NURS 8310 Discussion: Screening for Disease
Discussion: Screening for Disease
The relevance of cervical cancer as a global health concern is reflected by its position as the fourth most common female cancer worldwide, being at four percent (Kessler, 2017). Unfortunately, almost 84 percent of cervical cancer incidences occur in underdeveloped countries, including Africa, Latin America, and the Caribbean (Kessler, 2017, p. 172). Furthermore, within the United States, cervical cancer is evident as the 14th most frequent cancers (Kessler, 2017, p. 173). Nearly half of those women who are sexually active have a susceptibility to the human papillomavirus (HPV), the main cause for cervical cancer (Centers for Disease Control and Prevention, 2021b). Within the United States about 79 percent of men and women are infected with HPV, leading to over 11,000 women developing HPV leading to cancer (Kessler, 2017, p. 173). Risk factors do include about 90 percent of HPV infections leading to an untraceable predisposition to cervical cancer within one to two years (Kessler, 2017, p. 174). Immunocompromised women from drugs or chlamydia are proven to lead to cervical cancer incidences (Kessler, 2017). Preventative measures do include HPV vaccinations for males and females, limiting partners, use of condoms with men, and avoiding sex with multiple partners (Kessler, 2017). The HPV vaccination was made available in 2006, for multiple groups of individuals. HPV vaccination is recommended to be present after the first sexual incidence or prior to this original experience (Kessler, 2017). Three vaccines are available to prevent HPV, including Gardasil. The Centers for Disease Control and Prevention suggest the first does may start at age nine but should be initiated from ages 11 to 12 and the second dose six to 12 months later (Centers for Disease Control and Prevention, 2021a). However, it is not recommended that those who are not vaccinated are to converse with providers as there may be less benefit from ages 27 to 45 (Centers for Disease Control and Prevention, 2021a).
Those exposed to HPV still are encouraged to receive vaccination after being exposed to protect their future affiliates. In addition, it is recommended that women are screened with a Pap test to reflect abnormal findings to review need for treatment. If detected, abnormal Pap tests can return to normal nine out of ten times, or about 90 percent, of HPV infections without treatment (Kessler, 2017, p. 176). Age does take a factor into this situation, showing females between 30 and 65 years old should have testing every five years, and those under 30 years old HPV testing alone should not be completed (Kessler, 2017, p. 176). For those who were vaccinated, amongst males and females, has not yet met the recommended vaccination levels (Kessler, 2017).
Ethical considerations include the healthcare disparities of those of lower economical status who cannot afford vaccinations, whether from financial complication with or without insurance. Education and provisions for areas of rural standing may decrease exposure or understanding of the importance of the vaccination. There may be community assistance provided within various areas of states, counties, or cities. Ethical considerations may be justified by means of provider, parent, and community support. Religious, cultural, and/or ethnicity acceptance or understanding can be evident for vaccinations. For example, Hispanic women were shown to have increased knowledge of a Pap test by means of educational sessions (Kessler, 2017, p. 179). These can be provided within pre-adolescent, adolescent, and adult situations to understand risks as an early age and multiple partners, particularly in sexual education for males, females, and having sexual encounters with multiple individuals and those males who are uncircumcised (Kessler, 2017, p. 179). Basic sexual education is a knowledge base for all to understand, regardless of religious entities. An example may be of the Catholicism individuals. There may be a belief of not having multiple partners and ensuring virginity until marriage. However, lack of knowledge in itself may show an aspect of negligence of others. Even if the belief or acceptance may not be present, the knowledge does assist a population-based status for all.
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Basis and Influence on Assessment
A population of those under age 18 are encouraged to be vaccinated but is noted to be not evident due to lack of knowledge or
information for those of this age group (Kessler, 2017). Parental barriers are evident related to the belief of being low risk or financial implications. Providers’ lack of recommendation may also play a vital role of decreased vaccination rates (Kessler, 2017). This screening could be both population-based within age groups who are who are not sexually active and high-risk for those who are sexually active, have multiple partners, obese, and/or do not have regular Pap tests (Kessler, 2017). These barriers can be overcome by increased communication. This can influence multiple associations to review the assessment of those at risk, at need for further education, at need for financial needs, and setting up health visits (Kessler, 2017). For example, there may be a requirement for college males to have further information of the vaccine through education or the need for parents to be aware of the preventative initiations for HPV in prevention of cervical cancer in females.
Moving Policy Forward
The use of reported data can allow for the Health Belief Model and the Transtheoretical Model can be used to educate on interventions. Overall, more knowledge of series of strategies and behavioral change is evident supporting again the need for increased communication and gain of knowledge (Kessler, 2017). What is to be communicated is of utmost importance, this includes vaccines are safe, efficient, tolerated, and that the need for follow-up vaccines are useful (Kessler, 2017). Policies should occur at the three levels of patient, provider, and health system (Cartmell et al., 2018). A health system policy aspect to take into consideration is the healthcare costs affiliated with purchasing and storing vaccines, calling for a need for an internal validity evaluation. Those that may need additional coverage or assistance can be presented within an organization’s policy to improve vaccinations (Friis & Sellers, 2021; Kessler, 2017). For patient and provider levels, implementation of a system to educate and support individuals about the vaccine can allow motivation of conversations, decrease missed opportunities from parents or adults for vaccine, utilize local health department resources, build vaccine recommendations, and view further refusal or acceptance of vaccinations (Centers for Disease Control and Prevention, 2017; Cartmell et al., 2018).
References
Cartmell, K., Young-Pierce, J., McGue, S., Alberg, A., Luque, J., Zubizarreta, M., & Brandt, H.
(2018). Barriers, facilitators, and potential strategies for increasing HPV vaccination: A statewide assessment of inform action. Papillomavirus Research, 5, 21-31. https://doi.org/10.1016/j.pvr.2017.11.003
Centers for Disease Control and Prevention. (2021a, July). HPV vaccine. U.S. Department of
Health & Human Services. https://www.cdc.gov/hpv/parents/vaccine-for-hpv.html
Centers for Disease Control and Prevention. (2021b, December). Basic information about
cervical cancer. U.S. Department of Health & Human Services. https://www.cdc.gov/cancer/cervical/basic_info/index.htm#:~:text=It%20occurs%20most%20often%20in,person%20to%20another%20during%20sex.
Centers for Disease Control and Prevention. (2017). Top 10 tips for HPV vaccination success:
Attain and maintain high HPV vaccination rates. U.S. Department of Health & Human Services. https://www.cdc.gov/hpv/hcp/2-dose/top-10-vaxsuccess.html#:~:text=Use%20an%20effective%20approach%20by,HPV%20cancers%2C%20and%20whooping%20cough.
Friis, R. & Sellers, T. (2021). Epidemiology for public health practice (6th ed.). Jones & Barlett
Learning.
Kessler, T. (2017). Cervical cancer: Prevention and early detection. Seminars in
Oncology Nursing, 33(2), 172-183. https://doi.org/10.1016/j.soncn.2017.02.005