Abstract
PurposeTo compare participants’ knowledge about gene expression profiling (GEP) tests and recurrence risks after reading an information leaflet with that following viewing of an information film.MethodsUsing a randomised cross-over design, at time-point one (T1), women aged 45–75 years without breast cancer either read leaflets or watched information films about Oncotype DX or Prosigna tests. Participants answered nine questions assessing knowledge (maximum score 18). Next-day information in the opposite modality was provided and knowledge re-assessed. Additional questions probed which format was easiest to understand, participants’ preferences for film or leaflet and their reasons for these.Results120 women participated (60 received OncotypeDX films and leaflets; 60 received the Prosigna versions). T1 mean knowledge scores were higher following film viewing (13.37) compared with that after reading leaflets (9.25) (mean difference 4.1; p < 0.0001; 95% CI 3.2, 5.0). When participants read leaflets first and subsequently viewed films, all increased their scores (mean + 6.08, from T1 of 9.25, p < 0.0001; 95% CI 5.44, 6.72). When films were viewed first, followed by leaflets, (36/60, 60%), participants’ scores declined (mean-1.55 from T1 of 13.37, p < 0.001; 95% CI -2.32, -0.78). A majority of participants expressed preferences for the films (88/120, 73.3%) irrespective as to whether they described OncotypeDX or Prosigna. Reasons included the clarity, ease of understanding, visual material and reassuring voice-over.ConclusionDiscussions between oncologists and patients about recurrence risk results can be challenging. Information leaflets may aid understanding but often employ complex language. Information films significantly improved knowledge and were preferred by participants.
Highlights
Advances made in our understanding of the molecular biology of breast cancer have undoubtedly improved diagnostic testing and increased the therapeutic options available to patients
We developed two eight-minute films explaining what gene expression profiling (GEP) tests are, why they are used in breast cancer and how results help determine whether or not chemotherapy is recommended as a treatment option
Snowballing and purposive sampling were employed to recruit 120 women from a varied socio-educational distribution and of appropriate ages to mirror those of women with breast cancer
Summary
Advances made in our understanding of the molecular biology of breast cancer have undoubtedly improved diagnostic testing and increased the therapeutic options available to patients. OncotypeDX and Prosigna are two gene expression profiling (GEP) tests that provide recurrence risk results; these help determine the likely therapeutic benefit of adding chemotherapy to hormones alone in patients with early, oestrogen-positive, HER2-negative breast cancer [1, 2]. Medicine is not an exact science, so discussing risks and uncertainty is challenging especially when communicating with anxious patients with low tolerances of uncertainty, who may feel that more treatment must be better than less.
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