COMPUTER EDUCATION FOR BREAST CANCER GENETIC TESTING

该项目的长期目标是提高患者对乳腺癌风险和基因测试的了解。我们之前已经开发了一种面向患者的光盘，名为《计算机咨询：乳腺癌风险和基因测试》。拟议的研究将进行一项临床试验，以评估光盘在教育妇女了解乳腺癌风险、基因测试的选择和影响方面的有效性。这个项目需要36个月的时间完成，涉及两个具体目标：具体目标1：评估我们的光盘在教育妇女了解乳腺癌风险方面的有效性，以及基因测试的选择和影响。我们将分两个阶段完成这一目标。在第一阶段，我们将从宾夕法尼亚州中部的不同妇女群体那里获得关于光盘和调查工具的重要反馈。将从普通内科诊所和乳腺癌支助小组招募40名妇女(其中至少四分之一是少数族裔)，以评估光盘的可用性和有效性。调查数据将用于改进光盘和研究仪器，为随机试验做准备。第二阶段将通过对三个研究地点的210名患者进行随机、前后测试控制组交叉试验，评估CD-ROM对那些真正考虑进行乳腺癌易感性基因测试的人的影响。基于计算机的教育的有效性将与一对一教育对患者的影响进行比较：风险认知；接受基因检测的意愿；关于乳腺癌风险和基因检测的知识；对他们关于基因检测的决定的满意度；以及决策冲突。还将获得对每项教育干预的可接受性的评估。具体目标2：评估之前的基于计算机的教育会议对患者和遗传咨询师之间后续互动的影响。作为随机试验的一部分，我们将研究增加一个基于计算机的教育程序是否改善了患者和遗传咨询师之间的互动。在那些单独接受遗传咨询师教育的人和那些在与遗传咨询师会诊之前接受计算机培训的人之间，将通过测量以下指标进行比较：与遗传咨询师相处的时间；针对遗传咨询师的问题的质量和数量；患者和遗传咨询师的满意度；以及咨询会话的感知有效性。

The long term goal of this project is to improve patient understanding about breast cancer risk and genetic testing. We have previously developed a patient-oriented CD-ROM called "Counseling by Computer: Breast Cancer Risk and Genetic Testing ." The proposed research is to conduct a clinical trial to evaluate the effectiveness of the CD-ROM at educating women about breast cancer risk, and options and implications of genetic testing. This project will take 36 months to complete and involves two specific aims: Specific Aim 1: to evaluate the effectiveness of our CD-ROM at educating women about breast cancer risk, and the options and implications of genetic testing. We will complete this aim in two phases. During phase 1 we will obtain critical feedback on the CD-ROM and survey instruments from a diverse group of women in Central Pennsylvania. Forty women (at least 1/4 of whom are minorities) will be recruited from a general internal medicine clinic and breast cancer support group to evaluate the useability and effectiveness of the CD-ROM. The survey data will be used to refine the CD-ROM and study instruments in preparation for a randomized trial. Phase 2 will be to evaluate the impact of the CD-ROM on those actually considering genetic testing for breast cancer susceptibility, through a randomized, pretest-posttest control-group, crossover trial of 210 patients at three study sites. The effectiveness of computer-based education will be compared with one-on-one education for the impact on patients': risk perception; intent to receive genetic testing; knowledge about breast cancer risk and genetic testing; satisfaction with their decision about genetic testing; and decisional conflict. An assessment of the acceptability of each educational intervention will also be obtained. Specific Aim 2: to evaluate the impact of a prior computer-based educational session on subsequent interactions between patients and genetic counselors. As part of the randomized trial, we will study whether the addition of a computer-based educational program improves the interactions between patients and genetic counselors. Comparisons will be made between those educated by a genetic counselor alone, and those educated by a computer prior to their session with a genetic counselor, by measuring: the amount of time spent with a genetic counselor; the quality and quantity of questions directed to the genetic counselor; patient's and genetic counselor's satisfaction; and perceived effectiveness of the counseling session.