Tamoxifen Education for Women at Risk for Breast Cancer

描述（由申请人提供）：美国约15.5%的女性可能由于遗传和与个人病史相关的因素而患乳腺癌的风险较高（Freedman，2003）。加强筛查和化学预防是这些妇女可利用的监测和预防选择。特别是决定开始他莫昔芬治疗是一个复杂而困难的决定。虽然这种选择性雌激素替代调节剂的保护作用已经得到充分证实，但副作用如潮热和治疗后发生血凝块和子宫癌的附带风险是抵消因素。美国预防服务工作组最近建议初级保健医生向其高危女性患者提供关于他莫昔芬选择的咨询，乳房健康项目和妇女健康中心的其他医生已经向其患者提供这些服务十年或更长时间（Kinsinger，2002）。 一个原型的基于互联网的多媒体教育计划，重点是乳腺癌问题和他莫昔芬预防将开发的高风险白人和非洲裔美国妇女。该计划将包括图像，文本，图形和视频教学内容，沿着个性化的风险评估和交互式决策规划模块。教育干预旨在补充医生对乳房健康的个人咨询。将向女性患者及其医生提供关于风险水平和决策因素的打印反馈。将提供一份附有注释的讨论主题清单，以组织咨询会议。本研究将运用社会学习理论、自我效能理论及社会行销原理设计健康教育课程。 将对短期和中期成果进行衡量。将评估乳腺癌主题的知识、他莫昔芬的利弊、态度和行为变量、对他莫昔芬决策的满意度以及对决策过程的满意度。我们将在线收集售前和售后数据，并在一个月后通过电子邮件和电话进行随访调查。医生对其患者对相关问题的理解的评级将随附于数据记录中。将收集定性数据，以协助设计一个第二阶段的临床试验比较网络，咨询和印刷教育模式。

DESCRIPTION (provided by applicant): Some 15.5 percent of women in the United States may be at higher risk for developing breast cancer as a result of their genetic inheritance and factors relating to their personal history (Freedman, 2003). Intensified screening and chemoprophylaxis are among the monitoring and prevention options available to these women. The decision to begin tamoxifen therapy, in particular, is a complex and difficult one. While the protective effects of this selective estrogen replacement modulator have been well-established, side effects such as hot flashes and collateral risks for developing blood clots and uterine cancer subsequent to therapy are countervailing considerations. The United States Preventive Services Task Force has recently recommended that Primary Care physicians provide counseling regarding the tamoxifen option to their high risk women patients, and other physicians in Breast Health Programs and in Women's Health Centers have been providing these services to their patients for a decade or more (Kinsinger, 2002). A prototype Internet-based multimedia education program focusing on breast cancer issues and tamoxifen prophylaxis will be developed for high-risk Caucasian and African-American women. The program will include images, text, graphics, and video teaching content, along with an individualized risk assessment and an interactive decision planning module. The educational intervention is intended to complement personal counseling on breast health by a physician. Printed feedback regarding level of risk and decision factors will be provided to the woman patient and to her physician. An annotated checklist of discussion topics will be provided to structure the counseling session. Social learning theory, self-efficacy theory, and social marketing principles will be employed in the design of the health education program. Both short-term and intermediate-term outcomes will be measured. Knowledge of breast cancer topics, pros and cons of tamoxifen, attitudinal and behavioral variables, satisfaction with the tamoxifen decision, and satisfaction with the decision process will be assessed. Pre-Post data will be collected online and a Follow-Up survey will be conducted one month later by email and telephone. Physician ratings of their patient's understanding of relevant issues will be appended to the data record. Qualitative data will be collected to assist in the design of a Phase II clinical trial comparing web, counseling, and print education modalities.