103 Background: Pts with mCRPC have multiple treatment options and face challenges to IDM. This leads some to make poorly informed or goal-discordant decisions. Consultation audio recordings are known to improve IDM by improving recall, but uptake has been limited. It is unclear whether pt-administered apps are an effective, feasible strategy to increase access to recordings and improve IDM. Methods: We conducted a single-site implementation trial. Pts were English-speaking with progressive mCRPC and an upcoming oncology visit in which treatment options including docetaxel would be discussed. Pre-visit, a coordinator sent instructions, provided coaching, and sent text reminders to help pts create recordings using their mobile device. To evaluate change in IDM pre- vs post- the audio-recorded visit, we used an investigator-developed questionnaire testing pt knowledge about docetaxel (19 items, 0-100% correct) and the decisional conflict scale-informed subscale (3 items, 0=feels extremely uninformed to 100=feels extremely informed). Change was evaluated using the Wilcoxon signed-rank test. We also measured implementation: rates of consent, instruction receipt, recording, and listening, as well as pt-reported helpfulness of the app in decision-making. Lastly, we interviewed pts to understand benefits, barriers, and facilitators. Results: Of 78 pts approached, 44 (56%) consented, and 41 (53%) were evaluable. Top reasons for not consenting were too busy (7, 21%), illness (5, 15%), and inadequate devices (4, 12%). Mean age was 75y [56-90], and 34 (83%) were White. Median knowledge about docetaxel increased from 47 to 53 (P=0.048), corresponding to one additional correct response. Median informed subscore increased from 50 to 75 (P=0.011), corresponding to an improvement from feeling neither informed nor uninformed to feeling informed. All pts received instructions, 38 (93%) recorded their visits, and 28 (68%) listened to the recording. Twenty-six pts (63%) found the app helpful in decision-making. In pt interviews, benefits of recording were better recall of treatment options and toxicities, greater decision confidence, and peace of mind. Most frequently reported barriers to use were technology unfamiliarity and disconnected pt portal, telehealth, and recording applications; facilitators were app simplicity and caregiver/coordinator assistance. Conclusions: Implementation of self-administered mobilerecordings was feasible and associated with increased pt knowledge and feeling more informed about treatment with docetaxel in pts with mCRPC. Future efforts should focus on non-White, no/limited-English-speaking populations, and increasing recording/listening rates by addressing barriers and augmenting facilitators (e.g., integrating recordings in electronic pt portals). Clinical trial information: NCT05127850 .

5105 Background: To tailor care to cancer biology, oncologists offer germline testing to patients with APC. Little is known about whether pre-test counseling conducted by oncologists leads to well-informed, preference-concordant decisions in Veterans with APC. Methods: We conducted a prospective mixed-methods study of consecutive patients with APC who were offered germline testing at an oncology visit at the San Francisco VA. Seven days after the visit, patients were administered the Decisional Conflict Scale (DCS; 16 items scored 0-100, higher = more decisional conflict) and a True/False knowledge test (20 items, scored 0-100% correct). We conducted semi-structured interviews using a theory-informed guide to explore patients’ knowledge, decision-making process, and decisional needs for germline testing. Two coders analyzed the interviews using thematic analysis. Results: Of 68 patients approached, 31 (46%) consented. Mean age was 76y, 21 (68%) were White, and 14 (45%) completed at least college. Mean DCS score was 24 (SD 22); six (19%) patients scored >37.5, which is associated with decision delay. Mean knowledge score was 69% (SD 16); four patients scored < 50%. Patients were least knowledgeable about the results disclosure process (37% correct), presence of privacy laws protecting genetics data (50%), types of test results (50%), and implications of a variant of uncertain significance (50%). Twenty-seven patients (87%) desired germline testing. The most common reasons were to help family and advance research; personal treatment benefits were rarely mentioned. Patients felt the decision was easy, but four experienced uncertainty and decided against testing due to fear of losing service-connected disability benefits. Themes included knowledge deficits about testing benefits/risks, results disclosure process, and impact on disability insurance; presence or absence of autonomy; misconceptions (commercialization or weaponization of genetics data, conflating germline testing and research); disparities due to racial discrimination or homelessness; barriers (poor memory, distress from APC, insufficient details about testing from oncologist, and no access to informational resources); and facilitators (trust in oncologist and the VA, family support, and extra time to make a decision). Patients requested a variable degree of decision support prior to germline testing, ranging from none to a combination of informational materials and coaching. Conclusions: Decisional conflict was low in most but not all patients. Patients’ knowledge deficits, misconceptions, and unawareness of choice due to personal, oncologist, and systemic barriers suggest some did not make informed decisions. To deliver patient-centered oncologist-directed germline testing, future research should focus on developing and implementing decision support personalized to patients’ needs.

