Study protocol: a cluster randomized controlled trial of web-based decision support tools for increasing BRCA1/2 genetic counseling referral in primary care

Silverman, Thomas; Vanegas, Alejandro; Marte, Awilda; Mata, Jennie; Sin, Margaret; Ramirez, Juan Carlos Rodriguez; Tsai, Wei‐Yann; Crew, Katherine D.; Kukafka, Rita

doi:10.1186/s12913-018-3442-x

Cited by 10 publications

(13 citation statements)

References 71 publications

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“…Previous studies have shown that guideline dissemination is not necessarily adequate to change practice behavior (41,42). Integration of cancer risk assessment and clinical management guidelines within routine primary care workflow, including reminder systems (chart-based or computerized) (43,44), cancer risk and prevention-related decision support tools (30,45,46) (https://clinicaltrials.gov/ct2/show/NCT02986230), and provider assessment and feedback (which have been successful for improving screening rates for breast, cervical and colon cancer) (47), is imperative for widespread implementation and to make an impact on prescribing behaviors of PCPs (42,48).…”

Section: Discussionmentioning

confidence: 99%

Assessment of and Interventions for Women at High Risk for Breast or Ovarian Cancer: A Survey of Primary Care Physicians

Samimi

Heckman-Stoddard

Holmberg

et al. 2021

Cancer Prevention Research

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As clinical guidelines for cancer prevention refer individuals to primary care physicians (PCPs) for risk assessment and clinical management, PCPs may be expected to play an increasing role in cancer prevention. It is crucial that PCPs are adequately supported to assess an individual's cancer risk and make appropriate recommendations. The objective of this study is to assess use, familiarity, attitude and behaviors of PCPs regarding breast and ovarian cancer risk and prevention, to better understand the factors that influence their prescribing behaviors. We conducted a cross-sectional, web-based survey of PCPs in the United States, recruited from an opt-in healthcare provider panel. Invitations were sent in batches until the target sample size of 750 respondents (250 each for OB/GYN, internal medicine and family medicine) was met. Selfreported use of breast/ovarian cancer risk assessments was low (34.7%-59.2%) compared with discussion of cancer family history (96.9%), breast exams (87.1%) and mammograms (92.8%). While most respondents (48.0-66.8%) were familiar with cancer prevention interventions, respondents who reported to be less familiar were more likely to report cautious attitudes. When presented with hypothetical cases depicting patients at different breast/ovarian cancer risks, up to 34.0% of respondents did not select any of the clinically recommended course(s) of action. This survey suggests that PCP use of breast/ovarian cancer risk assessment tools and ability to translate the perceived risks to clinical actions is variable. Improving implementation of cancer risk assessment and clinical management guidelines within primary care may be necessary to improve the appropriate prescribing of cancer prevention interventions.

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Section: Discussionmentioning

confidence: 99%

Assessment of and Interventions for Women at High Risk for Breast or Ovarian Cancer: A Survey of Primary Care Physicians

Samimi

Heckman-Stoddard

Holmberg

et al. 2021

Cancer Prevention Research

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“…RealRisks is a patient-centered, web-based decision aid (DA) that calculates a woman's 5-year and lifetime risks for developing breast cancer according to the Gail model [25], determines her eligibility for chemoprevention and other breast cancer risk-reducing options, provides tailored education based upon her personalized risk profile, and elicits the patient's preferences and values surrounding breast cancer prevention decisions [[26], [27], [28]]. BNAV is a provider-centered decision support tool that delivers summaries of patient risk profiles and preferences along with educational resources in order to support provider decision-making surrounding breast cancer risk reduction [29,30]. Secondary study objectives include determining whether these tools improve decision antecedents (accuracy of breast cancer risk perceptions, chemoprevention knowledge, decision self-efficacy), decision quality (informed choice, decision conflict, shared decision-making), and appropriate referrals to a high-risk breast clinic.…”

Section: Trial Objectivesmentioning

confidence: 99%

Study protocol: Randomized controlled trial of web-based decision support tools for high-risk women and healthcare providers to increase breast cancer chemoprevention

