Decision Support for Multigene Panel Testing and Family Risk Communication among Racially/Ethnically Diverse Young Breast Cancer Survivors - Project Summary/Abstract: The introduction of multi-gene panel testing for hereditary breast and ovarian cancer (HBOC) syndrome has rapidly changed the clinical approach to genetic testing for patients and their families. Young breast cancer survivors (YBCS), diagnosed at age ≤50 years old, may have inherited a pathogenic/likely pathogenic (P/LP) variant in a breast cancer susceptibility gene, e.g., BRCA1, BRCA2, PALB2, etc. Recent studies have found suboptimal rates of genetic testing among young breast cancer patients with less than 50% completion rates for hereditary breast and ovarian cancer (HBOC) syndrome. Racial and ethnic disparities in genetic testing completion and results have been well documented. My long-term career goal is to become a leading independent investigator in breast cancer prevention and control, focusing on cancer genetics/genomics, risk communication, biobehavioral oncology, and reduction of cancer health disparities among racial/ethnic minority women. The specific aims are: In Aim 1, we propose to identify factors associated with completion of HBOC multigene panel testing, cancer risk-reducing behaviors, and family risk communication among racially/ethnically diverse young breast cancer survivors (YBCS) (N=300) within a sequential explanatory mixed-methods study. In addition, we will conduct qualitative interviews with (N=40) YBCS who completed genetic testing and those who have not completed genetic testing to explore knowledge, attitudes, beliefs about genetic testing, and to identify barriers and facilitators to the communication of genetic risk to their at-risk relatives. We will illuminate quantitative findings with qualitative data collected. In Aim 2, we will apply user-centered design to modify the existing genetic testing module within the RealRisks decision aid to meet the needs of YBCS and to add family risk communication content and conduct participatory workshops and usability testing (N=20). Lastly, in Aim 3, we will conduct a pilot randomized controlled trial of standard patient education alone or in combination with the modified RealRisks decision aid among racially/ethnically diverse YBCS. This career development award will provide me with protected time and the opportunity to pursue my training goals in several targeted areas: (1): Acquire and apply advanced statistical analytics for conducting mixed methodology and intervention research; (2) increase knowledge and skills in biobehavioral oncology, cancer survivorship, clinical application of genetic/genomic medicine, risk communication in families, cascade genetic testing, adapting web-based decision support interventions for underserved populations, and breast cancer health disparities; (3) gain didactic and experiential learning in the conduct of randomized controlled trials; and (4) develop leadership skills in the ethical conduct of scientific research, grant writing, increasing scholarly productivity, and management skills for scientific independence. In summary, this Mentored Research Scientist Development Award to Promote Diversity will provide me with invaluable experiences to successfully transition into a scientific independence, ultimately reducing health disparities.
