Implementing a Survivorship Screening Tool in Breast Cancer Survivors: An Evidence-Based Quality Improvement Project

Background: With advancements in cancer therapies, more patients are achieving remission. Following treatment, many of these patients struggle with ongoing physical, psychosocial, and practical concerns (Hussey et al., 2024). Providers face challenges in identifying and meeting these specialized needs while managing capacity (Love et al., 2022). The National Comprehensive Cancer Network (NCCN) recommends using standardized screening tools to identify unmet physical and psychosocial needs in cancer survivors (Sanft et al., 2023). Local Problem: Providers at an outpatient breast oncology clinic in Salt Lake City, UT, do not utilize a standardized tool to assess for unmet needs post-treatment, leading to potential missed identification of patients' needs and missed opportunities for referrals to survivorship resources. This project aimed to implement a standardized screening protocol to improve need identification and increase referrals. Methods: A quality improvement project was designed to improve the quality and quantity of screening for unmet needs in breast cancer survivors. The NCCN Survivor Assessment Survey was adapted to fit clinic needs and implemented with four providers over six weeks. Interventions: Pre- and post-implementation surveys assessed provider screening practices, attitudes, and knowledge of survivorship resources. Education sessions with involved staff reviewed the screening tool, workflow, and available resources. Weekly provider feedback provided opportunities for adjustments to the protocol as needed. Screening and referral rates were analyzed and collected from the electronic health record (EHR). Data from survey responses were compiled and analyzed. Results: Implementing a standardized screening protocol increased screening rates, identification of needs, and referrals to survivorship resources. 92% (n=123) of patients screened reported at least one unmet need, and 71% (n=88) of those patients were referred to survivorship resources, compared to 43% (n=77) before implementation. All providers (n=4) found the tool easy to use and integrate into their clinical workflow. 75% (n=3) of providers were satisfied with the tool, with 25% (n=1) neutral. Providers noted improved need identification and patient provider communication. Conclusion: Implementation of a standardized screening tool to assess for unmet needs in breast cancer survivors is effective and increases referrals to survivorship resources. The next steps include integrating the tool into the EHR for streamlined delivery and expanding it to other clinics and diagnosis groups within the organization.