Breast Self-Examination Program Needs Assessment

PART I: ABOUT THE PROJECT

This is a project to create a 30-minute self-examination program that could be used at home. It was requested by Omar Hassan, the director of the Oncology Department at the Al-Amal hospital. The project targets all adult women starting from their early twenties.

This report describes the need for the project. The needs were gathered during an interview with Omar Hassan. Several interviews were made with Suzanne Miller, the oncologist who works in the Oncology Department of the hospital. I also collected information from the National Breast Cancer Foundation, American Cancer Society, Mayo Clinic, and John Hopkins websites.

This report begins with the background of the situation followed by the requirements of the project. Then it has the objectives of the project and the drafts of the instruments to evaluate the project.

PARTII: BACKROUND OF THE SITUATION

This section of the report describes the needs for the program, and its objectives. It describes the sponsor's request, states the business need for the project, describes the current and the ideal performance, states the list of the mains and the supporting tasks, and states the learners and their environment.

The requestOmar Hassan, the director of the director of Oncology Department at Al-Amal hospital has requested the development of a 30-minute lesson at home program for adult women at their early 20s. The goal of this program is to increase self-awareness of women to recognize how their breasts normally look and feel. They should report any unusual changes to the doctor as soon as they find them.

Business Need Underlying the RequestThe business need underlying the request is containing expenses. This project is intended to increase the chance of cure if breast cancer was discovered early. It leads to have less radical treatment, which reduces expensive breast cancer treatment costs.If breast cancer was detected early, the cost of initial care for breast cancer is less expensive then if it was detected at later stages.

Gap between Real and Ideal Performance:

The Current Situation

Laila is a 35-year-old woman. She never performs a breast self-evaluation. She thinks that "it can happen to others but not me". Laila never attended a workshop or read about breast cancer. One day she felt something hard in her right breast. She thought that this small lump because of her coming menstrual period, so she ignored it. Weeks later, she discovered that lump became bigger. She got worried and told her best friend later about it. Her friend urged her to consult a doctor immediately. She went to the doctor, underwent mammogram exam, and found out that she has breast cancer at later stages. After that, she underwent a surgery that removed her entire right breast to eliminate the cancer but in vain. So she underwent a Chemotherapy treatment to kill growing cancerous cells in her body.

The Ideal Situation

Sarah is a 35-year-old woman. She took the e-learning program, which was provided by the Oncology Department of the Al-Amal hospital, once she heard about it. Sarah performs breast self-examination once a month regularly. She follows all the steps, and recognizes what are the unusual breast changes. One day when she was in front of the mirror conducting a breast self-exam, she felt unusual lump in her right breast. She immediately reported this to her doctor. The doctor examined her, and she underwent a mammogram test and needle biopsy. She had support from her family and friends while waiting for the result. Sarah was diagnosed with breast cancer but at early stages. She underwent a surgery as an intermediate treatment and a radiation therapy. Fortunately, Chemotherapy was not a part of her treatment because she had cancer at early stages.

Tasks in Current Performance

End Result:

Performer raises her risk of ignoring a cancer diagnosis until the late stages.

Main and Supporting Tasks:

Performer postpones conducting breast self-examinationo Identify forgetfulness as a reason for the postponing of conducting breast

self-examinationo Identify negligence as a reason for the postponing of performing breast self-

exam

Performer conducts breast self-examination improperlyo Identify forgetfulness as a reason for the postponing of conducting breast

self-examinationo Identify negligence as a reason for the postponing of performing breast

self-exam

After detecting a lump, performer ignores the symptom.

o Identify unawareness as a reason for ignoring the symptomo Identify carelessness as a reason for ignoring the symptom

Tasks in Ideal Performance

End result:

The learner performs a breast self-examination at home at least once a month.

Main and Supporting Tasks:

Increase breast cancer awarenesso Identify the purpose of a monthly breast self-exam

