The revised US Preventive Service Task Force (USPSTF) guidelinies for breast cancer screening were announced in November 2009 amid much controversy. These guidelines recommend against routine screening for women in their 40s and decrease in the frequency of screening for older women. Central to these guidelines is the premise that the use of screening should be "personalized," based on both a woman's risk of developing breast cancer as well as her overall health status. The promotion of individualized assessment for average risk women, extends the premise of risk-based screening for high risk women promoted by the American Cancer Society guidelines which recommend annual screening with magnefic resonance imaging (MRI) starting at age 30 for women with >20% lifetime risk of breast cancer. While individualized assessment is central to the key tenets of delivering pafient-centered, effective, efficient, fimely, equitable and safe care, unfortunately, clear evidence and tools to guide these discussions and personalized decisions are lacking, creating substantial uncertainty for women, providers and health care systems as they make screening decisions. Project 2 will develop and test a health information technology (IT) intervention to promote more personalized assessment of breast cancer risk and promote individualized screening recommendations. While there are several risk assessment tools available on the internet, this work is innovative as it will integrate a woman's personalized assessment with her electronic health record (EHR) for use by her providers. The widespread deployment and "meaningful use" of EHRs is a high priority in the US, and will require organizations to move forward in the collection and integration of personal health records (PHRs) for use by pafients. To address the growing importance of integrafing personalized risk assessment for breast cancer into screening recommendations, we propose the following Specific Aims and Hypotheses modeled after the Reach Effectiveness Adopfion Implementafion and Maintenance (RE-AIM) framework:
Specific Aim 1 : To develop an EHR-integrated, personalized breast cancer screening module that will use patient-reported risk data to generate a tailored risk assessment and screening recommendation profile forthe patient, and tailored breast cancer screening decision support for her provider.
Specific Aim 2 : To measure the effectiveness of this personalized breast cancer screening module by conducting a cluster randomized controlled trial (RCT) of women age 40 - 75 who receive their care in our regional collaborafive, the New England Collaborafive Breast Screening Network.
Specific Aim 3; To evaluate facilitators and barriers to the adoption and implementation of this personalized breast cancer screening module. We believe that our focus on systems-based approaches, using health IT integrated within an EHR, will become the norm given the financial incentives for the "meaningful use" of EHRs. The proposed work will advance our understanding of how to deliver personalized screening recommendafions in primary care practice in a regional collaborative with broad experience and expertise.
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