Enhancing at-Risk Latina Women's Use of Genetic Counseling for Hereditary Breast and Ovarian Cancer

 描述(申请人提供)：乳腺癌是拉丁裔癌症死亡的主要原因。拉丁裔人也有很高的BRCA1/2基因突变，这增加了他们患乳腺癌和卵巢癌的风险。遗传性乳腺癌和卵巢癌(HBOC)的遗传癌症风险评估(GCRA)可以为预防和治疗决策提供信息，从而降低乳腺癌风险。尽管指导方针将携带突变的高风险女性推荐到GCRA服务，但拉丁裔人对这些服务的使用不足。拉丁裔GCRA参与率低的原因包括环境因素(如机会、有限的西班牙语资源)和心理社会因素(如知识、识字、情感问题)。我们的初步数据表明，改善获得机会并不一定会转化为吸收，提供者面临着与拉丁裔就基因组学进行沟通的挑战。为了发展有效的HBOC沟通，关键是理解拉丁人对GCRA的直觉信念，这些信念受到先前的经验和文化(心理模型)的影响，因为它们影响风险信息的处理方式。了解人们对GCRA的情绪反应和潜在的矛盾心理也是必要的。几乎没有旨在增加拉丁语GCRA使用的干预措施。为了推动这一领域的发展，我们将进行一种新的风险沟通干预，旨在针对心理模型、情绪和矛盾心理。在计划行为理论和社会认知理论的指导下，我们将进行两个阶段的混合方法研究。在第一阶段，我们将采访关键的告密者(n=10)和处于危险中的拉丁裔(n=20)，以描述他们的心理模型和其他心理社会因素。这些数据将为风险-效益信息提供信息，这些信息将在焦点小组(n=20)中进行评估和改进，并通过拉丁裔演员和媒体干预(即YouTube视频)中受信任的医学人物传递。在第二阶段，我们将试行对高危拉丁裔(n=40)的干预。在基线之后，女性将观看15分钟的视频，完成后续评估，并将被转介给患者导航员进行资源链接。GCRA摄取将在3个月时进行评估。我们的主要结果是打算使用GCRA。具体目标是：目标1.描述和描绘拉丁裔的GCRA心理模型(风险和利益认知、情绪等)AIM 2.利用AIM 1提供的数据，为面临风险的拉丁裔编写风险-效益沟通信息的内容，并将这些内容并入西班牙语YouTube视频。目的3.评估主要结果(使用GCRA的意图)和中间结果(如态度)的可接受性和干预前的差异。我们还将探讨干预后GCRA摄取作为次要结果。H.2.1。这一干预将导致使用GCRA H.2.2的意向显著增加。干预将导致中间结果的改善：知识、态度、自我效能和矛盾心理。H.2.3。干预后，30%的拉丁裔将在干预后3个月参加GCRA。H.2.4。大多数人(≥75%)将对干预措施感到满意

 DESCRIPTION (provided by applicant): Breast cancer is the leading cause of cancer death among Latinas. Latinas also have a high prevalence of BRCA1/2 gene mutations, which increases their risk of developing breast and ovarian cancer. Genetic cancer risk assessments (GCRA) for hereditary breast and ovarian cancer (HBOC) can inform prevention and treatment decisions resulting in breast cancer risk reduction. Despite guidelines to refer women at a high risk of carrying a mutation to GCRA services, Latinas underuse these services. Reasons for Latinas' low GCRA participation include environmental (e.g. access, limited Spanish resources) and psychosocial factors (e.g. knowledge, literacy, emotional concerns). Our preliminary data suggest that improving access may not necessarily translate into uptake and that providers face challenges communicating about genomics with Latina. To develop effective HBOC communication it is key to understand Latinas' intuitive beliefs about GCRA, which are informed by prior experience and culture (mental models), as they impact how risk information is processed. It is also necessary to understand emotional reactions and potential ambivalence about GCRA. There have been few interventions designed to increase GCRA use in Latinas. To move the field forward we will conduct a novel risk communication intervention designed to target mental models, emotions, and ambivalence. Guided by the Theory of Planned Behavior and Social Cognitive Theory, we will conduct a two-phased mixed methods study. In Phase I we will interview key informants (n=10) and at- risk Latinas (n=20) to describe their mental models and other psychosocial factors. These data will inform the risk-benefit messages that will be evaluated and refined in focus groups (n=20) and delivered via Latina actors and a trusted medical personality in a media intervention (i.e.YouTube video). In Phase II we will pilot the intervention on at-risk Latinas (n=40). After the baseline, women will watch the 15-minute video, complete a follow-up assessment, and will be referred to a patient navigator for resource linkages. GCRA uptake will be assessed at 3-months. Our primary outcome is intentions to use GCRA. Specific aims are: Aim 1. Describe and portray Latinas' GCRA mental models (risks and benefits perceptions, emotions, etc.) Aim 2. Using data from Aim 1, develop the content of the risk-benefit communication messages for at-risk Latinas and incorporate these into a Spanish-language YouTube video. Aim 3. Evaluate the acceptability and pre-post intervention differences on the primary outcome (intentions to use GCRA) and intermediate outcomes (e.g. attitudes). We will also explore post-intervention GCRA uptake as a secondary outcome. H.2.1. The intervention will result in a significant increase in intentions to use GCRA H.2.2. The intervention will result in improvements in intermediate outcomes: knowledge, attitudes, self- efficacy, and ambivalence. H.2.3. After the intervention, 30% of Latinas will participate in GCRA by 3 months post-intervention. H.2.4. The majority (≥75%) will be satisfied with the intervention