• A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.

o What is its purpose?

o How is it conducted?

o What information does it gather?

• Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

NOTE 3–4 pages, not including title and reference pages)
needs introduction

To Prepare

• Review this week’s Learning Resources and consider factors that impact the validity and reliability of various assessment tools and diagnostic tests. You also will review examples of pediatric patients and their families as it relates to BMI.
• Search the Walden Library and credible sources for resources explaining the tool or test you were assigned. What is its purpose, how is it conducted, and what information does it gather?
• Also, as you search the Walden library and credible sources, consider what the literature discusses regarding the validity, reliability, sensitivity, specificity, predictive values, ethical dilemmas, and controversies related to the test or tool.
  • Based on the risks you identified, consider what further information you would need to gain a full understanding of the patient’s health. Think about how you could gather this information in a sensitive fashion.

CASE: 75-year-old non-English speaking female recently diagnosed with breast cancer

MAMMOGRAM ASSESSMENT TOOL

• A description of how the assessment tool or diagnostic test you were assigned is used in healthcare.

• What is its purpose?

• How is it conducted?

• What information does it gather?

• Based on your research, evaluate the test or the tool’s validity and reliability, and explain any issues with sensitivity, reliability, and predictive values. Include references in appropriate APA formatting.

 ANSWER

Assessment Tools and Diagnostic Tests:

Mammogram Assessment Tool

Introduction

Advanced nurse practitioners (APNs) encounter many health-related complaints, symptoms, and signs among patients, which require extensive, comprehensive, and evaluation to determine the ailment, directions, as well as the treatment and management regimens. When an APN encounters a patient, they conduct initial assessments that help rule out the normality and abnormalities. This is enabled through diagnostic reasoning and efficient assessment tools necessary for screening, performing diagnostic tests, and disease confirmation. Diagnostic reasoning involves reflecting and thinking of diverse dispositions and potential causes of the complaints or disease (Hazra & Gogtay, 2017). Diagnostic reasoning is essential among APNs as it guides them and ensures maximized accuracy and safety before commencing any treatment. This results in enhanced safety and high-quality healthcare providence among patients, a critical mandate, and nursing code. Dains et al. (2019) argue that when an APN suspects causal factors using a patient’s symptoms or previous health records and patient’s knowledge, integrating diagnostic reasoning helps them gather additional and further information enabling effective diagnostic tests, utilization of appropriate assessment tools, and development of reliable treatment regimens (Dains, 2019).

This assignment focuses on the mammogram assessment tool, a breast cancer detection and screening tool using the case study of a 75-year old non-English speaking female recently diagnosed with breast cancer.

Mammogram Description and Purpose

In clinical practice, APNs utilize many diagnostic tests and assessment tools for screening and disease confirmation. A mammogram is a low-dose or low-energy examination and x-ray pictures of breasts used in healthcare to screen, detect, and investigate breast cancer signs. An early breast cancer diagnosis includes three modes. They involve performing a mammogram test or screening accompanied by regular clinical exams and breast self-examinations. The mammogram is conducted for two purposes, namely screening and diagnostic purposes, that highlight primary information gathered (Schonberg, 2017). Screening purposes include detecting early signs, symptoms, and new abnormalities in breasts, micro-calcifications examination, identifying any changes, and detecting cancer before the signals begin striking. Screening mammography is conducted for routine checks, and tests highly recommended among women, especially those aged 40 years and older. This is because breast cancer cases and mortality rates keep increasing, and the risks plus susceptibility levels increase as age progresses. Diagnostic purposes include investigating unsure or skeptical changes in a patient’s breast, such as pain in the nipple, cysts, breast lump development, discharge in the nipple, nipple thickening, and abnormal skin semblance. Nonetheless, even though diagnostic mammograms find these symptoms and signs, it does not become an automatic breast cancer marker, as the signs could be benign. Diagnostic mammography is an extended version of screening mammography that requires more x-rays and mammograms to view the breast from diverse angles.

Mammography assessment includes compressing a patient’s breast between two plates on a low radiation and energy x-ray machine to spread out breast tissues for maximum screening. The x-ray machine thus captures black and white pictures of the breast examining possible abnormalities such as cancer signs, tumors, and lumps. The information gathered and results found in a mammogram assessment include false-positive results, false-negative results, over diagnosis and overtreatment. False-positive results occur when a health practitioner finds an abnormality (positive) that is noncancerous (negative); false-negative results shows a lack of abnormality (negative) yet breast cancer is present (Schonberg, 2017). Over diagnosis occurs when mammogram screening finds cancer and ductal carcinoma in situ (DCIS) requiring no treatment as they would never threaten a patient’s life or cause cancerous symptoms. If treatment is conducted, it is considered overtreatment or unnecessary treatment of an over diagnosed cancer. If the results are negative and benign found, regular mammogram screening should be made and if any abnormality and suggestive malignancy are detected, a biopsy should be conducted to confirm the presence of cancer before the commencement of any treatment.

