Public Health Approaches and Barriers to Educating Providers about Hereditary Breast and Ovarian Cancer Syndrome.
Public Health Approaches and Barriers to Educating Providers about Hereditary Breast and Ovarian Cancer Syndrome.
复制标题
DOI：
10.3390/healthcare4010019
复制
发表时间：
2016-03-11
期刊：
影响因子：
--
通讯作者：
Duquette D
中科院分区：
文献类型：
--
作者：
Trepanier AM;Supplee L;Blakely L;McLosky J;Duquette D
密歇根州卫生与公众服务部实施并评估了两项举措，旨在提高提供者对适合进行乳腺癌和/或卵巢癌遗传风险评估和遗传性乳腺癌和卵巢癌综合征检测的患者的认识。第一项倡议的目标是选定诊断出符合HBOC风险标准的患者的提供者。具体而言，该倡议使用2008-2009年州癌症登记数据来确定在四个新建立的癌症遗传学诊所的卫生系统中诊断出≤50岁女性乳腺癌、男性乳腺癌和卵巢癌的所有提供者。使用一种被称为双向报告（BDR）的方法，生成并发送报告，突出显示每个提供者所见过的这些案例的数量。475例癌症（全州5005例符合标准的病例中的9.5%）的报告被发送给69个提供者，其中包含有关如何以及为什么将这些患者转介进行遗传咨询的信息。与收到报告的提供者联系，以评估报告是否提高了认识或导致了行动（遗传咨询/转诊）。尽管多次尝试联系，但根据收到的少数答复和流失率，无法确定这一举措对提供者的影响。然而，该项目使MDHHS确定了哪些提供者看到的高危患者比例最大，从而为HBOC教育工作的目标提供者创造了机会。第二项倡议涉及创建和广泛传播一个在线的、互动式的基于案例的教育模块，以提高人们对HBOC使用高风险和低风险患者情况的认识和转诊决策。在一年内，共有1835个独立用户访问该模块。总的来说，用户浏览了2724次主题页面和1369次交互式案例研究。护理点工具（情况说明书）被浏览1624次，下载764次。申请继续医学教育学分的用户满意度较高。在线教育模块的覆盖范围比双向报告倡议要广泛得多，但受众是自我选择的。结合有针对性和广泛的提供者教育工作可能是提高目标受众对HBOC认识的更好方法，从那些看到最大比例风险患者的提供者开始。
The Michigan Department of Health and Human Services implemented and evaluated two initiatives designed to enhance provider knowledge of patients appropriate for breast and/or ovarian cancer genetic risk assessment and hereditary breast and ovarian cancer (HBOC) syndrome testing. The first initiative targeted select providers who had diagnosed patients meeting HBOC risk criteria. Specifically, the initiative used 2008–2009 state cancer registry data to identify all providers who had diagnosed breast cancers in women ≤50 years of age, male breast cancers, and ovarian cancers in four health systems with newly established cancer genetics clinics. Using a method coined bidirectional reporting (BDR), reports highlighting how many of these cases each provider had seen were generated and mailed. Reports on 475 cancers (9.5% of the 5005 cases statewide meeting criteria) were sent to 69 providers with information about how and why to refer such patients for genetic counseling. Providers who received a report were contacted to assess whether the reports increased awareness or resulted in action (genetic counseling/referral). Based on the few responses received, despite multiple attempts to contact, and attrition rate, it is not possible to ascertain the impact of this initiative on providers. However the project resulted in the MDHHS identifying which providers see the largest proportion of at-risk patients, creating an opportunity to target those providers with HBOC education efforts. The second initiative involved creating and broadly disseminating an online, interactive case-based educational module to increase awareness and referral decisions for HBOC using high- and low-risk patient scenarios. A total of 1835 unique users accessed the module in a one year. Collectively the users viewed topic pages 2724 times and the interactive case studies 1369 times. Point of care tools (fact sheets) were viewed 1624 times and downloaded 764 times. Satisfaction among the subset of users applying for continuing medical education credit was high. The online educational module had a much broader reach than the bidirectional reporting initiative but to a self-selected audience. Combining targeted and broad-based provider education efforts may be a better way to increase HBOC awareness in the target audience, starting with those providers seeing the largest proportion of patients at risk.