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.
Highlights
Despite strong evidence of benefit, breast cancer risk assessment and chemoprevention are underutilized by primary care physicians
Our study demonstrates that a comprehensive lecture-based educational program improved the knowledge of Breast Cancer Risk Assessment Tool (BCRAT) in internal medicine resident primary care physicians (PCPs)
On a more positive note, our study demonstrates that internal medicine residents are willing and able to absorb knowledge on breast cancer risk assessment and prevention
Summary
Despite strong evidence of benefit, breast cancer risk assessment and chemoprevention are underutilized by primary care physicians. A number of validated, quantitative risk-assessment models incorporate features of a patient’s medical and family history to accurately estimate their individual risks [3]. Examples of such risk assessment models in use today include the Gail model [4], the Claus model [5] and the Tyrer-Cuzick model [6], each with its own unique strengths and limitations. Similar guidelines issued by American Society of Clinical Oncology [9] and United States Preventative Services Task Force [10] advocate for use of BCRAT and other breast cancer risk assessment tools to identify women who will benefit from chemoprevention. BCRAT is one of the most widely used breast cancer risk assessment tools by primary care physicians (PCPs) due to its simplicity and easy accessibility on the internet [11]
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