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. 2018 Dec 17;18(1):134.
doi: 10.1186/s12911-018-0716-5.

Pilot study of decision support tools on breast cancer chemoprevention for high-risk women and healthcare providers in the primary care setting

Rita Kukafka  1   2   3 , Jiaqi Fang  4 , Alejandro Vanegas  5 , Thomas Silverman  5 , Katherine D Crew  4   5   6
Affiliations

Pilot study of decision support tools on breast cancer chemoprevention for high-risk women and healthcare providers in the primary care setting

Rita Kukafka et al. BMC Med Inform Decis Mak. .

Abstract

Background: Breast cancer chemoprevention can reduce breast cancer incidence in high-risk women; however, chemoprevention is underutilized in the primary care setting. We conducted a pilot study of decision support tools among high-risk women and their primary care providers (PCPs).

Methods: The intervention included a decision aid (DA) for high-risk women, RealRisks, and a provider-centered tool, Breast Cancer Risk Navigation (BNAV). Patients completed validated surveys at baseline, after RealRisks and after their PCP clinical encounter or at 6-months. Referral for high-risk consultation and chemoprevention uptake were assessed via the electronic health record. The primary endpoint was accuracy of breast cancer risk perception at 6-months.

Results: Among 40 evaluable high-risk women, median age was 64.5 years and median 5-year breast cancer risk was 2.19%. After exposure to RealRisks, patients demonstrated an improvement in accurate breast cancer risk perceptions (p = 0.02), an increase in chemoprevention knowledge (p < 0.01), and 24% expressed interest in taking chemoprevention. Three women had a high-risk referral, and no one initiated chemoprevention. Decisional conflict significantly increased from after exposure to RealRisks to after their clinical encounter or at 6-months (p < 0.01). Accurate breast cancer risk perceptions improved and was sustained at 6-months or after clinical encounters. We discuss the side effect profile of chemoprevention and the care pathway when RealRisks was introduced to understand why patients experienced increased decision conflict.

Conclusion: Future interventions should carefully link the use of a DA more proximally to the clinical encounter, investigate timed measurements of decision conflict and improve risk communication, shared decision making, and chemoprevention education for PCPs. Additional work remains to better understand the impact of decision aids targeting both patients and providers.

Trial registration: ClinicalTrials.gov Identifier: NCT02954900 November 4, 2016 Retrospectively registered.

Keywords: Breast cancer; Chemoprevention; Decision aids; Decision conflict; Decision support; Risk communication.

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Conflict of interest statement

Ethics approval and consent to participate

This study was approved by the Institutional Review Board of Columbia University, IRB AAAP4151. Informed consent was obtained from all individual participants included in the study. Consent to participate was given in written form. All procedures performed involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Consort Diagram
Fig. 2
Fig. 2
Screenshots of RealRisks, patient-centered decision aid: (a) Graphic novel-style narrative; (b) Interactive game to communicate breast cancer risk; (c) Preference elicitation about the risks and benefits of chemoprevention
Fig. 3
Fig. 3
Screenshots of BNAV (Breast cancer risk NAVigation) provider-centered tool: (a) Slide presentations; (b) Link to download references
See this image and copyright information in PMC

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