Facilitating decision-making in women undergoing genetic testing for hereditary breast cancer: BRECONDA randomized controlled trial results

Kerry A Sherman; Christopher J Kilby; Laura-Kate Shaw; Caleb Winch; Judy Kirk; Kathy Tucker; Elisabeth Elder

doi:10.1016/j.breast.2017.10.001

Facilitating decision-making in women undergoing genetic testing for hereditary breast cancer: BRECONDA randomized controlled trial results

Breast. 2017 Dec:36:79-85. doi: 10.1016/j.breast.2017.10.001. Epub 2017 Oct 12.

Authors

Kerry A Sherman¹, Christopher J Kilby², Laura-Kate Shaw³, Caleb Winch³, Judy Kirk⁴, Kathy Tucker⁵, Elisabeth Elder⁶

Affiliations

¹ Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia. Electronic address: [email protected].
² Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia; Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia.
³ Centre for Emotional Health, Department of Psychology, Macquarie University, Sydney, Australia.
⁴ Familial Cancer Service, Crown Princess Mary Cancer Centre, Westmead Hospital, Sydney, Australia; Sydney Medical School, University of Sydney, Sydney, Australia; Centre for Cancer Research, The Westmead Institute for Medical Research, Sydney, Australia.
⁵ Hereditary Cancer Clinic, Prince of Wales Hospital, Sydney, Australia.
⁶ Westmead Breast Cancer Institute, Westmead Hospital, Sydney, Australia.

PMID: 29031121
DOI: 10.1016/j.breast.2017.10.001

Abstract

Background: Decision-making concerning risk-reducing mastectomy for women at hereditary risk of breast cancer entails complex personal choices. Deciding whether and how to restore breast shape after risk-reducing mastectomy is a key part of this process. We developed a web-based decision aid, BRECONDA (Breast Reconstruction Decision Aid), to assist women in decision-making regarding breast reconstruction.

Method: This study assessed the efficacy of BRECONDA to assist women at increased risk of breast cancer in making decisions regarding risk-reducing mastectomy in terms of decisional conflict, knowledge, and satisfaction with information. Women at hereditary risk of breast cancer (N = 64) were recruited into this randomized controlled trial from four Australian hereditary cancer clinics. Participants initially provided online consent and completed baseline questionnaires assessing decisional conflict, knowledge, and satisfaction with information. They were then randomly assigned to either: 1) Intervention - unlimited access to BRECONDA, with usual care; or, 2) Control - usual care. At 2-months follow-up (N = 60) the outcomes were re-assessed. Intervention participants also completed user acceptability ratings for the intervention overall and specific key modules.

Results: MANCOVA analyses indicated that Intervention participants reported lower decisional conflict (P = 0.027), and greater knowledge (P = 0.019) and satisfaction with information (P < 0.0005) at 2-months follow-up compared with Controls. Intervention participants reported high user acceptability and satisfaction with the intervention.

Conclusion: BRECONDA benefits women considering risk-reducing mastectomy by reducing decisional conflict, and improving knowledge and satisfaction with information. These benefits, coupled with high user acceptability, demonstrate the feasibility of implementing BRECONDA in the hereditary cancer risk context.

Keywords: Breast cancer; Decision aid; Decision-making; Decisional conflict; Hereditary risk; Randomized controlled trial.

Publication types

Randomized Controlled Trial

MeSH terms

Adult
Breast Neoplasms / genetics*
Breast Neoplasms / prevention & control*
Conflict, Psychological
Decision Making*
Decision Support Techniques*
Female
Genetic Testing
Health Knowledge, Attitudes, Practice
Humans
Internet
Mammaplasty
Middle Aged
Patient Education as Topic
Patient Satisfaction*
Prophylactic Mastectomy / psychology*