P3-08-04: “How Important Is This for Me?” – The Role of Necessity Beliefs as Determinants of Breast Cancer Prevention Intentions among High-Risk Women.
Authors: Verma S , Paquet L , Stacey D , Davis I , Bedard M , Lowry S , Ianni L 
Published: June 2012

Background Women at elevated risk for breast cancer (BC) face complex risk management decisions. Understanding the determinants of pre-counselling risk management intentions would be useful to clinicians in helping high-risk women make their decisions. Across several medical conditions, the Necessity-Concerns Framework (NCF) has emphasized the role of patient’ beliefs about interventions offered to them as central to decision-making. In the NCF, beliefs are conceptualized as perceived personal need for an intervention (necessity) and as concerns about its perceived negative effects. To date, the NCF has not been applied to investigate decision-making in the high-risk setting. Our objective was to use the NCF to describe the risk management beliefs of high-risk women prior to initial consultation. The relative importance of BC fear, perceived susceptibility to BC and necessity-concerns beliefs in predicting prevention intentions was also examined.

Methods A survey was sent to patients prior to their first risk consultation. BC fear was assessed with Champion BC Fear Scale and perceived susceptibility was measured by asking women to rate their likelihood of developing BC (0 =definitely will not get it to 100=definitely will get it). For each of screening, lifestyle modifications, pharmacoprevention (PP) and prophylactic surgery (PS), women rated (1=strongly disagree to 5=strongly agree) their need for the option (e.g., my health in the future will depend on this option, this option will protect me from becoming worse), and its negative consequences (e.g. I worry about the long-term effects of this option, this option will disrupt my life). Intentions were assessed by asking how strongly (1=definitely not to 5=Definitely Yes) they intended to adopt each option. The planned sample size is 100 women and recruitment is on-going. We report data from 44 women who have completed the questionnaire.

Results: The majority intended to adopt screening (92%) and lifestyle (91%) compared to PP (23%) or PS (18%). Screening and lifestyle were associated with stronger intentions, higher perceived need, and lower concerns than PP and PS (all t-tests, p &lt;0.0001). Hierarchical regression analyses revealed that perceived need predicted intentions for each option (all ps &lt; 0.005, except for screening, p &lt; .1) whereas concern beliefs were only correlated with PP intentions (β=-.398, p &lt; .005). Fear of BC was related to PP intentions (β=.401, p &lt; .005) and to intentions to remain smoke-free (β=-.341, p &lt; .05). Perceived susceptibility did not contribute to intentions.

Conclusions Our preliminary findings are promising and suggest that the NCF is useful for understanding decision-making in the high-risk setting. The findings emphasize the importance of necessity beliefs in BC risk management decisions. For the group as whole, across each risk management option, the strongest predictor of intentions was a women's perception of her personal need for the option. Concerns about negative effects and BC fear played only a minor role and perceived susceptibility did not predict intentions. These observations stress the importance of making screening or prevention recommendations hand in hand with the individual beliefs and concerns.

Citation Information: Cancer Res 2011;71(24 Suppl):Abstract nr P3-08-04.