledge and Practices with Respect institution, and answers were collected from each respondent to HBOC and Its Screening by mail. By mailing in their replies, the respondents were deemed to have provided consent. The total number of dis- When the nurses were asked whether they knew about tributed questionnaires was 597, while the number of valid HBOC, 41.6% reported that they did not know about it, responses was 317 (53.1%). 1 3 Journal of Cancer Education Table 1 Current practices of the Questions Possible answers Rates nurses with respect to family history Do you ask about the family history of patients? (n = 317) Yes 63% No 36% Unknown 1% Do you ask about the family history of the extended family members up to the Yes 23% third-degree relatives? (If the answer to the previous question is yes, n = 199) No 75% Unknown 2% When you see a cancer patient, are you aware of their family history? (n = 317) I am aware 52% I am not aware 48% questioned (86.6%) or to implement it in nursing (53.4%) (Table 2). The topics nurses wanted to learn about included the pathology of HBOC (76%), basic information about inher- itance (68.5%), the reality of HBOC care (61.5%), genetic testing (47.6%), and genetic counseling (33.1%). The major- ity of nurses were interested in hour-long study sessions. The internet (85.5%) and journals (70.3%) were the most frequently used sources for learning (Table 2). Discussion Fig. 1 The degree of nurses’ knowledge regarding hereditary breast The current study found that knowledge regarding HBOC and ovarian cancer among Japanese nurses working in the field of breast cancer care is limited, whereas their interest in learning more about whereas 58.4% reported that they did. However, fewer than it is pronounced. In this study, the nurses had limited knowledge of HBOC 10% of the respondents knew about the characteristics of HBOC or the characteristics leading to suspicion of HBOC inheritance. These findings agree with previous publications, which showed limited knowledge of hereditary breast can- (Fig. 1). Open-ended questions were also asked about the knowl- cer/HBOC among nurses in Brazil and Turkey, especially with respect to genetic counseling [9, 10]. Our study was edge and practices of nurses with respect to questions or consultation requests concerning genetics by breast cancer based on self-assessment of HBOC knowledge among nurses. However, the utilization of objective assessment patients (Supplementary Table  S2). The most frequently asked question was “Can my close relatives (especially my tools may provide more reliable information. Such tools should focus on examining nurses’ knowledge of cancer daughter) inherit the cancer from me?” The most common answer to this question was “I recommended a self-exami- genetics and HBOC. A range of factors should be assessed, including knowledge of the risk factors, epidemiology, nation and a breast cancer screening test.” inheritance patterns, screening, diagnosis, and treatment for HBOC. Similar questionnaires have been developed and Attitudes of Nurses Regarding Learning About have been successfully implemented to assess the knowl- edge of nurses regarding hereditary breast cancer [9, 10]. HBOC Moreover, future studies should compare HBOC awareness between nurses from cancer centers that have and have not Ninety-one percent of the participants in the survey were willing to learn about HBOC; furthermore, 88.6% of the implemented HBOC educational programs. The nurses were aware of the significance of HBOC respondents wished to participate in HBOC study group meetings. However, before the survey, the majority of awareness and screening. A previous study showed that involving nurses in screening for HBOC could help iden- respondents had had the opportunity to learn only about breast cancer (62%) but not about heritability (3%). The tify patients who required further testing [14]. Moreover, nurses’ knowledge regarding pharmacogenetics and phar- most important reasons for wishing to learn were wanting to utilize this knowledge to provide information when being macogenomics in general may improve patient outcomes 1 3 Journal of Cancer Education Table 2 Nurses’ attitudes regarding learning about inheritance and hereditary breast and ovarian cancer (HBOC) Questions Answers Rates Have you had an opportunity to learn about cancer and inherit- I only had an opportunity to learn about breast cancer 62% ance? (n = 317) I only had an opportunity to learn about inheritance 3% I had an opportunity to learn about both 9% I have had neither learning opportunity 26% Do you wish to learn about HBOC? (n = 317) Yes 91% No 8% Unknown 1% Reasons for wishing to learn (n = 281) I would like to utilize what I learn to provide information when 86.6% being questioned I would like to implement what I learn in nursing 53.4% It is useful for me and people close to me, such as relatives 31.4% It is a hot topic these days 15.2% Reasons for not wishing to learn (n = 26) I do not feel a particular need to learn 11 I am not interested 9 There is no established system yet, etc 6 Topics nurses want to learn about (n = 281) HBOC pathology (incidence rates of cancer, inheritance, etc.) 76.0% Basic information about inheritance 68.5% The reality of HBOC care (identifying patients, asking about the 61.5% family history, etc.) Genetic testing 47.6% Genetic counseling 33.1% Do you wish to participate in a study group meeting on HBOC? I wish to participate 88.6% (n = 317) I do not