Purpose: Using an innovative web-based tool, patients at high risk for hereditary cancer are

identified and enrolled in a high-risk assessment program to receive the counseling, testing, and
education they need to take charge of their health and proactively manage their cancer risk.
Relevance: Nursing leadership identified a need for services for the at-risk patient. No program
existed to help non-cancer patients access the tools necessary to identify and manage their risk.
With a focus on patient empowerment, a high risk assessment program was created to support
these patients. This program encourages collaboration with multiple specialties to ensure each
patient receives coordinated care, with the goal of increasing patient education and access to risk
reducing interventions.
Strategy and Implementation: Driven by nursing input, a new process was created to identify
the patient with increased risk for hereditary cancer. Patients coming to the breast center for
mammograms take a short web-based survey to assess family history and they are subsequently
triaged into two risk levels, average or increased risk. The program began with nurse navigators
calling increased risk patients and coordinating their care. It later evolved to include an APN
providing genetic counseling and testing, in addition to patient education and management of
risk through a variety of interventions. The APN creates a complex care plan, including
additional screening methods, medication management, and surgical options. Referrals are made
to a breast surgeon, medical oncologist, dietician, and/or counselor to address the holistic needs
of the patient. Through the program, patients are given the tools needed to take charge of their
health and manage their risk proactively.
Evaluation/Outcomes: In seven months, the breast center has screened 8070 patients,
identifying 1943 patients at increased risk for hereditary cancer. Two hundred twenty patients
have been tested, with seventy nine patients qualifying for high risk care planning. Fourteen
patients have been identified as carriers of high risk mutations, receiving intensive counseling
and support from nursing and interdisciplinary providers to help manage their risk.
Implications for practice: This program has successfully helped patients take control of their
health through an innovative, web based survey and complex care planning created by an APN.
Continued patient education and counseling can effectively reduce the chance of patients
developing a hereditary cancer.