The FYI on MRI: A Multilevel Decision Support Intervention for Screening Breast MRI

点击翻译按钮获取中文摘要

PROJECT SUMMARY The proposed K08 career development award will provide Dr. Conley with the training and mentorship necessary to become an independent clinical scientist focused on leveraging multilevel approaches to support informed decision making about risk-based cancer screening in diverse populations. She has identified decision-making about screening breast MRI among high-risk Black and Latina women as a critical issue to address in order to achieve this goal. This proposal describes a 5-year comprehensive program of training and mentored research for an academic career at the intersection of medical decision making and risk-based cancer screening. This K08 will provide key training in community engaged research, medical decision making, multilevel interventions, and cancer risk prediction models. The intensive research experience provided by the K08 aims will provide the opportunity to implement and practice the skills gained through the training goals. The primary objective of the proposed research is to develop and test a multilevel intervention to support informed decision making about screening breast MRI among high-risk Black and Latina women. Women at high risk for breast cancer (i.e., ≥20% lifetime risk) can decide to supplement mammography screening with MRI or continue with mammography alone. Some women will benefit from screening with breast MRI, though some will experience harms due to the higher rate of biopsies, false-positive results, and higher costs. Thus, informed decision making about screening breast MRI is critical for high-risk women. An informed decision is defined as a decision that is made with sufficient knowledge, and is in line with the person’s preferences. To make informed decisions about screening breast MRI, high-risk women must: (1) be identified as high risk; (2) be made aware that breast MRI is an option; (3) understand MRI’s benefits and drawbacks; and (4) make a decision aligned with their preferences. However, lack of awareness and access may prevent high-risk Black and Latina women from making an informed decision about breast MRI. The study’s specific aims are: (1) develop and deliver a universal breast cancer risk assess- ment protocol in a community setting; (2) develop a culturally-relevant decision aid with input from diverse stake- holders; and (3) assess the effect of the multilevel decision support intervention (i.e., risk assessment + decision aid) on informed decisions about breast MRI. Dr. Conley’s mentorship team – including world-renowned behav- ioral scientists, clinical trialists, breast oncologists, epidemiologists, and biostatisticians – will provide guidance to support her research aims and complement her didactic training. These factors, in addition to the supportive research environment at Georgetown Lombardi Comprehensive Cancer Center, will enable her to achieve the proposed project aims. The proposed study will provide pilot data for a future R01 application to test the effec- tiveness of this intervention in the NCI Community Oncology Research Program. Dr. Conley will also possess the skills and experience to leverage multilevel approaches to support informed decision-making about risk- based cancer screening in diverse populations. This will result in sustained and impactful scientific contributions.