A web-based personalized risk communication and decision-making tool for women with dense breasts: Design and methods of a randomized controlled trial within an integrated health care system

Abstract

Background: Mammographic breast density is one of the strongest risk factors for breast cancer after age and family history. Mandatory breast density disclosure policies are increasing nationally without clear guidance on how to communicate density status to women. Coupling density disclosure with personalized risk counseling and decision support through a web-based tool may be an effective way to allow women to make informed, values-consistent risk management decisions without increasing distress.

Methods/design: This paper describes the design and methods of Engaged, a prospective, randomized controlled trial examining the effect of online personalized risk counseling and decision support on risk management decisions in women with dense breasts and increased breast cancer risk. The trial is embedded in a large integrated health care system in the Pacific Northwest. A total of 1250 female health plan members aged 40-69 with a recent negative screening mammogram who are at increased risk for interval cancer based on their 5-year breast cancer risk and BI-RADS® breast density will be randomly assigned to access either a personalized web-based counseling and decision support tool or standard educational content. Primary outcomes will be assessed using electronic health record data (i.e., chemoprevention and breast MRI utilization) and telephone surveys (i.e., distress) at baseline, six weeks, and twelve months.

Discussion: Engaged will provide evidence about whether a web-based personalized risk counseling and decision support tool is an effective method for communicating with women about breast density and risk management. An effective intervention could be disseminated with minimal clinical burden to align with density disclosure mandates. Clinical Trials Registration Number:NCT03029286.

Keywords: Breast MRI; Breast cancer; Breast density; Chemoprevention; Prevention; Risk communication.

Figure 1. Study flow diagram

Abbreviations: GHC: Group Health Cooperative (now Kaiser Permanente Washington), BCSC: Breast Cancer Surveillance Consortium; Pts: participants; GHRI: Group Health Research Institute (now Kaiser Permanente Washington Health Research Institute); ACS: American Cancer Society.

Figure 2

Intervention page: “The Breast Density Risk Factor”

Figure 3

Intervention page: “Your Personal Risk of Breast Cancer”

Figure 4

Intervention page: “Deciding about Medication”