title: Development of decision-support intervention for Black women with breast cancer.
abstract: BACKGROUND
  Adjuvant therapy improves breast cancer survival but is underutilized by Black women. Few interventions have addressed this problem. This preliminary report describes the process we used to develop a decision-support intervention for Black women eligible for adjuvant therapy. Aims were to use qualitative methods to describe factors that influence Black women's adjuvant therapy decisions, use these formative data to develop messages for a treatment decision-support intervention, and pilot test the acceptability and utility of the intervention with community members and newly diagnosed women.
  
  
  METHODS
  Thirty-four in-depth interviews were conducted with breast cancer patients in active treatment, survivors and cancer providers to gather qualitative data. Participant ages ranged from 38 to 69 years. A cultural framework was used to analyze the data and to inform intervention messages. Most women relied on their providers for treatment recommendations. Several women reported problems communicating with providers and felt unprepared to ask questions and discuss adjuvant treatment options. Other factors related to treatment experiences were: spiritual coping, collectivism and sharing breast cancer experiences with other Black survivors.
  
  
  RESULTS
  Using these formative data, we developed an intervention that is survivor-based and includes an in-person session which incorporates sharing personal stories, communication skills training and decision support. Intervention materials were reviewed by community members, researchers/clinicians and patients newly diagnosed with breast cancer.
  
  
  CONCLUSIONS
  Patients reported satisfaction with the intervention and felt better prepared to talk with providers. The intervention will be tested in a randomized trial to enhance decision support and increase use of indicated adjuvant treatment.
authors.affiliation: Cancer Control Program, Georgetown University, Washington, DC 20007, USA. vls3@georgetown.edu
authors.forename: Vanessa B
authors.initials: VB
authors.lastname: Sheppard
authors.forename: Karen Patricia
authors.initials: KP
authors.lastname: Williams
authors.forename: Toni Michelle
authors.initials: TM
authors.lastname: Harrison
authors.forename: Yvonne
authors.initials: Y
authors.lastname: Jennings
authors.forename: Wanda
authors.initials: W
authors.lastname: Lucas
authors.forename: Juleen
authors.initials: J
authors.lastname: Stephen
authors.forename: Dana
authors.initials: D
authors.lastname: Robinson
authors.forename: Jeanne S
authors.initials: JS
authors.lastname: Mandelblatt
authors.forename: Kathryn L
authors.initials: KL
authors.lastname: Taylor
mesh_terms: D000328:Adult; D000368:Aged; D001294:Attitude to Health; D044383:Black People / Q000523:psychology*; D001943:Breast Neoplasms / Q000208:ethnology* / Q000473:pathology / Q000523:psychology / Q000628:therapy*; D017024:Chemotherapy, Adjuvant / Q000523:psychology*; D003142:Communication; D003657:Decision Making; D005260:Female; D006801:Humans; D008408:Mastectomy / Q000523:psychology*; D015412:Mastectomy, Segmental / Q000523:psychology*; D008875:Middle Aged; D009042:Motivation; D009367:Neoplasm Staging; D010342:Patient Acceptance of Health Care / Q000523:psychology; D010353:Patient Education as Topic; D017060:Patient Satisfaction; D010817:Physician-Patient Relations; D010865:Pilot Projects; D018714:Radiotherapy, Adjuvant / Q000523:psychology*; D012944:Social Support; D029181:Spirituality; D017741:Survivors / Q000523:psychology*