Abstract PS8-35: Use of a web-based decision aid to promote chemoprevention uptake among racially/ethnically diverse women at high-risk for developing breast cancer: A qualitative study
Authors: Guzman Ashlee , Silverman Thomas , Mata Jennie , Kukafka Rita , Crew Katherine D , Jones Tarsha 
Published: February 2021

Abstract
Background: Chemopreventive agents such as selective estrogen receptor modulators (SERMs; tamoxifen and raloxifene) and aromatase inhibitors (AIs; exemestane and anastrozole) have proven efficacy in reducing breast cancer risk by 41%-79% in high risk women. Women at high risk of developing breast cancer face the complex decision of whether to take SERMs or AIs for breast cancer chemoprevention. Underserved racial/ethnic minority women are less likely to take chemoprevention, contributing to higher rates of advanced tumors, and poorer clinical outcomes compared to non-Hispanic whites, which could exacerbate health disparities. RealRisks is a patient-centered web-based decision aid (DA) that was designed to promote understanding of breast cancer risk and to engage diverse women in planning a preference-sensitive course of decision-making about taking chemoprevention. We aimed to understand perceptions of women at high-risk for developing breast cancer regarding their use of RealRisks.
Methods: We completed enrollment to a randomized controlled trial (RCT) among 300 racially/ethnically diverse high-risk women assigned to standard educational materials alone or in combination with RealRisks, with the primary endpoint of chemoprevention uptake at 6 months. We conducted a qualitative study using semi-structured interviews with a subset of 27 high-risk women enrolled in the intervention arm of the RCT to understand how they interact with the DA. All interviews were audio-recorded, transcribed verbatim, and compared against the digital recordings to ensure accuracy of the content. Content analysis was used as a method to analyze the data and to generate themes.
Results: The mean age of the participants was 60.9 years (SD, 10.3). Our sample was racially and ethnically diverse with 59.3% non-Hispanic white, 18.5% non-Hispanic black, 14.8% Hispanic/Latina, and 3.7% Asian. Most participants had a family history of breast cancer (70.4%) and most (78%) reported using RealRisks after being granted access to the DA. Three overarching themes emerged from the qualitative analyses: (1) acceptability of the intervention, (2) usability of the intervention, (3) and information needs. RealRisks was found to be acceptable among the women who used the DA (n=21/27). Most women (n=18/21) felt that RealRisks improved their knowledge about breast cancer risk and chemoprevention options and informed their decision-making about whether or not taking chemoprevention was the right choice for them (n=17/21). Most women reported that RealRisks was easy to navigate, user-friendly, and easily accessible online. Alternatively, a subset of women (n=9/21) shared challenges with using the DA, as they wanted more tailoring based on user characteristics; felt that the DA was specifically targeting multi-ethnic populations that did not reflect them; used difficult terminology; and had a strong emphasis on chemoprevention drugs. Participants offered recommendations for improving the DA and shared their information needs, which mainly focused on wanting to learn about guidelines for mammography screening and lifestyle modification.
Conclusions: With this qualitative study, we demonstrated the acceptability of the RealRisks web-based DA among diverse high-risk women with a few caveats and recommendations for improvement. These results emphasize the need for more tailoring of the DA based on user characteristics and a holistic approach to reducing breast cancer risk, to include information on breast cancer screening, as well as lifestyle risk factors. Next steps include incorporating feedback from this study to further enhance the DA and to optimize the modular architecture within RealRisks to include additional modules to meet the needs of diverse high-risk women.
Citation Format: Ashlee Guzman, Thomas Silverman, Jennie Mata, Rita Kukafka, Katherine D Crew, Tarsha Jones. Use of a web-based decision aid to promote chemoprevention uptake among racially/ethnically diverse women at high-risk for developing breast cancer: A qualitative study [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS8-35.