Preventing Breast Cancer: Decisions and Effects among Women at Elevated Risk

预防乳腺癌：高风险女性的决定和影响

• 批准号: 9325474
• 负责人: Tasleem J Padamsee
• 金额: $ 11.51万
• 依托单位: OHIO STATE UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2014
• 资助国家: 美国
• 起止时间: 2014-09-16 至 2019-08-31
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/9325474
• 关键词: Affect; African American; Area; BRCA1 Mutation; BRCA2 gene; Behavior; Bilateral; Biometry; Biostatistical Methods; Breast; Breast Cancer Prevention; Cancer Control; Cancer Etiology; Career Mobility; Categories; Cessation of life; Characteristics; Chemoprevention; Choice Behavior; Clinical; Complex; Comprehensive Cancer Center; DNA Sequence Alteration; Data; Data Analyses; Decision Making; Diagnosis; Disease; Educational workshop; Environment; Ethnic Origin; Face; Family history of; Foundations; Gene Mutation; Goals; Health; Institutes; Intervention; Intervention Studies; Interview; Knowledge; Learning; Link; Literature; Maps; Mastectomy; Medical; Medical Genetics; Medical Sociology; Mental Health; Mentored Research Scientist Development Award; Mentors; Mentorship; Methodology; Methods; Modeling; Motivation; Not Hispanic or Latino; Ohio; Outcome; Pathway interactions; Patients; Population Research; Prevention; Prevention Research; Preventive; Process; Psychological Factors; Public Health; Public Health Nurses; Public Health Nursing; Race; Recommendation; Research; Research Personnel; Research Support; Risk; Risk Reduction; Science; Severities; Shapes; Socioeconomic Status; Structure; Sum; Surveys; Tamoxifen; Testing; Time; Training; Training Programs; Training Support; Universities; Variant; Water; Woman; Women' s Health; breast surgery; cancer health disparity; cancer prevention; cancer risk; career; career development; caucasian American; cost effective; experience; health disparity; improved; innovation; interdisciplinary approach; lifetime risk; malignant breast neoplasm; member; mutation carrier; preference; prevent; programs; prophylactic; psychosocial; public health relevance; skills; symposium; therapy design

DESCRIPTION (provided by applicant): One in eight U.S. women will be diagnosed with breast cancer in her lifetime, and breast cancer is one of the top two causes of cancer death among U.S. women in all racial categories. For women at elevated risk due to strong family history of the disease or certain mutations of the BRCA1 or BRCA2 genes, lifetime risk can be 60% or higher. Several effective biomedical mechanisms have been developed to prevent breast cancer among women at elevated risk, but they are utilized far less frequently - and sometimes by different women - than the medical literature would recommend (Ozanne & Esserman 2010; Tuttle et al. 2010). Fewer than 1% of U.S. women use tamoxifen for chemoprevention, for instance, even though over 15% are at elevated risk for invasive breast cancer and tamoxifen reduces this risk by half (Fisher et al. 1998; Freedman et al. 2003; Waters et al. 2010). Bilateral prophylactic mastectomy is chosen by only a fifth of mutation carriers, for whom it is considered a clinical option, but is also undergone by many women at lower levels of risk, for whom it is unlikely to reduce risk (Friebel et al. 2007; McLaughlin et al. 2009; Tuttle e al. 2010). It is simultaneously unknown why women make the choices they do, and evident that women rarely receive the systematic information and support that would allow them to make educated, health-protective choices fully aligned with their own preferences. Missing from our ability to effectively leverage available methods of prevention is an understanding of the decision-making processes women utilize in the time between learning that their risk is elevated and choosing a course of preventive action. Absent this link, we do not know (a) how women decide among the prevention pathways available; (b) to what degree they are able to implement choices that reflect accurate knowledge and their own preferences; (c) what motivations, interactions, and constraints most forcefully shape their choices; (d) how the features of decision-making affect physical and psychosocial health; or (e) how these dynamics vary across sub-groups defined by race-ethnicity, socioeconomic status, and severity of breast cancer risk. The proposed K01 research will be the first to start from the personal accounts of White and African American women at elevated risk, and trace the full range of dynamics by which they navigate pathways to all potential prevention behaviors. By revealing women's decision-making processes and their effects, this project will illuminate modifiable target points for tailored decision support interventions. Such interventions can empower women to implement health-protective decisions that reflect their own preferences by providing high quality information, interaction, and support. The project will also generate significant public health impact by supporting decision making that leads to better physical and psychosocial health outcomes, and more cost- effective use of biomedical risk-reduction mechanisms. The proposed study is the first stage of a research agenda to understand and support women's decision making in the area of breast cancer prevention. It will explore the processes through which women deliberate and decide among their prevention options, the choices they make as a result, and the effects of not only prevention choices but also the preceding decision-making processes on women's physical and psychosocial well-being. To achieve these goals, it will utilize original data to be collected during the K01. In-depth, semi- structured interviews will be used to generate a thorough understanding of women's decision-making processes, and to generate specific hypotheses about the key decision-making factors that shape prevention choices, and the effects of both decision-making factors and prevention behavior choices on health. Original survey data will be used to test these hypotheses. This application for the NCI Mentored Research Scientist Development Award to Promote Diversity also proposes a structured program of training necessary for the candidate to build the new substantive and methodological proficiencies she will require to undertake the innovative proposed research. This K01 will build on the candidate's existing expertise in medical sociology and qualitative health research through formal training and mentoring in cancer prevention and cancer health disparities, decision science, advanced methods of biostatistical analysis, and the design of interventions to support patient decision making. The highly qualified team of mentors and consultants come from the fields of public health, nursing, breast surgery, clinical genetics, and biostatistics, reflecting a strong multi-disciplinary approach to supporting the complex prevention decisions of women at elevated risk for breast cancer. In sum, this K01 will fill a critical gap in our understanding of breast cancer prevention by investigating the causes and effects of women's prevention choices, and will include the training and research experience necessary to establish the candidate as an independent investigator in the areas of cancer prevention, health disparities, decision science, and intervention research.