Explain the purpose of a monthly breast self-exam. Explain the importance of a monthly breast self-exam

o Identify the advantages of performing the breast self-examination Explain the physical advantages of performing breast self-

examination State effective early treatment as one of the physical

advantages of breast self-exam State high possibility of avoiding Chemotherapy as one of

the physical advantages of breast self-exam Identify the psychological advantages of performing breast self-

examination Explain that eliminating worries as one of the

psychological advantages of performing breast self-examination

Explain that having early support from family and friends as one of psychological advantages of performing breast self-examination

o Identify the risk factors for developing breast cancer Explain the definition of risk factor of breast cancer Explain that having one or multiple risk factors does not mean

getting the disease Explain that gender-age-lifestyle and genetics as different kinds of

risk factors for developing breast cancer State being a woman is the main risk factor that as related

to gender State getting older is the risk factors that as related to the

age State personal history of breast cancer as one of the

genetics risk factors State family history of breast cancer as one of the genetics

risk factors Name inherited genes that increase cancer as one of the

genetics risk factors State having the first menstrual period before age 12 as one

of the genetics risk factors State beginning menopause after age 55 as one of the

genetics risk factors State obesity as one of lifestyle risk factors State obesity as one of lifestyle risk factors State drinking alcohol as one of lifestyle risk factors State exposure to radiation treatment as one of lifestyle risk

factors State never been pregnant as one of lifestyle risk factors State having the first child after age 35 as one of lifestyle

risk factors

Perform breast self-examo Describe what occurs in a breast self-examo Explain when to perform a monthly breast self-exam

State 3-5 days after a menstrual period starts as the ideal time to conduct a monthly breast self-exam

State once a month at least as a minimum requirement of time

o Name the places where one can perform the breast self-exam State in front of the mirror as a place where one can perform the

breast self-exam State when you are lying on your back as a place where one can

perform the breast self-exam State under the shower as a place where one can perform the breast

self-exam

o Perform a set of breast self-exam in front of a mirror

The first step, perform the exam as follows: Create a well-lit area in front of the mirror Stand facing the mirror topless Raise both of your arms over the head Inspect visually for any breast changes in color, changes in

skin, changes or swelling in the nipples unusual changes.

The second step, perform the exam as follows: Bring down both of you arms to your side Inspect visually for any breast changes in color, changes in

skin, changes or swelling in the nipples unusual changes.

The third step, perform the exam as follows:

Rest both of your palms on your hips Press both of your palms firmly on your hips to flex your

breast muscles. Visually inspect for any breast changes in color, changes in

skin, changes or swelling in the nipples or for any unusual changes.

Identify unusual breast changeso Name symptoms to look for when conducting breast self-examination

State redness or pitting of the skin as unusual change State pain in the breast or in the armpit that is not related to

menstrual period as unusual change. State thickened tissue area in the breast as unusual change State clear or bloody fluid from the nipple as unusual change State change in nipple looks as unusual change State rash around nipples as unusual change State change in skin texture or color as unusual change State swelling in one of the armpits as unusual change

o Explain what to do if you notice a symptom State calm down when seeing or feeling something unusual during

the breast self-exam State probability of lumpiness is due to menstrual changes with

menstrual period State that lumpiness could be benign State to contact a health care provider

Target Learners

General Demographics:

Primary performers are adult women, and their ages start from their early twenties.

They may have previous diagnosis of breast cancer They may have family history of breast cancer They may had their menstrual periods before 12 years old They may have genetics defects name the ones that are relevant They have any or some of risk factors like smoking, obesity and drinking

alcohol that put them at a greater risk for breast cancer.

Three Learners In-Depth

Low Maintenance Learner Nadia is a 35-year-old woman. She frequently educates herself about breast cancer from the articles on the Internet, and in the newspapers. She cares about performing breast self-examination once a month. Last year, Nadia participated in a running event to raise funds for breast cancer awareness. She

doesn’t mind joining this program because she thinks it will expand her awareness of breast cancer.

Average Learner: Anna is 30-year-old woman. She does not care about breast cancer self-examination because she does not have a family history or family members who had breast cancer. She performed breast self-exam twice or three times a year. Sometimes Anna reads articles about the breast cancer while she is waiting for something or when the article has an interesting story. Anna thinks this program will give her the right step to breast cancer awareness.

High Maintenance Learner: Sarah is a 40-year-old woman. She is a smoker, and has an aunt who had breast cancer then died last year. She has never performed the breast self-examination. Moreover, she has never read any article about the awareness of breast cancer. She thinks this program is perfect for her because she has no background knowledge of breast cancer at all.

Constraints on the Project

Product Constraints:None, because the sponsor has never worked with an instructional designer, so

there are is constraint for design guidelines, editorial guidelines, or course structure.

Software Constraints: Having a programmer for creating the application Using Microsoft PowerPoint to show the semi-finished program to the

sponsor Using Adobe Illustrator for drawing the breast self-exam’s steps.

Business Constraints: The sponsor would like the program to be available on 12th of January

2014 Not-to-exceed budget: not stated. It includes some external services for an

illustrator to illustrate the steps for breast self-exam.