71 Background: In a quest to tailor care to tumor biology, oncologists now offer germline testing to all patients with APC. We explored the degree to which germline testing decisions reflect patient preferences about potential benefits and harms discussed by oncologists. Methods: We conducted a prospective qualitative study of consecutive patients with APC who were offered germline testing at an oncology visit at the San Francisco VA. We audio-recorded visits and conducted semi-structured interviews using a theory-informed guide with patients after their visit to understand their decision-making process for germline testing. We analyzed the interviews using the Critical Incident Technique to identify positive or negative deviations from well-informed, preference-based decisions. We also reviewed consent documentation in the electronic health record. Results: Of 61 patients approached, 30 completed interviews after their germline testing discussion. Mean age was 75y; 19 (63%) were White, 9 (30%) Black, and 2 (6%) Other race; and 13 (43%) were service-connected for APC. Twenty-six (87%) patients consented to germline testing; the primary reasons were altruistic (to help family and contribute to knowledge). Four patients (13%) declined testing, all primarily due to the fear of potential loss or reduction of service-connected benefits. All four patients reported they would reconsider testing if assured that these benefits would be protected regardless of test results. Of the four patients, two had initially consented to testing with their oncologist but later changed their minds and did not notify anyone. The two patients received germline testing when they underwent PSA testing, but they were not aware that they had germline testing performed. Both had negative test results, and they therefore did not experience threats to their service-connected benefits. Conclusions: Some Veterans with service-connected benefits for APC decline germline testing due to the fear of potential loss or reduction of these benefits, thereby foregoing potential treatment benefits. An advisory board is working with the Veterans Benefits Administration to protect service-connected benefits for these Veterans. In addition, a few Veterans may agree to germline testing with their oncologist, but then change their minds due to concerns surrounding service-connected benefits. From a quality improvement perspective, the experiences of the patients in this study who changed their minds counts as a near-miss. Although uptake of germline testing was high in this cohort, current workflows may need to be addressed to account for a change of heart, and further research is needed to understand root causes and identify possible remedies of the near-misses. Overall, our findings illustrate the importance of informed consent for germline testing to ensure that results are desired and valued by both oncologist and patient.

ABSTRACT Introduction Consultation audio recordings improve patient decision‐making but are underutilized. Patient‐administered recording apps on mobile devices may increase access, but implementation has not been evaluated. Methods We conducted a single‐arm study delivering education, coaching, and reminders for patients to record their appointment using a mobile recording app. Patients had progressive, advanced prostate cancer and an upcoming appointment where the option of docetaxel would be discussed. We used the RE‐AIM framework for evaluation. Reach was the proportion of patients who participated. Effectiveness was change in informed decision‐making pre‐ vs. post‐appointment. We used a questionnaire evaluating patient knowledge about docetaxel (0%–100% correct) and the decisional conflict scale‐informed subscale (0 = feels extremely uninformed to 100 = extremely informed) to compare means using the paired t‐test. Adoption was the proportion of providers agreeing to be recorded. Implementation was coordinator adherence to intervention delivery. We conducted semistructured interviews with patients, caregivers, and providers to assess barriers, facilitators, and suggestions for recording implementation. Results Of 102 patients approached, 50 (49%) patients participated. Mean age was 75 years, 38 (76%) were Non‐Hispanic White, and 43 (86%) had telehealth appointments. Knowledge increased from 44.7% to 49.5% (p = 0.019), particularly about palliative care (42% answering correctly to 60%, p = 0.035). Decisional conflict‐informed subscale increased from 48.9 to 70.9 (p < 0.001). Forty‐three patients (85%) made a recording, of whom 33 (77%) reported the recording helped treatment decision‐making. All 17 providers agreed to be recorded. Coordinator adherence was high. Multi‐level barriers, suggestions, and facilitators mostly related to intervention complexity and stakeholder compatibility. Conclusion Patient‐administered audio recordings had a positive effect on decision‐making, particularly for palliative care awareness. For broader implementation, efforts should focus on revising institutional policies; teaching patients or caregivers to use existing recording functions on their devices; leveraging artificial intelligence for transcription and summarization; and integrating recording into telehealth technology and electronic patient portals. Trial Registration: https://clinicaltrials.gov/study/NCT05127850

