The overarching goals are to improve clinician knowledge about evidence-based practices
for neoadjuvant therapy for breast cancer, increase appropriate referrals to medical
oncology for consideration of preoperative systemic therapy (as determined by adherence
to NCCN pre-operative systemic therapy guidelines), and to improve communication between
the multidisciplinary team and patient regarding the appropriateness, selection, and
timing of neoadjuvant therapy. Secondary objectives include a) evaluation of the impact
of the intervention on actual prescription of neoadjuvant therapy to eligible patients
and b) evaluation of the impact of the intervention on surgeons and medical oncologists'
knowledge, attitudes, and beliefs about the benefits of neoadjuvant therapy. We will also
explore the acceptability and utilization of the Carevive care plan during medical
oncologists' initial consultations after referral of patients from surgical practices. In
this project, 25 newly diagnosed breast cancer patients will be recruited over a 3-6
month period, screened for eligibility for neoadjuvant therapy, and assessed for patient
treatment preferences at time of surgical consultation using a novel and commercially
available electronic technology, the Carevive Care Planning System (CPS). Patients will
receive a care plan that explains neoadjuvant therapy among possible treatment options.
In addition, patients will be screened for distress as well as eligibility for genetic
counseling (according to NCCN referral criteria) and fertility preservation (according to
ASCO guidelines) referrals, and the Carevive care plans provided will also incorporate
personalized referrals to these related services where applicable.
Retrospective chart reviews (from both surgical and medical oncology practices
participating in this project), complemented by data extracted from the Carevive CPS,
will be used to assess changes in rates of referrals to medical oncology for discussion
and actual prescriptions of neoadjuvant therapy, as compared to historical data from
prior publications documenting low rates of referral to, and receipt of, neoadjuvant
therapy. Provider questionnaires exploring knowledge, attitudes, and beliefs about the
benefits of neoadjuvant therapy will be completed at baseline and again at follow-up (≤4
weeks following intervention visit of their last patient) and changes will be explored
using a pre-/post-test design. Use of a care planning technology to provide tailored
education and individualized information may provide an easy, accessible and effective
way to improve provider abilities to proactively identify patients eligible for specific
therapies, understand patient treatment goals, concerns, drive shared decision making
(SDM) and sufficiently collaborate with the multi-disciplinary team to provide optimal
care.
