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Women’s interest in taking tamoxifen and raloxifene for breast cancer prevention: response to a tailored decision aid

  • Angela Fagerlin
  • Amanda J. Dillard
  • Dylan M. Smith
  • Brian J. Zikmund-Fisher
  • Rosemarie Pitsch
  • Jennifer B. McClure
  • Sarah Greene
  • Sharon Hensley Alford
  • Vijayan Nair
  • Daniel F. Hayes
  • Cheryl Wiese
  • Peter A. Ubel
Clinical trial

Abstract

Although tamoxifen can prevent primary breast cancer, few women use it as a preventive measure. A second option, raloxifene, has recently been approved. The objective of the study was to determine women’s interest in tamoxifen and raloxifene after reading a decision aid (DA) describing the risks and benefits of each medication. Women with 5-year risk of breast cancer ≥ 1.66 from two large health maintenance organizations were randomized to receive a DA versus usual care. After reading an on-line DA that discussed the risks and benefits of tamoxifen and raloxifene, women completed measures of risk perception, decisional conflict, behavioral intentions, and actual behavior related to tamoxifen and raloxifene. 3 months following the intervention, 8.1% of participants had looked for additional information about breast cancer prevention drugs, and 1.8% had talked to their doctor about tamoxifen and/or raloxifene. The majority, 54.7%, had decided to not take either drug, 0.5% had started raloxifene, and none had started tamoxifen. Participants were not particularly worried about taking tamoxifen or raloxifene and did not perceive significant benefits from taking these drugs. Over 50% did not perceive a change in their risk of getting breast cancer if they took tamoxifen or raloxifene. After reading a DA about tamoxifen and raloxifene, few women were interested in taking either breast cancer prevention drug.

Keywords

Decision aids Patient education Tamoxifen Raloxifene Breast cancer prevention 

Notes

Acknowledgments

We would like to thank Drs Victor Strecher and Mick Couper for their assistance in the design of the study. The Center for Heath Communication Research (especially Michael Nowak) did an excellent job turning our DA into a well-designed and easily navigated web site. We would also like to thank Roy Pardee and Rick Krajenta for their assistance for compiling the databases of eligible participants. We express our gratitude to the Department of Radiology at Henry Ford Health System, particularly Dr. Matthew Burke, for their help in identifying eligible patients. We are also thankful to Aleksandra Jankovic for her assistance with several analyses. Finally, we are very grateful to all the women who participated in this study.

Funding

Financial support for this study was provided by a grant from the National Institutes for Health (P50 CA101451). Drs. Fagerlin and Smith were supported by MREP early career awards from the U.S. Department of Veterans Affairs. Dr. Zikmund-Fisher is supported by a career development award from the American Cancer Society. Dr. Hayes received support from Fashion Footwear Charitable Foundation of New York/QVC Presents Shoes on Sale. The funding agreements ensured the authors’ independence in designing the study, interpreting the data, and publishing the report.

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Copyright information

© Springer Science+Business Media, LLC (outside the USA)  2011

Authors and Affiliations

  • Angela Fagerlin
    • 1
    • 2
    • 3
  • Amanda J. Dillard
    • 1
    • 3
  • Dylan M. Smith
    • 1
    • 2
    • 3
  • Brian J. Zikmund-Fisher
    • 1
    • 2
    • 3
  • Rosemarie Pitsch
    • 3
  • Jennifer B. McClure
    • 4
  • Sarah Greene
    • 4
  • Sharon Hensley Alford
    • 5
  • Vijayan Nair
    • 6
  • Daniel F. Hayes
    • 7
  • Cheryl Wiese
    • 4
  • Peter A. Ubel
    • 8
    • 9
  1. 1.Ann Arbor VA HSR&D Center for Practice Management and Outcomes ResearchAnn ArborUSA
  2. 2.Division of General Internal MedicineUniversity of MichiganAnn ArborUSA
  3. 3.Center for Behavioral and Decision Sciences in MedicineAnn ArborUSA
  4. 4.Group Health Center for Health StudiesSeattleUSA
  5. 5.Henry Ford Health SystemDetroitUSA
  6. 6.Department of StatisticsUniversity of MichiganAnn ArborUSA
  7. 7.Breast Oncology Program, Comprehensive Cancer CenterUniversity of MichiganAnn ArborUSA
  8. 8.Fuqua School of BusinessDuke UniversityDurhamUSA
  9. 9.Sanford School of Public PolicyDuke UniversityDurhamUSA

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