BPI20-014: Clinical Pathway and Education Implementation to Support Guideline Adherent Breast Cancer Care for Rural Women Under Age 50

Background: Adherence to National Comprehensive Cancer Network (NCCN) guidelines improves breast cancer therapy outcomes. While physician guideline adherence is often high, room for improvement exists. Shared surgical decision making, genetic counseling, and fertility preservation, which are salient to young women with breast cancer, may be overlooked when physicians do not encounter young patients often (e.g. rural cancer centers) or are not informed nor seek current guidelines. We sought to improve the efficacy and efficiency with which rural oncology providers recognize and address physical, psychosocial, and decision-making needs of young women with breast cancer through development and implementation of clinical pathways and NCCN guideline supported educational content. Methods: The Consolidated Framework for Implementation Research (CFIR) informed our process with the goal of reducing barriers to pathway acceptance. To increase physicians’ confidence in the pathways, development was led by an expert medical oncologist known in the community. Ease of access was supported by hosting pathways on a newly developed Pathwaytocure.org website along with expert-developed, NCCN guideline supported, educational webinars. Transparency was increased by seeking input on draft pathways from the multidisciplinary oncology teams at the Fred & Pamela Buffett Cancer Center and collaborating rural cancer centers using a survey measuring pathways’ logic and feasibility, representation of evidence-based care, multidisciplinary approach, variability for patient preferences, promotion of patient-provider communication and shared decision-making. Stakeholders were also involved by engaging “champion” physicians at the rural centers to encourage pathway use. Evaluation at six months post-implementation will determine whether pathways meet providers’ and patients’ needs and assess NCCN guideline adherence. Results: Six pathways based on ER, PR, and HER2 status were developed to map pre-treatment assessments, consultations, considerations, neoadjuvant and adjuvant therapy and survivorship care. Oncology provider survey return rate was 25%. Results indicated satisfaction but changes needed to pathway design and content. Modified pathways were implemented in September 2019. Website analytics and pathway outcomes will be reported. Conclusion: Stakeholder input is essential to identify clinical pathway modifications needed to support physician acceptance, satisfaction, and use.