Testing a culturally targeted narrative video to reduce disparities in the use of genetic counseling and testing in Latina women at-risk of HBOC

测试针对文化的叙事视频，以减少对有 HBOC 风险的拉丁裔女性使用遗传咨询和检测的差异

• 批准号: 10322177
• 负责人: Alejandra Hurtado de Mendoza Casaus
• 金额: $ 55.19万
• 依托单位: GEORGETOWN UNIVERSITY
• 依托单位国家: 美国
• 财政年份: 2021
• 资助国家: 美国
• 起止时间: 2021-01-01 至 2025-12-31
• 项目状态: 未结题
• 来源: https://reporter.nih.gov/project-details/10322177
• 关键词: Address; Adoption; Attitude; Awareness; BRCA mutations; Behavior; Behavioral Model; Cancer Patient; Cancer Survivor; Clinic; Cognition; Community Health; Consolidated Framework for Implementation Research; Counseling; Data; Education; Elements; Eligibility Determination; Emotional; Emotions; Evidence based intervention; Exhibits; Face; Future; General Population; Genetic Counseling; Genetic Enhancement; Genomics; Guidelines; Happiness; Health education; Health system; Healthcare; Healthcare Systems; Hereditary Breast and Ovarian Cancer Syndrome; Hour; Hybrids; Intervention; Knowledge; Language; Latina; Latina Population; Latinx population; Linguistics; Malignant Neoplasms; Minority Groups; Outcome; Participant; Process; Randomized; Randomized Controlled Trials; Reporting; Research; Research Design; Risk; Risk Management; Schedule; Screening procedure; Self Efficacy; Services; Site; Speed; Survivors; Telephone; Testing; Training; Translation Process; Translations; Transportation; Visual Aid; Woman; acceptability and feasibility; arm; community clinic; cost; design; disparity reduction; efficacy evaluation; efficacy study; efficacy testing; evidence base; genetic counselor; genetic predictors; genetic testing; health literacy; hereditary risk; implementation outcomes; implementation research; improved; innovation; interest; literacy; minority patient; preference; primary outcome; process evaluation; psychosocial; racial and ethnic; racial minority; response; satisfaction; success; testing services; testing uptake; tool; treatment risk; underserved minority; uptake

ABSTRACT National guidelines recommend that women at increased risk for Hereditary Breast and Ovarian Cancer (HBOC) due to BRCA1/2 mutations be referred for genetic counseling and consider genetic testing. Awareness of a positive result can inform treatment decisions for cancer patients and risk management plans in both cancer survivors and women unaffected with cancer. The slow translation of guidelines into practice particularly impacts minority populations who receive services in community health clinics. Latina women have lower awareness and use of genetic counseling and testing (GCT) than non-Latina Whites. Latinas face multiple health care, pragmatic, and psychosocial barriers to GCT uptake. Latinas prefer culturally targeted interventions in Spanish with plain language, visual aids, and a narrative format. We developed a culturally targeted narrative video in Spanish for at-risk Latinas. Piloted in a single-arm trial (N=40), Latinas reported high satisfaction and exhibited a significant increase in knowledge from pre- to post-test. Nearly all participants (95%) reported an interest in GCT, and 62% completed genetic counseling. We will use an innovative hybrid research design that combines elements of traditional efficacy studies as well as best practices from implementation research to enhance the quality and speed of the translational process. Guided by an expanded Integrated Behavioral Model, we will conduct a RCT to evaluate the efficacy of our video vs. the FORCE fact sheet on enhancing GCT uptake and psychosocial outcomes. To maximize the potential for implementation in community clinics, we will train clinic staff to administer the Referral Screening Tool (RST), a validated tool to identify women at-risk of HBOC. Guided by the Consolidated Framework for Implementation Research, we will conduct an Implementation Focused Process Evaluation to gather data on clinic implementation outcomes for use of the Referral Screening Tool and the video. We will refer participants to free Spanish telephone genetic counseling. We will randomize 300 at-risk Latinas at four sites with large Latinx populations. Our primary outcome is genetic counseling uptake. Aim 1. Evaluate the impact of our video vs. fact sheet on GCT uptake. Participants in the video arm will have higher genetic counseling uptake (H1.1.) and higher genetic testing uptake (H1.2.) at 4 months. Aim 2. Evaluate the impact of our video vs. fact sheet on psychosocial and process evaluation outcomes. H2.1: Video participants will have higher knowledge, positive attitudes, subjective norms, self-efficacy, and positive anticipatory emotions. H2.2. Video participants will have higher acceptability and feasibility ratings. Exploratory aim: Evaluate mechanisms of the video's impact on genetic counseling uptake (knowledge, attitudes, norms, self-efficacy, anticipatory emotions). If counseling uptake does not differ by arm, then we will evaluate predictors of uptake. Aim 3. Examine key implementation outcomes of feasibility, acceptability, adoption, fidelity, and future sustainability of using the Referral Screening Tool and the video at the community clinics.

