One of the accomplishments I am most proud of is driving the creation of a successful high-risk breast program in a large community-based health system. I am often asked how we did it. For advice on getting started, check out the first blog in this series. If you have already implemented a high-risk breast program, congratulations! It’s time to look toward the future and consider expanding your program. This will involve scaling successful initiatives and broadening the program's reach to benefit more patients. Here are some practical, engaging, and impactful best practices I have discovered that you can use to expand your high-risk breast program.

Leverage Data and Metrics

First off, let's talk data. I know, data might sound a bit dry, but trust me, it's the backbone of your program. Utilize the data you’ve collected to pinpoint areas that are ripe for expansion. Metrics like patient satisfaction, referral rates, and genetic testing outcomes can highlight what’s working well and where you can grow. Having robust data also helps justify the expansion to stakeholders by showing the program's impact and return on investment (ROI).

Moreover, regularly analyzing and presenting this data can uncover trends and insights that might not be immediately apparent. For example, tracking patient demographics and outcomes over time can help identify specific populations that might benefit the most from the program, or who may need additional support to access it. Sharing these insights with stakeholders builds a compelling case for continued investment and expansion.

Monitor and Report Outcomes

Monitor and report outcomes regularly to stakeholders, including patients, providers, and funding sources. Transparent reporting builds trust and demonstrates the program's value. Highlight success stories, improvements in patient outcomes, and the overall impact of the program on community health.

Creating comprehensive annual reports that include detailed metrics, patient testimonials, and case studies can effectively communicate the program's achievements. Sharing these reports through various channels, such as newsletters and social media, can enhance visibility and support.

Invest in Advanced Technology to Deepen and Broaden Your Efforts

Invest in advanced technologies and digital health tools to streamline workflows, improve data collection, and enhance patient care. Technologies such as those leveraged by the Ambry CARE Program^® (CARE) can extend your program's reach by both standardizing risk assessment at a single site so that no patients are missed and reaching additional sites remotely that may be underserved. Digital health assessment and telehealth genetic counseling, which are both components of CARE, can help extend your program’s geographic reach.

Integrating these digital tools can also enhance the precision and efficiency of identifying high-risk individuals. Guidelines for hereditary cancer testing are constantly evolving. CARE can support you in ensuring that the assessment your patients complete is based on the latest guidelines.

Lastly, digital tools can facilitate patient education and engagement, ensuring they remain informed and proactive about their health. For instance, through CARE’s Patient Portal your high-risk program can provide patients with easy access to resources, education, and reminders for return visits.

Strengthen Partnerships

Partnerships like we formed with Ambry are your secret weapon. Strengthening existing partnerships and forming new ones with healthcare institutions, research organizations, and community groups can enhance your resources, knowledge sharing, and outreach capabilities. For instance, partnering with genetic testing companies can streamline the testing process and provide valuable data for assessing program efficacy. Consider partnering with local clinics, mobile health units, and telemedicine services to provide risk assessment, genetic counseling, and screening services to these populations. Tailoring outreach and education efforts to the unique needs of these communities can also enhance participation and engagement.

Continuous Training and Development

Your team is your greatest asset, so make sure you give them the tools they need to succeed with this service. Provide ongoing training and development opportunities for healthcare providers involved in the program. Keeping staff updated with the latest advancements and best practices ensures high-quality care. Consider hosting regular training sessions, attending relevant conferences, and encouraging staff to pursue certifications in genetic counseling and breast cancer risk assessment.

Incorporating simulation-based training can help staff practice and refine their skills in a controlled environment. Additionally, fostering a culture of continuous learning within the program encourages innovation and the adoption of new, evidence-based practices.

Enhance Patient Education

Education is power. Along with your staff, you can also train your patients in ways to partner with your better for their healthcare journey. Expand patient education initiatives to raise awareness about breast cancer risk factors, screening guidelines, and preventive measures. Use various channels such as workshops, webinars, social media, and informational brochures to reach a broader audience. Education should be ongoing, ensuring patients understand the importance of regular screenings and genetic testing.

Consider creating a comprehensive online resource center that includes videos, articles, and interactive tools to help patients and their families understand their risk and the steps they can take to mitigate it. Partnering with patient advocacy groups can also amplify your educational efforts and reach more individuals.

Implement Comprehensive Patient Navigation Services

Patient navigation services can make a world of difference. Implementing comprehensive patient navigation services can significantly improve patient outcomes and satisfaction. Patient navigators can assist individuals in understanding their risk, coordinating appointments, and accessing resources and support services. This personalized approach helps ensure that patients do not fall through the cracks and receive timely, appropriate care.

Patient navigators can also act as liaisons between patients and healthcare providers, facilitating communication and ensuring that patients fully understand their treatment options and the steps they need to take. By offering consistent support throughout the patient's journey, navigators can reduce anxiety and improve adherence to recommended screenings and interventions.

Community Outreach

Don't underestimate the power of your community. Increase community outreach efforts to engage with more individuals at risk. Partner with local organizations to host events, screenings, and educational sessions. Community outreach can help identify individuals who might not otherwise have access to high-risk breast programs, ensuring a wider impact.

Developing outreach programs specifically tailored to diverse communities can help address disparities in access to care. For instance, offering multilingual resources and partnering with community leaders can enhance trust and participation among underrepresented groups.

