NRG Oncology/National Surgical Adjuvant Breast and Bowel Project Decision-Making Project-1 Results: Decision-making in Breast Cancer Risk Reduction

摘要

Selective estrogen receptor modulators (SERMs) reduce breast cancer risk. Adoption of SERMs as prevention medication remains low. This is the first study to quantify social, cultural, and psychological factors driving decision-making regarding SERM use in women counseled on breast cancer prevention options.A survey study was conducted with women counseled by a healthcare provider (HCP) about SERMs. A statistical comparison of responses was performed between those who decided to use and those who decided not to use SERMs. Independent factors associated with the decision were determined using logistic regression.Of 1023 participants, 726 made a decision: 324 (44.6%) decided to take a SERM and 402 (55.4%) decided not to. The most important factor for deciding on SERM use was the HCP recommendation. Other characteristics associated with the decision included: attitudes and perceptions regarding medication intake, breast cancer worry, trust in HCP, family members with blood clots, and others’ experiences with SERMs. The odds of SERM intake when HCP-recommended were higher for participants with a positive attitude towards taking medications than for those with a negative attitude (interaction p-value=0.01).This study highlights the importance of social and cultural aspects for SERM decision-making, most importantly personal beliefs and experiences. HCPs' recommendations play a statistically significant role in decision-making and are more likely to be followed if in line with patients’ attitudes.Results indicate the need of developing interventions for HCPs that not only focus on the presentation of medical information but, equally as important, on addressing patients’ beliefs and experiences.