Abstract
Purpose: The “Choosing Wisely” recommendations issued by the Society of Surgical Oncology in 2016 recommend against routine use of Sentinel Lymph Node Biopsy (SLNBx) in select patients 70 years and older. Despite this guideline, SLNBx rates are consistently above 80% across the U.S in those eligible for omission. Our objective was to institute a year-long quality improvement initiative across Novant Health Cancer Institute- NHCI’s three major regions to more closely adhere to the “Choosing Wisely” guideline and to document the shared decision-making process.
Methods: Starting in 2025, we utilized our statewide Breast Cancer Tumor Council meetings for educational discussions and shared standardized Electronic Medical Record (EMR) dot phrases. Quarterly reviews were conducted to quantify improvements in adherence to the guideline, document the shared decision making, and document the reason for completion of SLNBx in patients otherwise candidates for SLNBx omission.
Results: Prior to implementation, 91.5% of patients who were candidates to omit biopsy via the “Choosing Wisely” criteria received SLNBx. After implementation of this initiative, only 13.3% of qualified patients received SLNBx when meeting these criteria. Adherence to documentation was further evaluated and showed 97% of “Choosing Wisely” decisions were documented after implementation of this initiative.
Conclusions: Rapid evolution in clinical practice is achievable in time frames as short as one year, even for practices that have been commonplace for decades. The implementation of a focused institutional-wide goals and leveraging the workflow integration of the EMR can drive clinical practice changes, which ultimately lead to improvements in patient care.
Keywords
Sentinel Lymph Node Biopsy, Breast cancer, Choosing Wisely, Quality improvement, Older adults, Guideline adherence, Shared decision-making, Axillary staging