JL308. Utilization of Cancer Screening Guidelines by APRNs
Joyce Dains, DrPH, JD, RN, FNP-BC, FNAP, FAANP, Department of Nursing, The University of Texas MD Anderson Cancer Center, Houston, TX
Introduction/Purpose: Utilization of established cancer screening guidelines ensures recommendations that are individualized to a patient’s level of risk. The purpose of this survey was to understand how APRNs in Texas access and utilize current cancer screening guidelines. Methods: The instrument was investigator developed with 21 multiple choice response items. To ensure validity, the items were based on review of the literature and previous work. Internal consistency of the responses had a Cronbach’s alpha coefficient 0.89, indicating high reliability. Results: From 2525 randomly selected APRNs in Texas, 367 completed the survey, for a response rate of 14.5%. Over 70% of the respondents worked in private practice (42.7%), community or public health clinic (17.7%), or hospital-based outpatient clinic (13.2%). More than 60% of the respondents practiced in an urban setting with the remaining in more rural settings. The gender was overwhelmingly female (90.9%). Almost half (46%) had been in practice 10 year or less, another 40% in practice 11-20 years. Two-thirds of the participants were over age 40, with 39% over age 50. Overall, 82% of the respondents indicated that they utilized cancer screening guidelines. Of those, 91.3% used screening guidelines for breast cancer, 88.3% for cervical cancer, 90.3% for colorectal cancer, and 26.2% for other cancers. The most common source of guidelines was the American Cancer Society (73%) and the United States Preventive Service Task Force (68%). Other sources included the National Comprehensive Cancer Network and MD Anderson Cancer Center. Of the respondents who used cancer screening guidelines, more than 50% indicated that one of more of the guidelines was not appropriate for their practice. The most common reasons for not using guidelines included uncertainty about which guideline to use (10.3%), too many guidelines (10.4%), and changing guidelines that are difficult to keep up with (11.9%). A majority of respondents indicated that guidelines embedded in the electronic medical record (72.6%), an interactive tool (53.2%), and education about what guidelines are available (51.3%) would be helpful for utilization of guidelines. Conclusion/Implications for Practice: Although a low response rate may impact findings, overall results indicate that respondents are uncertain about which set of cancer screening guidelines to use and find it difficult to keep up with the updates. The respondents would like one set of simple and accessible guidelines that could be easily and automatically updated. A challenge will be to make the guidelines simple and easy to use, widely publicize their availability, and make them accessible and easy to update.
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