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Healthcare 2016, 4(1), 19;

Public Health Approaches and Barriers to Educating Providers about Hereditary Breast and Ovarian Cancer Syndrome

Center for Molecular Medicine and Genetics, Wayne State University, 540. E. Canfield, Detroit, MI 48154, USA
Medical Genetics, Spectrum Health, 25 Michigan Street NE, Grand Rapids, MI 49503, USA
Saint Joseph Mercy Hospital, 5301 East Huron River, Ypsilanti, MI 48197, USA
InformedDNA, 360 Central Ave, St Petersburg, FL 33701, USA
Michigan Department of Health and Human Services, 201 Townsend, Lansing, MI 48909, USA
These authors contributed equally to the work.
Formerly of the Michigan Department of Health and Human Services, Lansing, MI 48909de, USA
Author to whom correspondence should be addressed.
Academic Editor: Sampath Parthasarathy
Received: 4 December 2015 / Revised: 29 February 2016 / Accepted: 2 March 2016 / Published: 11 March 2016
(This article belongs to the Special Issue Implementation of Public Health Genomics)
View Full-Text   |   Download PDF [216 KB, uploaded 11 March 2016]


The Michigan Department of Health and Human Services implemented and evaluated two initiatives designed to enhance provider knowledge of patients appropriate for breast and/or ovarian cancer genetic risk assessment and hereditary breast and ovarian cancer (HBOC) syndrome testing. The first initiative targeted select providers who had diagnosed patients meeting HBOC risk criteria. Specifically, the initiative used 2008–2009 state cancer registry data to identify all providers who had diagnosed breast cancers in women ≤50 years of age, male breast cancers, and ovarian cancers in four health systems with newly established cancer genetics clinics. Using a method coined bidirectional reporting (BDR), reports highlighting how many of these cases each provider had seen were generated and mailed. Reports on 475 cancers (9.5% of the 5005 cases statewide meeting criteria) were sent to 69 providers with information about how and why to refer such patients for genetic counseling. Providers who received a report were contacted to assess whether the reports increased awareness or resulted in action (genetic counseling/referral). Based on the few responses received, despite multiple attempts to contact, and attrition rate, it is not possible to ascertain the impact of this initiative on providers. However the project resulted in the MDHHS identifying which providers see the largest proportion of at-risk patients, creating an opportunity to target those providers with HBOC education efforts. The second initiative involved creating and broadly disseminating an online, interactive case-based educational module to increase awareness and referral decisions for HBOC using high- and low-risk patient scenarios. A total of 1835 unique users accessed the module in a one year. Collectively the users viewed topic pages 2724 times and the interactive case studies 1369 times. Point of care tools (fact sheets) were viewed 1624 times and downloaded 764 times. Satisfaction among the subset of users applying for continuing medical education credit was high. The online educational module had a much broader reach than the bidirectional reporting initiative but to a self-selected audience. Combining targeted and broad-based provider education efforts may be a better way to increase HBOC awareness in the target audience, starting with those providers seeing the largest proportion of patients at risk. View Full-Text
Keywords: hereditary breast and ovarian cancer syndrome (HBOC); public health initiative; genetic counseling; provider education hereditary breast and ovarian cancer syndrome (HBOC); public health initiative; genetic counseling; provider education
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Trepanier, A.M.; Supplee, L.; Blakely, L.; McLosky, J.; Duquette, D. Public Health Approaches and Barriers to Educating Providers about Hereditary Breast and Ovarian Cancer Syndrome. Healthcare 2016, 4, 19.

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