To better understand Veterans' decisions about germline testing, we conducted a single-site, qualitative study of 32 Veterans with advanced prostate cancer. Seven days after oncologist-patient discussions about germline testing, we conducted semi-structured interviews with patients exploring their decision-making process using an interview guide. Four of 14 Veterans with service-connected disability benefits for prostate cancer declined germline testing for fear of losing benefits, as their livelihood depended on these benefits. All 18 Veterans without service-connected benefits agreed to testing. Veterans declining germline testing for this concern can lead to suboptimal cancer care because targeted treatments that could improve their outcomes may go unrecognized. Our findings contributed to new language in the Veterans Benefits Administration Compensation and Pension Manual clarifying that genetic testing showing hereditary predisposition is insufficient to deny service-connected benefits for conditions presumed to be caused by military exposures. Clinicians should communicate this protection when counseling Veterans about genetic testing.

Veteran access to sleep medicine is of paramount importance to the Veterans Health Administration (VA). To increase access, VA has created community referral policies and programs, as well as telehealth programs. In 2017, the Office of Rural Health (ORH) funded a TeleSleep initiative focused on reaching rural Veterans with unmet sleep needs. ORH provided 3–6 years of funding to help 19 hubs support 98 spoke sites serving rural Veterans. As ORH funding concluded, each hub identified its path to sustainment. This case study follows one TeleSleep hub in VA's western geographic region as it transitioned from ORH funding sustainment as a regional Sleep Clinical Resource Hub. This case study describes the real-world process of adaptation in care delivery strategies. One key area of adaptation revolved around whether to deliver care via the patient's home facility or the provider's home facility. In early 2021, the TeleSleep team implemented an innovative provider transfer model, where temporary reinforcements from the TeleSleep hub increased the workforce capacity of spoke sites, similar to the concept of locum tenens. In this provider transfer model, TeleSleep clinicians scheduled, documented, and billed for each encounter at the Veteran's home facility. Positioning TeleSleep clinicians as local providers facilitated communication and referrals and promoted continuity and quality of care for Veterans in their home facility. This provider transfer model reduced the administrative burden of providers and schedulers and supported patient-side-only documentation of care. While this mirrors current locum tenens practice, transferring providers did not fit VA's financial model as implemented by the western region's Sleep Clinical Resource Hub. Therefore, in December 2021, VA aligned TeleSleep with VA's preferred practice of patient rather than provider transfers. In the patient transfer model, providers schedule and document in both the provider and patient electronic health records, and bill in the provider's facility. However, reflecting on this period of innovation, TeleSleep team members concluded that the provider transfer model could improve patient safety and care coordination while reducing the administrative burden of frontline clinicians. Further research and development are needed to align the provider transfer model with VA's financial model.

Breast cancer risk reduction strategies have been well-validated, but barriers remain for high-risk individuals to adopt them. We performed a study among participants with high risk of breast cancer to validate whether a virtual breast health decision tool impacted a participant’s willingness to start risk-reducing activities, identify barriers to adopting these strategies, and understand if it affects breast cancer anxiety. The study sample was 318 participants in the personalized (investigational) arm of the Women Informed to Screen Depending on Measures of risk (WISDOM) clinical trial. After reviewing the tool, these participants completed a feedback survey. We demonstrated that 15 (4.7%) women were taking endocrine risk reduction, 123 (38.7%) were reducing alcohol intake, and 199 (62.6%) were exercising. In the three-month follow-up survey of 109 respondents, only 8 of 61 (13.1%) women who considered endocrine risk reduction pursued it. In contrast, 11 of 16 (68%) participants who considered alcohol reduction pursued the activity, and 14 of 24 (58%) women who considered exercise followed through. Participants listed fear of side effects as the most common barrier to endocrine risk reduction. We also present further steps to be taken to improve the effectiveness of the Breast Health Decisions tool.