抽象的 国家指南建议女性患遗传性乳腺癌和卵巢癌 (HBOC) 的风险增加 由于 BRCA1/2 突变，应转诊进行遗传咨询并考虑进行基因检测。意识 阳性结果可以为癌症患者的治疗决策和两种癌症的风险管理计划提供信息 幸存者和未受癌症影响的妇女。指南转化为实践的速度缓慢尤其影响 在社区卫生诊所接受服务的少数民族人口。拉丁裔女性的意识较低 与非拉丁裔白人相比，遗传咨询和检测 (GCT) 的使用率更高。拉丁裔面临多重医疗保健， GCT 吸收的务实和社会心理障碍。拉丁裔更喜欢用西班牙语进行针对文化的干预 具有通俗易懂的语言、视觉教具和叙述格式。我们开发了一个针对文化的叙事视频 针对高危拉丁裔的西班牙语。在单臂试验（N = 40）中，拉丁裔表示非常满意并表现出 从测试前到测试后知识的显着增加。几乎所有参与者 (95%) 都表示有兴趣 GCT，62% 完成了遗传咨询。我们将使用创新的混合研究设计，结合 传统功效研究的要素以及实施研究的最佳实践，以增强 翻译过程的质量和速度。在扩展的综合行为模型的指导下，我们将 进行 RCT 来评估我们的视频与 FORCE 情况说明书在增强 GCT 吸收和使用方面的效果 心理社会结果。为了最大限度地发挥社区诊所的实施潜力，我们将对诊所进行培训 工作人员管理转介筛查工具 (RST)，这是一种经过验证的工具，用于识别有 HBOC 风险的女性。引导 根据实施研究综合框架，我们将开展以实施为重点的研究 过程评估，收集有关诊所实施结果的数据，以便使用转介筛选工具和 视频。我们将向参与者推荐免费的西班牙语电话遗传咨询。我们将随机抽取 300 名有风险的人 拉丁裔人口较多的四个地点都有拉丁裔。我们的主要结果是遗传咨询的接受率。 目标 1. 评估我们的视频与情况说明书对 GCT 吸收的影响。视频组的参与者将有 4 个月时，遗传咨询的接受率更高（H1.1.），基因检测的接受率更高（H1.2.）。 目标 2. 评估我们的视频与情况说明书对社会心理和过程评估结果的影响。 H2.1： 视频参与者将会有更高的知识、积极的态度、主观规范、自我效能感和积极的态度。 预期的情绪。 H2.2。视频参与者将具有更高的可接受性和可行性评级。 探索性目标：评估视频对遗传咨询采用的影响机制（知识、态度、 规范、自我效能、预期情绪）。如果各部门的咨询接受情况没有差异，那么我们将评估 吸收的预测因子。 目标 3. 检查可行性、可接受性、采用性、保真度和未来的关键实施成果 在社区诊所使用转诊筛选工具和视频的可持续性。