3030 — Successful Implementation Strategies Designed to Improve Familial Cancer Risk Assessment and Referral of Women Veterans at Risk for Hereditary Cancer
Scheuner MT, Rhodes S, Hamilton A, Austin C, Goldzweig C, and Mittman B, VA Greater Los Angeles Healthcare System; Gilman S, VA Long Beach Healthcare System; Yano EM, VA Greater Los Angeles Healthcare System;
Women with hereditary cancer syndromes have high risks for cancer, they are at risk for mulitple primary cancers, and they typically develop cancer at younger ages. Consequently, enhanced cancer screening and prevention are recommended. However, most clinicians are not prepared to identify and manage individuals with hereditary cancer. We developed an implementation plan for VA clinicians in Women’s Health designed to improve familial risk assessment for hereditary cancer and increase appropriate referrals for genetic consultation.
Implementation strategies included a Computerized Patient Record System (CPRS) reminder that documents structured family history and facilitates referral for genetic consultation, practice-feedback reports, lectures, website, information sheets, and opinion leaders. We used semi-structured interviews and chart review to evaluate our implementation plan. We assessed clinician behavior change by comparing family history documentation and genetics referral in randomly selected charts pre- (Oct-Dec, 2009; n = 78) and post-implementation (Apr 2010-Mar 2011; n = 442).
Clinicians unanimously endorsed the lectures and CPRS reminder, indicating that their documentation of cancer family history had improved and their confidence in recognizing high-risk patients increased. The reminder was completed for 1,087 (30%) women Veterans during implementation of which 105 were referred for genetic consultation. In the first three months, 7% were not referred for genetic consultation but had high-risk family histories meeting criteria for referral; this number decreased to <1% in the last four months. Documentation of any cancer family history increased from 44% of charts to 70%, and documentation of specific family history characteristics necessary for genetic risk assessment increased: second-degree relatives (14% to 49%); lineage of relatives (4% to 20%); and age at cancer diagnosis (5% to 26%).
Our implementation strategies resulted in more comprehensive family history documentation, recognition of high-risk cases, and increased appropriate referrals for genetic consultation.
Women with genetic predisposition to cancer have high risks for developing one or more cancers, usually at younger ages. Our implementation strategies have been successful in improving familial cancer risk assessment and referral of high-risk women. Spread of our implementation plan has the potential to promote access to genetic services and risk-appropriate cancer screening and prevention.