@Article{信息:doi 10.2196 / / jmir。4028，作者=“Kukafka, Rita和Yi, Haeseung和Xiao, Tong和Thomas, Parijatham和Aguirre, Alejandra和Smalletz, Cindy和David, Raven和Crew, Katherine”，标题=“为什么乳腺癌风险的数字是不够的:多民族，低计算能力女性的决策辅助评估”，期刊=“J医学互联网研究”，年=“2015”，月=“七月”，日=“14”，卷=“17”，数=“7”，页=“e165”，关键词=“乳腺癌;决策;风险沟通;消费者健康信息学;基因检测;决定援助;背景:包括基因检测在内的乳腺癌风险评估可用于将人群划分为不同的风险群体，并根据每个群体的需要进行筛查和预防干预，但在初级保健环境中实施风险分层乳腺癌预防是复杂的。目的:为了解决初级保健环境中乳腺癌风险评估、风险沟通和预防策略的障碍，我们开发了一个基于web的决策辅助工具，RealRisks，旨在改善乳腺癌预防的基于偏好的决策，特别是在低数量女性中。方法:RealRisks结合了基于经验的动态接口来传达风险，旨在减少不准确的风险认知，并提供了量身定制的乳腺癌风险、基因检测和化学预防模块。 To begin, participants learn about risk by interacting with two games of experience-based risk interfaces, demonstrating average 5-year and lifetime breast cancer risk. We conducted four focus groups in English-speaking women (age ≥18 years), a questionnaire completed before and after interacting with the decision aid, and a semistructured group discussion. We employed a mixed-methods approach to assess accuracy of perceived breast cancer risk and acceptability of RealRisks. The qualitative analysis of the semistructured discussions assessed understanding of risk, risk models, and risk appropriate prevention strategies. Results: Among 34 participants, mean age was 53.4 years, 62{\%} (21/34) were Hispanic, and 41{\%} (14/34) demonstrated low numeracy. According to the Gail breast cancer risk assessment tool (BCRAT), the mean 5-year and lifetime breast cancer risk were 1.11{\%} (SD 0.77) and 7.46{\%} (SD 2.87), respectively. After interacting with RealRisks, the difference in perceived and estimated breast cancer risk according to BCRAT improved for 5-year risk (P=.008). In the qualitative analysis, we identified potential barriers to adopting risk-appropriate breast cancer prevention strategies, including uncertainty about breast cancer risk and risk models, distrust toward the health care system, and perception that risk assessment to pre-screen women for eligibility for genetic testing may be viewed as rationing access to care. Conclusions: In a multi-ethnic population, we demonstrated a significant improvement in accuracy of perceived breast cancer risk after exposure to RealRisks. However, we identified potential barriers that suggest that accurate risk perceptions will not suffice as the sole basis to support informed decision making and the acceptance of risk-appropriate prevention strategies. Findings will inform the iterative design of the RealRisks decision aid. ", issn="1438-8871", doi="10.2196/jmir.4028", url="//www.mybigtv.com/2015/7/e165/", url="https://doi.org/10.2196/jmir.4028", url="http://www.ncbi.nlm.nih.gov/pubmed/26175193" }