Clinical Trial

Breast Cancer Research and Treatment

, Volume 119, Issue 3, pp 613-620

Women’s decisions regarding tamoxifen for breast cancer prevention: responses to a tailored decision aid

  • Angela FagerlinAffiliated withAnn Arbor VA HSR&D, Center for Clinical Management ResearchDivision of General Internal Medicine, University of MichiganCenter for Behavioral and Decision Sciences in Medicine Email author 
  • , Brian J. Zikmund-FisherAffiliated withAnn Arbor VA HSR&D, Center for Clinical Management ResearchDivision of General Internal Medicine, University of MichiganCenter for Behavioral and Decision Sciences in Medicine
  • , Dylan M. SmithAffiliated withAnn Arbor VA HSR&D, Center for Clinical Management ResearchDivision of General Internal Medicine, University of MichiganCenter for Behavioral and Decision Sciences in Medicine
  • , Vijayan NairAffiliated withDepartment of Statistics, University of Michigan
  • , Holly A. DerryAffiliated withCenter for Behavioral and Decision Sciences in Medicine
  • , Jennifer B. McClureAffiliated withGroup Health Center for Health Studies
  • , Sarah GreeneAffiliated withGroup Health Center for Health Studies
  • , Azadeh StarkAffiliated withHenry Ford Health System
  • , Sharon Hensley AlfordAffiliated withHenry Ford Health System
    • , Paula LantzAffiliated withSchool of Public Health, University of Michigan
    • , Daniel F. HayesAffiliated withBreast Oncology Program, Comprehensive Cancer Center, University of Michigan
    • , Cheryl WieseAffiliated withGroup Health Center for Health Studies
    • , Sarah Claud ZweigAffiliated withHenry Ford Health System
    • , Rosemarie PitschAffiliated withCenter for Behavioral and Decision Sciences in Medicine
    • , Aleksandra JankovicAffiliated withCenter for Behavioral and Decision Sciences in Medicine
    • , Peter A. UbelAffiliated withAnn Arbor VA HSR&D, Center for Clinical Management ResearchDivision of General Internal Medicine, University of MichiganCenter for Behavioral and Decision Sciences in MedicineDepartment of Psychology, University of Michigan

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Abstract

Tamoxifen reduces primary breast cancer incidence, yet causes serious side effects. To date, few women with increased breast cancer risk have elected to use tamoxifen for chemoprevention. The objective of the study was to determine women’s knowledge of and attitudes toward tamoxifen following exposure to a tailored decision aid (DA). A total of 632 women with a 5-year risk of breast cancer ≥1.66% (Mean = 2.56, range = 1.7–17.3) were recruited from two healthcare organizations. Participants viewed an online DA that informed them about their 5-year risk of breast cancer and presented individually tailored content depicting the risks/benefits of tamoxifen prophylaxis. Outcome measures included behavioral intentions (to seek additional information about tamoxifen, to talk to a physician about tamoxifen, and to take tamoxifen); knowledge; and perceived risks and benefits of tamoxifen. After viewing the DA, 29% of participants said they intended to seek more information or talk to their doctor about tamoxifen, and only 6% believed they would take tamoxifen. Knowledge was considerable, with 63% of women answering at least 5 of 6 knowledge questions correctly. Participants were concerned about the risks of tamoxifen, and many believed that the benefits of tamoxifen did not outweigh the risks. This study is the largest to date to test women’s preferences for taking tamoxifen and one of the largest to have tested the impact of a tailored DA. After viewing the DA, women demonstrated good understanding of tamoxifen’s risks and benefits, but most were not interested in taking tamoxifen for breast cancer chemoprevention.

Keywords

Decision aids Patient education Tamoxifen Breast cancer prevention