The long-term goals of this work are to optimize surveillance mammography use for older breast cancer
survivors and decrease overscreening for a group in critical need of evidence-based, unified approaches for
follow-up care. The proposed study will address significant knowledge gaps through expert consensus and
prospective data collection. This study will provide a framework for discussions on how/when to stop
mammography in older breast cancer survivors with limited life expectancy (who typically have a low risk for in-
breast recurrences with rates similar to that of screening populations) and how to optimally discuss life
expectancy with patients, with the goal to enhance communication between patients and clinicians as well as
between primary care clinicians (PCs) and specialists. In this unique, multilevel proposal, we will build on our
prior work to develop consensus on mammography and follow-up care for breast cancer survivors aged ?75 by
(a) refining expert-panel recommendations, (b) examining clinician and patient attitudes towards these
recommendations and discussing life expectancy, and (c) testing a communication tool to facilitate decision-
making, all through direct engagement of clinicians and patients.
In Aim 1, we will convene experts and patients to refine recommendations for mammography and
follow-up care for breast cancer survivors age ?75 and further develop and cognitively test a communication
tool that summarizes recommendations for clinicians and patients with a focus on how to comfortably include
conversations on life expectancy comfortably. We will then conduct 30 telephone-based patient interviews and
4-6 focus groups with oncologists and PCs to obtain their opinions about the communication tool, how to
communicate the benefits/risks of mammography, and optimal strategies for discussing life expectancy and
cessation of mammography and coordination of care. In Aim 2, we will test the communication tool with 45
older breast cancer survivors age ?75 and their oncologists using a pre-post intervention study. Here, we will
examine the feasibility and acceptability of the tool and the effect of using the tool on women's intentions for
mammography. We will also explore communication strategies across medical specialties. We hypothesize
that our communication tool will be feasible, acceptable for patients and providers, and lead to fewer women
intending to receive mammography in the next year. This study will provide preliminary data for a larger pilot
and eventual, prospective, randomized study, with the overarching goal to further assess impact, improve
coordination of care, and disseminate our novel and urgently needed intervention.
The goals of this study are undoubtedly in line with the missions set forth by the NIH and NCI to
address the research gaps in older patients. Further, with approximately 70,000 women age ?75 per year
diagnosed with breast cancer in the United States and a growing population of older breast cancer patients,
efforts to improve and equalize the quality of follow-up care we deliver will become increasingly important.
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