Impact of an Educational Intervention on Nurse Practitioner Student Knowledge Regarding High Risk Breast Cancer Screening Options

Statement of Problem: The current recommendations by the United States Preventive Services Task Force (USPSTF) regarding ‘no cost sharing’ genetic screening and chemo-preventive medications only for high risk women with breast cancer, in tandem with recommendations cover mammograms at ‘no cost’ sharing’ biennially for low to moderate risk women 50 through 74, will contribute to another rise in breast cancer deaths among women. This problem is compounded by the non-uniformity by which primary care providers refer high risk women to a specialist for a more tailored assessment of personal risk factors/screening options, including the ‘no cost sharing’ preventative measures for high risk women that the USPSTF does endorse, namely genetic testing/counseling and risk-reducing medications for specific high risk women. The implementation of USPSTF guidelines will require the application of comprehensive, quantitative breast cancer risk assessments in primary care facilities across the country. However, the information about the feasibility and effect of individualized risk assessment in the primary care setting is limited (Anderson et al., 2015). Available evidence suggests this is not standard practice for U.S. primary care providers (Anderson et al., 2015). This study will help identify the key variables that contribute to the non-uniform referral pattern of high risk women for genetic testing and chemo-preventive medications in the U.S. This researcher will study the education of primary care providers and how this effects referrals for risk-reducing medications and/or genetic counseling services. The population of interest for this study will be a group of nurse practitioner students enrolled in an advanced practice care of women class at a local university in San Diego County. They will be provided with information regarding high-risk factors for breast cancer, and preventative ‘no cost sharing’ options that are offered under USPSTF guidelines. This researcher will look at the effects of a single session educational program on the students’ knowledge of breast cancer risk factors and screening options for high risk women. Preventative methods targeted in this study will include genetic counseling and risk reducing medications. MRI for high-risk women and women with dense breasts will be presented as a screening option, but it will be made clear that this is not a ‘no cost sharing’ benefit. The educational intervention and survey tool will be modeled on the intervention and tool used in a 2015 study by Bryan et al., which assessed the impact of an educational intervention on provider knowledge, attitudes and comfort level regarding counseling about breast cancer screening. Bryan et al.’s educational intervention included a review of the risks and benefits of screening women ages 40-49, individual risk assessment, and counseling methods (Bryan, Estrada, Castiglioni, & Snyder, 2015).