Integration of a MRI Screening Program for Women at High Risk of Breast Cancer: A Quality Improvement Project

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Glade, Mary Jane
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Background: It is estimated that in the year 2019, over 260,000 cases of breast cancer will be diagnosed in the United States and over 40,000 women will die from breast cancer (Siegel, Miller, & Jamal, 2019). National guidelines recommend that women at high risk of breast cancer be screened with annual mammography as well as magnetic resonance imaging (MRI; Bevers et al., 2018). There is a need to identify these high risk women and improve research based screening to reduce the incidence of breast cancer and overall morbidity and mortality.|Purpose: The purpose of this Doctoral Nursing Practice scholarly project was to design and implement a pilot study for quality improvement (QI) to identify and screen women at high risk for breast cancer utilizing breast MRI.|Methods: An extensive literature review and assessment of the practice site was completed and a logic model for change was utilized as the framework the QI project. Providers at a private clinic underwent one on one training regarding best evidence and tools for managing this population. Pre-project questionnaires assessed barriers and attitudes to the aims of the project. High risk women identified during the project were followed for 60 days to track for MRI completion and compared to similar data obtained through retrospective chart review for the year prior. Results of MRIs completed during the project were also tracked.|Results: Four of six providers completed the pre-project questionnaires, the majority indicating a need for further education. During the project period 74 women were identified compared to 30 in the chosen comparison period. During the follow-up period 31% versus 17% underwent MRI screening.|Discussion/Implications: Primary care providers, when armed with appropriate tools and education, can identify patients at the highest risk of cancer. Identifying and screening these patients according to professional guidelines and current research will lead to overall improvements in cancer morbidity and mortality.
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