Breast Cancer Chemoprevention among Women: Effect of Involvement and Risk Communication
Bhansali, Archita Hiren
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Objective: The purpose of this study was to test the effect of patient involvement levels, developed using different breast cancer risk scenarios and message format on their intention to initiate breast cancer chemoprevention. Method: In this experimental field study involvement was manipulated at 2 levels (high and low) and was developed using two scenarios. Breast cancer risk levels were considered using the Gail risk score. A breast cancer risk level of 16% with family history was used for low risk scenario and breast cancer risk level of 55% with family history and a breast biopsy was used for high risk scenario. Message format was manipulated 2 levels (graphic and written) and was developed using concepts of chunking and picture superiority. Women across the Houston metropolitan area evaluated two chemoprevention drug decision aids after reading scenarios simulating high and low involvement. A pre-validated, self-administered survey instrument was used to measure their perceived susceptibility to breast cancer, perceived severity to breast cancer, perceived benefits, perceived adverse events and intention to start chemoprevention using a Likert scale ranging from 1 (strongly disagree) to 5 (strongly agree). ANCOVA and post-hoc analyses were done using SAS® 9.3. Results: Of the 320 women included in the study (81.4% response rate) majority were married 144 (46.45%), white 160 (51.61%) with a mean age of 40.25 (± 11.27) years. Majority 182 (58.52%) had at least one family member with a history of cancer. A univariate and post hoc analyses indicated women with high involvement level had significantly higher mean (4.14 ± 0.99) intention to start chemoprevention when compared to women in a low involvement scenario (2.52 ± 1.1). Message format had a direct effect of perceived susceptibility to breast cancer. There was an indirect effect of message format on perceived severity to breast cancer, perceived benefit of chemoprevention and perceived adverse events of chemoprevention. There was a mediating effect of perceived susceptibility to breast cancer. There was a direct and indirect effect of message format on intention to start chemoprevention. Conclusion: Patient involvement manipulated using breast cancer risk levels plays an important role in intention to initiate chemoprevention. Message format plays a role on intention to start chemoprevention. Interventions can be targeted among women emphasizing on their breast cancer risk.