Utilization of a breast cancer risk assessment tool by internal medicine residents in a primary care clinic: impact of an educational program

Abstract

BackgroundDespite strong evidence of benefit, breast cancer risk assessment and chemoprevention are underutilized by primary care physicians. This study evaluates the impact of an educational program on knowledge and utilization of the NCI Breast Cancer Risk Assessment Tool (BCRAT) by internal medicine residents.MethodsInternal medicine residents at the primary care clinic at William Beaumont Hospital participated in an educational program on breast cancer risk assessment and chemoprevention. A questionnaire was used to assess knowledge and practice before and after participation. Electronic health records of women between the ages of 35 and 65 who were seen by participating residents for annual health exams between Dec 15, 2015 and Dec 14, 2016 were reviewed. Utilization of BCRAT by the residents was compared pre- and post-educational program.ResultsA total of 43 residents participated in the study. 31 (72.1%) residents reported no prior knowledge about BCRAT. The remaining 12 (27.9%) reported limited knowledge of BCRAT, but the majority of these (n = 10, 83.3%) had not used it in the last six months. For each question on the pre-educational knowledge assessment, fewer than 10% of the residents responded correctly. After implementation of the educational program, there was a significant increase in the proportion of residents who answered correctly (Range: 67 to 100%, p < 0.001).Electronic health records of 301 clinic patients were reviewed, 118 (39.2%) in the pre-educational program group and 183 (60.8%) in the post-educational program group. There was a higher use of BCRAT in the post-educational program group compared to the pre-intervention group (3.8% vs. 0%, p < 0.05). However, a majority (n = 294, 98.7%) of eligible patients from both groups did not undergo breast cancer risk assessment.ConclusionsOur study demonstrates that an educational intervention improved residents’ knowledge of BCRAT. Despite this improvement, a significant proportion of patients did not undergo breast cancer risk assessment. Expanding the scope and duration of this intervention and combining it with innovative use of technology to improve utilization should be the subject of future investigation.Electronic supplementary materialThe online version of this article (10.1186/s12885-019-5418-6) contains supplementary material, which is available to authorized users.

Physicians' perceptions of breast density notification laws and appropriate patient follow‐up

“…Hence, it is concerning that so few physicians indicated that breast cancer risk should be assessed following receipt of breast density notification, and that those who indicated additional imaging were not equally likely to indicate that breast cancer risk should be assessed. These findings are consistent with evidence showing under-utilization of breast cancer risk assessment in primary care settings, [50][51][52][53] suggesting greater need for relevant training and system-level support. 54 Physicians who performed breast cancer risk assessment were more likely to indicate that breast cancer risk should be assessed and that women should receive additional imaging following notification receipt (see bivariate analyses in Appendix 1), though it only predicted the latter in multivariate analyses.…”

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