P1310 - The Effects of an Educational Intervention on Improving Providers' Confidence and Knowledge Toward Hereditary Gastrointestinal Cancer Screening

Monday, October 25, 2021

10:30 AM – 4:15 PM PT

Location: Shoreline Exhibit Hall

Has Audio

Presenting Author(s)

Megan M. Hennessey, MD

Dartmouth-Hitchcock Medical Center
Lebanon, NH, United States

Megan M. Hennessey, MD¹, Simran Gupta, MD², ishaan P. Dharia, MD³, Reem Q. Al Shabeeb, MD⁴, Erika Pashai, MD⁵, Eliseo Acevedo-Diaz, MPH⁵, Samuel A. Schueler, MD⁵, Marie L. Borum, MD, EdD, MPH⁵
¹Dartmouth-Hitchcock Medical Center, Washington, DC; ²Brown University, Washington, DC; ³Mount Sinai Medical Center, Washington, DC; ⁴Inova Fairfax Hospital, Falls Church, VA; ⁵George Washington University School of Medicine and Health Sciences, Washington, DC

Introduction: Providing screening and genetic counseling/testing for patients at increased risk for hereditary gastrointestinal cancer syndromes (HGCS) requires knowledge and attention to family history. Evidence shows that complete family histories are not consistently obtained, which may lead to delayed or missed detection of HGCS. As part of a multiphase effort to improve HGCS screening in our gastroenterology division, we sought to assess baseline and post-educational intervention confidence and knowledge regarding HGCS screening.

Methods: An exam assessing baseline knowledge of HGCS was administered to attending gastroenterologists and gastroenterology fellows. A 45-minute lecture reviewing screening for HGCS and indications for genetic counseling/testing was then delivered. The lecture covered polyposis and nonpolyposis colorectal cancer syndromes, hereditary gastric cancer syndromes, and genetic conditions predisposing to pancreatic and esophageal cancer. A family history template to screen for HGCS was introduced (Image 1). Providers then completed a post-test which contained all of the pre-test questions plus questions assessing perceptions towards potential impact of the family history template on screening and genetics referrals.

Results: 12 providers completed the pre-test and 10 of those 12 completed the post-test.

While average Likert scale values assessing confidence towards screening and genetics referrals and average percentage-correct on knowledge questions regarding HGCS were all increased on the post-test as compared to the pre-test, there were no statistically significant differences (Table 1). Following the educational intervention, providers felt the proposed screening form would increase the number of family histories documented (Likert scale= 5.7), percentage of patients identified for HGCS screening (Likert scale= 5.4), and number of referrals for genetic counseling/screening (Likert scale=5.7).

Discussion: A brief educational intervention may improve providers' confidence towards HGCS screening and genetic counseling referrals, though no statistically significant pre- vs. post- intervention changes were demonstrated, likely due to small sample size. Gastroenterology attendings and fellows in our division felt a family history screening template would increase family history documentation, HGCS screening, and HGCS related genetic counseling referrals. Follow-up study will assess the impact on these parameters after incorporation of the screening form our clinic.

Figure: Image 1: Hereditary gastrointestinal cancer clinic screening form

Question	Pre-Test	Post-Test	P value
I know how to identify and screen patients at increased risk for hereditary/genetic conditions predisposing to colorectal cancer? (mean (SD))*	4.83 (1.70)	5.00 (1.70)	0.821
I know how to identify and screen patients at increased risk for hereditary/genetic conditions predisposing to other gastrointestinal cancers (esophagus, gastric, pancreas)? (mean (SD))*	3.75 (1.48)	4.90 (1.66)	0.102
Hereditary diffuse gastric cancer is associated with which histologic type of breast cancer? (Correct (%))	5 (41.7)	7 (70.0)	0.369
Which of the following is associated with hereditary diffuse gastric cancer? (Correct (%))	2 (16.7)	4 (40.0)	0.458
A patient with a history of bilateral congenital hypertrophy of retinal pigment epithelium should trigger consideration for screening of which hereditary gastrointestinal syndrome? (Correct (%))	2 (16.7)	4 (40.0)	0.458
At what age does the American Gastroenterological Association recommend we consider beginning screening for pancreatic cancer in patients with Peutz-Jeghers syndrome? = (Correct (%))	4 (33.3)	7 (70.0)	0.199
Select each description warranting screening for Lynch syndrome per NCCN guidelines (Correct (%))	5 (41.7)	5 (50.0)	1.000
For a patient with tylosis and family history of tylosis with esophageal cancer (TEC), screening with EGD for squamous cell carcinoma should begin at what age? (Correct (%))	2 (16.7)	6 (60.0)	0.097
Name three syndromes that should be considered in a patient with of >2 hamartomatous gastrointestinal polyps (Correct (%))	10 (83.3)	9 (90.0)	1.000

*Derived from Likert scale of 1 – 7 where 7 represents highest level of confidence

Table: Table 1: Hereditary gastrointestinal cancer screening pre- and post-educational intervention responses

Disclosures:

Megan Hennessey indicated no relevant financial relationships.

Simran Gupta indicated no relevant financial relationships.

ishaan Dharia indicated no relevant financial relationships.

Reem Al Shabeeb indicated no relevant financial relationships.

Erika Pashai indicated no relevant financial relationships.

Eliseo Acevedo-Diaz indicated no relevant financial relationships.

Samuel Schueler indicated no relevant financial relationships.

Marie Borum indicated no relevant financial relationships.

Megan M. Hennessey, MD¹, Simran Gupta, MD², ishaan P. Dharia, MD³, Reem Q. Al Shabeeb, MD⁴, Erika Pashai, MD⁵, Eliseo Acevedo-Diaz, MPH⁵, Samuel A. Schueler, MD⁵, Marie L. Borum, MD, EdD, MPH⁵. P1310 - The Effects of an Educational Intervention on Improving Providers' Confidence and Knowledge Toward Hereditary Gastrointestinal Cancer Screening, ACG 2021 Annual Scientific Meeting Abstracts. Las Vegas, Nevada: American College of Gastroenterology.