Enhancing At-risk Latina Women's Use of Genetic Counseling for Hereditary Breast and Ovarian Cancer

December 11, 2019 updated by: Georgetown University

Enhancing At-risk Latina Women's Use of Genetic Counseling for Hereditary Breast and Ovarian Cancer: Using Mental Models to Develop Culturally Targeted Media

Compared to non-Latina Whites, Latinas have a higher prevalence of BRCA1/2 gene mutations but lower use of genetic cancer risk assessments services (GCRA). This study will develop and assess the impact of a novel culturally targeted media intervention to improve psychosocial outcomes and GCRA use in Latinas at-risk of hereditary breast and ovarian cancer. If the intervention is proven to be effective in a future randomized controlled trial, the intervention can be disseminated to clinics and adapted to other ethnic groups.

Study Overview

Status

Completed

Conditions

Intervention / Treatment

Detailed Description

Breast cancer is the most diagnosed cancer for Latinas and is their leading cause of cancer death. Compared to non-Latina Whites, Latinas are diagnosed younger and with more advanced breast cancer. They also have the second highest prevalence of BRCA1 or BRCA2 gene mutations, that significantly increases their lifetime risk of developing hereditary breast and ovarian cancer (HBOC). The US Preventive Services Task Force recommends referral for genetic cancer risk assessments (genetic counseling and risk assessment as appropriate; GCRA) for women at high risk of carrying a mutation. GCRA informs treatment for survivors and risk management decisions in unaffected women. Latinas have lower GCRA use than Whites.

Explanations for Latinas' suboptimal GCRA participation include environmental (e.g. access) and psychosocial factors (e.g. low knowledge, emotions). There are numerous interventions to promote GCRA use in White populations and the mere handful of interventions that do target Latinas mostly consists of Mexicans or Puerto Ricans. Empirical evidence about successful strategies to improve GCRA uptake is lacking, especially from a growing population of Central/South American immigrants, a group with nuanced different barriers (e.g. social isolation). Our preliminary data suggests that improving access does not necessarily translate into higher GCRA uptake. Our data also highlighted providers' challenges in communicating GCRA risk information given the dearth of genetic materials in Spanish and Spanish-speaking genetic counselors. Media-based tools used to educate Latinas before GCRA are needed. This study will fill these gaps.

To be effective, risk HBOC communication interventions should be anchored within the needs and cultural values of their audience. This is because individuals process risk information in the context of "mental models" - one's intuitive beliefs based on personal experiences and shared cultural knowledge. Mental models influence the interpretation of new information. Often there is incongruence between lay and expert mental risk models that leads to miscommunication and uninformed decision-making. For example, among Latinas, the word "testing" led to the misconception that genetic testing would be repeated akin to other screening tests like mammography. Understanding Latinas' mental models will facilitate targeted risk communication to identify knowledge gaps and reduce misconceptions. Interventions that only address knowledge and/or beliefs may not enhance uptake, as risk information evokes emotional reactions that are often stronger predictors of behaviors than cognitive factors. Anticipated negative emotions to GCRA have been associated with lower uptake. Latinas report ambivalence towards GCRA that may impact their decisions. As most interventions have focused on knowledge and/or access, our study makes a considerable shift in the field by addressing mental models and targeting emotions.

This experienced multidisciplinary team will conduct a risk communication intervention designed to target mental models, emotions, and cultural values. Guided by the Theory of Planned Behavior and Social Cognitive Theory, the investigators will conduct a two-phased mixed methods study. In Phase I the investigators will interview key informants (n=10) and at-risk Latinas (n=20) to describe their mental models and other psychosocial factors. These data will inform the risk-benefit messages that will be evaluated in focus groups (n=20) and used to develop a YouTube-based intervention, which will be delivered via Latina actors and a trusted medical personality. In Phase II the investigators will pilot the intervention on at-risk Latinas (n=40). Participants will complete a baseline survey, watch the 15-minute video, complete a follow-up assessment, and be referred to a patient navigator for resources. The primary outcome is intentions to use GCRA. GCRA uptake will be assessed at 3-months. Specific aims are:

Aim 1. Describe and portray Latinas' GCRA mental models (e.g. risks and benefits perceptions).

Aim 2. Using data from Aim 1, develop the content of the risk-benefit communication messages for at-risk Latinas and incorporate these into a Spanish-language YouTube video.

Aim 3. Evaluate the acceptability and pre- and post-intervention differences on the primary outcome (intentions to use GCRA) and intermediate outcomes (e.g. attitudes). We will also explore post-intervention GCRA uptake as a secondary outcome. H.2.1. The intervention will result in a significant increase in intentions to use GCRA, and in H.2.2. improvements of intermediate outcomes: knowledge, attitudes, self-efficacy, and emotional ambivalence. H.2.3. After the intervention, 30% of Latinas will participate in GCRA by 3-months post-intervention. H.2.4. The majority (≥75%) will be satisfied with the intervention.

