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

 描述（由申请人提供）：乳腺癌是拉丁美洲癌症死亡的主要原因。拉丁裔也有BRCA 1/2基因突变的高患病率，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）的遗传性癌症风险评估（GCRA）可以为预防和治疗决策提供信息，从而降低乳腺癌风险。尽管有指导方针将携带突变的高风险妇女转介到GCRA服务，但拉丁美洲人对这些服务的利用不足。拉丁裔低GCRA参与的原因包括环境（例如访问，有限的西班牙资源）和心理社会因素（例如知识，识字，情感问题）。我们的初步数据表明，改善获取可能不一定转化为吸收，供应商面临与拉丁美洲人沟通基因组学的挑战。为了开发有效的HBOC沟通，关键是要了解拉丁美洲人对GCRA的直觉信念，这是由先前的经验和文化（心理模型）所告知的，因为它们会影响风险信息的处理方式。同时也有必要了解对GCRA的情绪反应和潜在的矛盾心理。有一些干预措施旨在增加GCRA在拉丁美洲的使用。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，我们将进行两阶段的混合方法研究。在第一阶段，我们将采访关键的线人（n=10）和风险拉丁美洲人（n=20），以描述他们的心理模型和其他心理社会因素。这些数据将告知风险-受益信息，这些信息将在焦点小组（n=20）中进行评估和细化，并通过拉丁裔演员和媒体干预中值得信赖的医学人士（即YouTube视频）进行传递。在第二阶段，我们将对高危拉丁美洲人（n=40）进行试点干预。基线后，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。将在3个月时评估GCRA摄取。我们的主要结果是使用GCRA的意图。具体目标是：目标1。描述和描绘拉丁美洲人的GCRA心理模型（风险和利益的看法，情绪等）目标2.使用目标1中的数据，为处于风险中的拉丁美洲人开发风险-受益沟通信息的内容，并将其纳入西班牙语YouTube视频。目标3.评价主要结局（使用GCRA的意图）和中间结局（例如态度）的可接受性和干预前后差异。我们还将探讨干预后GCRA摄取作为次要结局。H.2.1.该干预措施将导致使用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个月内参加GCRA。H.2.4.大多数人（≥75%）对干预措施表示满意

 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