描述（由申请人提供）：一生中将被诊断出美国八分之一的妇女，而乳腺癌是美国妇女在所有种族类别中癌症死亡的前两个原因之一。对于由于疾病的强大家族史或BRCA1或BRCA2基因的某些突变而导致风险较高的妇女，终生风险可能为60％或更高。已经开发出几种有效的生物医学机制来预防风险升高的女性的乳腺癌，但是与医学文献所建议的相比，这些机制的使用频率要频繁，有时是不同的女性（有时是不同的女性）（Ozanne＆Esserman 2010； Tuttle等，2010）。例如，不到1％的美国妇女使用他莫昔芬进行化学预防，尽管超过15％的侵入性乳腺癌的风险较高，而他莫昔芬则将这种风险降低了一半（Fisher等人，1998年； Freedman等人，2003年； Waters等人，Waters等人，2010年）。双侧预防性乳房切除术仅由突变载体的五分之一选择，因为 它被认为是一种临床选择，但也受到许多处于较低风险水平的妇女的经历，他们不太可能降低风险（Friebel等，2007； McLaughlin等，2009； Tuttle EAl。2010）。同时尚不清楚女性为什么做出自己的选择，并且显然女性很少获得系统的信息和支持，从而使她们能够做出受过教育的，健康的保护选择，完全符合自己的喜好。缺少我们有效利用可用预防方法的能力，这是对妇女在学习风险升高和选择预防措施的过程之间使用的决策过程的理解。没有此链接，我们不知道（a）妇女如何在可用的预防途径中做出决定； （b）他们能够在多大程度上实施反映准确知识和自身偏好的选择； （c）哪些动机，互动和约束最有力地塑造了他们的选择； （d）决策的特征如何影响身体和社会心理健康；或（e）这些动态如何在种族种族，社会经济地位和乳腺癌风险严重程度定义的子组中有所不同。拟议的K01研究将是第一个从风险较高的白人和非裔美国妇女的个人记载开始的，并追溯了她们探索所有潜在预防行为的各种动态。通过揭示妇女的决策过程及其影响，该项目将为量身定制的决策支持干预措施阐明可修改的目标点。这种干预措施可以使妇女通过提供高质量的信息，互动和支持来实施健康保护决策，以反映自己的偏好。该项目还将通过支持决策来产生重大的公共卫生影响，从而带来更好的身体和社会心理健康成果，并更有效地利用生物医学风险降低机制。拟议的研究是研究议程的第一阶段，旨在了解和支持预防乳腺癌领域的妇女决策。它将探讨妇女在预防选择中进行故意和决定的过程，结果不仅预防选择的影响，而且对妇女身体和社会心理健康的前面决策过程的影响。为了实现这些目标，它将利用在K01期间收集的原始数据。深入的，半结构化的访谈将用于对妇女的决策过程产生透彻的了解，并产生有关塑造预防选择的关键决策因素的特定假设，以及决策因素和预防行为选择对健康的影响。原始调查数据将用于检验这些假设。 NCI指导的研究科学家发展奖促进多样性的申请也提出了一项结构化的培训计划，使候选人建立了她将需要进行创新的拟议研究所需的新的实质性和方法论学。该K01将基于候选人在医学社会学和定性健康研究方面的现有专业知识，通过对癌症预防和癌症健康差异的正式培训和指导，决策科学，生物统计学分析的高级方法以及支持患者决策的干预措施的设计。高素质的导师和顾问团队来自公共卫生，护理，乳房外科手术，临床遗传学和生物统计学的领域，反映了一种强烈的多学科方法来支持妇女对乳腺癌风险升高的妇女的复杂预防决策。总而言之，该K01通过研究妇女预防选择的原因和影响，将填补我们对乳腺癌预防的关键差距，并包括在癌症预防，健康差异，决策科学和干预研究领域建立候选人所必需的培训和研究经验。