A Randomized, Controlled Trial to Increase Discussion of Breast Cancer in Primary Care

Kaplan, Celia P.; Livaudais‐Toman, Jennifer; Tice, Jeffrey A.; Kerlikowske, Karla; Gregorich, Steven E.; Pérez‐Stable, Eliseo J.; Pasick, Rena J.; Chen, Alice; Quinn, Jessica; Karliner, Leah

doi:10.1158/1055-9965.epi-13-1380

Cited by 38 publications

(49 citation statements)

References 30 publications

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“…12 A pragmatic trial of a free-standing, breast cancer–focused risk assessment tool in primary care found improvements in discussion of breast cancer risk and also speaking with a genetic counselor. 13 Several platforms assess risk based on family history alone. 14,15 A pragmatic trial of web-based Family Healthware was associated with improvements in risk perception, and modest increases in self-reported physical activity and fruit and vegetable intake, but a reduced likelihood of receiving cholesterol screening.…”

Section: Discussionmentioning

confidence: 99%

A Cluster Randomized Trial of a Personalized Multi-Condition Risk Assessment in Primary Care

Haas

Baer

Eibensteiner

et al. 2017

American Journal of Preventive Medicine

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Introduction Personal risk for multiple conditions should be assessed in primary care. This study evaluated whether collection of risk factors to generate electronic health record (EHR)-linked health risk appraisal (HRA) for coronary heart disease, diabetes, breast cancer, and colorectal cancer was associated with improved patient–provider communication, risk assessment, and plans for breast cancer screening. Methods This pragmatic trial recruited adults with upcoming visits to 11 primary care practices during 2013–2014 (N=3,703). Pre-visit, intervention patients completed a risk factor and perception assessment and received an HRA; coded risk factor data were sent to the EHR. Post-visit, intervention patients reported risk perception. Pre-visit, control patients only completed the risk perception assessment; post-visit they also completed the risk factor assessment and received the HRA. No data were sent to the EHR for controls. Accuracy/improvement of self-perceived risk was assessed by comparing self-perceived to calculated risk. Results The intervention was associated with improvement of patient–provider communication of changes to improve health (78.5% vs 74.1%, AOR=1.67, 99% CI=1.07, 2.60). There was a similar trend for discussion of risk (54.1% vs 45.5%, AOR=1.34, 95% CI=0.97, 1.85). The intervention was associated with greater improvement in accuracy of self-perceived risk for diabetes (16.0% vs 12.6%, p=0.006) and colorectal cancer (27.9% vs 17.2%, p<0.001) with a similar trend for coronary heart disease and breast cancer. There were no changes in plans for breast cancer screening. Conclusions Patient-reported risk factors and EHR-linked multi-condition HRAs in primary care can modestly improve communication and promote accuracy of self-perceived risk.

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Section: Discussionmentioning

confidence: 99%

A Cluster Randomized Trial of a Personalized Multi-Condition Risk Assessment in Primary Care

Haas

Baer

Eibensteiner

et al. 2017

American Journal of Preventive Medicine

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“…Data were included from all participants who completed the baseline interview for the BreastCARE study, which tested a breast cancer risk reduction education intervention among women scheduled for an appointment with their primary care doctor at SFGH or UCSF’s general medicine practices [23]. Women completed the risk assessment questionnaire by telephone or tablet computer in their preferred language (English, Spanish, or Chinese) before their appointment in 2011–2012.…”

Section: Methodsmentioning

confidence: 99%

“…RST scores were computed for S1; the RST score had been computed previously for S2 [23]. When computing the 6 Point Scale and the RST from S1, we assumed that an entry in the column labeled “diagnosed before age 50?”, which is next to the column labeled “breast cancer” (Figure 2), referred to age at diagnosis of breast cancer for females whether or not there was an entry in the adjacent “breast cancer” box.…”

Section: Methodsmentioning

confidence: 99%

Validation of an Efficient Screening Tool to Identify Low-Income Women at High Risk for Hereditary Breast Cancer

