Optimizing Hereditary Cancer Risk Assessment and Genetic Testing Workflow in Interprofessional Women's Health Practice: A Multicenter Survey of Advanced Practice Providers.

INTRODUCTION

Advanced practice providers (APPs), including certified nurse-midwives (CNMs)/certified midwives and nurse practitioners, are well positioned to meet the growing demand for women's health care services. In interprofessional obstetric and gynecologic settings, APPs' scope of practice includes performing hereditary cancer risk assessments (HCRAs) and genetic evaluations, comparable with physicians. However, time constraints, limited confidence, and inadequate resources may hinder APPs' ability to routinely and effectively incorporate HCRA and genetic testing into practice.

PROCESS: This prospective, single-arm health care quality improvement initiative introduced workflow innovations and tools to improve HCRA workflow. This intervention included training on using online family history screening and virtual patient education tools within a standardized HCRA. Metrics related to genetic evaluation and testing completion and the experiences of women and APP respondents were recorded preintervention and postintervention. Data were analyzed using descriptive statistics and univariate conditional logistic regression models.

OUTCOMES: Following workflow standardization, APPs noted increases of 27.1 percentage points in the proportion of women offered genetic testing and 26.4 percentage points in the genetic testing completion rate (26.4%). APPs agreed or strongly agreed that the workflow modification improved their confidence in performing HCRA (91.7%) and meeting the standard of care (91.7%) and supported guideline adherence (83.3%) and ease of practice integration (66.7%).

DISCUSSION: APPs care for women with similar risk profiles as physicians and are equally capable of implementing novel tools and processes to provide evidence-based, personalized HCRA consistent with their scope of practice.