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Cancer Control Research

Abstract

The long term goal of this project is to improve patient understanding about breast cancer risk and genetic testing. We have previously developed a patient-oriented CD-ROM called "Counseling by Computer: Breast Cancer Risk and Genetic Testing ." The proposed research is to conduct a clinical trial to evaluate the effectiveness of the CD-ROM at educating women about breast cancer risk, and options and implications of genetic testing. This project will take 36 months to complete and involves two specific aims: Specific Aim 1: to evaluate the effectiveness of our CD-ROM at educating women about breast cancer risk, and the options and implications of genetic testing. We will complete this aim in two phases. During phase 1 we will obtain critical feedback on the CD-ROM and survey instruments from a diverse group of women in Central Pennsylvania. Forty women (at least 1/4 of whom are minorities) will be recruited from a general internal medicine clinic and breast cancer support group to evaluate the useability and effectiveness of the CD-ROM. The survey data will be used to refine the CD-ROM and study instruments in preparation for a randomized trial. Phase 2 will be to evaluate the impact of the CD-ROM on those actually considering genetic testing for breast cancer susceptibility, through a randomized, pretest-posttest control-group, crossover trial of 210 patients at three study sites. The effectiveness of computer-based education will be compared with one-on-one education for the impact on patients': risk perception; intent to receive genetic testing; knowledge about breast cancer risk and genetic testing; satisfaction with their decision about genetic testing; and decisional conflict. An assessment of the acceptability of each educational intervention will also be obtained. Specific Aim 2: to evaluate the impact of a prior computer-based educational session on subsequent interactions between patients and genetic counselors. As part of the randomized trial, we will study whether the addition of a computer-based educational program improves the interactions between patients and genetic counselors. Comparisons will be made between those educated by a genetic counselor alone, and those educated by a computer prior to their session with a genetic counselor, by measuring: the amount of time spent with a genetic counselor; the quality and quantity of questions directed to the genetic counselor; patient's and genetic counselor's satisfaction; and perceived effectiveness of the counseling session.