高危女性和初级保健环境中的医疗保健提供者的乳腺癌化学预防决策支持工具的初步研究。
Pilot study of decision support tools on breast cancer chemoprevention for high-risk women and healthcare providers in the primary care setting.
机构信息
Columbia University, Mailman School of Public Health, 622 West 168th Street, PH-20, New York, NY, 10032, USA.
Columbia University, College of Physicians and Surgeons, New York, NY, USA.
出版信息
BMC Med Inform Decis Mak. 2018 Dec 17;18(1):134. doi: 10.1186/s12911-018-0716-5.
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.
背景
乳腺癌化学预防可以降低高危女性的乳腺癌发病率；然而，化学预防在初级保健环境中并未得到充分利用。我们对高危女性及其初级保健提供者（PCP）的决策支持工具进行了一项试点研究。
方法
该干预措施包括针对高危女性的决策辅助工具（DA），即 RealRisks，以及以提供者为中心的工具，即乳腺癌风险导航（BNAV）。患者在基线时、使用 RealRisks 后以及他们的 PCP 临床就诊后或 6 个月时完成了经过验证的调查。通过电子健康记录评估高危咨询转诊和化学预防的采用情况。主要终点是 6 个月时乳腺癌风险感知的准确性。
结果
在 40 名可评估的高危女性中，中位年龄为 64.5 岁，中位 5 年乳腺癌风险为 2.19%。在接触 RealRisks 后，患者对乳腺癌风险的准确感知有所改善（p=0.02），对化学预防知识的了解有所增加（p<0.01），并且有 24%的人表示有兴趣服用化学预防药物。有 3 名女性被转诊至高危科室，但无人开始化学预防。接触 RealRisks 后，决策冲突明显增加，直至临床就诊或 6 个月时（p<0.01）。准确的乳腺癌风险感知在 6 个月或临床就诊后得到改善并持续存在。我们讨论了化学预防的副作用概况以及引入 RealRisks 时的护理途径，以了解为什么患者的决策冲突加剧。
结论
未来的干预措施应更紧密地将 DA 的使用与临床就诊联系起来，研究决策冲突的时间测量，改善风险沟通、共同决策以及 PCP 的化学预防教育。需要进一步的工作来更好地了解针对患者和提供者的决策辅助工具的影响。
试验注册
ClinicalTrials.gov 标识符：NCT02954900 2016 年 11 月 4 日回顾性注册。
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