Department of Health Behavior and Health Education, UNC Gillings School of Global Public Health, University of North Carolina, Chapel Hill, NC 27599-7440, USA.
Breast Cancer Res Treat. 2012 Jun;133(2):553-61. doi: 10.1007/s10549-011-1791-9. Epub 2011 Oct 1.
Doctors commonly use genomic testing for breast cancer recurrence risk. We sought to assess whether the standard genomic report provided to doctors is a good approach for communicating results to patients. During 2009-2010, we interviewed 133 patients with stages I or II, node-negative, hormone receptor-positive breast cancer and eligible for the Oncotype DX genomic test. In a randomized experiment, patients viewed six vignettes that presented hypothetical recurrence risk test results. Each vignette described a low, intermediate, or high chance of breast cancer recurrence in 10 years. Vignettes used one of five risk formats of increasing complexity that we derived from the standard report that accompanies the commercial assay or a sixth format that used an icon array. Among women who received the genomic recurrence risk test, 63% said their doctors showed them the standard report. The standard report format yielded among the most errors in identification of whether a result was low, intermediate, or high risk (i.e., the gist of the results), whereas a newly developed risk continuum format yielded the fewest errors (17% vs. 5%; OR 0.23; 95% CI 0.10-0.52). For high recurrence risk results presented in the standard format, women made errors 35% of the time. Women rated the standard report as one of the least understandable and least-liked formats, but they rated the risk continuum format as among the most understandable and most liked. Results differed little by health literacy, numeracy, prior receipt of genomic test results during clinical care, and actual genomic test results. The standard genomic recurrence risk report was more difficult for women to understand and interpret than the other formats. A less complex report, potentially including the risk continuum format, would be more effective in communicating test results to patients.
医生通常使用基因组测试来评估乳腺癌复发风险。我们旨在评估向医生提供的标准基因组报告是否是向患者传达结果的一种好方法。在 2009 年至 2010 年期间，我们采访了 133 名患有 I 期或 II 期、无淋巴结转移、激素受体阳性乳腺癌且有资格进行 Oncotype DX 基因组测试的患者。在一项随机实验中，患者观看了六个情景介绍，这些情景介绍了假设的复发风险测试结果。每个情景都描述了 10 年内乳腺癌复发的低、中、高机会。情景使用了我们从伴随商业检测的标准报告中得出的五种越来越复杂的风险格式之一，或者使用了一种图标数组的第六种格式。在接受基因组复发风险测试的女性中，有 63%的女性表示医生向她们展示了标准报告。标准报告格式在识别结果是低、中还是高风险（即结果的要点）方面产生了最多的错误，而新开发的风险连续体格式产生的错误最少（17%对 5%；OR 0.23；95%CI 0.10-0.52）。对于以标准格式呈现的高复发风险结果，女性有 35%的时间会出错。女性认为标准报告是最不容易理解和最不喜欢的格式之一，但她们认为风险连续体格式是最容易理解和最喜欢的格式之一。健康素养、计算能力、在临床护理期间是否收到过基因组测试结果以及实际的基因组测试结果对结果的影响差异不大。标准基因组复发风险报告对女性来说比其他格式更难理解和解释。一种不太复杂的报告，可能包括风险连续体格式，将更有效地向患者传达测试结果。
