Informed choice about breast cancer prevention: randomized controlled trial of an online decision aid intervention

Abstract Introduction Tamoxifen and raloxifene are chemopreventive drugs that can reduce women's relative risk of primary breast cancer by 50%; however, most women eligible for these drugs have chosen not to take them. The reasons for low uptake may be related to women's knowledge or attitudes towards the drugs. We aimed to examine the impact of an online breast cancer chemoprevention decision aid (DA) on informed intentions and decisions of women at high risk of breast cancer. Methods We conducted a randomized clinical trial, assessing the effect of a DA about breast cancer chemoprevention on informed choices about chemoprevention. Women (n = 585), 46- to 74-years old old, completed online baseline, post-test, and three-month follow-up questionnaires. Participants were randomly assigned to either an intervention group, a standard control group that answered questions about chemoprevention at baseline, or a three-month control group that did not answer questions about chemoprevention at baseline. The main outcome measures were whether women's intentions and decisions regarding chemoprevention drugs were informed, and whether women who viewed the DA were more likely to make informed decisions than women who did not view the DA, using a dichotomous composite variable 'informed choice' (yes/no) to classify informed decisions as those reflecting sufficient knowledge and concordance between a woman's decision and relevant attitudes. Results Analyses showed that more intervention than standard control participants (52.7% versus 5.9%) made informed decisions at post-test, P <0.001. At the three-month follow-up, differences in rates of informed choice between intervention (16.9%) and both control groups (11.8% and 8.0%) were statistically non-significant, P = 0.067. Conclusions The DA increased informed decision making about breast cancer chemoprevention, although the impact on knowledge diminished over time. This study was not designed to determine how much knowledge decision makers must retain over time. Examining informed decisions increases understanding of the impact of DAs. A standard for defining and measuring sufficient knowledge for informed decisions is needed. Trial registration ClinicalTrials.gov: NCT00967824http://deepblue.lib.umich.edu/bitstream/2027.42/112557/1/13058_2013_Article_3282.pd

Informed choice about breast cancer prevention: randomized controlled trial of an online decision aid intervention

Abstract Introduction Tamoxifen and raloxifene are chemopreventive drugs that can reduce women's relative risk of primary breast cancer by 50%; however, most women eligible for these drugs have chosen not to take them. The reasons for low uptake may be related to women's knowledge or attitudes towards the drugs. We aimed to examine the impact of an online breast cancer chemoprevention decision aid (DA) on informed intentions and decisions of women at high risk of breast cancer. Methods We conducted a randomized clinical trial, assessing the effect of a DA about breast cancer chemoprevention on informed choices about chemoprevention. Women (n = 585), 46- to 74-years old old, completed online baseline, post-test, and three-month follow-up questionnaires. Participants were randomly assigned to either an intervention group, a standard control group that answered questions about chemoprevention at baseline, or a three-month control group that did not answer questions about chemoprevention at baseline . The main outcome measures were whether women's intentions and decisions regarding chemoprevention drugs were informed, and whether women who viewed the DA were more likely to make informed decisions than women who did not view the DA, using a dichotomous composite variable 'informed choice' (yes/no) to classify informed decisions as those reflecting sufficient knowledge and concordance between a woman's decision and relevant attitudes. Results Analyses showed that more intervention than standard control participants (52.7% versus 5.9%) made informed decisions at post-test, P <0.001. At the three-month follow-up, differences in rates of informed choice between intervention (16.9%) and both control groups (11.8% and 8.0%) were statistically non-significant, P = 0.067. Conclusions The DA increased informed decision making about breast cancer chemoprevention, although the impact on knowledge diminished over time. This study was not designed to determine how much knowledge decision makers must retain over time. Examining informed decisions increases understanding of the impact of DAs. A standard for defining and measuring sufficient knowledge for informed decisions is needed. Trial registration ClinicalTrials.gov: NCT00967824http://deepblue.lib.umich.edu/bitstream/2027.42/135728/1/13058_2013_Article_3282.pd

Statin use and risk of hepatocellular carcinoma in a U.S. population

Statins (3-hydroxy-3-methylglutaryl coenzyme A reductase inhibitors) are medications widely prescribed to reduce cholesterol levels. Observational studies in high-risk populations, mostly in Asia, have suggested that statins are associated with a reduced risk of hepatocellular carcinoma (HCC). The current study sought to evaluate the association of statin use and HCC in a U.S.-based, low-risk, general population

Molecular Epidemiology, Racial/Ethnic Differences and Chemoprevention of Breast Cancer: Population-based Studies from Metropolitan Detroit.

