Evaluating the impact of nurse navigation on high-risk breast clinic appointment uptake in a cancer risk assessment program.

Abstract

e13510 Background: Patients in the breast imaging center are offered comprehensive cancer risk assessment (CRA) using validated risk assessment models (Tyrer-Cuzick 8, GAIL, and NCCN guidelines for genetic testing) at the time of screening mammography. All patients who receive a high-risk breast cancer score are recommended to follow-up at the high-risk breast clinic (HRBC) to determine a personalized management plan including MRI screening, genetic testing, and treatment options. Insufficient communication and patient education regarding breast cancer screening contributes to low HRBC appointment uptake. Nurse navigation (NN) was used to increase the HRBC appointment completion rate. This project aims to assess the effect of NN on HRBC appointment uptake in patients with a high-risk of breast cancer. Methods: Data regarding NN and HRBC appointment uptake for all women at a breast imaging center with a high-risk breast cancer score between July 2021 and January 2022 was extracted from the EMR and grouped into cohorts to assess the impact of NN on HRBC appointment completion. Family history of breast cancer, breast cancer risk model type, and insurance status were also extracted to analyze their relationships with HRBC appointment uptake. A chi-squared analysis was performed to assess the significance of the results. Results: NN contact and HRBC appointment completion of 4090 patients were analyzed. Of the 4090 patients, 1787 (43.7%) were successfully contacted by a nurse navigator. Patients with a family history of breast cancer were more likely to have contact with the nurse navigator (p = 0.022) and complete HRBC appointment (p = 0.017). The distribution of breast cancer risk model and distribution of insurance type were different for patients who completed HRBC appointments and those who did not, (p = 0.0012) and (p = 0.0027), respectively. Of the 4090 total patients, 122 (3.0%) attended the HRBC. Of the 1787 patients contacted by a nurse navigator, 80 (4.5%) completed HRBC appointments (p < 0.0001). Conclusions: Coupling NN with a CRA program at the breast imaging center increased the number of qualified patients who completed HRBC appointments who would not have been identified prior to this program. Patients with a family history of breast cancer, certain types of breast cancer risk model, and certain types of insurance were found to have increased uptake of HRBC appointments. As a result, more patients will receive recommended supplemental screenings and management from a multidisciplinary care team.[Table: see text]