Response to Nadine Pierre Jean
This post presents guidelines on screening procedures for eating disorders, including anorexia nervosa, bulimia nervosa, and binge eating. The use of the Sick Control One stone Fat Food (SCOFF) tool is suggested as the primary measure for screening (George, 2015). However, in some patient scenarios, this measure may be inappropriate. For example, some other mental disorders, such as major depressive disorder, may have similar symptoms (National Institute of Mental Health, 2018). The patient with such a condition may also believe that they are fat and report the loss of weight while not having an eating disorder. Thus, the SCOFF tool would provide a misleading result and may lead to poor patient outcomes.
In such a scenario, I would evaluate not only the patient’s answers but other symptoms that may indicate the condition. For example, an individual may be initially referred to the screening for anorexia, bulimia or binge eating but show signs of suicidal behavior, which means that it is vital to assess their general mental health state and consider the prevalence of other conditions rather than an eating disorder.
As an advanced practice nurse, I would try to incorporate the suggested guidelines into my practice, while using a comprehensive approach to screening for eating disorders. I would advocate for using the SCOFF tool in cases when patients feel comfortable with answering questions and sharing personal information. However, if individuals are nervous or irritated, I would suggest the utilization of other types of evaluation, such as self-assessment questionnaires and the analysis of patients’ behavior related to diet and nutrition.
Response to Melissa Bosser
This report features several screening guidelines for different types of cancer. The recommendations include the use of Pap tests, mammogram, sigmoidoscopy, and pelvic exam. The scenario in which my colleague’s guidelines might be inappropriate is the use of mammogram for breast cancer diagnosis in women more than 74 years old (Braithwaite, Demb, & Henderson, 2016). Braithwaite et al. (2016) note that for this age group, there is a high risk of false-positive mammography result, which causes misdiagnosis. It means that the current screening guidelines may be ineffective and result in poor patient outcomes.
To provide appropriate care in the scenario with an elderly patient, it is vital to optimize the screening strategy and measure the impact of benefits and harms associated with false mammography results and misdiagnosis. Evidence suggests that in women more than 74 old, the annual screening is ineffective as it may not allow saving the patient’s life due to the average life expectancy (Braithwaite et al., 2016).
In this scenario, I would analyze the patient’s family history of breast cancer and past biopsies, as well as evaluate the level of breast density before deciding on the screening method. In addition, I would consider the life expectancy factor to assess the benefits for the individual.
As an advanced practice nurse, I would advocate for changes in the existing methods used for cancer screening in the elderly. I would suggest the implementation of other screening technologies that have emerged during recent years, such as digital tomosynthesis (Braithwaite et al., 2016). Moreover, I would insist on the changes in screening policies, asking to consider the presence of comorbidity, the life expectancy factor, and the cost-effectiveness of mammography to avoid adverse patient outcomes in elderly individuals.
References
Braithwaite, D., Demb, J., & Henderson, L. M. (2016). Optimal breast cancer screening strategies for older women: Current perspectives. Clinical Interventions in Aging, 11, 111-125. Web.
George, S. (2015). Screening tool detects eating disorders. Web.
National Institute of Mental Health. (2018). Depression. Web.