In 2013, the American Cancer Society estimated that breast cancer will be the leading cause of cancer and the second leading cause of cancer death in women. The 10 year survival rate is over 80%, resulting in a large and growing number of breast cancer survivors. Risk of recurrence is an important concept as it may be associated with well-being and assists in decision-making about treatment (e.g., lumpectomy vs. bilateral mastectomy). Few studies have examined the perceived risk of breast cancer recurrence, and recent literature has shown that perceived risk of breast cancer recurrence is inaccurate among women with a history of breast cancer. This is evidenced by an increasingly alarming trend of patients who are presumably not at elevated risk to opt for aggressive surgical treatment in the form of mastectomy along with prophylactic mastectomy of healthy breast tissue. Likely contributing to this inappropriate utilization of surgical intervention, approximately 40% of patients reported not receiving desired information about breast cancer recurrence risk. These challenges may be more salient in the rural, Appalachian population, which has an increased mortality from breast cancer and less education compared to the general population. The current proposal plans to address these difficulties with a cancer risk communication intervention that has been developed using McGuire's Input-Output theory. Our highly experienced research team will investigate the short-term comparative efficacy of our novel cancer risk communication tool (Breast Risk Informational Materials [BRIM3]: booklet + telephone), which has been tested for acceptability and appropriateness in a series of studies by our team in diverse socio-economic, regional, and racial populations. Guided by a Dynamic Communication Model, our specific aims include: 1.To assess patient satisfaction with BRIM3 and the overall clinical experience; 2. To understand the impact of our intervention on knowledge, risk perception, and worry; and 3. To determine if the BRIM3 has an impact on communication with physicians and overall well-being. In addition, our secondary aim will explore the impact of our intervention on health behaviors (i.e., screening, treatment decision-making). The study will utilize a randomized control trial methodology (standard of care vs. BRIM3) with assessments at 3 time points (diagnosis, post-intervention, and 6 month follow-up). Participants (n=200) will be breast oncology patients recruited through member hospitals in the Appalachia Community Cancer Network in two states. If found efficacious in the short-term, BRIM3 will be tested in a larger, longer-term, dissemination study throughout the Appalachian region to understand the effectiveness of the intervention. In addition, the BRIM3 may be adapted to other cancer types and other populations. Our ultimate goal with the current line of research is to improve the experience of cancer care by improving cancer recurrence risk communication.
With advances in breast cancer treatment and survival, risk of cancer recurrence is an important concept as it assists with decision-making about treatment and is associated with well-being. The current study proposes to test the BRIM3 (a breast cancer recurrence risk counseling intervention) to improve knowledge, well-being, patient satisfaction, and decision-making. The BRIM3 may be adapted to other cancers and other populations to improve the experience of cancer care.
