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Practice Analysis of ABC Certified Mastectomy Fitters

January 2019


3. Development of the Test Specifications

The test specifications were developed as part of the Practice Analysis meeting on July 13, 2019, following the conclusion of discussions about the important task and knowledge statements. Detailed edits to the previous test specifications were completed. The new test specifications are presented in Appendix B. The development of the test specification included the approval of the final list of task and knowledge statements for each of the content areas and linking the knowledge statements to the task statements.

The linking study is not meant to be an exhaustive listing of related knowledge; instead, it is designed to provide evidence that the important knowledge is related to the important tasks. The results of the linking study are presented in Appendix C.

Twenty-nine (29) tasks were identified by the Task Force Committee as important to the competent performance of mastectomy fitter professionals. Table one lists the tasks by domain.

Table 1

Domains and Tasks
1. Patient Assessment 
1Review patient's prescription/referral
2Obtain relevant patient medical history, including previous use of post-mastectomy items, diagnosis and activities of daily living (ADL)
3Discuss patient's expectations and goals
4Perform a diagnosis-specific functional clinical examination that includes observation of chest wall and evaluation of range of motion, manual dexterity, skin integrity and shape/physical characteristics
5Consult with other healthcare professionals and caregivers about patient's condition, as needed
6Refer patient, if appropriate, to other healthcare professionals (e.g., therapist, physician) for intervention beyond mastectomy fitter's scope of practice
2. Formulation of Treatment Plan 
1Use the assessment results to formulate a treatment plan, including goals and expected outcomes to increase patient comfort, enhance function, accommodate deformity (e.g., shoulder drop, scoliosis) and improve balance, symmetry and appearance
2Consult with licensed healthcare prescriber to obtain supporting documentation and/or modify the original prescription, if necessary
3Document the patient's need described in the treatment plan
4Identify post-mastectomy items to support the treatment plan
5Communicate to patient and/or caregiver about the recommended treatment plan and timeline for completion
6Inform patient or responsible parties of their financial responsbilities as they pertain to the recommended treatment plan and/or any coverage limitations
3. Implementation of Treatment Plan 
1Measure patient and select appropriate post-mastectomy items to implement treatment plan
2Assess fit and comfort of post-mastectomy items and make any necessary adjustments
3Ensure that post-mastectomy items are provided as prescribed
4Educate patient and/or caregiver about the use and care of post-mastectomy items (e.g., wearing schedules, cleaning), including benefits, possible risks and warranty information
5Advise the patient and/or caregiver about their rights and responsibilities
6Document treatment using established record-keeping techniques to verify implementation of treatment plan
7Develop and communicate follow-up plan
4. Follow-up 
1Obtain feedback from patient and/or caregiver about the outcome of the treatment plan (e.g., tolerance, comfort, ability to don and doff, proper usage and function)
2Re-evaluate the patient through a follow-up clinical examination that may include review of changes to patient status, shape and physical characteristics
3Identify need for changes relative to initial treatment goals and expectations by assessing fit of post-mastectomy items
4Modify or adjust post-mastectomy items based on assessment and/or patient/caregiver feedback
5Educate patient and/or caregiver on proper use of post-mastectomy items relative to modifications/adjustments
6Document follow-up care, including any changes in treatment plan
5. Practice Management 
1Comply with federal and state regulations for the delivery of items within the Certified Mastectomy Fitter Scope of Practice (e.g., CMS, Medicaid, OSHA, HIPAA)
2Comply with policies and procedures regarding universal precautions and infection control
3Comply with documentation requirements (e.g., document retention, verification that post-mastectomy items were delivered and billed as prescribed)

Thirty-three (33) knowledge and skills statements were identified by the Task Force Committee as important for CFm professionals to know. Table 2 lists the knowledge and skills statements.

Table 2

Knowledge and Skills Statements
Knowledge of:
Musculoskeletal anatomy, including upper limb and spinal
Anatomical landmarks
Tissue characteristics/management
Post-surgical edema
Range of motion
Medical terminology
Breast treatment options
Lymphatic system
Prescription/referral documents
Documentation and document retention requirements
Policies and procedures regarding Protected Health Information (PHI)
Roles and responsibilities associated with other healthcare professions
Reimbursement coverage criteria (e.g., CMS/third party payers)
Material safety procedures and standards (e.g., OSHA, SDS)
Universal precautions and infection control
Ethical standards regarding proper patient management
Scope of practice related to mastectomy fitter credential
When to refer the patient to other healthcare providers/caregivers
Post-mastectomy items
Post-mastectomy item fitting criteria
Examination techniques
Measurement tools and techniques
Care and maintenance of post-mastectomy items
Item warranties
Inventory control and management
Federal and state rules, regulations, and guidelines (e.g., CMS, ADA, state licensure)
Skill in:
Performing clinical examinations and interviewing patients
Interpretation of physical findings
Developing or modifying a treatment plan
Adapting treatment plan relative to the patient's functional needs (e.g., patients with stroke, cognitive impairment)
Measuring and fitting post-mastectomy items
Evaluating fit and function of post-mastectomy items

Eleven (11) mastectomy items were identified by the Task Force Committee as important to the competent performance of CFm professionals. Table 3 lists the approved mastectomy items.

Table 3

Mastectomy Items
Mastectomy Item List
Breast prothesis, mastectomy bra
Breast prothesis, mastectomy bra, with integrated breast prothesis form, unilateral
Breast prosthesis, mastectomy bra, with integrated breast prosthesis form, bilateral
External breast prosthesis garment, with mastectomy form, post-surgical
Breast prosthesis, non-silicone
Breast prosthesis, silicone
Nipple prosthesis
Custom-fabricated breast prosthesis
Breast prosthesis, silicone, with integral adhesive
Adhesive skin support attachment for use with external breast prosthesis
Compression garments

The expert panel's next activity was to provide content weights for each of the domains. This was accomplished by having each of the participants give their individual estimates, entering those estimates into a spreadsheet and discussing the aggregated data. Table 4 below shows each domain, the percentage weights assigned and the total number of items as finalized by the Test Specifications Committee.

Table 4

Weighting Exercise
 DomainsPercentage WeightNumber of Items
1Patient Assessment29%32
2Formulation of Treatment Plan15%16
3Implementation of Treatment Plan32%35
5Practice Management16%18