Finding Opportunity to Provide Patient-Centered Care in Response to Breast Density Legislation

The following post was contributed by Courtney L. Sullivan, MS, RRA, RT (R), RDMS, CN-BI

Through a lay letter notification that was sent in the mail, a woman receives her mammogram results to discover that everything is normal. Relieved, she makes a note in her calendar to schedule her annual screening exam in one year, and then she reads the following:

“Your mammogram shows that your breast tissue is dense. Dense breast tissue is very common and is not abnormal. However, dense breast tissue can make it harder to find cancer on a mammogram and may also be associated with an increased risk of breast cancer. This information about the result of your mammogram is given to you to raise your awareness. Use this information to talk to your doctor about your own risks for breast cancer. At that time, ask your doctor if more screening tests might be useful, based on your risk. A report of your results was sent to your physician.”

What does she do now? The above notification is verbiage required by New York State law that mandates radiologists to inform patients if they are found to have dense breast tissue. In January 2013, New York State joined the many states that have passed breast density legislation laws.

Although these laws are increasingly being enacted across the country, there are no evidence-based guidelines to support additional screening options for dense breast tissue, and also no guarantee of insurance coverage. As a result, breast density notifications often lead to confusion for both patients and their referring physicians.

Patients often turn to their referring physicians to answer questions, yet it is the radiologist that has the most expertise in breast imaging and additional screening for dense tissue. While these laws are currently mandated on a state level, a proposal has been made to make breast density notification a federal standard which implies that this is a topic that is only going to become more pressing.

In attempts to ease some of the anxieties and confusion around breast density, the radiology department at Weill Cornell Medical College at NewYork-Presbyterian Hospital developed a consultation service for patients and their physicians. The department recognized a lack of education surrounding issues of breast density and saw an opportunity to get patients involved in their own care.

The consultation service, formally known within the institution as WiCare (Weill Cornell Imaging Consultation and Radiologic Expertise), consists of one RRA (Registered Radiologist Assistant) and 12 breast radiologists that work together to ensure that patients have the resources to make well informed decisions.

A study described in an article recently published in Clinical Imaging examined the initial experience with the radiology consultation service and found that consultation was successful in increasing patient confidence and perception regarding breast density, ultimately facilitating communication between patients and their providers.

While there was room for improvement, over 78 percent of patients felt that after undergoing consultation they had enough support to make a decision. On an optional survey distributed anonymously post consultation, one patient commented, “everything was clearly explained, and any concerns were addressed with care.” Others stated that they felt much more knowledgeable and at ease, and that all options were thoughtfully posted.

Since implementing breast density consultations, WiCare has expanded consultation efforts to other areas in radiology offering a range of services that include imaging ordering assistance for referring physicians, synthesis of outside imaging studies and resident-driven imaging rounds. The key to effective consultation is quality and efficiency, and with current fee-for-service payment models this has continued to be a concern in terms of the radiologist’s time and productivity.

Different from radiology consultation services attempted in the past, WiCare utilizes the RRA role allowing the radiologist to spend the most efficient quality time with patients and physicians for all consultation activities. With the ultimate goal of creating an environment that is patient-centered, all elements of the consultation service encourage communication in the shared decision making process between patients, physicians and radiologists to increase quality of care.

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