Effectiveness of evidence-based decision aids for women with pathogenic BRCA1 or BRCA2 variants in the german health care context: results from a randomized controlled trial

BMC Medical Informatics and Decision Making

Research

Rita Schmutzler¹  Kerstin Rhiem¹  Marcus Redaèlli²  Stephanie Stock²  Vanessa Mildenberger²  Sibylle Kautz-Freimuth²  Arim Shukri²  Hannah Kentenich²  Dusan Simic² 

[1] Center for Familial Breast and Ovarian Cancer, Center for Integrated Oncology (CIO), Faculty of Medicine and University Hospital Cologne, University of Cologne, Kerpener Straße 62, 50937, Cologne, Germany;Institute of Health Economics and Clinical Epidemiology, Faculty of Medicine and University Hospital Cologne, University of Cologne, Gleueler Straße 176-178, 50935, Cologne, Germany;

关键词: BRCA1;    Decision aids;    Decisional conflict;    Decision-making;    Hereditary breast and ovarian cancer;    Preventive options;    Preference-sensitive decisions;   

DOI  :  10.1186/s12911-023-02327-9

 received in 2023-03-06, accepted in 2023-10-05,  发布年份 2023

来源: Springer

【 摘 要 】

BackgroundWomen with pathogenic BRCA1 or BRCA2 variants are at high risk for breast and ovarian cancer. Preventive options include risk-reducing breast and ovarian surgeries and intensified breast surveillance. However, individual decision-making is often associated with decisional conflicts. Two evidence-based decision aids have recently been developed for these women (healthy or with unilateral breast cancer) for the German context to support them in their decision-making process. This study evaluated their effectiveness.MethodsIn a randomized controlled study, women (aged 18–70 years) with pathogenic BRCA1 or BRCA2 variants were randomly assigned 1:1 to the intervention (IG, n = 230) or control (CG, n = 220) group. All participants received usual care. After baseline survey (t0), IG participants additionally received the DAs. Follow-up surveys were at three (t1) and six (t2) months. Primary outcome was decisional conflict at t1. Secondary analyses included decision status, decision regret, knowledge on risks and preventive options, self-reported psychological symptoms, acceptability of DAs, and preparation for decision-making.ResultsOf 450 women recruited, 417 completed t0, 398 completed t1 and 386 completed t2. Compared to CG, IG participants had lower decisional conflict scores at t1 (p = 0.049) and t2 (p = 0.006) and higher scores for knowledge (p = 0.004), acceptability (p = 0.000), and preparation for decision-making (p < 0.01).ConclusionsThese DAs can help improve key parameters of decision-making in women with pathogenic BRCA1 and BRCA2 variants and, thus, provide a useful add-on to the current counseling and care concept for these women in Germany.Trial registrationGerman Clinical Trials Register, DRKS-ID: DRKS00015823, retrospectively registered 14/06/2019.

【 授权许可】

CC BY   
© BioMed Central Ltd., part of Springer Nature 2023

【 图 表 】

Fig. 2

Scheme. 1

Fig. 4