Identification of barriers at the primary care provider level to improve inflammatory breast cancer diagnosis and management

Gayathri R Devi; Laura J Fish; Alexandra Bennion; Gregory E Sawin; Sarah M Weaver; Katherine Reddy; Rashmi Saincher; Anh N Tran

doi:10.1016/j.pmedr.2023.102519

Identification of barriers at the primary care provider level to improve inflammatory breast cancer diagnosis and management

Prev Med Rep. 2023 Nov 21:36:102519. doi: 10.1016/j.pmedr.2023.102519. eCollection 2023 Dec.

Authors

Gayathri R Devi^{1

2}, Laura J Fish³, Alexandra Bennion^{1

2

4}, Gregory E Sawin³, Sarah M Weaver^{1

2}, Katherine Reddy^{2

4}, Rashmi Saincher^{2

3}, Anh N Tran^{2

3}

Affiliations

¹ Division of Surgical Sciences, Department of Surgery, Duke University School of Medicine, USA.
² Duke Consortium for Inflammatory Breast Cancer, Duke Cancer Institute, 2606 DUMC, Durham, NC 27710, USA.
³ Department of Family Medicine and Community Health, Duke University School of Medicine, 2715 DUMC, Durham, NC 27710, USA.
⁴ Trinity School of Arts and Sciences, Duke University, 2606 DUMC, Durham, NC 27710, USA.

Abstract

The purpose of this study, based in the United States, was to evaluate knowledge gaps and barriers related to diagnosis and care of inflammatory breast cancer (IBC), a rare but lethal breast cancer subtype, amongst Primary Care Providers (PCP) as they are often the first point of contact when patients notice initial symptoms. PCP participants in the Duke University Health System, federally qualified health center, corporate employee health and community practices, nearby academic medical center, Duke physician assistant and advanced practice nurse leadership program alumni were first selected in a convenience sample and for semi-structured interviews (n = 11). Based on these data, an online survey tool was developed and disseminated (n = 78) to assess salient measures of IBC diagnosis, health disparity factors, referral and care coordination practices, COVID-19 impact, and continuing medical education (CME). PCP reported access to care and knowledge gaps in symptom recognition (mean = 3.3, range 1-7) as major barriers. Only 31 % reported ever suspecting IBC in a patient. PCP (n = 49) responded being challenged with referral delays in diagnostic imaging. Additionally, since the COVID-19 pandemic started, 63 % reported breast cancer referral delays, and 33 % reported diagnosing less breast cancer. PCP stated interest in CME in their practice for improved diagnosis and patient care, which included online (53 %), lunch time or other in-service training (33 %), patient and provider-facing websites (32 %). Challenges communicating rare cancer information, gaps in confidence in diagnosing IBC, and timely follow-up with patients and specialists underscores the need for developing PCP educational modules to improve guideline-concordant care.

Keywords: Breast cancer; COVID; Health disparity; Medical education; Primary care; Race; Rare disease; Telemedicine.