The purpose of this study is to test the impact of a multilevel decision support intervention on informed decisions about breast MRI among high-risk Black and Latina women. Participants (N=80) will be randomized to (1) enhanced usual care (risk assessment + referral to nurse practitioner) or (2) decision support (enhanced usual care + decision aid). Assessments will take place at baseline (T0) and 1-month post-intervention (T1). The primary outcome is informed decisions about breast MRI at T1.
female
aged 18-74 years
self-identifying as Black and/or Latina
no personal history of breast cancer
aged <18 or ≥75
pregnancy
Parallel
Enhanced Usual Care
BehavioralRisk assessment and notification, referral to nurse practitioner (NP) at the Ralph Lauren Center (RLC)
Decision Support
BehavioralThe decision aid describes two different breast cancer screening plans: (1) annual mammography only; and (2) annual mammography plus annual breast MRI. The decision aid provides balanced information about breast MRI, including its risks, limitations, and benefits.
Informed decisions about breast MRI
According to the Multidimensional Measure of Informed Choice, an informed decision is made with adequate knowledge and consistent with the respondent's preferences. Thus, two groups are classified as having made an informed decision: (1) those with adequate MRI knowledge, whose preferences align with screening with mammogram + MRI, and who intend to undergo MRI; and (2) those with adequate MRI knowledge, whose preferences align with screening with mammogram only, and who do not intend to undergo MRI. The knowledge, preferences, and intentions scores collected at T1 will be used to identify informed decisions.
Decision Satisfaction
The Satisfaction With Decision (SWD) scale includes 6 items rated from "strongly disagree" (1) to "strongly agree" (5). Items are averaged to create a total score ranging from 1-5 (higher=greater satisfaction). Instructions will specify decisions about breast cancer screening.
Decisional Conflict
The low-literacy version of the Decisional Conflict Scale (DCS) includes 10 items rated as "yes" (0), "unsure" (2), or "no" (4). Items are summed and transformed to create total scores ranging from 0-100 (higher=more conflict). Instructions will specify decisions about breast cancer screening.
MRI Knowledge
This breast MRI knowledge scale includes 10 true/false items based on the content of the breast MRI decision aid. Items are scored as correct (1) or incorrect (0); item scores are summed to create total scores (higher=greater knowledge). Adequate knowledge is specified as ≥50% correct.
Screening Preferences
Respondents will rate factors that are viewed as important by people deciding about breast cancer screening (e.g., length of procedure, false positives, cost, etc.) on a 12-point scale ranging from "not at all important" (0) to "extremely important" (11). Items are averaged to create are averaged to create a total score ranging from 0-11 (lower=preference for screening with mammogram only, higher=preference for screening with mammogram + breast MRI).
Screening Intentions
Participants will indicate screening intentions on a single item with a 7-point scale ranging from "mammogram only" (-3) to "mammogram + breast MRI" (3), with "unsure" as the mid-point (0).
Enacted Decision
Receipt of MRI (yes/no) will be assessed via EMR review.
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