Purpose: Breast cancer prevention has the potential to decrease the incidence of the disease, yet remains underused. We have developed a web-based tool that provides automated risk assessment and personalized decision support designed for collaborative use between patients and clinicians. We assessed the feasibility of using this tool in a primary care setting.
Methods: Women, 40-65, were recruited from a schedule of patients attending annual physicals in a primary care clinic at an academic hospital. Patients with a history of breast cancer, genetic testing, or chemoprevention education were excluded. Information used to assess breast cancer risk was gathered from phone interviews and medical records. Patients were randomized to view the decision aid either before their appointment or with their PCP during their appointment. Feasibility of the decision aid was assessed through: 1) Visit duration; 2) Patient Acceptability; and 3) Clinician Satisfaction. The outcomes were gathered from surveys administered to patients before and after appointments, and to providers after appointments.
Results: 64 women were approached over 5-months. 42/64 (68%) consented and were enrolled. 26/42 (62%) patients viewed the decision aid. Use of the decision aid did not result in a longer visit (p=0.57). Nor did it negatively influence the provider’s satisfaction with the visit (p=0.28). A majority of patients had a positive review of the decision aid and thought it was helpful in making a decision. A higher number of subjects who viewed the decision aid were either at moderate or high risk as calculated by the Gail or BRCAPro models (p =0.0138). 15/42 (36%) patients were at moderate or high risk. The PCPs’ perceptions of these patients’ risk was in line with the calculated risk for 11/15 (73%) of the patients. While a discussion regarding breast cancer risk reduction occurred with 14/15 (93%) of these patients, PCPs chose to use the decision aid during the appointment with 6/15 (40%) of them.
Conclusions: Performing personalized risk assessment and use of the decision aid in the primary care setting was feasible and acceptable. These results suggest risk assessment alone is enough to encourage a discussion about breast cancer risk reduction for some providers. This method of risk assessment and decision support holds promise in the effort to reduce the incidence and burden of breast cancer.