wish to participate 7.9% Unknown 3.5% How long should the study group meeting sessions be? Less than 30 min 12.5% 1 h 62.1% 2 h 12.8% Over 2 h 1% Unknown 11.6% Wishes for the study group meetings (open-ended) Short duration/multiple times/serialization e-Learning/on-demand/live Inclusion of physicians Provision of documents Q&A of frequently asked questions Held on weekends/in the evenings after work How do you check on what you do not know during nursing work? Internet 85.5% (n = 317) Journals (nursing journals, academic journals, etc.) 70.3% Questioning an acquaintance 36.0% [15]. Therefore, the results of the present and previous The development of web-based educational interven- studies indicate that genetics and genomics knowledge is tions in the fields of genetics and genomics is an area of critical for oncology nurses [16]. active research [17]. Standards for the core competencies The current study found that nurses are motivated of healthcare professionals in the field of genomic medicine to learn about HBOC characteristics, mainly to answer have been established to serve as a basis for the development patients’ questions and to implement the newly acquired of educational programs [18]. These standards relate to the knowledge in nursing. Previous studies also found that the domains of knowledge, attitudes, and abilities [5]. Educa- majority of nurses are motivated to continue their educa- tional genetics interventions, including interactive work- tion in the field of cancer genetics [9 , 10]. shops and PowerPoint modules, have also been developed 1 3 Journal of Cancer Education Takeshi Nagayasu: Supervision and have shown to be effective in educating primary health- care providers [19]. In this survey, the nurses reported that Data Availability All data generated or analyzed during this study are they used the internet as a primary source of learning. In included in this published article (and its supplementary information Nagasaki Prefecture, there are many minor islands, and files). interactive study group meetings via e-learning and internet are being considered by our team and institution, including Code Availability Not applicable. in remote areas. Promoting nurses’ knowledge of cancer genetics will also Declarations have beneficial effects on patient education. For example, Ethics Approval Nurses working in the field of breast cancer care at 23 education for breast self-examination of women and BRCA1 institutions in Nagasaki Prefecture were contacted for participation in or BRCA2 mutations has been proven to be feasible [20]. this descriptive study. The study was approved by the Ethics Committee This study has several limitations. First, it used self-report of the Nagasaki University Hospital. measures to assess nurses’ awareness of HBOC. These find- Consent to Participate A questionnaire was distributed via physicians ings should be confirmed through more objective assess- at each institution, and answers were collected from each respondent ments. Second, it did not directly evaluate the effect of by mail. By mailing in their replies, the respondents were deemed to nurses’ knowledge regarding HBOC on the effectiveness of have provided consent. patient screening and the identification of patients at high Consent for Publication The consent for publication was not required risk for HBOC. Third, even though it assessed nurses’ pref- as no intervention occurred. erences regarding the development of an educational pro- gram, further studies should determine the optimal design Conflict of Interest The authors declare no competing interests. of the program. Open Access This article is licensed under a Creative Commons Attri- bution 4.0 International License, which permits use, sharing, adapta- tion, distribution and reproduction in any medium or format, as long Conclusion as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes The results of this awareness survey among nurses work- were made. The images or other third party material in this article are included in the article’s Creative Commons licence, unless indicated ing in breast cancer care institutions in Nagasaki Prefecture otherwise in a credit line to the material. If material is not included in indicate that most nurses do not know about the disease the article’s Creative Commons licence and your intended use is not characteristics and inheritance patterns of HBOC but are permitted by statutory regulation or exceeds the permitted use, you will eager to learn about them. Therefore, further focused learn- need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. ing opportunities should be provided to nurses working in breast cancer care. Supplementary Information The online version contains supplemen- References tary material available at https://doi. or g/10. 1007/ s13187- 022- 02132-4 . 1. Harbeck N, Penault-Llorca F, Cortes J, Gnant M, Houssami N, Acknowledgements We thank the institutions that participated in this Poortmans P, Ruddy K, Tsang J, Cardoso F (2019) Breast cancer. study: Imamura Women’s Clinic, Inoue Hospital, Isahaya General Hos- Nat Rev Dis Primers 5(1):66 pital, Itoyanagi Breast Clinic, Izumikawa Hospital, Kobayashi Hospi- 2. 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Journal

Journal of Cancer Education – Springer Journals

Published: Apr 1, 2023

Keywords: Educational program; Genetic screening; Hereditary breast and ovarian cancer; Oncology nurses

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