BackgroundIn fiscal year 2021, the Veterans Health Administration (VHA) provided care for sleep disorders to 599,966 Veterans, including 189,932 rural Veterans. To further improve rural access, the VA Office of Rural Health developed the TeleSleep Enterprise-Wide Initiative (EWI). TeleSleep's telemedicine strategies include tests for sleep apnea at the Veteran's home rather than in a sleep lab; Clinical Video Telehealth applications; and other forms of virtual care. In 2017 and 2020, VHA provided 3-year start-up funding to launch new TeleSleep programs at rural-serving VA medical facilities.MethodsIn early 2022, we surveyed leaders of 24 sites that received TeleSleep funding to identify successes, failures, facilitators, and barriers relevant to sustaining TeleSleep implementations upon expiration of startup funding. We tabulated frequencies on the multiple choice questions in the survey, and, using the survey's critical incident framework, summarized the responses to open-ended questions. TeleSleep program leaders discussed the responses and synthesized recommendations for improvement.Results18 sites reported sustainment, while six were “on track.” Sustainment involved medical centers or regional entities incorporating TeleSleep into their budgets. Facilitators included: demonstrating value; aligning with local priorities; and collaborating with spoke sites serving rural Veterans. Barriers included: misalignment with local priorities; and hiring delays. COVID was a facilitator, as it stimulated adoption of telehealth practices; and also a barrier, as it consumed attention and resources. Recommendations included: longer startup funding; dedicated funding for human resources to accelerate hiring; funders communicating with local facility leaders regarding how TeleSleep aligns with organizational priorities; hiring into job classifications aligned with market pay; and obtaining, from finance departments, projections and outcomes for the return on investment in TeleSleep.

OBJECTIVE:Interventions to support patients' engagement in shared decision making (SDM) are lacking within high-grade glioma (HGG) healthcare. Consultation Planning, Recording and Summarising (CPRS) has shown evidence of increasing patient decision self-efficacy, reducing uncertainty, and regret of decisions. This is the first study of CPRS within a HGG population and delivered over serial medical consultations.METHOD:A one-arm prospective qualitative longitudinal design was used to evaluate the CPRS intervention and evaluated with participants at sequential clinic appointments depending on their care, in Edinburgh, Scotland. We report on serial semi structured interviews of 16 patients and their partners.RESULTS:Consultation planning before the consultation supported patients to feel known by strengthening the patient voice within the consultation. It prepared patients to actively participate in the consultation, despite the distressing nature of the content. Recording and summarising supported patients to understand their situation. The provision of a consultation record enabled accurate recall, a paced uptake of information and supported the family to feel fully informed. Ultimately, patients understood why decisions were being made rather than being part of making decisions.CONCLUSIONS:The CPRS intervention helped patients to understand and to feel known by increasing patient capacity for communication in the consultation, with support before, during, and after the consultation. The intervention focused on preparing patients for SDM but patients did not perceive that they had meaningful choices to make. Further research could look at the inclusion of patient decision aids to support this process.

This case study describes, for the time frame of June 2021 through August 2022, the U.S. Veterans Health Administration (VHA) organizational response to a manufacturer's recall of positive airway pressure devices used in the treatment of sleep disordered breathing. VHA estimated it could take over a year for Veterans to receive replacement devices. Veterans awaiting a replacement faced a dilemma. They could continue using the recalled devices and bear the product safety risks that led to the recall, or they could stop using them and bear the risks of untreated sleep disordered breathing. Using a program monitoring approach, we report on the processes VHA put in place to respond to the recall. Specifically, we report on the strategic, service, and operational plans associated with VHA's response to the recall for Veterans needing replacement devices. In program monitoring, the strategic plan reflects the internal process objectives for the program. The service plan articulates how the delivery of services will intersect the customer journey. The operational plan describes how the program's resources and actions must support the service delivery plan. VHA's strategic plan featured a clinician-led, as opposed to primarily legal or administrative response to the recall. The recall response team also engaged with VHA's medical ethics service to articulate an ethical framework guiding the allocation of replacement devices under conditions of scarcity. This framework proposed allocating scarce devices to Veterans according to their clinical need. The service plan invited Veterans to schedule visits with sleep providers who could assess their clinical need and counsel them accordingly. The operational plan distributed devices according to clinical need as they became available. Monitoring our program processes in real time helped VHA launch and adapt its response to a recall affecting more than 700,000 Veterans.

