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）：八分之一的美国女性一生中会被诊断出患有乳腺癌，乳腺癌是美国所有种族女性癌症死亡的两大原因之一。对于因家族病史或 BRCA1 或 BRCA2 基因某些突变而面临较高风险的女性，终生风险可能高达 60% 或更高。人们已经开发出几种有效的生物医学机制来预防高风险女性患乳腺癌，但它们的使用频率远低于医学文献建议的频率（有时由不同的女性使用）（Ozanne & Esserman 2010；Tuttle et al. 2010）。例如，只有不到 1% 的美国女性使用他莫昔芬进行化学预防，尽管超过 15% 的女性患浸润性乳腺癌的风险较高，而他莫昔芬将这种风险降低了一半（Fisher 等人，1998 年；Freedman 等人，2003 年；Waters 等人）等，2010）。只有五分之一的突变携带者选择双侧预防性乳房切除术，因为 它被认为是一种临床选择，但许多风险较低的女性也经历过这种情况，对她们来说，它不太可能降低风险（Friebel 等人，2007 年；McLaughlin 等人，2009 年；Tuttle 等人，2010 年）。同时，我们还不清楚为什么女性会做出这样的选择，而且很明显，女性很少获得系统的信息和支持，使她们能够做出完全符合自己喜好的受过教育、保护健康的选择。我们有效利用现有预防方法的能力缺失的是对女性在得知自己的风险升高和选择预防措施之间的决策过程的了解。如果没有这种联系，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做出反映准确知识和自己偏好的选择； (c) 哪些动机、相互作用和约束最有力地影响他们的选择； (d) 决策的特点如何影响身心健康； (e) 这些动态在由种族、民族、社会经济地位和乳腺癌风险严重程度定义的亚组之间有何变化。拟议的 K01 研究将首次从高风险白人和非裔美国女性的个人账户开始，追踪她们引导所有潜在预防行为的全方位动态。通过揭示妇女的决策过程及其影响，该项目将阐明定制决策支持干预措施的可修改目标点。此类干预措施可以通过提供高质量的信息、互动和支持，使妇女能够做出反映其自身偏好的健康保护决策。该项目还将通过支持决策来产生重大的公共卫生影响，从而带来更好的身心健康结果，并更经济地利用生物医学风险降低机制。拟议的研究是了解和支持女性在乳腺癌预防领域决策的研究议程的第一阶段。它将探讨妇女在预防选择中进行深思熟虑和决定的过程、她们由此做出的选择，以及预防选择和之前的决策过程对妇女身心健康的影响。为了实现这些目标，它将利用 K01 期间收集的原始数据。将使用深入的半结构化访谈来全面了解妇女的决策过程，并就影响预防选择的关键决策因素以及决策因素和预防措施的影响提出具体假设。对健康的预防行为选择。原始调查数据将用于检验这些假设。这份 NCI 指导研究科学家发展奖促进多样性申请还提出了一个结构化的培训计划，该计划是候选人所需的结构化培训计划，以培养她进行创新性拟议研究所需的新的实质性和方法论能力。 K01 将通过癌症预防和癌症健康差异、决策科学、先进的生物统计分析方法以及支持患者决策的干预措施设计方面的正式培训和指导，以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为基础。高素质的导师和顾问团队来自公共卫生、护理、乳腺外科、临床遗传学和生物统计学领域，体现了强大的多学科方法来支持乳腺癌高危女性的复杂预防决策。总之，本 K01 将通过调查女性预防选择的原因和影响，填补我们对乳腺癌预防理解的一个关键空白，并将包括使候选人成为癌症领域独立研究者所需的培训和研究经验预防、健康差异、决策科学和干预研究。