Christine E. Lynn College of Nursing, Florida Atlantic University, 777 Glades Road, Boca Raton, FL, 33431, USA.
Department of Biomedical Informatics, Vagelos College of Physicians and Surgeons, Columbia University Irving Medical Center, New York, NY, USA.
BMC Med Inform Decis Mak. 2022 Aug 4;22(1):208. doi: 10.1186/s12911-022-01954-y.
Chemoprevention with anti-estrogens, such as tamoxifen, raloxifene or aromatase inhibitors, have been shown to reduce breast cancer risk in randomized controlled trials; however, uptake among women at high-risk for developing breast cancer remains low. The aim of this study is to identify provider-related barriers to shared decision-making (SDM) for chemoprevention in the primary care setting.
Primary care providers (PCPs) and high-risk women eligible for chemoprevention were enrolled in a pilot study and a randomized clinical trial of web-based decision support tools to increase chemoprevention uptake. PCPs included internists, family practitioners, and gynecologists, whereas patients were high-risk women, age 35-75 years, who had a 5-year invasive breast cancer risk ≥ 1.67%, according to the Gail model. Seven clinical encounters of high-risk women and their PCPs who were given access to these decision support tools were included in this study. Audio-recordings of the clinical encounters were transcribed verbatim and analyzed using grounded theory methodology.
Six primary care providers, of which four were males (mean age 36 [SD 6.5]) and two were females (mean age 39, [SD 11.5]) and seven racially/ethnically diverse high-risk female patients participated in this study. Qualitative analysis revealed three themes: (1) Competing demands during clinical encounters; (2) lack of knowledge among providers about chemoprevention; and (3) limited risk communication during clinical encounters.
Critical barriers to SDM about chemoprevention were identified among PCPs. Providers need education and resources through decision support tools to engage in risk communication and SDM with their high-risk patients, and to gain confidence in prescribing chemoprevention in the primary care setting.
在随机对照试验中，抗雌激素药物如他莫昔芬、雷洛昔芬或芳香酶抑制剂的化学预防已被证明可降低乳腺癌风险；然而，在有发展为乳腺癌高风险的女性中，这种药物的使用率仍然很低。本研究旨在确定初级保健环境中化学预防共享决策（SDM）中与提供者相关的障碍。
初级保健提供者（PCP）和有资格接受化学预防的高危女性参加了一项试点研究和一项基于网络的决策支持工具的随机临床试验，以提高化学预防的使用率。PCP 包括内科医生、家庭医生和妇科医生，而患者是年龄在 35-75 岁之间、根据 Gail 模型具有 5 年侵袭性乳腺癌风险≥1.67%的高危女性。本研究纳入了接受这些决策支持工具的高危女性及其 PCP 的 7 次临床接触。临床接触的音频记录被逐字转录，并使用扎根理论方法进行分析。
本研究纳入了 6 名初级保健提供者，其中 4 名男性（平均年龄 36 [SD 6.5]）和 2 名女性（平均年龄 39 [SD 11.5]）和 7 名不同种族/族裔的高危女性患者。定性分析揭示了三个主题：（1）临床接触期间的竞争需求；（2）提供者对化学预防的知识不足；（3）临床接触期间的风险沟通有限。
在 PCP 中确定了化学预防 SDM 的关键障碍。提供者需要通过决策支持工具获得教育和资源，以便与他们的高危患者进行风险沟通和 SDM，并在初级保健环境中对开处化学预防药物有信心。