IntroductionA single-arm pre-post pilot study in an academic setting found that pre-consultation decision support was associated with improved patient knowledge among men with early-stage prostate cancer. We now report on exploratory analyses from a controlled study featuring patients from both academic and community settings.MethodsWe enrolled 58 men to usual care and 61 men to the intervention. We evaluated whether the intervention was associated with patients answering key knowledge items correctly just before their urology visit.ResultsJust prior to the urology visit, 39/56 or 70% in the intervention group replied correctly to key knowledge items, compared to 31/55 or 56% in the usual care group (p=0.15). At baseline, the intervention group started with 42/60 or 70% correct and the usual care group started with 28/56 or 50% (p=0.03). This imbalance at baseline created a ceiling effect: more men in the usual care group had room to improve on their knowledge scores. Indeed, seven men moved from incorrect to correct in the usual care group, versus 5 in the intervention group; and five men in the intervention group moved from correct to incorrect versus 3 in the usual care group (p=0.44).DiscussionIn addition to small sample size, reasons for the null findings may include clustering of highly educated participants at the academic site combined with over-representation of academic site participants in the intervention group. We confirmed, from the pilot study, the feasibility of using pre-health student interns as health coaches. Future research should explore whether increasing adoption of telehealth will improve the feasibility of delivering pre-visit decision support in community settings.

We performed a 318-participant validation study of an individualized risk assessment tool in women identified as having high- or highest-risk of breast cancer in the personalized arm of the Women Informed to Screen Depending on Measures of risk (WISDOM) trial. Per protocol, these women were educated about their risk and risk reducing options using the Breast Health Decisions (BHD) tool, which uses patient-friendly visuals and 8th grade reading level language to convey risk and prevention options. Prior to exposure to the educational tool, 4.7% of women were already taking endocrine risk reduction, 38.7% were reducing alcohol intake, and 62.6% were exercising. Three months after initial use of BHD, 8.4% of women who considered endocrine risk reduction, 33% of women who considered alcohol reduction, and 46% of women who considered exercise pursued the risk-reducing activities. Unlike lifestyle interventions which are under the control of the patient, additional barriers at the level of the healthcare provider may be impeding the targeted use of endocrine risk reduction medications in women with elevated breast cancer risk.

PURPOSE: Men with metastatic castration-resistant prostate cancer increasingly encounter complex treatment decisions. Consultation audio recordings and summaries promote patient informed decision making but are underutilized. Mobile recording software applications may increase access. Little is known regarding the feasibility of implementation in clinical encounters. METHODS: We conducted a mixed-methods pilot study in men with progressive metastatic castration-resistant prostate cancer. We instructed patients to use a mobile software application to record an oncology visit. Patients could share the recording with our patient scribing program to receive a written summary. We assessed feasibility and acceptability with postvisit surveys. We measured patient-reported helpfulness of the intervention in decision making and change in Decisional Conflict Scale–informed subscale. We conducted semistructured interviews to explore implementation and analyzed transcripts using thematic analysis. RESULTS: Across 20 patients, 18 (90%) recorded their visits. Thirteen of 18 (72%) listened to the recording, and 14 of 18 (78%) received a summary. Eighteen of 20 (90%) visits were telehealth. Fourteen patients (70% of all 20; 78% of 18 question respondents) found the application easy to use. Nine patients (50% of 18 recording patients; 90% of 10 question respondents) reported that the recording helped treatment decision making. Decisional conflict decreased from baseline to 1-week postvisit (47.4-28.5, P < .001). Interviews revealed benefits, facilitators, contextual factors, and technology and patient-related barriers to recordings and summaries. CONCLUSION: In this single-institution academic setting, a mobile application for patients to record consultations was a feasible, acceptable, and potentially valued intervention that improved decision making in the telehealth setting. Studies in larger, diverse populations are needed.

