Development of Family1st-An interactive web-based tool with evidence-based approaches to communicate hereditary cancer risk to at risk relatives and promote cascade testing.

项目摘要/摘要 基因检测已经改变了癌症治疗。提供者使用基因检测结果来优化治疗和 提高早期发现能力。然而，基因检测的好处并未完全实现，因为 家庭内部沟通不畅。多项研究表明，患者很少会 将发现致病或可能致病的基因检测结果告知家属， 特别是在社区实践环境中。由于缺乏沟通，家庭成员 无法得到基因检测以进一步阐明自身风险，并接受相关的降低风险护理。此外， 因为在代表不足的种族和人口中，在获得遗传服务方面存在严重的不平等 对于少数民族来说，不同文化背景的家庭之间的有效沟通将是一种 这是克服这些遗传差异的关键一步。 我们将通过开发和试点测试来解决遗传护理和沟通方面的这些深刻差距 多层次电子健康干预，改善遗传性癌症风险的家庭沟通。在建议的 我们将传播学和行为理论相结合，开发出一种以患者和家庭为中心的多层次 水平干预，以促进遗传风险沟通(患者)和级联检测(家庭)(目标1)。为 目标1，我们将让患者、家庭成员和提供者参与开发和使用的迭代过程 测试。我们的干预措施将以西班牙语和英语开发，并将在电子健康上创建 我们团队专门为遗传风险沟通设计的平台。然后我们将评估 在服务不足的实践环境中进行试点研究干预的可行性和可接受性(目标2)。我们的 最重要的假设是，与平时相比，使用干预措施的患者比例更大 CARE将癌症风险信息传达给家庭成员以及使用 干预措施将更有可能得到基因检测。我们将在希望之城的背景下进行审判 实践社区，从向未得到充分服务的患者提供癌症基因护理的提供者那里获得 所有50个州(N=577)的无数临床环境。这项研究计划如果成功，将产生很大的影响 因为它将产生可扩展的、最先进的电子健康干预措施，以改善遗传病患者的家庭沟通 癌症风险将在未来的随机试验中进行评估。大量患者的身份鉴定 通过希望之城实践社区的癌症风险变量以及表达的需求和兴趣 这一批提供者确保了研究的可行性。在癌症遗传学、沟通、 在干预开发和临床试验方面，我们的团队处于实现拟议工作的理想位置。在……里面 SUM，FamilyFirst将通过提供基于证据的患者来满足癌症遗传学护理的关键需求- 集中干预，优化遗传性癌症风险在家庭内部的沟通。

PROJECT SUMMARY/ABSTRACT Genetic testing has transformed cancer care. Providers use genetic testing results to optimize treatment and improve early detection. The benefits of genetic testing, however, are incompletely realized because of communication failures within families. Across multiple studies it has been shown that patients infrequently inform family members about genetic test results that reveal pathogenic or likely pathogenic findings, particularly in the community practice setting. Because of this lack of communication, family members are unable to get genetic testing to further elucidate their own risk and receive relevant risk reducing care. Further, because there are profound inequities in the availability of genetic services among underrepresented racial and ethnic minorities, effective communication within families from different cultural backgrounds will be an essential step to overcoming these genetic disparities. We will address these profound gaps in genetic care and communication by developing and pilot testing a multi-level e-health intervention to improve family communication of hereditary cancer risks. In the proposed work we integrate communication science and behavioral theory to develop a patient and family focused multi- level intervention to facilitate genetic risk communication (patient) and cascade testing (family) (Aim 1). For Aim 1, we will engage patients, family members, and providers in an iterative process of development and user testing. Our intervention will be developed in both Spanish and English and will be created on an e-Health Platform that our team has specifically designed for genetic risk communication. We will then evaluate the feasibility and acceptability of the intervention in a pilot study in underserved practice settings (Aim 2). Our overarching hypothesis is that a greater proportion of patients who use the intervention as compared to usual care, will communicate cancer risk information to family members and that family members who use the intervention will be more likely to get genetic testing. We will conduct our trial in the context of the City of Hope Community of Practice, which draws from providers who deliver cancer genetic care to underserved patients in myriad clinical settings across all 50 states (N=577). This research program will have high impact if successful as it will yield a scalable, state-of-the-art e-health intervention to improve family communication of hereditary cancer risk that will be evaluated in a future randomized trial. Identification of large numbers of patients with cancer risk variants through the City of Hope Community of Practice and the expressed need and interest of this cohort of providers ensures study feasibility. With expertise in cancer genetics, communication, intervention development, and clinical trials, our team is ideally positioned to achieve the proposed work. In sum, Family1st will meet a critical need in cancer genetics care by providing an evidence-based, patient- centered intervention to optimize the communication of hereditary cancer risk within families.