Incorporating BRCA1 and BRCA2 Testing into Clinical Practice

This project seeks to support the clinical practice of using established guidelines for evaluating women at risk of hereditary breast and ovarian cancer. Breast cancer is the second most common cause of cancer in women and the second leading cause of cancer death. Breast cancer and ovarian cancer respectively have a 5-10% and 4-11% hereditary component to them. With the discovery of the BRCA1 and BRCA2 genes and their linkage to hereditary breast and ovarian cancers, increased interest has emerged in screening women at high risk for these gene mutations. However, relatively few clinicians are assessing women's risk for these mutations due to lack of knowledge. Gaps in clinical practice have been identified related to primary care. These gaps include the clinician's lack of knowledge in ability to assess women who are at high risk, recommended guidelines to use, how to referral to genetic counseling, and which women should be tested. The objectives of this project were to  identify clinicians', at Birth Care Health Care clinics, perceptions of how they are implementing established guidelines from USPSTF and NCCN in screening.  evaluate the medical record for evidence of screening by these clinicians based on established guidelines.  propose practice changes from the findings of my first two objectives in order to incorporate screening practices based on established guidelines. This project was implemented using a questionnaire that was created to evaluate the clinician's knowledge and to discover their current practices for screening for BRCA1/2 at Birth Care Health Care (BCHC). In addition, medical records were reviewed for evidence of screening practices to identify those at risk for BRCA1/2 mutations and management according to recommended guidelines. A presentation was given during a BCHC staff meeting presenting evidence of the survey and chart review along with recommendations for following guidelines, screening, referral, and genetic testing. This project was evaluated through the responses from the questionnaire, evidence of following recommended guidelines through the chart review, and improved clinician knowledge of BRCA screening, testing, and recommended guidelines. The goal of this project was to identify current practices and gaps related to screening women for BRCA1/2 mutations using recommended guidelines. This was achieved by using the theoretical framework, Ace Star Model of Knowledge Transformation; that allows the clinicians at BCHC to improve and increase quality of care through the use of evidence-based knowledge. Optimal decisions will be made through integration of the five stages of this theory as clinicians take recommended guidelines and incorporate them into clinical practice.