title: Assessing and managing breast cancer risk: clinicians' current practice and future needs.
abstract: Decision support tools for the assessment and management of breast cancer risk may improve uptake of prevention strategies. End-user input in the design of such tools is critical to increase clinical use. Before developing such a computerized tool, we examined clinicians' practice and future needs. Twelve breast surgeons, 12 primary care physicians and 5 practice nurses participated in 4 focus groups. These were recorded, coded, and analyzed to identify key themes. Participants identified difficulties assessing risk, including a lack of available tools to standardize practice. Most expressed confidence identifying women at potentially high risk, but not moderate risk. Participants felt a tool could especially reassure young women at average risk. Desirable features included: evidence-based, accessible (e.g. web-based), and displaying absolute (not relative) risks in multiple formats. The potential to create anxiety was a concern. Development of future tools should address these issues to optimize translation of knowledge into clinical practice.
authors.affiliation: Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia.
authors.forename: Ian M
authors.initials: IM
authors.lastname: Collins
authors.affiliation: Academic Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
authors.forename: Emma
authors.initials: E
authors.lastname: Steel
authors.affiliation: Royal Women's Hospital, Melbourne, Australia.
authors.forename: G Bruce
authors.initials: GB
authors.lastname: Mann
authors.affiliation: Dept. of General Practice and Primary Care Academic Centre, University of Melbourne, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Perth, Australia.
authors.forename: Jon D
authors.initials: JD
authors.lastname: Emery
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
authors.forename: Adrian
authors.initials: A
authors.lastname: Bickerstaffe
authors.affiliation: Sir Peter MacCallum Dept. of Oncology, The University of Melbourne, Australia.
authors.forename: Alison
authors.initials: A
authors.lastname: Trainer
authors.affiliation: Centre for Medical Psychology & Evidence-based Decision-making (CeMPED), University of Sydney, Sydney, Australia.
authors.forename: Phyllis
authors.initials: P
authors.lastname: Butow
authors.affiliation: Dept. of General Practice and Primary Care Academic Centre, University of Melbourne, Australia.
authors.forename: Marie
authors.initials: M
authors.lastname: Pirotta
authors.affiliation: Centre for Cancer Genetic Epidemiology, Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK.
authors.forename: Antonis C
authors.initials: AC
authors.lastname: Antoniou
authors.affiliation: Centre for Cancer Prevention, Wolfson Institute of Preventive Medicine, Queen Mary University of London, UK.
authors.forename: Jack
authors.initials: J
authors.lastname: Cuzick
authors.affiliation: Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Hopper
authors.affiliation: Division of Cancer Medicine, Peter MacCallum Cancer Centre, Melbourne, Australia; Centre for Epidemiology and Biostatistics, Melbourne School of Population and Global Health, The University of Melbourne, Australia; Sir Peter MacCallum Dept. of Oncology, The University of Melbourne, Australia; Dept. of Medicine, St Vincent's Hospital, The University of Melbourne, Australia.
authors.forename: Kelly-Anne
authors.initials: KA
authors.lastname: Phillips
authors.affiliation: Academic Centre for Health Equity, Melbourne School of Population and Global Health, The University of Melbourne, Australia. Electronic address: l.keogh@unimelb.edu.au.
authors.forename: Louise A
authors.initials: LA
authors.lastname: Keogh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001291:Attitude of Health Personnel; D001943:Breast Neoplasms / Q000175:diagnosis / Q000628:therapy; D020000:Decision Support Systems, Clinical; D005260:Female; D017144:Focus Groups; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D057184:Practice Patterns, Nurses'; D010818:Practice Patterns, Physicians'; D036301:Qualitative Research; D018570:Risk Assessment; D014739:Victoria
keywords: BRCA; Breast cancer; Clinical decision support; Needs assessment; Risk reduction