Part III: Requirements of the Project:

Performance Objectives

Business Objectives

The business objective is to contain long-term expenses by spreading awareness among women to detect breast cancer early, and then report any unusual changes to the doctor. This would lead to have less radical treatment, which reduces the breast cancer treatment’s high costs.

Content ObjectivesEnd result: The end result is that the learner recognizes the importance of breast

cancer awareness and performs breast self-examination at home at least once a month.

Main and Supporting Objectives

Note: unless stated otherwise, it is assumed that learners must perform all the tasks with 100% accuracy, and without any help.

Increase breast cancer awarenesso Identify the purpose of a monthly breast self-exam

Explain the purpose of a monthly breast self-exam. Explain the importance of a monthly breast self-exam

o Identify the advantages of performing the breast self-examination Explain the physical advantages of performing breast self-

examination State effective early treatment as one of the physical

advantages of breast self-exam State high possibility of avoiding Chemotherapy as one of

the physical advantages of breast self-exam Identify the psychological advantages of performing breast self-

examination Explain that eliminating worries as one of the

psychological advantages of performing breast self-examination

Explain that having early support from family and friends as one of psychological advantages of performing breast self-examination

o Identify the risk factors for developing breast cancer Explain the definition of risk factor of breast cancer Explain that having one or multiple risk factors does not mean

getting the disease Explain that gender-age-lifestyle and genetics as different kinds of

risk factors for developing breast cancer State being a woman is the main risk factor that as related

to gender State getting older is the risk factors that as related to the

age State personal history of breast cancer as one of the

genetics risk factors State family history of breast cancer as one of the genetics

risk factors Name inherited genes that increase cancer as one of the

genetics risk factors State having the first menstrual period before age 12 as one

of the genetics risk factors State beginning menopause after age 55 as one of the

genetics risk factors State obesity as one of lifestyle risk factors State obesity as one of lifestyle risk factors State drinking alcohol as one of lifestyle risk factors State exposure to radiation treatment as one of lifestyle risk

factors State never been pregnant as one of lifestyle risk factors State having the first child after age 35 as one of lifestyle

risk factors

Perform breast self-examo Describe what occurs in a breast self-examo Explain when to perform a monthly breast self-exam

State 3-5 days after a menstrual period starts as the ideal time to conduct a monthly breast self-exam

State once a month at least as a minimum requirement of time

o Name the places where one can perform the breast self-exam State in front of the mirror as a place where one can perform the

breast self-exam State when you are lying on your back as a place where one can

perform the breast self-exam State under the shower as a place where one can perform the breast

self-exam

o Perform a set of breast self-exam in front of a mirror

The first step, perform the exam as follows: Create a well-lit area in front of the mirror Stand facing the mirror topless Raise both of your arms over the head Inspect visually for any breast changes in color, changes in

skin, changes or swelling in the nipples unusual changes.

The second step, perform the exam as follows: Bring down both of you arms to your side Inspect visually for any breast changes in color, changes in

skin, changes or swelling in the nipples unusual changes.

The third step, perform the exam as follows: Rest both of your palms on your hips Press both of your palms firmly on your hips to flex your

breast muscles. Visually inspect for any breast changes in color, changes in

skin, changes or swelling in the nipples or for any unusual changes.

Identify unusual breast changeso Name symptoms to look for when conducting breast self-examination

State redness or pitting of the skin as unusual change State pain in the breast or in the armpit that is not related to

menstrual period as unusual change. State thickened tissue area in the breast as unusual change State clear or bloody fluid from the nipple as unusual change State change in nipple looks as unusual change State rash around nipples as unusual change State change in skin texture or color as unusual change State swelling in one of the armpits as unusual change

o Explain what to do if you notice a symptom State calm down when seeing or feeling something unusual during

the breast self-exam State probability of lumpiness is due to menstrual changes with

menstrual period State that lumpiness could be benign State to contact a health care provider

Appendix

Drafts of Evaluations

Sample Satisfaction Survey (Kirkpatrick Level 1) (Adapted from Carliner, 2003)To assess the reactions of the learners toward the program.

1- Please describe this program in one word: _______________

2- Using a number, how would you describe this program?

1 2 3 4 5 Abysmal Average Outstanding

3- How much do you know about conducting breast cancer before taking this workshop?

1 2 3 4 5 Nothing Some A lot

4- How much do you know about the breast cancer after taking this workshop?

1 2 3 4 5 Nothing Some A lot

5- How likely are you going to use some or all of the skills taught in this workshop in every day life?

