The PROMPT (Patient- Reported Observations on Medical Procedure Timeliness for Breast Patients) study launched in May 2022. PROMPT is a novel quality improvement project for breast care centers that the American College of Surgeons (ACS) National Accreditation Program for Breast Centers (NAPBC) has accredited that is designed to examine the timeliness of breast cancer diagnosis and first treatment.
To date, no benchmarks have been established for the time between a screening mammogram and diagnostic mammogram and the time between a diagnostic mammogram and breast biopsy. Furthermore, time from biopsy to first treatment, either surgery or neoadjuvant therapy, is unregulated.
More than 370 NAPBC sites have enrolled in the PROMPT study, which will provide centers with metrics on the time from screening mammogram to first treatment, so that centers can benchmark their individual performance. PROMPT also will examine the patient perspective and experience with timeliness of diagnosis and treatment.
Two-Part, 2-Year Study
In the first part of the study, PROMPT will include qualitative interviews with patients who have undergone the diagnostic process and treatment for breast cancer. Patients will be asked about their experience with the diagnostic process, how long it took to get a breast biopsy, how long it took to begin therapy, and whether they felt their care was timely and patient-centered. Patients of diverse race and ethnicities undergoing care at a variety of breast centers across the country will be included, to understand the patient perspective on the timeliness of breast cancer diagnosis and treatment.
The second part of PROMPT will involve surveys of NAPBC sites regarding three metrics: time from screening mammogram to diagnostic mammogram, time from diagnostic mammogram to breast biopsy, and time from initial breast biopsy identifying cancer to first treatment. Data will be collected from 2019 to 2021 to examine the impact of the COVID-19 pandemic on timeliness of care.
The study team will aggregate data from the patient interviews and the timeliness metrics and send each participating NAPBC site its aggregated data from patient interviews, as well as the timeliness metrics of their center in comparison with the same metrics averaged across all sites. The goal is that centers will then use these data to design their own quality improvement projects at their respective institutions to approach the areas of greatest delay.
The first year of the PROMPT study will involve data collection, patient interviews, and data analysis. The second year of the study will involve each NAPBC site designing its own quality improvement projects with guidance from the study team. By participating in PROMPT, NAPBC sites not only will have access to unique data on timeliness of care, but also will receive credit for two NAPBC standards: Standard 3.2, clinical trial accrual, and Standard 6.1, quality improvement.
PROMPT will be one of the first studies to report timeliness metrics from multiple institutions and to report on patient perceptions of the timeliness of breast cancer care. Providing centers with robust data on their own timeliness, coupled with patient perspectives, will empower NAPBC sites not only to make the diagnostic process timelier and more efficient, but also more patient-centered. PROMPT aims to help centers improve the quality of care at a time when patients experience significant anxiety and uncertainty given their recent breast cancer diagnosis.
Dr. Katharine Yao is vice-chair of research, NorthShore University Healthsystem, and clinical professor of surgery, The University of Chicago Pritzker School of Medicine, IL. She is Vice-Chair, NAPBC.
