A Strategy for Changing Adherence to National Guidelines for Decreasing Laboratory Testing for Early Breast Cancer...

Area of Science:

• Oncology
• Clinical Practice Guidelines
• Healthcare Quality Improvement

Background:

• Delays in adopting updated clinical guidelines are common.
• National Comprehensive Cancer Network guidelines changed in June 2016, recommending against routine complete blood cell count (CBC) and liver function tests (LFT) for early breast cancer.
• An implementation strategy was created to stop routine lab orders for asymptomatic patients.

Purpose of the Study:

• To implement and assess a strategy for discontinuing routine complete blood cell count (CBC) and liver function tests (LFT) in early breast cancer patients.
• To evaluate the impact of updated National Comprehensive Cancer Network guidelines on clinical practice.

Main Methods:

• Audited ordering of CBC and LFT for clinical stage I-IIIA breast cancer patients in 2016.
• Utilized the National Quality Strategy implementation methodology to enact system-wide changes.
• Continuously tracked guideline compliance for ordering these tests.

Main Results:

• Overall guideline compliance for ordering CBC and LFT was 82% and 87%, respectively.
• Post-guideline change compliance for CBC and LFT was 78% and 87%.
• The study demonstrated a rapid shift in provider practice.

Conclusions:

• Provider practice regarding routine screening blood tests for early breast cancer was changed quickly.
• This contrasts with historical reports of slow adoption of guideline updates.
• The implementation strategy was effective in transitioning from routine ordering to omission of tests.