Crew

Silverman

Vanegas

et al. 2019

Contemporary Clinical Trials Communications

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Background Chemoprevention using selective estrogen receptor modulators and aromatase inhibitors has been shown to reduce invasive breast cancer incidence in high-risk women. Despite this evidence, few high-risk women who are eligible for chemoprevention utilize it as a risk-reducing strategy. Reasons for low uptake include inadequate knowledge about chemoprevention among patients and healthcare providers, concerns about side effects, time constraints during the clinical encounter, and competing comorbidities. Methods/design We describe the study design of a randomized controlled trial examining the effect of two web-based decision support tools on chemoprevention decision antecedents and quality, referral for specialized counseling, and chemoprevention uptake among women at an increased risk for breast cancer. The trial is being conducted at a large, urban medical center. A total of 300 patients and 50 healthcare providers will be recruited and randomized to standard educational materials alone or in combination with the decision support tools. Patient reported outcomes will be assessed at baseline, one and six months after randomization, and after their clinic visit with their healthcare provider. Discussion We are conducting this trial to provide evidence on how best to support personalized breast cancer risk assessment and informed and shared decision-making for chemoprevention. We propose to integrate the decision support tools into clinical workflow, which can potentially expand quality decision-making and chemoprevention uptake. Trial registration NCT03069742.

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“…Given the implications of genetic conversations, there is a need for interventions which address HCP confidence and skill when navigating these complex issues [5,29,31,32]. This is especially true as more responsibility is given to a wider population of HCPs to engage in this dialogue.…”

Section: Discussionmentioning

confidence: 99%

“…These conversations play an important role in informing not only an individual’s own choices about treatment and surveillance, but potentially those of other members of their family [ 4 , 7 , 29 – 31 ]. Unfortunately, there is evidence that HCPs without specific genetic training often lack confidence and knowledge about the referral pathway, the genetic background of inheritance, or how to speak to individuals about genetic testing and risk assessment [ 11 , 24 , 32 – 34 ].…”

Section: Introductionmentioning

confidence: 99%

A systematic review of communication interventions to help healthcare professionals discuss genetic testing for breast cancer

Starkings

Shilling

Jenkins

et al. 2020

Breast Cancer Res Treat

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Purpose This systematic review examined educational training interventions for healthcare professionals (HCPs) discussing genetic testing and risk for hereditary breast cancer. There was a particular focus on the presence, and content, of communication elements within these packages. Methods Searches were run via CINAHL, EMBASE, PUBMED, and PsychInfo in February 2019 to identify training interventions available to HCPs with reference to communication skills. Studies were assessed for quality, with relevant intervention and outcome data extracted and synthesized. This review followed the Preferred Reporting Items for Systematic Review and Meta-analyses (PRISMA) statement and was registered on the PROSPERO database (CRD42019124010). Results Of 3,988 items, seven papers, two of which were linked, were eligible for inclusion. There was a mix of randomized and single arm studies with web-based and face-to-face interventions. Content included an overview of genetics, hereditary and familial background, and recommended practice techniques. Outcomes focused on communication, self-efficacy, knowledge, and satisfaction. Interventions were designed for genetic counselors, physicians, primary care physicians (PCPs), medical students, and nurses. None of the papers featured oncologists or surgeons. Conclusions This review revealed an overall lack of publications which evaluated interventions to assist HCPs discussing hereditary breast cancer risk and testing. Studies failed to operationalize which 'communication skills' they included, nor did they consistently report randomization, outcome measures, or analysis. Discussing the need for, and management of, genetic testing for inherited cancer risk with individuals and their families can be challenging. As genetic testing in breast cancer becomes more common, the provision of specific communication-based training programs, with reference to genetic testing, risk assessments, and counseling skills is warranted.

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Study protocol: a cluster randomized controlled trial of web-based decision support tools for increasing BRCA1/2 genetic counseling referral in primary care

Cited by 10 publications

References 71 publications

Assessment of and Interventions for Women at High Risk for Breast or Ovarian Cancer: A Survey of Primary Care Physicians

Assessment of and Interventions for Women at High Risk for Breast or Ovarian Cancer: A Survey of Primary Care Physicians

Study protocol: Randomized controlled trial of web-based decision support tools for high-risk women and healthcare providers to increase breast cancer chemoprevention

A systematic review of communication interventions to help healthcare professionals discuss genetic testing for breast cancer

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