title: Individualized survival curves improve satisfaction with cancer risk management decisions in women with BRCA1/2 mutations.
abstract: OBJECTIVE
  Women with BRCA1/2 mutations are faced with complex decisions about breast and ovarian cancer risk management. This study was conducted to determine the effect of a tailored decision support system (DSS) that provides individualized survival and cancer incidence curves specific to expected outcomes of alternative management strategies.
  
  
  METHODS
  This was a double-blind, randomized controlled trial of 32 women with BRCA1/2 mutations. Primary outcome measures were decision satisfaction, cancer anxiety, perceptions of cancer risk given alternative management strategies, and management decisions.
  
  
  RESULTS
  Twenty-seven women completed a 6-week follow-up. Women in the intervention arm (n = 13) reported significantly higher decision satisfaction at follow-up than women in the control arm (n = 14; adjusted mean difference, 9.7; P < .0005). The effect of the DSS was greater among women with low cancer anxiety at baseline than women with high cancer anxiety at baseline (P = .01 for interaction). However, the DSS did not significantly alter cancer anxiety at follow-up, perceptions of cancer risk given alternative management strategies, or management decisions.
  
  
  CONCLUSIONS
  The presentation of individualized survival and incidence curves for alternative management options improves satisfaction about cancer risk management decisions among women with BRCA1/2 mutations without increasing anxiety or changing management decisions. The benefit of the DSS is greatest among women with relatively low cancer-related anxiety at baseline.
authors.affiliation: Department of Medicine, University of Pennsylvania School of Medicine, Philadelphia, PA, USA. karmstro@mail.med.upenn.edu
authors.forename: Katrina
authors.initials: K
authors.lastname: Armstrong
authors.forename: Barbara
authors.initials: B
authors.lastname: Weber
authors.forename: Peter A
authors.initials: PA
authors.lastname: Ubel
authors.forename: Nikki
authors.initials: N
authors.lastname: Peters
authors.forename: John
authors.initials: J
authors.lastname: Holmes
authors.forename: J Sanford
authors.initials: JS
authors.lastname: Schwartz
mesh_terms: D000328:Adult; D001007:Anxiety; D001943:Breast Neoplasms / Q000453:epidemiology / Q000235:genetics* / Q000628:therapy; D003657:Decision Making; D020000:Decision Support Systems, Clinical; D004311:Double-Blind Method; D005260:Female; D019398:Genes, BRCA1; D024522:Genes, BRCA2; D006801:Humans; D015994:Incidence; D008875:Middle Aged; D017060:Patient Satisfaction; D011379:Prognosis; D012308:Risk Management; D016019:Survival Analysis