Microworlds for Breast Cancer Risk Reduction

降低乳腺癌风险的微观世界

• 批准号: 6545424
• 负责人: MARIA L JIBAJA-WEISS
• 金额: $ 15.05万
• 依托单位: BAYLOR COLLEGE OF MEDICINE
• 依托单位国家: 美国
• 财政年份: 2002
• 资助国家: 美国
• 起止时间: 2002-08-01 至 2004-07-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/6545424
• 关键词: African American; Hispanic Americans; Internet; academic achievement; breast neoplasm /cancer diagnosis; breast neoplasms; cancer prevention; cancer risk; caucasian American; clinical research; computer assisted medical decision making; computer system design /evaluation; decision making; female; health behavior; human subject; interview; low socioeconomic status; neoplasm /cancer education; patient oriented research; perception; preference; public health; questionnaires; women's health

DESCRIPTION (provided by applicant): The long-term objective of this project is to foster enhanced risk communication and informed decision making among women at high risk for breast cancer and considering risk reduction. Specifically, this project will develop a computerized decision support tool that educates women about their risk factors and methods for risk reduction, and which includes an explicit value clarification exercise to aid them in weighing their preferences and concerns about the methods. Such a tool will aid them in making a shared decision with their health care provider regarding a personalized strategy for breast cancer risk reduction. In the long run, this tool may be integrated into a more comprehensive breast cancer decision support system, which includes a quantifiable benefit/risk index - based on their preferences and concerns for the outcomes. The program will be targeted to low-income, low-literacy, minority women through an urban public health program. Also, the program will use culturally, linguistically, and educationally appropriate media in order to make the information meaningful to the audience. The tool will be Internet based, but designed to play off-line during testing. The specific aims of the project are to 1) use qualitative methods with low-income, low-literacy minority women to explore their basic perceptions, conceptualizations and meanings of "risk" (related to invasive breast cancer), and explore their preferences, concerns, and decision making processes related to breast cancer risk reduction strategies, 2) create a computerized Decision Support Module to aid women in determining their personal risk of breast cancer and in weighing their preferences and concerns about various risk reduction strategies (i.e. mammography and clinical breast examination, chemoprevention, more aggressive approaches), with both educational and assessment components that can be tailored to user profile, and 3) conduct a process evaluation of the Decision Support Module implementation strategy and preliminary outcome assessment and refinement, in a clinical population of low-income and low-literacy minority women. As a result of this exploratory grant, we will plan a future formal evaluation of the Decision Support Module using a community primary carebased, randomized controlled trial, focusing on low-income and low-literacy minority women. In this subsequent project planned for the future, two intervention arms and one control arm will be included. The first intervention arm will include the full-computerized tool, with both the personal risk communication module and value clarification exercise. The second intervention arm will include only the personal risk communication module, and thus provide a direct evaluation of impact of a value clarification exercise on women's preferences for breast cancer prevention. We believe this will be a novel and important study, providing an approach to risk communication for breast cancer prevention that will be appropriate for use with low-income and low-literacy minority women facing this decision.

描述（由申请人提供）：本项目的长期目标是促进乳腺癌高危妇女加强风险沟通和知情决策，并考虑降低风险。具体而言，该项目将开发一个计算机化的决策支持工具，教育妇女了解她们的风险因素和减少风险的方法，其中包括明确的价值澄清活动，以帮助她们权衡自己对方法的偏好和关切。这样的工具将帮助他们与他们的医疗保健提供者就降低乳腺癌风险的个性化策略做出共同决定。从长远来看，这一工具可能会被整合到一个更全面的乳腺癌决策支持系统中，该系统包括一个可量化的获益/风险指数-基于他们的偏好和对结果的关注。该方案将通过城市公共卫生方案，针对低收入、低识字率的少数民族妇女。此外，该计划将使用文化，语言和教育适当的媒体，以使信息有意义的观众。该工具将基于互联网，但设计为在测试期间离线运行。该项目的具体目标是：1）对低收入、低识字率的少数民族妇女使用定性方法，探索她们对“风险”的基本看法、概念化和含义（与浸润性乳腺癌相关），并探讨他们的偏好，关注点和与乳腺癌风险降低策略相关的决策过程，2）建立一个计算机化的决策支持模块，以帮助妇女确定其个人患乳腺癌的风险，并权衡其对各种降低风险战略的偏好和关注（即乳房X线摄影和临床乳房检查、化学预防、更积极的方法），具有教育和评估组成部分，可根据用户情况定制，以及3）对决策支持模块实施战略进行过程评估，并对初步结果进行评估和改进，在低收入和低识字率的少数民族妇女的临床人群中。由于这一探索性赠款，我们将计划使用社区初级保健为基础的随机对照试验，重点是低收入和低识字率的少数民族妇女的决策支持模块的未来正式评估。在计划未来的后续项目中，将包括两个干预臂和一个控制臂。第一个干预部门将包括完全计算机化的工具，包括个人风险沟通模块和价值澄清练习。第二个干预组将只包括个人风险沟通模块，从而直接评估价值澄清活动对妇女预防乳腺癌偏好的影响。我们相信这将是一项新颖而重要的研究，为乳腺癌预防提供了一种风险沟通的方法，适用于面临这一决定的低收入和低识字率的少数民族妇女。