Mammograms help detect and find any breast changes among women, which previously had mammograms stored in films; however, in the contemporary world digital mammography is integrated. Digital mammograms convert x-ray into electronic images and breast pictures that can be saved in computers and printed for patients and health practitioners. In addition to increased efficiency in detecting breast cancer during early stages, mammography screening enables early development of treatment regimens among patients, hence reducing breast cancer related mortality rates. It is also beneficial when carrying out as it helps find breast cancer in a patient with asymptomatic signs or in the asymptomatic stage. According to Schonberg (2017), mammography screening reduces breast cancer mortalities by 19% among women aged 40-69 years, however, among older women such as the patient in the case study (75 years), there lacks adequate clinical trial tests and data to certify the certainty of reduced mortality. Mammography screening among elder women can be beneficial in two ways: one, breast cancer cases increase as age progresses, thus, screening tests are more effective and beneficial in population with a prevalent condition such as the ages of 70 plus. Second, sensitivity of mammography screening enhances and improves with age. Women in their 70s have a digital mammography of 86-88% compared to 81% among those in their 50s.

Evaluation of Mammogram Tool’s Validity and Reliability

The evaluation of the validity and reliability of the mammogram assessment tool can be conducted by assessing performance standards namely, sensitivity, specificity, accuracy, and predictive value. According to Zeeshan et al. (2018), digital mammograms are highly accurate and effective assessment tools for breast cancer detection (Zeeshan, Salam, & Khalid, 2018). In a cross-sectional analytical study conducted, the authors found and concluded that the digital mammograms have a sensitivity of 97%. Sensitivity refers to the possibility of positive test outcomes when a disease is existing or present. Second, the authors found a specificity of 64.5%, which denotes the possibility of negative results in an absence of a disease. Third, predictive values denote the likelihood of a patient having or lacking a disease depending on the tests results. In the case study, the positive predictive value was 89% and the negative value 90.9%. A positive predictive value shows the possibility of a patient with a positive mammography screening results truly having breast cancer while the latter shows the probability of a patient with negative mammography results truly lacking breast cancer. Finally, a diagnostic accuracy of 89.3% (Zeeshan, Salam, & Khalid, 2018). According to the authors, digital mammography enjoys a competitive advantage over the conventional film mammography almost replacing it and is a profoundly accurate breast cancer-assessment tool.

However, increased debate on the effectiveness, reliability, and validity of the tool is discussed due to the limitation the tool possesses. Research on survival rates and effectiveness of integrating the mammogram assessment tool among older women remains scarce, the presence of false-negative results, false-positive results, over diagnosis and over treatment limit its reliability and validity. Even though the mammogram assessment tool is described and endorsed as best breast cancer screening tool, the lack of evidence and research showing survival cases among older women shows that Zeeshan et al.’s (2018) argument and findings are generalized (Zeeshan, Salam, & Khalid, 2018). Moreover, inaccurate and erroneous physical examination results in false readings and results that impede appropriate and effective treatment choice. This erroneousness results in compromising a patient’s life and health quality. In conclusion, APNs should possess adequate knowledge on high-quality utilization of diagnostic tests and assessment tools for maximized quality healthcare.

References

Dains, J. E. (2019). Seidel’s guide to physical examination: An interprofessional approach (9th ed.). Elsevier Mosby: St. Louis, MO.

Hazra, A., & Gogtay, &. N. (2017). Biostatistics Series Module 7: The Statistics of DiagnosticTests. Indian Journal Of Dermatology, Vol 62(1),18-24. doi:10.4103/0019-5154.198047.

Schonberg, M. A. (2017). Decision making around mammography screening for older women. Journal of the American Geriatrics Society, Vol 64(12), pp: 2413-2418. doi: 10.1111/jgs.14503.

Zeeshan, M., Salam, B., & Khalid, Q. S. (2018). Diagnostic Accuracy of Digital Mammography in the Detection of Breast Cancer. Cureus, Vol 10(4): e2448. doi: 10.7759/cureus.2448.