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检测的了解。我们之前已经开发了一个面向病人的CD-ROM，名为“计算机咨询：乳腺癌风险和基因检测”。拟议的研究是进行一项临床试验，以评估光盘在教育妇女了解乳腺癌风险以及基因检测的选择和影响方面的有效性。该项目将耗时36个月完成，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，以及基因检测的选择和影响。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不同群体的妇女那里获得关于CD-ROM和调查工具的关键反馈。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1/4是少数民族），以评估光盘的可用性和有效性。调查数据将用于改进CD-ROM和研究仪器，为随机试验做准备。第二阶段将评估光盘对那些考虑进行乳腺癌易感性基因检测的人的影响，通过一个随机的、测试前-测试后的对照组，在三个研究地点对210名患者进行交叉试验。比较计算机化教育与一对一教育对患者风险认知的影响；接受基因检测的意愿；了解乳腺癌风险和基因检测；对基因检测决定的满意度；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：评估先前的计算机教育课程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，我们将研究计算机教育项目是否能改善患者和遗传咨询师之间的互动。将通过以下测量方法对单独接受遗传咨询师教育的人与在接受遗传咨询师之前接受计算机教育的人进行比较：与遗传咨询师相处的时间；向遗传咨询师提出的问题的质量和数量；患者及遗传咨询师满意度；以及心理咨询的有效性。

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.