Engage with Policymakers

Get political. Engage with policymakers to advocate for policies that support high-risk breast programs. Policy changes can provide funding, improve access to genetic testing, and promote widespread adoption of risk assessment protocols. Advocacy efforts can also raise public awareness about the importance of early detection and prevention.

Building relationships with policymakers and participating in legislative advocacy can help shape healthcare policies that benefit high-risk breast programs. Additionally, collaborating with professional organizations and patient advocacy groups can amplify your advocacy efforts.

Develop a Sustainability Plan

Think long-term. Create a sustainability plan to ensure the program's long-term viability. Explore diverse funding sources, including grants, donations, and partnerships, to support expansion efforts. Financial planning is crucial for maintaining program operations and enabling growth without compromising service quality.

Engaging philanthropic organizations and leveraging community fundraising initiatives can provide additional financial support. Furthermore, demonstrating the program's impact through detailed reports and success stories can attract long-term investors and sponsors.

Evaluate and Adapt

All of the above advice can be helpful as you grow your high-risk program. You must always be flexible and ready to adapt to take advantage of opportunities. Continuously evaluate the program's effectiveness and make necessary adaptations. Solicit feedback from patients and providers to identify areas for improvement and address any challenges. Regular evaluations can help refine the program and ensure it remains responsive to patient needs and healthcare advancements. This can also build trust with program stakeholders.

Implementing a structured feedback system, such as regular surveys or focus groups, allows for timely and actionable insights. Additionally, benchmarking your program against national standards and best practices can highlight areas for enhancement and validate your progress.

Patients can provide valuable perspectives on what aspects of the program are working well and where there may be gaps. By involving them in the process, you demonstrate a commitment to patient-centered care and can make more informed decisions about program development and expansion.

Conclusion

By following these best practices, healthcare providers can expand high-risk breast programs, ultimately improving outcomes for more individuals at elevated risk of breast cancer. Building and expanding such programs requires vision, collaboration, and dedication, but the impact on patients' lives makes it a worthwhile endeavor. So, let's get to work and make a difference!

Resources

Genetic Testing and Counseling

Tung, N., Battelli, C., Allen, B., Kaldate, R., Bhatnagar, S., Bowles, K., ... & Ryan, P. D. (2011). Genetic testing for hereditary cancer predisposition: BRCA1/2, Lynch syndrome, and beyond. *American Journal of Medical Genetics Part C: Seminars in Medical Genetics, 157*(4), 146-158. https://doi.org/10.1002/ajmg.c.30320

Kurian, A. W., Hare, E. E., Mills, M. A., Kingham, K. E., McPherson, L., Whittemore, A. S., ... & Ford, J. M. (2017). Uptake, outcomes, and costs of expanded panel genetic testing to assess cancer risk. *Journal of Clinical Oncology, 35*(24), 2540-2547. https://doi.org/10.1200/JCO.2016.71.9260

Multidisciplinary Approaches

Taylor, C., Munro, A. J., Glynne-Jones, R., Griffith, C., Trevatt, P., Richards, M., & Ramirez, A. J. (2010). Multidisciplinary team working in cancer: what is the evidence? *BMJ, 340*, c951. https://doi.org/10.1136/bmj.c951

Edwards, M. J., Wilkins, E., Ball, C. G., Groot, G., & Fung-Kee-Fung, M. (2009). The impact of a multidisciplinary breast cancer clinic on patient management and satisfaction. *Journal of Surgical Oncology, 99*(1), 34-38. https://doi.org/10.1002/jso.21173

Technology and Digital Health Tools

Vidal-Alaball, J., Acosta-Roja, R., Pastor Hernández, N., Sanchez Luque, U., Morrison, D., Narejos Pérez, S., ... & López Seguí, F. (2020). Telemedicine in the face of the COVID-19 pandemic. *Journal of Medical Internet Research, 22*(8), e22032. https://doi.org/10.2196/22032

Yala, A., Lehman, C., Schuster, T., Portnoi, T., & Barzilay, R. (2019). A deep learning mammography-based model for improved breast cancer risk prediction. *Radiology, 292*(1), 60-66. https://doi.org/10.1148/radiol.2019182716

Dileep G, Gianchandani Gyani SG. Artificial Intelligence in Breast Cancer Screening and Diagnosis. Cureus. 2022 Oct 15;14(10):e30318. doi: 10.7759/cureus.30318. PMID: 36381716; PMCID: PMC9650950.

Patient Education and Engagement

Masi, C. M., Blackman, D. J., & Peek, M. E. (2007). Interventions to enhance breast cancer screening, diagnosis, and treatment among racial and ethnic minority women. *Medical Care Research and Review, 64*(5_suppl), 195S-242S. https://doi.org/10.1177/1077558707305410

Frosch, D. L., & Elwyn, G. (2014). Don't blame patients, engage them: transforming health systems to address health literacy. *Journal of the American Medical Association, 311*(9), 843-844. https://doi.org/10.1001/jama.2014.401

Community Outreach and Access to Care

Brawley, O. W. (2002). Disaggregating the effects of race and poverty on breast cancer outcomes. *Cancer, 97*(1), 285-291. https://doi.org/10.1002/cncr.11019

DeGroff, A., Sharma, K., Satsangi, A., & Kenney, K. (2021). A systematic review of mammography educational interventions for low-income women. *American Journal of Preventive Medicine, 60*(2), e55-e68. https://doi.org/10.1016/j.amepre.2020.09.020