A Comprehensive Informatics Framework to Increase Breast Cancer Risk Assessment and Chemoprevention in the Primary Care Setting

The U.S. Preventive Services Task Force recommends that clinicians engage in shared decision making with women at high-risk for breast cancer about medications to reduce their risk, also known as chemoprevention. However, uptake has been low (< 5%) in the primary care setting. The goal of this project was to implement a comprehensive informatics framework to increase breast cancer risk assessment and chemoprevention in the primary care setting. We built a novel breast cancer risk navigation (BNAV) tool, which incorporates the Gail breast cancer risk model into the electronic health record. To address patient-related barriers to chemoprevention, an interactive decision aid, RealRisks, was developed that allows participants to experience risk through an activity. An automated system of theory-based tailored messaging was built to alert providers to engage in guideline-concordant chemoprevention practices. This innovative technology has high potential to facilitate evidence-based decision support for women's health in primary care setting.