title: Development of a personalized decision aid for breast cancer risk reduction and management.
abstract: BACKGROUND
  Breast cancer risk reduction has the potential to decrease the incidence of the disease, yet remains underused. We report on the development a web-based tool that provides automated risk assessment and personalized decision support designed for collaborative use between patients and clinicians.
  
  
  METHODS
  Under Institutional Review Board approval, we evaluated the decision tool through a patient focus group, usability testing, and provider interviews (including breast specialists, primary care physicians, genetic counselors). This included demonstrations and data collection at two scientific conferences (2009 International Shared Decision Making Conference, 2009 San Antonio Breast Cancer Symposium).
  
  
  RESULTS
  Overall, the evaluations were favorable. The patient focus group evaluations and usability testing (N = 34) provided qualitative feedback about format and design; 88% of these participants found the tool useful and 94% found it easy to use. 91% of the providers (N = 23) indicated that they would use the tool in their clinical setting.
  
  
  CONCLUSIONS
  BreastHealthDecisions.org represents a new approach to breast cancer prevention care and a framework for high quality preventive healthcare. The ability to integrate risk assessment and decision support in real time will allow for informed, value-driven, and patient-centered breast cancer prevention decisions. The tool is being further evaluated in the clinical setting.
authors.affiliation: Department of Surgery, Institute for Health Policy Studies, University of California at San Francisco, San Francisco, CA, USA. elissa.m.ozanne@dartmouth.edu.
authors.forename: Elissa M
authors.initials: EM
authors.lastname: Ozanne
authors.forename: Rebecca
authors.initials: R
authors.lastname: Howe
authors.forename: Zehra
authors.initials: Z
authors.lastname: Omer
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Esserman
mesh_terms: D000328:Adult; D000368:Aged; D001943:Breast Neoplasms / Q000517:prevention & control* / Q000628:therapy; D003657:Decision Making; D020000:Decision Support Systems, Clinical / Q000295:instrumentation / Q000592:standards*; D003661:Decision Support Techniques; D019468:Disease Management; D005260:Female; D017144:Focus Groups; D006801:Humans; D020407:Internet / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D018802:Patient-Centered Care / Q000592:standards; D018570:Risk Assessment; D040242:Risk Reduction Behavior