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What is the best way for healthcare professionals to communicate changes in estimated risk of breast cancer?

医疗保健专业人员传达乳腺癌估计风险变化的最佳方式是什么？

基本信息

批准号：
2456973
负责人：
金额：
--
依托单位：
University of Manchester
依托单位国家：
英国
项目类别：
Studentship
财政年份：
2020
资助国家：
英国
起止时间：
2020 至无数据
项目状态：
未结题

来源：
https://gtr.ukri.org/projects?ref=studentship-2456973
关键词：
What best way healthcare professionals

项目摘要

Risk estimation models for common multifactorial diseases such as breast cancer are often used, e.g. in Family History Clinics to inform decisions about prevention options. Their use is increasing, e.g. 58,000 women who attended routine breast-screening were provided risk estimates in the PROCAS study (1). A challenge for the use of these risk estimation models in clinical practice is that an individual's risk estimate can change, for several reasons. First, new versions of risk estimation algorithms, e.g., Tyrer-Cuzick model are updated. Second, these models can include more information sources: historically, they were based on self-reported family history and hormone-related factors, e.g. parity. They can now include information about breast density and Single Nucleotide Polymorphisms (SNPs) (2). Thirdly, estimates of lifetime breast cancer risk decrease with age, as each individual is older at later timepoints. The extent of change can be large. In the Family History Risk (FH-Risk) study, 914 Manchester-based women received risk estimates between 1993-2010. They were told their risk was "high", "moderate", "average" or "below average"; women at high or moderate risk were offered prevention options, i.e. enhanced screening or chemoprevention (3). A sub-sample of 106 women had their risks re-evaluated using the latest version of the Tyrer-Cuzick model, including mammographic density and 18 SNPs. Of these 106 women, the lifetime risk of 53 women decreased by one or more risk categories (e.g. from high to moderate). Forty women did not change category whilst the risk of 13 women increased. There is a dearth of research exploring the impact of receiving revised risk estimates for any disease: a scoping search failed to identify any such studies. Whilst there appears to be little emotional impact of receiving breast cancer risk estimates (4), many people do not trust the estimates they received (5). Receiving revised risk estimates may further undermine trust in healthcare professionals or credibility of risk estimation, as changes may produce revised management plans.This PhD will: (a) identify the key issues for women who receive revised risk estimates; (b) develop materials to support consultations involving revised risk estimates, and (c) assess emotional impact, understanding of risk information, trust in healthcare professionals, and views of prevention options of women in the Family History Risk study. This research will produce an evidence base to help healthcare professionals communicate better with women about changes in estimated breast cancer risk, and more widely, changing risk of other diseases, e.g. Cardiovascular Disease.(1) Evans DG et al, Improvement in risk prediction, early detection and prevention of breast cancer in the NHS Breast Screening Programme and family history clinics: a dual cohort study. NIHR Programme Grants for Applied Research, 2016: 4(11).(2) Evans DGR et al, Breast cancer pathology and stage are better predicted by risk stratification models that include mammographic density and common genetic variants. Breast Cancer Res Tr 2019; 176(1): 141-148.(3) Evans DG et al, The impact of a panel of 18 SNPs on breast cancer risk in women attending a UK familial screening clinic: a case-control study. J Med Genet. 2017; 54(2):111-113.(4) French DP et al. Psychological impact of providing women with personalised 10-year breast cancer risk estimates. Br J Cancer 2018; 118(12): 1648-1657.(5) Bayne M et al. (in press) Effect of interventions including provision of personalised cancer risk information on accuracy of risk perception and psychological responses: a systematic review and meta-analysis. Pat Ed Couns. DOI: 10.1016/j.pec.2019/08/010

乳腺癌等常见多因素疾病的风险评估模型经常被用于家族史诊所，以便为预防方案的决策提供信息。它们的使用正在增加，例如，PROCAS研究为58,000名参加常规乳房筛查的妇女提供了风险估计(1)。在临床实践中使用这些风险估计模型的一个挑战是，由于几个原因，个人的风险估计可能会改变。首先，更新新版本的风险估计算法，例如，Tyrer-Cuzick模型。其次，这些模型可以包括更多的信息来源：在历史上，它们是基于自我报告的家族史和与激素相关的因素，例如产次。它们现在可以包括有关乳房密度和单核苷酸多态性(SNPs)的信息(2)。第三，对终生乳腺癌风险的估计随着年龄的增长而降低，因为每个人在以后的时间点上都会变老。变化的幅度可能很大。在家族史风险(FH-RISK)研究中，914名曼彻斯特女性在1993-2010年间接受了风险评估。他们被告知她们的风险为“高”、“中等”、“中等”或“低于平均水平”；为高风险或中等风险的妇女提供预防选择，即加强筛查或化学预防(3)。106名女性的子样本使用最新版本的Tyrer-Cuzick模型重新评估了她们的风险，包括乳房X光检查密度和18个SNPs。在这106名妇女中，53名妇女的终生风险降低了一个或多个风险类别(例如，从高到中等)。40名女性没有改变类别，而13名女性的风险增加。目前还缺乏探讨接受任何疾病的修订风险估计的影响的研究：范围搜索未能确定任何此类研究。虽然收到乳腺癌风险评估的情感影响似乎很小(4)，但许多人不相信他们收到的评估(5)。接受修订的风险评估可能会进一步破坏对医疗保健专业人员的信任或风险评估的可信度，因为变化可能会产生修订的管理计划。本博士学位将：(A)确定接受修订的风险评估的女性的关键问题；(B)制定支持涉及修订的风险评估的咨询的材料；以及(C)评估情绪影响、对风险信息的理解、对医疗专业人员的信任以及女性在家族史风险研究中对预防选择的看法。这项研究将产生一个证据基础，以帮助保健专业人员更好地与女性沟通估计的乳腺癌风险的变化，以及更广泛地说，其他疾病的风险的变化，例如心血管疾病。(1)Evans DG等人，NHS乳房筛查计划和家族病史诊所中乳腺癌风险预测的改进：一项双重队列研究。NIHR应用研究计划拨款，2016：4(11)。(2)Evans DGR等人，乳腺癌病理和分期通过包括乳房X光检查密度和常见基因变异的风险分层模型更好地预测。乳腺癌研究报告2019；176(1)：141-148。(3)Evans DG等人，一个由18个SNP组成的小组对接受英国家族筛查诊所的女性乳腺癌风险的影响：一项病例对照研究。J Med Genet。2017年；54(2)：111-113。(4)法国民主党等。为女性提供个性化的10年乳腺癌风险评估的心理影响。BR J癌症2018；118(12)：1648-1657。(5)Bayne M等人。(出版)包括提供个性化癌症风险信息在内的干预措施对风险感知和心理反应准确性的影响：系统回顾和荟萃分析。帕特·埃德·康斯。DOI：10.1016/j.pe.2019/08/010