Testing an Intelligent Tutoring System Intervention to Enhance Genetic Risk Assessment in Underserved Blacks and Latinas at Risk of Hereditary Breast Cancer

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Abstract BRCA1/2 mutation carriers are at higher risk of developing breast and ovarian cancer (HBOC). Breast cancer survivors with a BRCA1/2 mutation are at higher risk of developing contralateral breast cancer. Genetic cancer risk assessments (GCRA) for HBOC can inform prevention and treatment decisions. Despite guidelines to refer women at risk of carrying a mutation to GCRA, Latina and Black women underuse these services. Reasons for low GCRA use include access and psychosocial factors (e.g. low knowledge). Our preliminary data with at-risk Black and Latina women suggests that improving access does not necessarily translate into higher GCRA uptake. Theoretically guided interventions that support GCRA uptake in underserved populations are needed. Fuzzy Trace Theory posits that people tend to construct gist representations that capture the essential bottom-line meaning of the risk information, including the emotional experience. However, most interventions tend to prioritize quantitative risk communication and do not often consider emotional aspects, despite evidence that emotions influence risk perceptions. BRCA-gist is an Intelligent Tutoring System intervention informed by Fuzzy Trace Theory that uses avatars to emulate tailored one-to-one human tutoring and includes the HBOC risk messages’ bottom-line meaning. The preliminary efficacy of BRCA-gist has been established in a non-clinical sample of mostly White college students but has not been tested in at-risk women. This study aims to adapt BRCA-gist and test its feasibility, acceptability, and efficacy in a sample of at-risk Black and Latina women. In Aim 1 we will gather input from providers (n=10) about adaptations for implementation in clinical settings and from at-risk Latina and Black women (n=20) about cultural adaptations. In Aim 2 we will randomize at-risk Black and Latina women to BRCA-gist (n=50) or NCI Web arms (n=50). Participants will complete a baseline and a post- intervention assessment. A research assistant will refer them to local free genetic counseling services. Our primary outcome is GCRA uptake at 3 months. Aim 1: Adapt BRCA-gist. Providers and at-risk Black and Latina women will do the BRCA-gist intervention and provide suggestions to make cultural adaptations to implement BRCA-gist in community/clinic settings. Aim 2: Test the feasibility, acceptability, and efficacy of BRCA-gist intervention in a two-arm RCT. We expect high overall retention (≥75%) and high satisfaction among women in the BRCA-gist arm (≥75%) (H.2.1., H.2.2). H.2.3. Participants in the BRCA-gist arm (vs. NCI Web) will have a higher uptake of GCRA services 3 months post intervention. H.2.4. Participants in the BRCA-gist arm (vs. NCI Web) will have a greater increase in knowledge, gist comprehension, and GCRA intentions. We will explore differences by ethnicity and health literacy and assess emotional reactions to risk information to inform future affective-tailored interventions. If successful, BRCA-gist can be tested in larger samples and could constitute a scalable inexpensive intervention with promising translational applications and potential to reduce disparities.