| Autor: |
Bowles EJA; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA., O'Neill SC; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA., Li T; Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, District of Columbia, USA., Knerr S; Department of Health Services, University of Washington, Seattle, Washington, USA., Mandelblatt JS; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA., Schwartz MD; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA., Jayasekera J; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA., Leppig K; Clinical Genetics, Washington Permanente Medical Group, Seattle, Washington, USA., Ehrlich K; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA., Farrell D; PeopleDesigns, Raleigh-Durham, North Carolina, USA., Gao H; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA., Graham AL; Lombardi Comprehensive Cancer Center, Georgetown University Medical Center, Washington, District of Columbia, USA.; Truth Initiative, Washington, District of Columbia, USA., Luta G; Department of Biostatistics, Bioinformatics, and Biomathematics, Georgetown University, Washington, District of Columbia, USA., Wernli KJ; Kaiser Permanente Washington Health Research Institute, Kaiser Permanente Washington, Seattle, Washington, USA. |
| Abstrakt: |
Background: Breast density increases breast cancer risk and decreases mammographic detection. We evaluated a personalized web-based intervention designed to improve breast cancer risk communication between women and their providers. Materials and Methods: This was a secondary outcome analysis of an online randomized trial. Women aged 40-69 years were randomized, February 2017-May 2018, to a control ( n = 503) versus intervention website ( n = 492). The intervention website included information about breast density, personalized breast cancer risk, chemoprevention, and magnetic resonance imaging. Participants self-reported communication about density with providers (yes/no) at 6 weeks and 12 months. We used logistic regression with generalized estimating equations to evaluate the association of study arm with density communication. In secondary analyses, we tested if the intervention was associated with indicators of patient activation (breast cancer worry, perceived risk, or health care use). Results: Women (mean age 62 years) in the intervention versus control arm were 2.39 times (95% confidence interval [CI] = 1.37-4.18) more likely to report density communication at 6 weeks; this effect persisted at 12 months (odds ratio [OR] = 1.71, 95% CI = 1.25-2.35). At 6 weeks, this effect was only significant among women who reported (OR = 3.23, 95% CI = 1.24-8.40) versus did not report any previous density discussions (OR = 1.64, 95% CI = 0.83-3.26). A quarter of women in each arm never had a density conversation at any time during the study. Conclusions: Despite providing personalized density and risk information, the intervention did not promote density discussions between women and their providers who had not had them previously. This intervention is unlikely to be used clinically to motivate density conversations in women who have not had them before. Clinical trial registration number NCT03029286. |
