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Evaluating the Implementation and Maintenance of a Breast Cancer Risk-Assessment and Prevention Program.

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The Breast Cancer Personalized Risk Assessment, Education, and Prevention (B-PREP) program successfully increased chemoprevention uptake in high-risk patients. Program maturation decreased initiation time, with clinicians citing support and evaluation as key to sustainability.

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Area of Science:

  • Oncology
  • Preventive Medicine
  • Health Services Research

Background:

  • Understanding factors driving success in high-risk breast health programs is crucial for developing similar initiatives.
  • The Breast Cancer Personalized Risk Assessment, Education, and Prevention (B-PREP) program was evaluated using the RE-AIM framework.

Purpose of the Study:

  • To evaluate the impact and sustainability of the B-PREP program.
  • To assess the program's reach, effectiveness, adoption, implementation, and maintenance.

Main Methods:

  • Retrospective review of prospectively maintained database for 5972 patients from January 2017 to September 2024.
  • Reach was measured by patient volume over time; effectiveness by chemoprevention uptake.
  • Clinician and staff surveys using the Program Sustainability Assessment Tool (PSAT) assessed implementation and maintenance.

Main Results:

  • Of 5972 patients, 31.1% had high-risk lesions (HRL).
  • Chemoprevention initiation rate was 7.38% overall, significantly higher for HRL patients (22.5%) vs. non-HRL (0.5%).
  • Sustained chemoprevention (≥6 months) was also higher for HRL patients (15.4%). PSAT scores indicated high sustainability (6.13/7), particularly in adaptation, evaluation, and environmental support.

Conclusions:

  • The B-PREP program effectively increased annual chemoprevention use and decreased initiation time as the clinic matured.
  • Key sustainability factors identified by clinicians included a supportive environment, regular program evaluation, and adaptability.