title: Communicating risk of hereditary breast and ovarian cancer with an interactive decision support tool.
abstract: OBJECTIVE
  Women with hereditary breast and ovarian cancer syndrome (HBOC) face a higher risk of earlier, more aggressive cancer. Because of HBOC's rarity, screening is recommended only for women with strong cancer family histories. However, most patients do not have accurate history available and struggle to understand genetic concepts.
  
  
  METHODS
  Cancer in the Family, an online clinical decision support tool, calculated women's HBOC risk and promoted shared patient-provider decisions about screening. A pilot evaluation (n=9 providers, n=48 patients) assessed the tool's impact on knowledge, attitudes, and screening decisions. Patients used the tool before wellness exams and completed three surveys. Providers accessed the tool during exams, completed exam checklists, and completed four surveys.
  
  
  RESULTS
  Patients entered complete family histories (67%), calculated personal risk (96%), and shared risk printouts with providers (65%). HBOC knowledge increased dramatically for patients and providers, and many patients (75%) perceived tool results as valid. The tool prompted patient-provider discussions about HBOC risk and cancer family history (88%).
  
  
  CONCLUSIONS
  The tool was effective in increasing knowledge, collecting family history, and sparking patient-provider discussions about HBOC screening.
  
  
  CONCLUSIONS
  Interactive tools can effectively communicate personalized risk and promote shared decisions, but they are not a substitute for patient-provider discussions.
authors.affiliation: Health Communication Program, RTI International, Research Triangle Park, NC 27709, USA. drupert@rti.org
authors.forename: Douglas J
authors.initials: DJ
authors.lastname: Rupert
authors.forename: Linda B
authors.initials: LB
authors.lastname: Squiers
authors.forename: Jeanette M
authors.initials: JM
authors.lastname: Renaud
authors.forename: Nedra S
authors.initials: NS
authors.lastname: Whitehead
authors.forename: Roger J
authors.initials: RJ
authors.lastname: Osborn
authors.forename: Robert D
authors.initials: RD
authors.lastname: Furberg
authors.forename: Claudia M
authors.initials: CM
authors.lastname: Squire
authors.forename: Janice P
authors.initials: JP
authors.lastname: Tzeng
mesh_terms: D000328:Adult; D001943:Breast Neoplasms / Q000175:diagnosis / Q000235:genetics*; D020000:Decision Support Systems, Clinical; D005260:Female; D020022:Genetic Predisposition to Disease; D005820:Genetic Testing; D058015:Health Communication; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008875:Middle Aged; D010051:Ovarian Neoplasms / Q000175:diagnosis / Q000235:genetics*; D012306:Risk; D018570:Risk Assessment / Q000379:methods*; D012959:Socioeconomic Factors
keywords: Artificial intelligence; BRCA; Breast cancer; Genetic testing; Ovarian cancer; Risk communication