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Patient and Provider Web-Based Decision Support for Breast Cancer Chemoprevention: A Randomized Controlled Trial.

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Web-based decision aids for breast cancer chemoprevention did not increase uptake in high-risk women. However, these tools improved risk perception, knowledge, and informed choice at one month.

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Area of Science:

  • Oncology
  • Preventive Medicine
  • Health Informatics

Background:

  • Guidelines recommend breast cancer chemoprevention for high-risk women, yet utilization remains low.
  • Antiestrogen therapy is a key chemoprevention strategy for women at elevated risk.
  • Physician recommendation and patient decision-making are crucial for chemoprevention uptake.

Purpose of the Study:

  • To evaluate the effectiveness of a web-based decision aid in increasing breast cancer chemoprevention uptake among high-risk women.
  • To assess the impact of decision support tools on patient decision antecedents and decision quality.
  • To determine if enhanced decision support improves knowledge, risk perception, and informed choice regarding chemoprevention.

Main Methods:

  • A randomized controlled trial involving 282 high-risk women (ages 35-75) without prior breast cancer history or chemoprevention use.
  • Participants received either standard educational materials or materials combined with a web-based decision aid.
  • Healthcare providers had access to a web-based decision support tool. Primary endpoint was chemoprevention uptake at 6 months; secondary outcomes assessed at 1 and 6 months.

Main Results:

  • No significant difference in chemoprevention uptake at 6 months between the intervention (2.1%) and control (3.5%) groups.
  • At 1 month, the intervention group showed significant improvements in accurate breast cancer risk perception (56% vs. 39%), chemoprevention knowledge (49% vs. 27%), and informed choice (41% vs. 23%).
  • Decision conflict was significantly lower in the intervention group at 1 month (P < 0.001), but these benefits diminished by 6 months.

Conclusions:

  • Web-based decision support tools did not significantly increase breast cancer chemoprevention uptake in high-risk women.
  • These tools demonstrated short-term improvements in decision quality, including enhanced risk perception, knowledge, and informed choice.
  • Further research is needed to identify strategies that effectively translate improved decision-making into increased chemoprevention utilization.