Abstract P6-09-11: Wide Scale, Automated Breast Cancer Risk Assessment and Decision Support for High Risk Women: www.BreastHealthDecisions.org

Abstract

Abstract Purpose: Despite compelling evidence indicating chemopreventive agents can reduce the risk of developing breast cancer, they remain underused. This is common in elective therapies that hold the possibility of side effects. Effective risk stratification and patient-provider communication are critical for identifying those patients who stand to benefit most from these agents. However, there are few tools available for wide scale breast cancer risk assessment that also integrate decision support. To address this critical gap in healthcare delivery, we developed and performed preliminary evaluations of www.BreastHealthDecisions.org. This tool provides automated risk assessment and internet-based, patient-tailored decision support. Development Methods: www.BreastHealthDecisions.org was developed to guide informed, value-driven, and patient-centered breast cancer prevention decisions. We implemented four commonly used breast cancer risk prediction models in the form of web-services to provide wide scale automated, individualized breast cancer risk assessments. Our internet-based decision aid is then tailored to individual patients based on risk predictions from these models. The decision aid is designed to integrate patient data from multiple sources including electronic surveys, electronic medical record (EMR), and other databases. Evaluation Methods: Under Institutional Review Board approval, we evaluated the risk assessment tool and decision aid through patient focus groups, usability testing, and provider interviews (including breast specialist, primary care physicians, and genetic counselors). This included demonstrations and data collection at two scientific conferences (2009 International Shared Decision Making Conference, 2009 San Antonio Breast Cancer Symposium) Result: Overall, the evaluations were favorable. The patient focus group evaluations and usability testing (N=34) provided qualitative feedback about the format and design of the decision aid; 88% of these participants found the tool useful and 94% found it easy to use. 91% of the providers (N=23) indicated that they would use the risk assessment tool and decision aid in their clinical setting. Conclusion: www.BreastHealthDecisions.org represents a new approach to breast cancer prevention care and a framework for high quality preventive healthcare. The ability to integrate wide scale risk assessment and decision support in real time will allows for informed, value-driven, and patient-centered breast cancer prevention decisions. The tool is being further evaluated in a randomized controlled trial designed to determine the optimal mode of delivery in the primary care setting. Citation Information: Cancer Res 2010;70(24 Suppl):Abstract nr P6-09-11.