Article

A Randomized, Controlled Trial to Increase Discussion of Breast Cancer in Primary Care

Cancer Epidemiology Biomarkers & Prevention (Impact Factor: 4.13). 04/2014; 23(7). DOI: 10.1158/1055-9965.EPI-13-1380
Source: PubMed

ABSTRACT

Background: Assessment and discussion of individual risk for breast cancer within the primary care setting are crucial to discussion of risk reduction and timely referral. Methods: We conducted a randomized controlled trial of a multiethnic, multilingual sample of women aged 40-74 years from two primary care practices (one academic, one safety-net) to test a breast cancer risk assessment and education intervention. Patients were randomly assigned to control or intervention group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). Intervention (BreastCARE) patients and their physicians received an individualized risk report to discuss during the visit. One-week follow-up telephone surveys with all patients assessed patient-physician discussion of: family cancer history, personal breast cancer risk, high-risk clinics, and genetic counseling/testing. Results: 655 control and 580 intervention women completed the risk assessment and follow-up interview; 25% were high-risk by family history, Gail, or Breast Cancer Surveillance Consortium risk models. BreastCARE increased discussions of family cancer history (OR=1.54, 95% CI=1.25-1.91), personal breast cancer risk (OR=4.15, 3.02-5.70), high-risk clinics (OR=3.84, 2.13-6.95), and genetic counseling/testing (OR=2.22, 1.34-3.68). Among high-risk women, all intervention effects were stronger. Conclusions: An intervention combining an easy-to-use, quick risk assessment tool with patient-centered risk reports at the point of care can successfully promote discussion of breast cancer risk reduction between patients and primary care physicians, particularly for high-risk women. Impact: Next steps include scaling and dissemination of BreastCARE with integration into electronic medical record systems.

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Available from: Eliseo J Pérez-Stable, Oct 13, 2014
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    ABSTRACT: Purpose: To estimate the effects of a tablet-based, breast cancer risk education intervention for use in primary care settings (BreastCARE) on patients' breast cancer knowledge, risk perception and concern. Methods: From June 2011-August 2012, we enrolled women from two clinics, aged 40-74 years with no personal breast cancer history, and randomized them to the BreastCARE intervention group or to the control group. All patients completed a baseline telephone survey and risk assessment (via telephone for controls, via tablet computer in clinic waiting room prior to visit for intervention). All women were categorized as high or average risk based on the Referral Screening Tool, the Gail model or the Breast Cancer Surveillance Consortium model. Intervention patients and their physicians received an individualized risk report to discuss during the visit. All women completed a follow-up telephone survey 1-2 weeks after risk assessment. Post-test comparisons estimated differences at follow-up in breast cancer knowledge, risk perception and concern. Results: 580 intervention and 655 control women completed follow-up interviews. Mean age was 56 years (SD = 9). At follow-up, 73% of controls and 71% of intervention women correctly perceived their breast cancer risk and 22% of controls and 24% of intervention women were very concerned about breast cancer. Intervention patients had greater knowledge (≥75% correct answers) of breast cancer risk factors at follow-up (24% vs. 16%; p = 0.002). In multivariable analysis, there were no differences in correct risk perception or concern, but intervention patients had greater knowledge ([OR] = 1.62; 95% [CI] = 1.19-2.23). Conclusions: A simple, practical intervention involving physicians at the point of care can improve knowledge of breast cancer without increasing concern. Trial registration: ClinicalTrials.gov identifier NCT01830933.
    Full-text · Article · Oct 2015 · Breast (Edinburgh, Scotland)