Abstract Introduction A nurse navigator is a registered nurse who serves as a patient advocate, educator, and coordinator for newly referred cancer patients. Nurse navigators assist with the coordination of care before a patient’s first appointment with their provider. In some healthcare centers, they are also the point-person throughout a patient’s entire treatment process. The nurse navigator role is designed to promote cancer patient empowerment through advocacy, educational support, resource navigation, and psychosocial care. Our study attempted to assess the impact of a newly implemented nurse navigator program, in an academic setting, and measure the effect on patient knowledge, care coordination, and emotional well-being before their breast oncology appointment. Methods A mixed-methods approach was implemented. We provided an Institutional Review Board-approved 9-question survey created from items adapted from Patient Satisfaction with Interpersonal Relationship with Navigators (PSN-I) to UCSF Breast Care Center patients before their first appointments with a breast oncology provider. After survey completion, patients were asked to participate in an open-ended interview about their patient experience with a member of the study team. Results 50 patients were surveyed. 22 (44%) patients surveyed had nurse contact and 28 (56%) did not have prior nurse contact before their appointment. With regards to patient knowledge prior to the oncology appointment, 16 out of 22 (73%) of patients with nurse contact felt informed compared to 16 out of 28 (57%) of patients without nurse contact. With regards to having initial questions answered before their visit, 11 out of 22 (50%) of patients with nurse contact strongly agreed compared to 4 out of 28 (14.3%) of patients without nurse contact. In response to the statement, “my care is coordinated effectively in the Breast Care Center,” 15 out of 22 (68%) of patients with nurse contact strongly agreed compared to 12 out of 28 (43%) of patients without nurse contact. Patients with nurse contact were asked whether speaking with a nurse did 1) improve their patient experience and 2) better deal with stressful emotions. Among 22 patients with nurse contact, 16 (73%) of patients with nurse contact strongly agreed to statement 1, and 20 (91%) agreed with statement 2. Patients without nurse contact were asked to predict whether nurse contact would 1) improve their patient experience and 2) better deal with stressful emotions. Out of 28 patients, 14 (50%) strongly agreed to both statements. From our open-ended interviews, we found the following themes: appreciation for preliminary knowledge, identification of knowledge gaps, appointment scheduling, and insurance coverage barriers, and humanistic care from nurse navigators. Patients reported that they appreciate not only a nurse navigator’s facilitation in coordination and education but also their companionship during their cancer journey. Conclusions Nurse navigators can play a vital role in improving patient knowledge, workflow/care coordination, and emotional well-being at cancer centers. A greater proportion of patients with initial nurse contact felt informed before their appointment and believed their care was effectively coordinated than those without nurse contact. The majority of patients with nurse contact believed their nurses improved their patient experience and relieved anxiety and stress. Based on this study, we will fully implement initial contact with patients to provide information and coordinate services for in-person visits. Given the changes brought by COVID, that first contact could also be with a nurse or physician via video consult prior to an in-person appointment. Future studies should investigate the impact of a longitudinal nurse navigator in providing continuity of care beyond the first referral. Citation Format: Tianyi Wang, Yash Huilgol, Jennifer James, Jeff Belkora, Janet Black, Carrie D'Andrea, Laura Esserman. Nurse navigation in the ambulatory oncology clinic: Patient-centered findings from a survey of 50 breast cancer patients [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS9-17.

BACKGROUND Research indicates that nurse navigators can play key roles in promoting empowerment for patients with cancer through advocacy, educational support, resource navigation, and psychosocial care. OBJECTIVES This study attempted to elucidate the efficacy of nurse navigation in patient knowledge, care coordination, and well-being before a breast oncology appointment. METHODS Staff provided a nine-question survey to 50 newly referred patients before their initial appointment. After survey completion, patients had the option to participate in an open-ended interview about their experience. FINDINGS A greater proportion of patients with initial nurse navigation than those without felt informed before their appointment and thought that their care was effectively coordinated. Although some patients without nurse navigation experienced delays and confusion in scheduling their appointment, no patients with nurse navigators reported such issues.

Undergraduate students often seek summer or academic-year internships as part of their academic and professional development. This case report illustrates a systematic self-marketing approach to generating internship opportunities, based on the theory of diffusion of innovations, and insights from the field of relationship marketing. Steps in the process for obtaining job or internship offers include: identifying areas of desired contribution; enlisting allies; identifying role models; interviewing role models; and demonstrating your value and joining the team. This case report illustrates how one student followed these steps to generate an internship opportunity. Overall, relationship marketing skills can help students improve their career prospects. Diverse students from under-resourced backgrounds may face barriers to accessing allies and role models. Such students should seek out pipeline programs that provide mentoring and other connections. These programs will improve student ability to engage in relationship marketing by expanding their network of allies, role models, and mentors. Employers should also identify pipeline programs and partner with them to assure greater inclusion of students from under-resourced backgrounds in their internship programs.