Breast cancer affects more women than any other cancer and is the second leading cause of cancer deaths among this group. Despite progress in our understanding of brest cancer risks and treatment improvements, there remain considerable knowledge gaps. The studies contained herein address some of these gaps; specifically, this dissertation focuses on health disparities, markers of progression, and prevention of breast cancer. Arab-Americans are an understudied minority, particularly because US population-based statistics do not separate them from “Caucasian”, resulting in lacking health statistics. In this dissertation, breast cancer characteristics at diagnosis are compared to European- and African-American women from the Detroit SEER tumor registry. Overall, Arab-American women have a distribution of breast cancer histology and overall survival similar to European-American women. Conversely, the stage, age, and hormone receptors at diagnosis among Arab-Americans were similar to African-American women. Molecular profiling of aggressive vs. non-aggressive early breast tumors is a strategy employed to investigate potential independent prognostic markers, RhoC and EZH2. RhoC, a Rho family GTPase, has been identified as a major phenotypic driver of inflammatory breast cancer, the most lethal form of breast cancer. EZH2 is a histonemethyltransferase polycomb group protein, which has been implicated in the process of cellular differentiation and cancer progression. Our results suggest that EZH2 is associated with hormonal receptor negativity, Her2 receptor positivity, cellular proliferation, family history, and being African-American. EZH2 positive tumors were significantly more likely to recur. However, the potential for RhoC to be a significant predictor of subsequent recurrence and/or distant metastasis for T1 breast cancers remains unresolved based on our study. Finally, we consider bisphosphonates, a class of drugs used primarily for osteoporosis, as breast cancer chemopreventive agents. Results reported here strongly support that bisphosphonates may be a potential chemopreventive agent. Indeed, our data suggest that exposure to bisphosphonates is associated with lowering breast cancer risk by half or more. This is comparable to the results of the trials involving tamoxifen, an approved breast cancer chemopreventive agent. In conclusion, this dissertation presents new knowledge about breast cancer characteristics in special populations, phenotypic markers, and support of a novel chemopreventive.Ph.D.Epidemiological ScienceUniversity of Michigan, Horace H. Rackham School of Graduate Studieshttp://deepblue.lib.umich.edu/bitstream/2027.42/62269/1/smha_1.pd

Watson Health: A New Approach to Population Health and Research

Background/Aims: The population health management movement requires key strategies be employed by some of the nation’s largest and most prestigious physician groups and health systems (most included in the HCSRN) to automate the management of their populations and improve health outcomes. Watson Health represents a health information technology (IT) and big data insights approach to enhance patient experience, management and outcomes. We bring together common data sources for evidence that is consistent across platforms, including payers, providers and pharmaceuticals. Methods: Utilizing advanced analytics and IT structures, Watson Health data infrastructure management allows physicians and researchers to gain insights from existing data assets. Built on top of the enterprise data warehouse, interface strategies such as Explorys and Phytel have been built and instituted at several organizations. We have established trusted data for all stakeholders in the health care ecosystem to provide evidence that is needed for the collaboration between all aspects of health management and life sciences development. Results: With the Explorys and Phytel tools, we were able to build tools to assist physicians and other care-team members. Data from registries, other providers, pharmacies, claims and laboratory sources was used to identify gaps in care that needed to be filled. Identification of specific patient populations can easily be identified for care alerts, clinical trial eligibility, research enrollment or follow-up at a huge time savings for the care team and research staff. Conclusion: To create a sustainable health care system that provides affordable, high-quality health care to all, a population health management approach like that offered by Watson Health needs to be adopted by physicians and outcomes validated by health care research. Current electronic health records lack many of the features required to improve population health; therefore, new technologies are important to reach the overarching goal to improve population health