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Risk visualization in personalized breast cancer screening

Projectomschrijving

Risicovisualisatie bij gepersonaliseerde borstkankerscreening

Vraagstuk

Binnen nu en 10 jaar gaat het bevolkingsonderzoek borstkanker in Nederland veranderen. In de toekomst krijgen vrouwen meer gepersonaliseerde informatie over hun risico op borstkanker. Deze informatie is onder andere gebaseerd op de dichtheid van iemand borstweefsel en leefstijlfactoren. Aangezien de complexiteit van de informatie zal toenemen, heeft dit gevolgen voor de gebruikte informatiematerialen voor vrouwen. Hoe kan deze informatie over het risico op borstkanker goed uitgelegd worden?

Onderzoek

Er wordt systematisch onderzoek gedaan naar communicatie van risico-informatie door middel van visualisaties. Het project bestaat uit een inventarisatie van de literatuur, kwalitatief onderzoek en een online experiment met vernieuwde gevisualiseerde risico-informatie.

Verwachte uitkomst

Een toolkit voor risicovisualisatie die gebruikt kan worden bij de informatievoorziening over borstkanker. Hiermee worden de geïnformeerde keuzes van vrouwen ondersteund.

Verslagen


Samenvatting van de aanvraag

BACKGROUND Due to the emergence of personalized breast cancer screening, it will be possible to categorize women to low, moderate or high risk profiles in the near future. These profiles will increase the personal relevance of the screening result for women, but also its complexity. Currently, communication of the outcome addresses a dichotomous mammography result (i.e. either a breast abnormality or not). Personalized screening will result in communication of a personalized multifaceted risk message:(a) no breast abnormality found;(b) personalized risk profile (low, medium, high risk);(c) corresponding advice for follow-up screening interval. Apart from the question to what extent such risk messages will influence women’s acceptance of the advised follow-up interval, it is essential to know how they will understand this personalized risk message. Adequate comprehension of one’s breast cancer risk is a main precondition for making well-informed further decisions in the screening program. Visualization of risk information seems a promising approach to support risk comprehension in addition to textual/numerical risk information, but visualizations can also generate unwarranted effects, especially among lower health literacy (HL) individuals. STUDY AIMS This project aims to design and test novel (interactive) visualizations of risk information in personalized breast cancer screening. Specific aims: (1) To gain insight in methods and underlying mechanisms of risk visualizations that support risk comprehension; (2) To design risk visualizations that support comprehension of the personalized multifaceted risk message for each risk profile (low, medium, high risk);(3) To assess the effects of the risk visualizations on risk comprehension (primary outcome), risk perception, worry, anxiety, attitudes towards participation, and hypothetical decisions/intentions regarding the follow-up interval (secondary outcomes). METHODS The project focuses on the personalized multifaceted risk message that women without a breast abnormality will receive in the near future, based on their breast density and lifestyle factors. This includes the components a-c, as mentioned above. The project will only use hypothetical information in all studies. In Study 1 (Aim 1), an inventory of different risk visualizations will be made, including interactive approaches, through a scoping review of systemic reviews on risk visualization. Study 2 (Aim 2) will design the most promising visualizations for the personalized multifaceted risk message relating to each risk profile, anticipating on developments in Dutch breast cancer screening. We envision that the following hypothetical information will be visualized: (1) quantitative categorical risk information (risk profile (low/medium/high risk)), possibly combined with some form of absolute risk; (2) qualitative risk information (explanation of underlying risk factors); and, in relation to (1) and (2);also (3) advised follow-up screening interval. Visualizations will be created through a participatory approach with women who will soon become the target group of screening (40-50 yrs old) and who have varying levels of HL (N=15 in Study 2.1; N=24 in Study 2.2). Experts will be consulted as well. Study 3 (Aim 3) will use an experiment to test the effects of the risk visualizations on women’s risk comprehension. The study population will consist of women between 40 -50 yrs, without personal history of breast cancer. Participants will be divided into three hypothetical risk profile groups (low risk (N=200), medium risk (N=200), high risk (N=200)). We intend to test the effects of two manipulations in each risk profile group in a 3x2 between-subjects design, i.e. visualizing quantitative categorical risk information (interactive visualization vs. static visualization vs. no visualization) and visualizing qualitative risk information (visualization (e.g., infographics of risk factors) vs. no visualization). ANOVA’s and ANCOVA’s will assess the effect of these two manipulations. It will also be studied whether the effects of the risk visualizations differ for the three risk profiles, and between women who differ in HL. EMBEDDING The project will be conducted at VUmc, in collaboration with AMC, RIVM and TUDelft. An advisory committee with experts in prediction modelling in personalized cancer screening, experts from the Dutch Centre for Population Screening (CvB), from the Dutch Association of Breast Cancer Patients (BVN), and experts in genetic risk stratification (in view of future inclusion of biomarkers) will be consulted. We will also consult experts in ethical questions in cancer screening where necessary. DELIVERABLES A risk visualization toolkit will be developed for use in breast cancer screening practice, consisting of a digital repository with downloadable and printable materials. This project will also result in novel scientific knowledge about risk visualization in personalized cancer screening.

Kenmerken

Projectnummer:
531002033
Looptijd: 100%
Looptijd: 100 %
2019
2022
Onderdeel van programma:
Gerelateerde subsidieronde:
Projectleider en penvoerder:
prof. dr. D.R.M. Timmermans PhD
Verantwoordelijke organisatie:
Amsterdam UMC Locatie VUmc