1 2 3 4 5 Not at all Not sure Very likely

6- The best part of this workshop was:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

7- The one thing the could improve this workshop is:

__________________________________________________________________

__________________________________________________________________

__________________________________________________________________

Sample Criterion-Referenced Assessment (Kirkpatrick level 2)

Learners will be assessed if they meet the objectives or not through a quiz and an observation

Main Objective#1: Increase breast cancer awareness

1- How many times do you need to perform breast self- examination?a- at least once a year b- at least once every 6 months c- at least once a month

Answers:a. Incorrect. Once a year is not enough at allb. Incorrect. Once every 6 months is not enoughc. Correct. You need to perform the self-exam at least once a month

2- Which answer is not known to be a risk factor of breast cancer?a- Obesityb- Sleep deprivation c- Family history

Answers:a. Incorrect. Obesity is one of the risk factors of breast cancer.b. Correct. Exercise is not one of the risk factor; it is bad for your health but not one of the risk factors of breast cancer.c. Incorrect. Having a family member that had breast cancer is one of the risk factors of breast cancer.

To assess learners' abilities of performing the self-examination correctly, this rubric is provided to observe and evaluate the learners. The observers should use this list of a rubric to observe the learners' actions and to comment on them in order to evaluate whether they are able to complete the self-examination correctly.

Main Objective#2: Perform a set of breast self-examination

Supporting Objectives

Supporting Tasks Actions CommentPrepare yourself in front of the mirror

Stand facing the mirror topless____Yes, ____No

Create a well-lit area in front of the mirror____Yes, ____No

Complete the first set of breast self-exam in front of the mirror

Raise both of your arms over the head____Yes, ____No

Inspect visually for any breast changes in color, changes in skin, changes or swelling in the nipples unusual changes.____Yes, ____No

Complete the second set of breast self-exam in front of the mirror

Bring down both of you arms to your side____Yes, ____No

Inspect visually for any breast changes in color, changes in skin, changes or swelling in the nipples unusual changes.____Yes, ____No

Complete the third set of breast self-exam in from of the mirror

Rest both of your palms on your hips____Yes, ____No

Press both of your palms firmly on your hips to flex your breast muscles.____Yes, ____No

Inspect visually for any breast changes in color, changes in skin, changes or

swelling in the nipples or for any unusual changes.____Yes, ____No

Main Objective# 3: Identify unusual breast changes

If you found a hard lump in your breast while performing breast self-exam, what should you do?

a- Do a massage for your breast, it could be due to stress.b- Ignore it because your menstrual period is coming soonc- See a doctor immediately

Answers:a. Incorrect. Stress has never been the cause of breast lumps.b. Incorrect. It could be benign lump because of your coming period, but you should see a doctor c. Correct. You should see a doctor immediately. Don't panic, it could be a benign lump.

Which answer is not known to be an indication of breast cancer?a. Breast feels swollen or painful before or during your menstrual periodsb. Change in breast color or texturec. Bloody discharge from one or both of the nipples

Answers:a. Correct. Breast feels swollen or painful before or during a mesnstrual period is not

an indication of breast cancer.b. Incorrect. Change in breast color or texture could be symptoms of breast cancerc. Incorrect. Bloody discharge could be an indication of breast cancer

Sample of Level 3 Evaluation

In order to evaluate how much learners acquired the skills and have retained them after a period of time, it would be possible to send them a survey and ask them if they can apply what they have learned into their jobs.

Evaluation SampleIn the name of the Al-Amal Hospital, we would like to thank you for taking our Breast Self-Examination learning program. To help us improving this learning program so we can spread the awareness among adult women, please fill out this survey. Name: _________Age: (optional)

1- When did you take our Breast Self-Examination program? _________2- Do you perform breast self-examination at least once a month?

If the answer is no, please explain the reason.3- Are you still aware of the unusual changes that can happen to the breasts?

Yes____, No_____4- Are you still aware of the risk factors of breast cancer? Yes____,

No______5- Are you still aware of the advantages of performing the breast self-exam?

Yes____, No_____6- Have you recommended your family and friends to take this learning

program? Yes_____, No_____If no please explain the reason.

Also, it would be possible to apply the rubric that was used in the level two evaluations to observe the learners. The collected data from this technique is more reliable than the survey, but it takes extra time and work to collect them.

Reference

Carliner, S. (2003) Training design basics. Baltimore, MD:ASTD press

The outline of this needs assessment is adapted from the three "Sample Reports of Needs assessment" that were created by David Price, Lai Ling Olivia Yu, and Elyse Croteau and were provided by Saul Carliner through Moodle.