Facilitating Web-based Patient Decision Support: Decision About Medication to Lower Breast Cancer Risk

BACKGROUND: * Breast cancer chemoprevention has been notably underutilized. * Barriers to integrating breast cancer risk reducing measures include: lack of time, low priority of risk reduction in comparison to treatment, the need to personalize risks and benefits of chemoprevention, and the need for resources/information necessary for women to make informed decisions. * Access to quality decision support resources to facilitate making informed, preference-sensitive decisions about chemoprevention may provide a mechanism to overcome some of the current barriers to chemoprevention utilization. OBJECTIVES: * Develop and refine a web-based patient decision support module for high-risk women making a decision about breast cancer chemoprevention. * Conduct a randomized study of TACHD decision support versus standard care online information support to evaluate the impact of the chemoprevention module of the TACHD decision support intervention. ELIGIBILITY: * Women with no history of cancer other than cervical carcinoma in situ or non-melanoma skin cancer * High risk for breast cancer based on at least one of the following: * Gail score \> 1.67 * History of atypical hyperplasia (either ductal or lobular) * History of lobular carcinoma in situ * Documentation of a deleterious BRCA1 or BRCA2 mutation * Considering a decision about chemoprevention with tamoxifen or raloxifene * Access to an IBM-compatible or MacIntosh personal computer with broadband Internet access * Access to an email account * Access to a telephone * Aged 35 or older * Able to communicate in English verbally and in writing DESIGN: * The project will be guided by the Cognitive-Social Health Information Processing (CSHIP) model overall, and incorporate the Ottawa Decision Support. Framework (ODSF) in one consistent decision support process. * Testing of the chemoprevention decision support module will be conducted in a two-group pre- post-test experimental design with 64 at-risk women identified through Fox Chase Risk Assessment Programs and the NCI Clinical Cancer Genetics Program (CCGP) at the National Naval Medical Center (NNMC). * A process evaluation analysis will assess participants' experiences using TACHD.