Researchers at the University of Pittsburgh Medical Center (UPMC) have developed a new tool within electronic health records aimed at curbing unnecessary sentinel lymph node biopsies (SLNB) in older patients with early-stage breast cancer. Published in JAMA Surgery, their study highlights the impact of the “HER nudge,” which prompts surgeons to reconsider the necessity of SLNB based on patient age and tumor characteristics.
SLNB is a procedure used to determine if breast cancer has spread to nearby lymph nodes, though it carries a risk of causing lymphedema—a chronic swelling that can impair quality of life. Despite guidelines advising against routine SLNB for older patients with low-risk tumors, many continue to undergo the procedure without substantial benefit to treatment or survival outcomes.
The “HER nudge” intervention led to a marked reduction in SLNB rates among eligible patients. Before its implementation, SLNB was performed on 46.9% of qualifying patients. Following the introduction of the nudge, this rate decreased to 23.8% over a 12-month period—a reduction of 49.3%. Subsequently, SLNB rates continued to decline, reaching 15.6% during an additional six months of observation.
Surgeons involved in the study expressed positive feedback about the nudge, describing it as acceptable, appropriate, and seamlessly integrated into their workflow. The tool operates within existing electronic health records, requiring no additional documentation or clicks.
In addition to reducing SLNB rates, researchers utilized artificial intelligence to monitor mentions of lymphedema symptoms in patient records. They found a decrease in cases warranting lymphedema evaluation, dropping from 6.2% before the nudge to 3.6% post-implementation.
Lead author Neil Carleton, Ph.D., emphasized the potential long-term benefits of fewer unnecessary surgeries in reducing lymphedema rates, though longer follow-up is needed to confirm these findings due to the condition’s delayed onset.
The study underscores the importance of targeted interventions within healthcare systems to align clinical practices with evidence-based guidelines, thereby improving patient outcomes and reducing unnecessary medical interventions.
Related topics:
