Rural Arizona Nurse Practitioners' Knowledge of Hereditary Breast and Ovarian Cancer Risk Assessment

Abstract

Problem statement: Mutations in the genetic material BRCA I/II are linked to increased incidence of cancer among the women who carry these alterations, raising lifetime risk of breast cancer to as high as 87%. Genetic testing exists to identify these alterations, empowering women to obtain advanced screening for breast and ovarian cancer, as well as incorporate prophylactic medications and surgeries for prevention of disease. Research has shown that appropriate risk assessment methods are not being utilized among primary care providers to identify those patients who would benefit from genetic counseling and testing. Purpose: To determine if a knowledge deficit about U.S. Preventative Services Task Force BRCA risk assessment recommendations exists among the rural Arizona nurse practitioner population, and to determine the level of confidence Arizona NPs have regarding the topic. Methods: A needs assessment completed via an 18-question online survey distributed through two provider organizations in Arizona. Inclusion criteria included NP must hold an active license in Arizona, NP must practice in primary healthcare, and practice site must serve patients who reside in a rural area of Arizona. Data collection remained open for three weeks. Analysis: Descriptive statistics using quantitative analysis evaluated provider demographics, responses to basic knowledge questions and clinical scenarios, and provider self-confidence analyses. Results: Participants were able to identify inheritance patterns of BRCA mutations, but incorrectly answered the majority of knowledge questions. Regarding self-reported confidence with awareness and use of the USPSTF guideline, nearly half of participants felt that they had at least average confidence. However, only one participant was able to answer every question correctly. Most agreed that the guidelines were relevant to their current practice. These results indicate a knowledge gap among NPs who care for patients living in rural Arizona. These results may inform future research aimed at educational interventions and practice improvement initiatives that will improve understanding and use of guidelines for screening, counseling, and testing patients at high-risk of carrying a harmful BRCA-mutation. Ultimately, these results will impact outcomes of patients living in rural Arizona.