Abstract BackgroundOptions for breast cancer risk reduction include endocrine medications (tamoxifen, raloxifene, aromatase inhibitors) and lifestyle modifications (increasing exercise, reducing BMI, or alcohol intake). At present, there are limited patient-facing resources that provide information on personalized risk and prevention strategies. To address this unmet need, the Breast Health Decisions (BHD) Tool was designed to educate and empower women in the WISDOM (Women Informed to Screen Depending on Measures of risk) Study, a preference-tolerant randomized control trial comparing personalized risk-based screening to traditional annual screening. The tool supports Aim 4 of the WISDOM Study: test whether risk-based screening, including individualized risk assessment and targeted risk reduction education for those in the top 2.5% risk, enables higher uptake of preventive interventions. We conducted a study of the first 100 participants counseled using the BHD Tool to assess its impact on risk-reduction strategies. MethodsThe BHD Tool, built on the Salesforce platform, integrates WISDOM Study risk assessments to generate personalized education about risk and risk reduction, using concise wording, 8th-grade reading level or lower, and visual representations to support shared decision making for high-risk women. Changes to improve usability were incorporated from an initial pilot study. The study population was WISDOM Study participants in the top 2.5% 5-year risk by age, excluding mutation carriers. 5-year risk was calculated using the Breast Cancer Surveillance Consortium risk modified by a polygenic risk score. The tool was available through the participants’ online study portals. Study staff contacted these participants to schedule consultations via Zoom with a WISDOM Breast Health Specialist, who navigated the participant through the tool during an interactive 45-minute consultation. Participants could decline the consultation and use the tool independently. A survey was conducted afterward to assess the tool’s utility in motivating women to pursue risk-reducing options. ResultsWe surveyed 100 high-risk participants who used the BHD Tool. 65% found it very helpful in understanding their breast cancer risk. 27 participants listed additional lifestyle improvements that they were practicing or hoping to begin, including yoga, walking, breast exams, self-exams, yard work, dietary improvements, meditation, and stress reduction. 37% of participants agreed that the tool eased their breast cancer worries and anxiety, while 44% were neutral and 17% disagreed. At the time of presentation, we will present 3-month follow up data and report which preventive actions were actually taken and barriers encountered. ConclusionsThe BHD Tool synthesizes up-to-date chemoprevention literature in a patient-friendly interface to help educate women about their prevention options and to facilitate future discussions with a provider to empower informed decisions. Data from the first 100 high-risk women who used this tool suggest that the majority of women presented with information about their risk are interested in reducing it. More are considering lifestyle measures than medications. The BHD tool will be made available to all women in the personalized arm of the WISDOM Study. Future improvements include making the tool accessible to clinicians who counsel high-risk women. Survey questionNumber of participants (N=100)Interested in reducing chance of developing breast cancer97Currently participating in a breast cancer risk reducing activity*77Reducing alcohol intake35Losing weight60Increasing exercise27Risk reducing medications5Considering participating in a breast cancer risk reducing activity*72Reducing alcohol intake12Losing weight26Increasing exercise24Risk reducing medications22*Participants can choose more than one risk-reducing activity Citation Format: Tianyi Wang, Mandy Che, Yash Huilgol, Deborah Goodman, Holly Keane, Vivian Lee, Jeff Belkora, Allison Fiscalini, Laura Esserman. Validation study results for a personalized prevention education aid in breast cancer risk reduction [abstract]. In: Proceedings of the 2020 San Antonio Breast Cancer Virtual Symposium; 2020 Dec 8-11; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2021;81(4 Suppl):Abstract nr PS7-43.

The uptake of contralateral prophylactic mastectomy (CPM) has increased steadily over the last twenty years in women of all age groups and breast cancer stages. Since contralateral breast cancer is relatively rare and the breast cancer guidelines only recommend CPM in a small subset of patients with breast cancer, the drivers of this trend are unknown. This review aims to evaluate the evidence for and acceptability of CPM, data on patient rationales for choosing CPM, and some of the factors that might impact patient preferences. Based on the evidence, future recommendations will be provided. First, data on contralateral breast cancer risk and CPM rates and trends are addressed. After that, the evidence is structured around four main patient rationales for CPM formulated as questions that patients might ask their surgeon: Will CPM reduce mortality risk? Will CPM reduce the risk of contralateral breast cancer? Can I avoid future screening with CPM? Will I have better breast symmetry after CPM? Also, three different guidelines regarding CPM will be reviewed. Studies indicate a large gap between patient preferences for radical risk reduction with CPM and the current approaches recommended by important guidelines. We suggest a strategy including shared decision-making to enhance surgeons' communication with patients about contralateral breast cancer and treatment options, to empower patients in order to optimize the use of CPM incorporating accurate risk assessment and individual patient preferences.