Evaluating a decision aid for breast cancer prevention: a pilot trial

描述(申请人提供)：在美国，乳腺癌是女性中最常见的癌症，也是45-60岁女性的主要死亡原因。化学预防和预防性手术等预防选择的有效性已经确立。然而，乳腺癌预防仍然没有得到充分利用，导致了可以避免的发病率和死亡率。有效利用乳腺癌预防的主要障碍是患者对这些干预措施的认识不准确，以及提供者在确定合格患者方面面临的挑战。为了解决这些障碍，我们的研究将在初级保健环境中使用决策辅助，以促进以患者为中心和以证据为基础的乳腺癌预防。方法：在我们以前工作的基础上，我们将评估在初级保健环境中用于乳腺癌预防的决策辅助的临床可行性和有效性。首先，我们将调整我们以前开发的决策辅助工具，以便在初级保健环境中使用。其次，我们将进行随机对照试验，以评估两种提供决策辅助工具的方法(在会诊前使用决策辅助工具或在咨询期间使用决策辅助工具)的有效性。调查团队和环境：调查团队是高度跨学科的，汇集了必要的经验和专业知识来完成拟议的研究。专业领域包括：临床研究、临床决策支持方法、妇女健康、乳腺癌预防和统计分析。拟议的小组开发和评价了许多决策支持工具和方法，使它们独一无二地适合并处于成功完成拟议研究的有利地位。潜在影响：拟议研究的目标是促进知情决策和以患者为中心的护理在乳腺癌预防方面的科学和应用。我们的研究将通过确保患者的选择与当前的临床知识和他们自己的价值观保持一致，来改善患者关于预防的决策。以初级保健环境为目标将使人们能够广泛确定哪些妇女可能受益于预防干预。通过测试决策辅助的两种交付方法，我们的目标是进一步推动决策辅助开发和实施的科学性。这项工作最终有望改善患者的健康状况，减轻乳腺癌的负担。 公共卫生相关性：乳腺癌预防方案的重大进展为减少这一致命疾病的发病率提供了机会。然而，乳腺癌预防仍然没有得到充分利用，导致了可以避免的发病率和死亡率。我们的研究将在初级保健环境中使用决策辅助，以促进以患者为中心和以证据为基础的乳腺癌预防。

DESCRIPTION (provided by applicant): In the United States, breast cancer is the most common cancer among women and the leading cause of death in women between the ages of 45-60. The efficacy of prevention options such as chemoprevention and prophylactic surgery has been established. Yet breast cancer prevention remains underused, resulting in avoidable morbidity and mortality. The main barriers to effective use of breast cancer prevention are inaccurate perceptions of these interventions by patients and challenges to providers in identifying eligible patients. To address these barriers, our research will use a decision aid in the primary care setting to facilitate patient-centered and evidence-based breast cancer prevention. THE APPROACH: Building on our previous work, we will evaluate the clinical feasibility and efficacy of a decision aid for breast cancer prevention in the primary care setting. First, we will adapt our previously developed decision aid for use in the primary care setting. Second, we will conduct a randomized controlled trial to evaluate the effectiveness of two methods of delivery for the decision aid (use of the decision aid prior to the consultation, or during the consultation). THE INVESTIGATIVE TEAM AND ENVIRONMENT: The investigative team is highly interdisciplinary and brings together the necessary experience and expertise to accomplish the proposed research. Areas of expertise include: clinical research, clinical decision support methods, women's health, breast cancer prevention, and statistical analyses. The proposed team has developed and evaluated numerous decision support tools and methods making them uniquely suited and well-positioned to successfully complete the proposed research. THE POTENTIAL IMPACT: The goal of the proposed research is to further the science and application of informed decision making and patient-centered care in the context of breast cancer prevention. Our research will improve patient decisions about prevention by ensuring that their choices are aligned with current clinical knowledge and their own values. Targeting the primary care setting will enable the widespread identification of women who are likely to benefit from prevention interventions. By testing two methods of delivery for the decision aid, we aim to further the science of decision aid development and implementation. This work is ultimately expected to improve patient health outcomes and decrease the burden of breast cancer. PUBLIC HEALTH RELEVANCE: Significant advances in options for breast cancer prevention present an opportunity to reduce the incidence of this deadly disease. Yet breast cancer prevention remains underused, resulting in avoidable morbidity and mortality. Our research will use a decision aid in the primary care setting to facilitate the use of patient- centered and evidence-based breast cancer prevention.