Pilot study of decision support tools on breast cancer chemoprevention for high-risk women and healthcare providers in the primary care setting

Rita Kukafka; Jiaqi Fang; Alejandro Vanegas; Thomas Silverman; Katherine D Crew

doi:10.1186/s12911-018-0716-5

Pilot study of decision support tools on breast cancer chemoprevention for high-risk women and healthcare providers in the primary care setting

BMC Med Inform Decis Mak. 2018 Dec 17;18(1):134. doi: 10.1186/s12911-018-0716-5.

Authors

Rita Kukafka^{1

2

3}, Jiaqi Fang⁴, Alejandro Vanegas⁵, Thomas Silverman⁵, Katherine D Crew^{4

5

6}

Affiliations

¹ Columbia University, Mailman School of Public Health, 622 West 168th Street, PH-20, New York, NY, 10032, USA. rk326@cumc.columbia.edu.
² Columbia University, College of Physicians and Surgeons, New York, NY, USA. rk326@cumc.columbia.edu.
³ Herbert Irving Comprehensive Cancer Center, New York, NY, USA. rk326@cumc.columbia.edu.
⁴ Columbia University, Mailman School of Public Health, 622 West 168th Street, PH-20, New York, NY, 10032, USA.
⁵ Columbia University, College of Physicians and Surgeons, New York, NY, USA.
⁶ Herbert Irving Comprehensive Cancer Center, New York, NY, USA.

Abstract

Background: Breast cancer chemoprevention can reduce breast cancer incidence in high-risk women; however, chemoprevention is underutilized in the primary care setting. We conducted a pilot study of decision support tools among high-risk women and their primary care providers (PCPs).

Methods: The intervention included a decision aid (DA) for high-risk women, RealRisks, and a provider-centered tool, Breast Cancer Risk Navigation (BNAV). Patients completed validated surveys at baseline, after RealRisks and after their PCP clinical encounter or at 6-months. Referral for high-risk consultation and chemoprevention uptake were assessed via the electronic health record. The primary endpoint was accuracy of breast cancer risk perception at 6-months.

Results: Among 40 evaluable high-risk women, median age was 64.5 years and median 5-year breast cancer risk was 2.19%. After exposure to RealRisks, patients demonstrated an improvement in accurate breast cancer risk perceptions (p = 0.02), an increase in chemoprevention knowledge (p < 0.01), and 24% expressed interest in taking chemoprevention. Three women had a high-risk referral, and no one initiated chemoprevention. Decisional conflict significantly increased from after exposure to RealRisks to after their clinical encounter or at 6-months (p < 0.01). Accurate breast cancer risk perceptions improved and was sustained at 6-months or after clinical encounters. We discuss the side effect profile of chemoprevention and the care pathway when RealRisks was introduced to understand why patients experienced increased decision conflict.

Conclusion: Future interventions should carefully link the use of a DA more proximally to the clinical encounter, investigate timed measurements of decision conflict and improve risk communication, shared decision making, and chemoprevention education for PCPs. Additional work remains to better understand the impact of decision aids targeting both patients and providers.

Trial registration: ClinicalTrials.gov Identifier: NCT02954900 November 4, 2016 Retrospectively registered.

Keywords: Breast cancer; Chemoprevention; Decision aids; Decision conflict; Decision support; Risk communication.

Publication types

Research Support, N.I.H., Extramural

MeSH terms

Adult
Aged
Breast Neoplasms / prevention & control*
Chemoprevention*
Clinical Decision-Making*
Decision Making*
Decision Support Techniques*
Female
Health Knowledge, Attitudes, Practice*
Humans
Middle Aged
Pilot Projects
Primary Health Care*
Risk Assessment*

Associated data

ClinicalTrials.gov/NCT02954900

Abstract

Publication types

MeSH terms

Associated data

Grants and funding