This study meets the Healthy People 2020 goals to enhance GCRA in at-risk populations, and the national priorities to increase diversity in genetics research participation and incorporate emotions into cancer research. Findings will inform new strategies for behavioral interventions targeting Latinas and a larger trial.

Study Type

Interventional

Enrollment (Actual)

88

Phase

  • Not Applicable

Contacts and Locations

This section provides the contact details for those conducting the study, and information on where this study is being conducted.

Study Locations

  • United States
    • District of Columbia
      • Washington, District of Columbia, United States, 20003
        • Capital Breast Care Center
    • Virginia
      • Alexandria, Virginia, United States, 22314
        • Nueva Vida

Participation Criteria

Researchers look for people who fit a certain description, called eligibility criteria. Some examples of these criteria are a person's general health condition or prior treatments.

Eligibility Criteria

Ages Eligible for Study

21 years and older (Adult, Older Adult)

Accepts Healthy Volunteers

Yes

Genders Eligible for Study

Female

Description

Inclusion Criteria:

  • self-identify as Latino/Hispanic, >21 years of age, and are at high risk of carrying a HBOC mutation using personal and family cancer histories based on the National Comprehensive Cancer Network

Exclusion Criteria:

  • not having the cognitive ability to provide informed consent

Study Plan

This section provides details of the study plan, including how the study is designed and what the study is measuring.

How is the study designed?

Design Details

  • Primary Purpose: Screening
  • Allocation: N/A
  • Interventional Model: Single Group Assignment
  • Masking: None (Open Label)

Arms and Interventions

Participant Group / Arm
Intervention / Treatment
Other: YouTube Video
Participants will watch a 15-minute YouTube video. The video will provide information about hereditary breast and ovarian cancer and about the process of genetic counseling and testing.
Behavioral: Genetic Counseling and Testing YouTube Video
Participants (n=40) will watch a 15-minute YouTube video that will describe the genetic counseling and testing process and risk/benefit information in a telenovela style format. Participants will complete pre- and post-assessments. After the session, participants interested in pursuing genetic counseling and testing services will be referred to the patient navigator at their respective sites, who will navigate participants to identified no cost or low cost services

What is the study measuring?

Primary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Genetic counseling uptake
Time Frame: three months post-intervention
Participation in genetic counseling services
three months post-intervention

Secondary Outcome Measures

Outcome Measure
Measure Description
Time Frame
Intentions Scale
Time Frame: within one hour before the intervention and within one hour post-intervention
Intentions to use genetic counseling services
within one hour before the intervention and within one hour post-intervention
Knowledge Scale
Time Frame: within one hour before the intervention and within one hour post-intervention
Knowledge about hereditary breast and ovarian cancer
within one hour before the intervention and within one hour post-intervention
Attitudes Scale
Time Frame: within one hour before the intervention and within one hour post-intervention
Attitudes about participating in genetic counseling services
within one hour before the intervention and within one hour post-intervention
Self-efficacy Scale
Time Frame: within one hour before the intervention and within one hour post-intervention
Self-efficacy in participating in genetic counseling services
within one hour before the intervention and within one hour post-intervention
emotional ambivalence Scale
Time Frame: within one hour before the intervention and within one hour post-intervention
emotional ambivalence about participating in genetic counseling services
within one hour before the intervention and within one hour post-intervention

Collaborators and Investigators

This is where you will find people and organizations involved with this study.

Sponsor

Georgetown University

Publications and helpful links

The person responsible for entering information about the study voluntarily provides these publications. These may be about anything related to the study.

General Publications

Study record dates

These dates track the progress of study record and summary results submissions to ClinicalTrials.gov. Study records and reported results are reviewed by the National Library of Medicine (NLM) to make sure they meet specific quality control standards before being posted on the public website.

Study Major Dates

Study Start (Actual)

May 24, 2016

Primary Completion (Actual)

November 15, 2019

Study Completion (Actual)

November 15, 2019

Study Registration Dates

First Submitted

February 22, 2017

First Submitted That Met QC Criteria

March 6, 2017

First Posted (Actual)

March 9, 2017

Study Record Updates

Last Update Posted (Actual)

December 12, 2019

Last Update Submitted That Met QC Criteria

December 11, 2019

Last Verified

September 1, 2019

More Information

Terms related to this study

Keywords

Additional Relevant MeSH Terms

Other Study ID Numbers

  • ADeMendoza

Plan for Individual participant data (IPD)

Plan to Share Individual Participant Data (IPD)?

NO

Drug and device information, study documents

Studies a U.S. FDA-regulated drug product

No

Studies a U.S. FDA-regulated device product

No

This information was retrieved directly from the website clinicaltrials.gov without any changes. If you have any requests to change, remove or update your study details, please contact register@clinicaltrials.gov. As soon as a change is implemented on clinicaltrials.gov, this will be updated automatically on our website as well.

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