Implementation of Standardized Hereditary Breast and Ovarian Cancer (HBOC) Risk Assessment and Genetic Referral

Objective: To increase identification and genetic referral rates for women at risk of Hereditary Breast and Ovarian Cancer (HBOC). Design: Evidence-based practice improvement initiative Setting/Local Problem: Private suburban OB/GYN practice in Tennessee with no standardized process for HBOC risk assessment or genetic referral. Participants: Women age 18 or older, presenting for routine well-woman visits. Intervention/Measurements: Using PDSA (plan-do-study-act) cycles, a familial risk assessment tool was selected, and a clinical decision-making algorithm for risk assessment and genetic referral was designed and implemented for use in well-woman encounters. Pre-implementation and post-implementation risk identification and referral rates were measured, as was compliance with the utilization of the risk assessment tool. The aim of this initiative was to increase identification and referral rates by 25%. Results: Women at risk of HBOC in the post-implementation group were 25.9 times more likely to be identified as at-risk (OR = 25.88, 95% CI [10.78-62.14]) and 31.5 times more likely to be offered genetic referral (OR = 31.50, 95% CI [13.37-74.22]) as compared to the pre-implementation group. Rates of risk identification and genetic referral for women at risk of HBOC increased by 58.2% and 69.3% respectively, surpassing the aims of this initiative and demonstrating the statistical significance of p Conclusion: The use of a standardized process for HBOC risk identification and genetic referral resulted in a significant increase in identification and genetic referral for women at risk in this setting. Nurses and advanced practice registered nurses (APRNs) play a critical role in the identification of women at risk of HBOC and their access to genetic services. Early identification of women with HBOC syndrome is a crucial first step in increasing the utilization of enhanced screening and interventions that can reduce HBOC-associated cancer morbidity, prevent cancer, and save lives. A publication of this project can be found in Nursing for Women\u27s Health