Stewart

Kaplan

Lee

et al. 2016

Public Health Genomics

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Background/Aims: We compared the 6-Point Scale, a screening tool to identify low-income women for referral to genetic counseling, with genetic counselors' (GCs') recommendation and the Referral Screening Tool (RST). Methods: RST and 6-Point Scale scores were computed for 2 samples: (1) S1, public hospital mammography clinic patients in 2006-2010 (n = 744), classified by GCs as high risk (meriting referral to counseling) or not high risk, and (2) S2, primary care patients enrolled in an education intervention study in 2011-2012 (n = 1,425). Sensitivity, specificity, and area under the ROC curve (AUROC) were computed for the 6-Point Scale score versus GC and RST classification as high risk. Results: The 6-Point Scale had low sensitivity (0.27, 95% confidence interval [CI] 0.21-0.34) but high specificity (0.97, 95% CI 0.95-0.99) and AUROC (0.85, 95% CI 0.81-0.90) versus GC classification, and high sensitivity (S1: 0.90, 95% CI 0.79-1.00; S2: 0.94, 95% CI 0.87-0.97), specificity (S1: 0.95, 95% CI 0.93-0.97; S2: 0.94, 95% CI 0.93-0.96), and AUROC (S1: 0.98, 95% CI 0.96-0.99; S2: 0.98, 95% CI 0.98-0.99) versus the RST. Conclusion: The 6-Point Scale compared favorably with the RST, a validated instrument, and is potentially useful as a simple tool for administration in a safety net setting, requiring minimal time investment by primary care physicians and their staff and no financial investment in tablet computers or software.

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“…While there have been concerns of a Bdigital divide^be-cause of more limited access to the Internet by minorities and lowsocioeconomic status (SES) populations, recent data show that racial gaps in internet and smartphone access have declined [35]. Studies have demonstrated that breast cancer risk assessment can be done online and implemented through mammography and primary care sites [36]. Websites focused on BRCA1/2 risk assessment (e.g., https://www.knowBRCA.org and http://www.…”

Section: Potential Strategies To Address Disparities In Testingmentioning

confidence: 99%

Health Care Disparities in Hereditary Ovarian Cancer: Are We Reaching the Underserved Population?

Randall

Armstrong

2016

Curr. Treat. Options in Oncol.

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Ovarian cancer is an uncommon but deadly disease. There is no effective screening for the disease, and the majority of women with ovarian cancer present in advanced stage and eventually die from their disease. The majority of families with multiple cases of breast and ovarian cancer are found to carry germline mutations in BRCA1/2. Recent, more sensitive sequencing techniques have shown that nearly 20 % of ovarian cancer is associated with germline mutations in cancer susceptibility genes, with approximately 15 % accounted for by deleterious mutations in BRCA1/2. Women found to have mutations in BRCA1/2 can be empowered to make decisions on reproduction, cancer prevention, or treatment that may either avoid cancer or prolong survival. Though initial studies suggested that African American (AA) women were significantly less likely than White women to have mutations in BRCA1/2, this has been found to be untrue. Despite this revelation, and the clear importance of BRCA1/2 mutation status to appropriate clinical management, AA women still undergo genetic counseling and testing at much lower rates than do comparable White women. This disparity is not explained by factors such as calculated risk of a mutation, insurance coverage, or previous knowledge of the availability of testing. To date, no effective strategies have been identified that can overcome this disparity. Possible approaches include use of patient navigators, online social media, or EMR-based decision support aids. Funders should support research in this area, as it represents an actionable means to decrease the burden of ovarian and breast cancer in AA women.

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A Randomized, Controlled Trial to Increase Discussion of Breast Cancer in Primary Care

Cited by 38 publications

References 30 publications

A Cluster Randomized Trial of a Personalized Multi-Condition Risk Assessment in Primary Care

A Cluster Randomized Trial of a Personalized Multi-Condition Risk Assessment in Primary Care

Validation of an Efficient Screening Tool to Identify Low-Income Women at High Risk for Hereditary Breast Cancer

Health Care Disparities in Hereditary Ovarian Cancer: Are We Reaching the Underserved Population?

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