Perception of Cancer Risk in Patients with Barrett's

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DESCRIPTION (provided by applicant): Barrett's esophagus (BE), defined as the development of intestinal metaplasia in the esophagus, is a premalignant condition that predisposes to adenocarcinoma of the esophagus. The incidence of cancer in the setting of BE without dysplasia is low, approximating 0.005 cases/patient-year. We have previously demonstrated that patients with BE on average greatly overestimate their risk of development of cancer, and that over-estimation of risk was associated with a trend toward increased utilization of resources, such as endoscopy and clinic visits. The objectives of this application are: 1) to assess the perceived risk of esophageal adenocarcinoma in subjects with non-dysplastic BE in a multi-center study, 2) to assess the relationship between risk perception and the utilization of resources in these subjects, and, 3) to develop an internet-based based, self-directed teaching intervention to be administered to subjects with BE in a subsequent RO1 application. The investigators are experienced clinical researchers with a long record of investigation in BE, aided by experts in behavioral sciences. This planning grant would provide a mechanism to confirm observations from preliminary data regarding the overestimation of patients' cancer risk in the setting of Barrett's esophagus, and would examine the association between risk perception and healthcare utilization. It would also provide the means to develop an intervention designed to address patients' misunderstandings of risk, in the framework of a well-validated model of healthcare behavior. This grant will allow refining of disease definitions, outcome measures, sample size, and analysis plans and to address feasibility issues of a subsequent multi-center trial applying the intervention developed in this grant. The resultant study application will assess health-related quality of life, health-related anxiety and healthcare utilization as outcomes.