Contents
- Acknowledgements
- Executive Summary
- Introduction
- Method
- 1. Development of the Domains and Task and Knowledge Statements
- 2. Expert Panel Review
- 3. Development of the Test Specifications
- Summary and Conclusion
- Appendix A
- Appendix B
- Appendix C
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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
| 1. Patient Assessment | |
|---|---|
| 1 | Review patient's prescription/referral |
| 2 | Obtain relevant patient medical history, including previous use of post-mastectomy items, diagnosis and activities of daily living (ADL) |
| 3 | Discuss patient's expectations and goals |
| 4 | Perform 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 |
| 5 | Consult with other healthcare professionals and caregivers about patient's condition, as needed |
| 6 | Refer 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 | |
| 1 | Use 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 |
| 2 | Consult with licensed healthcare prescriber to obtain supporting documentation and/or modify the original prescription, if necessary |
| 3 | Document the patient's need described in the treatment plan |
| 4 | Identify post-mastectomy items to support the treatment plan |
| 5 | Communicate to patient and/or caregiver about the recommended treatment plan and timeline for completion |
| 6 | Inform 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 | |
| 1 | Measure patient and select appropriate post-mastectomy items to implement treatment plan |
| 2 | Assess fit and comfort of post-mastectomy items and make any necessary adjustments |
| 3 | Ensure that post-mastectomy items are provided as prescribed |
| 4 | Educate 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 |
| 5 | Advise the patient and/or caregiver about their rights and responsibilities |
| 6 | Document treatment using established record-keeping techniques to verify implementation of treatment plan |
| 7 | Develop and communicate follow-up plan |
| 4. Follow-up | |
| 1 | Obtain 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) |
| 2 | Re-evaluate the patient through a follow-up clinical examination that may include review of changes to patient status, shape and physical characteristics |
| 3 | Identify need for changes relative to initial treatment goals and expectations by assessing fit of post-mastectomy items |
| 4 | Modify or adjust post-mastectomy items based on assessment and/or patient/caregiver feedback |
| 5 | Educate patient and/or caregiver on proper use of post-mastectomy items relative to modifications/adjustments |
| 6 | Document follow-up care, including any changes in treatment plan |
| 5. Practice Management | |
| 1 | Comply with federal and state regulations for the delivery of items within the Certified Mastectomy Fitter Scope of Practice (e.g., CMS, Medicaid, OSHA, HIPAA) |
| 2 | Comply with policies and procedures regarding universal precautions and infection control |
| 3 | Comply 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 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 |
| Documentation |
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 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
| Domains | Percentage Weight | Number of Items | |
|---|---|---|---|
| 1 | Patient Assessment | 29% | 32 |
| 2 | Formulation of Treatment Plan | 15% | 16 |
| 3 | Implementation of Treatment Plan | 32% | 35 |
| 4 | Follow-up | 8% | 9 |
| 5 | Practice Management | 16% | 18 |
