Schonberg Mara A, Jushchyshyn Jessica, Shah Ria, Ngo Long, Wolfson Emily A
Department of Medicine, Beth Israel Deaconess Medical Center, 1309 Beacon, Brookline, MA 02446, USA.
Patient Educ Couns. 2025 Aug;137:108819. doi: 10.1016/j.pec.2025.108819. Epub 2025 May 6.
Guidelines recommend women consider their breast cancer risk and life expectancy when deciding on breast cancer screening (e.g., intervals, when to stop) and prevention medication. We previously developed a competing-risk model to predict 10-year breast cancer risk and non-breast cancer death in women > 55 years to support decision-making. Here, we aimed to develop a decision aid (DA) website incorporating our model's risk estimates.
We designed the DA based on international standards using the free R package Shiny. We included a risk-assessment page, risk estimates, and decision support on breast cancer screening and prevention medications. We recruited national experts, Boston-area primary care practitioners (PCPs), and female patients > 55 years without breast cancer history to provide feedback on the DA via questionnaire or personal interview. We used thematic analysis to identify themes in participants' open-ended comments until reaching thematic saturation. Study questionnaires assessed DA helpfulness and ease-of-use.
Forty-five (53.6 %) of 84 eligible patients approached participated. Their mean age was 65.9 years (SD 7.9), 31 (68.9 %) were non-Hispanic White, and 31 (68.9 %) graduated college. Of 52 experts/PCPs contacted, 30 participated. Participants found the DA helpful (35/44 patients [79.5 %] and 28/29 [96.6 %] experts/PCPs) and easy-to-use (39/45 patients [86.7 %] and 28/29 PCPs/experts, [96.6 %]). They described the DA as "informative" and liked the "tailored-risk information." They suggested changes to simplify the DA and to better individualize the decision-support. We iteratively revised the website. We could not program some recommended changes using the free R application.
We developed an informative and easy-to-use breast cancer screening and prevention medication DA website (https://bcrisk55plus.shinyapps.io/risktool/) for women > 55 using free software. Next, we will program the website using HTML code and test its effects prospectively.
We anticipate that use of the DA will help women > 55 with breast cancer screening and prevention decisions.
指南建议女性在决定乳腺癌筛查（如筛查间隔、何时停止）和预防用药时，应考虑自身患乳腺癌的风险和预期寿命。我们之前开发了一种竞争风险模型，用于预测55岁以上女性10年内患乳腺癌的风险和非乳腺癌死亡风险，以支持决策制定。在此，我们旨在开发一个纳入我们模型风险估计值的决策辅助（DA）网站。
我们使用免费的R包Shiny，根据国际标准设计了该决策辅助工具。我们设置了一个风险评估页面、风险估计值，以及关于乳腺癌筛查和预防用药的决策支持内容。我们招募了全国专家、波士顿地区的初级保健医生（PCP）以及55岁以上无乳腺癌病史的女性患者，通过问卷调查或个人访谈的方式收集她们对该决策辅助工具的反馈。我们采用主题分析方法，在参与者的开放式评论中识别主题，直至达到主题饱和。研究问卷评估了决策辅助工具的实用性和易用性。
84名符合条件的患者中有45名（53.6%）参与。她们的平均年龄为65.9岁（标准差7.9），31名（68.9%）为非西班牙裔白人，31名（68.9%）拥有大学学历。在联系的52名专家/初级保健医生中，30名参与。参与者认为该决策辅助工具很有用（44名患者中的35名[79.5%]以及29名专家/初级保健医生中的28名[96.6%]）且易于使用（45名患者中的39名[86.7%]以及29名初级保健医生/专家中的28名[96.6%]）。他们将该决策辅助工具描述为“信息丰富”，并喜欢“个性化的风险信息”。他们建议进行修改以简化该决策辅助工具，并更好地实现决策支持的个性化。我们对网站进行了反复修订。使用免费的R应用程序，我们无法对一些建议的修改进行编程。
我们使用免费软件为55岁以上女性开发了一个信息丰富且易于使用的乳腺癌筛查和预防用药决策辅助网站（https://bcrisk55plus.shinyapps.io/risktool/）。接下来，我们将使用HTML代码对该网站进行编程，并前瞻性地测试其效果。
我们预计该决策辅助工具的使用将有助于55岁以上女性进行乳腺癌筛查和预防决策。
