Sheppard, Vanessa B. | Health Behavior and Policy | Virginia Commonwealth University

Testing an Intelligent Tutoring System Intervention to Enhance Genetic Risk Assessment in Underserved Blacks and Latinas at Risk of Hereditary Breast Cancer

Principal Investigator: Vanessa B. Sheppard, Ph.D.

Funding source: NIH / Georgetown University

Grant No. R21NR016905

Abstract BRCA1/2 mutation carriers are at higher risk of developing breast and ovarian cancer (HBOC). Breast cancer survivors with a BRCA1/2 mutation are at higher risk of developing contralateral breast cancer. Genetic cancer risk assessments (GCRA) for HBOC can inform prevention and treatment decisions. Despite guidelines to refer women at risk of carrying a mutation to GCRA, Latina and Black women underuse these services. Reasons for low GCRA use include access and psychosocial factors (e.g. low knowledge). Our preliminary data with at-risk Black and Latina women suggests that improving access does not necessarily translate into higher GCRA uptake. Theoretically guided interventions that support GCRA uptake in underserved populations are needed. Fuzzy Trace Theory posits that people tend to construct gist representations that capture the essential bottom-line meaning of the risk information, including the emotional experience. However, most interventions tend to prioritize quantitative risk communication and do not often consider emotional aspects, despite evidence that emotions influence risk perceptions. BRCA-gist is an Intelligent Tutoring System intervention informed by Fuzzy Trace Theory that uses avatars to emulate tailored one-to-one human tutoring and includes the HBOC risk messages’ bottom-line meaning. The preliminary efficacy of BRCA-gist has been established in a non-clinical sample of mostly White college students but has not been tested in at-risk women. This study aims to adapt BRCA-gist and test its feasibility, acceptability, and efficacy in a sample of at-risk Black and Latina women. In Aim 1 we will gather input from providers (n=10) about adaptations for implementation in clinical settings and from at-risk Latina and Black women (n=20) about cultural adaptations. In Aim 2 we will randomize at-risk Black and Latina women to BRCA-gist (n=50) or NCI Web arms (n=50). Participants will complete a baseline and a post- intervention assessment. A research assistant will refer them to local free genetic counseling services. Our primary outcome is GCRA uptake at 3 months. Aim 1: Adapt BRCA-gist. Providers and at-risk Black and Latina women will do the BRCA-gist intervention and provide suggestions to make cultural adaptations to implement BRCA-gist in community/clinic settings. Aim 2: Test the feasibility, acceptability, and efficacy of BRCA-gist intervention in a two-arm RCT. We expect high overall retention (≥75%) and high satisfaction among women in the BRCA-gist arm (≥75%) (H.2.1., H.2.2). H.2.3. Participants in the BRCA-gist arm (vs. NCI Web) will have a higher uptake of GCRA services 3 months post intervention. H.2.4. Participants in the BRCA-gist arm (vs. NCI Web) will have a greater increase in knowledge, gist comprehension, and GCRA intentions. We will explore differences by ethnicity and health literacy and assess emotional reactions to risk information to inform future affective-tailored interventions. If successful, BRCA-gist can be tested in larger samples and could constitute a scalable inexpensive intervention with promising translational applications and potential to reduce disparities.

Minority Based NCI Community Oncology Research Program

Principal Investigator: Vanessa Sheppard, Ph.D.

Funding Source: National Cancer Institute Grant No. 1UG1CA189869-01

Massey Cancer Center (MCC) will serve as the primary component site for an NCORP Minority/Underserved Community Site award in partnership with nine collaborating community component sites. The overall objectives of this partnership are to extend novel, innovative, and effective minority recruitment approaches to an expanded base of community component sites, increase opportunities for minority and medically underserved individuals to participate in Cancer Clinical Trial Research (CCTR), and to integrate Cancer Care Delivery Research (CCDR) into the overall MB-NCORP. Accordingly, the specific aims of this proposal are to (1) establish a research infrastructure that will further enable community component sites to conduct CCTR with an emphasis on trials relevant to minority and medically underserved populations, (2) conduct NCI-approved CCTR at the MCC primary component site and throughout the community component sites, and (3) integrate Cancer Care Delivery Research (CCDR) into the overall MB-NCORP.

The research design of the MB-NCORP offers a full menu of cancer studies including those in cancer prevention and control, screening, treatment, imaging, and CCDR. The proposed research is relevant to the mission of the NCI as MCC and the community component sites will bring cancer clinical trials and research to low-income, minority, and medically underserved individuals who otherwise would not have access to such studies. These studies will address many diverse factors from patient, provider, organizational, and policy perspectives that contribute to known disparities in cancer detection, treatment, and outcomes. Targeting the minority/underserved populations in their communities is a critical step toward alleviating the cancer care disparities prevalent in these populations.