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Background. Regular mammography screening has been shown to be the most effective means of detecting breast cancer and reducing mortality. Yet, screening rates for African-American women have consistently been lower than their white counterparts. The purpose of this study is to determine physician patterns for mammogram referral after using a reminder system, to assess the number of women who received a mammogram after receiving a referral, and to identify the barriers to mammography after receiving a referral among predominately African-American women seen in an urban primary care setting.
PURPOSE: To compare physician referral practices and attitudes for hereditary breast cancer between clinical practice locations: urban, suburban, and rural. METHODS: 214 physicians in Southwest Ohio's Tristate Region completed a self-administered questionnaire to assess referral practices and attitudes for hereditary breast cancer. Respondents were randomly sampled and grouped retrospectively into clinical practice location groups based on self-reported descriptor of practice location: suburban (39%), rural (32%), and urban (17%). Physician medical specialties included family practice, general practice, general surgery, internal medicine, obstetrics/gynecology, and oncology. RESULTS: Rural-practice physicians were less likely to have ever referred for hereditary breast cancer than suburban-practice physicians. Rural practice physicians were more likely to refer to an oncologist for this indication, whereas urban-practice physicians were more likely to refer to a genetic counselor. Rural practice physicians reported stronger barriers to referral, including distance to services and lack of awareness of services. Of all physicians who reported never referring, 61% reported having no need for such services, irrespective of clinical practice location. CONCLUSIONS: Women residing in rural areas are less likely to be referred for genetic services regarding hereditary breast cancer than their suburban counterparts. The reduced referral frequency among rural-practice physicians is partly due to increased barriers to referral. A significant proportion of physicians, regardless of practice location, may not recognize the benefit of genetic counseling and testing for hereditary breast cancer. Further studies are needed to investigate factors that influence physician referral for this indication, and that may vary by clinical practice location, including specialty, physician knowledge, and patient interest, and to assess the perceived value of genetic services among all physicians.
Abstract Background: Mammogram screening for surveillance and detection of breast cancer has long been recognized as a preventative health measure for women. However, easily recognizing when to screen individual women, based on age and risk factors, lacks clear guidance and often ends in fragmented and inconsistent practices among providers. Methods: By developing and implementing the Screening Mammogram Initiation Protocol (SMIP), the desired goals of this project were to: a) align breast cancer screening recommendations to better meet individualized patient needs in primary care utilizing best practice guidelines, b) increase the rate of breast cancer screening across various demographics, and c) create a standardized screening protocol tool that increases shared decision making based on individual risk factors. Outcome measures were reflected by an increase in provider knowledge towards female breast health counseling, an increase in rates of breast cancer screening discussions, and the successful implementation of the SMIP at a local primary care clinic. Results: Responses from the pre/post knowledge and post-implementation surveys showed improved provider understanding of the current breast cancer screening guidelines for average and high-risk females as well as 90% satisfaction utilizing the SMIP in practice. Electronic data collection after nine-weeks showed an eight percent increase in referrals for women aged 40-49 eligible for breast cancer screening and seven percent increase in referrals for women aged 50-59 respectively. Conclusion: This evidence-based change in practice project improved the quality of care by enhancing preventative health delivery, contributed to increased screening, and likely impacted breast cancer morbidity, and mortality rates.
Clinical Case Studies for the Family Nurse Practitioner is a key resource for advanced practice nurses and graduate students seeking to test their skills in assessing, diagnosing, and managing cases in family and primary care. Composed of more than 70 cases ranging from common to unique, the book compiles years of experience from experts in the field. It is organized chronologically, presenting cases from neonatal to geriatric care in a standard approach built on the SOAP format. This includes differential diagnosis and a series of critical thinking questions ideal for self-assessment or classroom use.