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

摘要 BRCA1/2突变携带者患乳腺癌和卵巢癌(HBOC)的风险更高。乳腺癌幸存者 有BRCA1/2突变的人患对侧乳腺癌的风险更高。遗传性癌症风险评估 HBOC的GCRA可以为预防和治疗决策提供信息。尽管有指导方针建议有携带艾滋病毒风险的女性 突变为GCRA的拉丁裔和黑人女性使用这些服务不足。GCRA使用率较低的原因包括访问和 社会心理因素(如知识贫乏)。我们对高危黑人和拉丁裔女性的初步数据表明 改善获取途径并不一定会转化为更高的GCRA接受率。理论上指导的干预措施 需要在服务不足的人群中支持GCRA的普及。模糊痕迹理论假设人们倾向于 构建捕捉风险信息的基本底线含义的GIST表示法，包括 情感体验。然而，大多数干预措施倾向于将量化风险沟通放在首位，而不是经常 考虑情绪方面，尽管有证据表明情绪会影响风险认知。BRCA-GIST是一个聪明的人 基于模糊踪迹理论的教学系统干预--利用化身模仿定制的一对一真人 辅导，并包括HBOC风险信息的底线含义。BRCA-GIST的初步疗效已被证实 建立在主要是白人大学生的非临床样本中，但尚未在高危女性中进行测试。 本研究旨在调整BRCA-GIST，并测试其可行性、可接受性和有效性。 拉丁裔女性。在目标1中，我们将收集来自提供者(n=10)的关于临床实施的适应的意见 环境和高危拉丁裔和黑人妇女(n=20)关于文化适应。在目标2中，我们将随机选择有风险的 黑人和拉丁裔妇女参加BRCA-GIST(n=50)或NCI Web Arms(n=50)。参与者将完成一个基线和一个后处理- 干预评估。一名研究助理将向他们推荐当地免费的遗传咨询服务。我们的初选 结果是3个月时GCRA摄取。 目标1：适应BRCA-GIST。提供者和高危黑人和拉丁裔妇女将进行BRCA-GIST干预并提供 建议进行文化适应，以在社区/诊所环境中实施BRCA-GIST。 目的2：检验BRCA-GIST干预在双臂随机对照试验中的可行性、可接受性和有效性。我们期望很高 总体保留(≥75%)和高满意度(≥75%)(H.2.1、H.2.2)。H.2.3。 BRCA-GIST ARM(与NCI Web相比)的参与者在干预3个月后将有更高的GCRA服务接受度。 H.2.4。BRCA-GIST ARM(VS NCI Web)的参与者将在知识、GIST理解、 和GCRA的意图。我们将探索种族和健康素养的差异，并评估对风险的情绪反应 为未来情绪化干预提供信息。 如果成功，BRCA-GIST可以在更大的样本中进行测试，并可能构成一种可扩展的廉价干预措施 前景看好的翻译应用和缩小差距的潜力。

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.