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. 2019 Mar 14;19(1):228.
doi: 10.1186/s12885-019-5418-6.

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

Siddhartha Yadav  1 , Sarah Hartkop  2 , Paola Yumpo Cardenas  3 , Rand Ladkany  2   3 , Alexandra Halalau  2   4 , Sandor Shoichet  2   4 , Michael Maddens  2   4 , Dana Zakalik  5   6
Affiliations

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

Siddhartha Yadav et al. BMC Cancer. .

Abstract

Background: Despite 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.

Methods: Internal 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.

Results: A 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.

Conclusions: Our 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.

Keywords: BCRAT; Breast Cancer; Chemoprevention; Gail; Internal medicine; Knowledge; Primary care physicians; Residents; Risk assessment.

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Conflict of interest statement

Ethics approval and consent to participate

The requirement for informed consent for chart review portion of this study was waived due to retrospective nature of the data. Prior to the participation in the study, resident physicians were provided with an Institutional Review Board-approved written print-out discussing the methodology of the study, the voluntary nature of participation including the option to withdraw from the study at any point, and the contact addresses for further questions and concerns. Since participation into the study and completion of questionnaire was optional for the resident physicians, consent was implied when residents participated in the program and completed the questionnaire. This study was approved by Institutional Review Board at Beaumont Health (HIC-2015-465).

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

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Study Design
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