Monday, October 24, 2011: 11:06 AM
Grand Ballroom EF (Hyatt Regency Chicago)
(DEC) Decision Psychology and Shared Decision Making

Laura Scherer, PhD1, Amanda J. Dillard, PhD2, Peter A. Ubel, MD3, Dylan Smith, PhD4, Sarah M. Greene, MPH5, Jennifer B. McClure, PhD5, Sharon M. Hensley Alford, PhD6 and Angela Fagerlin, PhD7, (1)VA HSR&D and University of Michigan, Ann Arbor, MI, (2)Grand Valley State University, Allendale, MI, (3)Duke University, Durham, NC, (4)Stony Brook University, Stony Brook, NY, (5)Group Health Research Institute, Seattle, WA, (6)Henry Ford Health System, Detroit, MI, (7)Internal Medicine, Ann Arbor, MI

Purpose: Women who are at high risk for breast cancer have the option of taking drugs that can reduce their risk (e.g. Tamoxifen).  One question is what factors determine women’s interest in chemoprevention.  All else equal, women who have higher breast cancer risk should show more interest in chemoprevention.  However, women’s anxiety about breast cancer may also play a significant role in this decision, above and beyond actual or perceived risk.

Method: 623 women who were at above average risk for breast cancer (Gail score > 1.66) were recruited to participate in a test of a decision aid (DA) for Tamoxifen.  All women read a decision aid, which provided them with their personalized breast cancer risk (i.e. Gail score), and also provided tailored statistics about the risks and benefits of chemoprevention.  Women were asked to report their perceived risk level, as well as their anxiety about developing breast cancer.  Finally, women were asked about their interest in chemoprevention.

Result: Actual risk (Gail score) did not predict interest in chemoprevention (p > .05).  However, both women’s perception of risk and anxiety about breast cancer significantly predicted interest in chemoprevention.  Regression analyses revealed that anxiety was a relatively strong predictor of interest, even when controlling for both actual and perceived risk (b = .31, p < .01).  By contrast, perceived risk was a significant yet much smaller predictor of interest, when controlling for actual risk and anxiety (b = .13, p < .01).

Conclusion: In the context of chemoprevention, actual risk does not predict interest in chemoprevention, and perceived risk only weakly predicts interest.  By far the strongest predictor of interest in chemoprevention was anxiety about breast cancer:  Women with more anxiety were more likely to be interested in chemoprevention, regardless of their actual or perceived risk.  These data reveal that anxiety can play an important role in decision-making about chemoprevention, and can potentially bias patients.  It could be helpful for DAs to provide information that decreases anxiety in low-risk individuals, so that they do not undergo medical interventions unnecessarily.  On the other hand, it may be necessary to modestly raise anxiety in high-risk individuals, so that they are moved to act.