A pilot study of a behavior-change intervention for preventive therapy among women at high risk for invasive breast...

BACKGROUND: The use of preventive therapy in women at high risk for invasive breast cancer is associated with a significant reduction in breast cancer risk, however, uptake remains suboptimal outside of clinical trials. We conducted a pilot study of a behavior-change intervention to encourage high-risk women to take preventive therapy. METHODS: Women aged 35–69 with a history of lobular carcinoma in situ (LCIS) or atypical hyperplasia (AH) receiving care at MD Anderson Cancer Center, Houston, Texas, were eligible. Following cognitive testing, the tool was field-tested using a pre-post design, comparing patients seen before its integration into clinical practice (pre-implementation cohort) with those seen after implementation (post-implementation cohort). Participants completed self-administered questionnaires assessing knowledge, treatment preferences, decisional conflict, shared decision-making and acceptability; clinicians completed surveys on their experiences with the tool. Descriptive analyses and standard tests of association were performed. RESULTS: Of the 48 women who participated, 21 were in the post-implementation cohort. The majority of participants were White (75%) and non-Hispanic (81%), with a median age of 53 years. Most participants (90%) reported never needing help with reading health materials and were comfortable searching for health information online (81%). Women in the post-implementation cohort had higher knowledge about breast cancer preventive therapy compared to those in the pre-implementation cohort. However, only 38% correctly understood that side effects such as hot flashes and vaginal symptoms occur infrequently. After discussing with their clinician, 57% of women in the post-implementation cohort stated an intent to take preventive therapy compared to 70% in the pre-implementation cohort. Both groups reported low decisional conflict. The majority of women in the post-implementation cohort had positive perceptions of the tool. Furthermore, clinicians gave high ratings for the tool’s acceptability (median 4, IQR: 3.75–4.5), feasibility (median 4; IQR: 4-4.5) and appropriateness (median 4, IQR: 4-4.5), and found it somewhat/very helpful (100%) to patients with making decisions about preventive therapy. CONCLUSION: Our findings suggest that the behavior-change tool was associated with improved patient knowledge about preventive therapy and had good acceptability. Future research should focus on enhancing patient education about the likelihood and management of side effects, measuring treatment initiation and adherence and identifying effective strategies to integrate these tools into clinical practice to support informed decision-making.