Introducing a Comprehensive Informatics Framework to Promote Breast Cancer Risk Assessment and Chemoprevention in the Primary Care Setting

Breast cancer is the most commonly diagnosed cancer among women in the United States, and current routine screening prevention methods are costly and expose patients to unnecessary risks of overtreatment. The utilization of a risk-based stratification model, genetic testing, and chemoprevention could decrease the incidence of invasive breast cancer but uptake has been low among high-risk women. The goal of this project was to implement a comprehensive informatics framework to promote breast cancer risk assessment and chemoprevention in the primary care setting that was informed by potential user feedback. The framework provides evidence-based decision support to both providers and patients. For providers we developed a novel breast cancer risk navigation (BNAV) tool which incorporates an evidence-based breast cancer risk model into the electronic health record. For patients a decision aid was designed that allows participants to experience risk through an activity and to address patient-related barriers to chemoprevention. We conducted usability testing to determine barriers and facilitators affecting the toolbox use by providers. A total of seven subjects were recruited and completed the usability testing. Using think-aloud protocols, semi-structured interviews, and subject recordings, we identified recurring themes related to the usability of BNAV. Themes specifically aligned with the content, ease of use, and navigation of the application. This feedback was used to make interface changes to the application that more appropriately tailored BNAV to engage the target population of primary care providers and thus more effectively optimizing shared decision-making associated with breast cancer risk assessment and prevention in clinical practice. A comprehensive informatics framework to increase breast cancer risk assessment and chemoprevention in the primary care setting has been successfully introduced to address this challenge. Given the proven efficacy of breast cancer chemoprevention in high-risk populations, higher uptake may significantly reduce the public health burden of this disease.