Dissemination of a breast reconstruction decision tool through social media and online communities

PROJECT SUMMARY Breast reconstruction after mastectomy is critical to comprehensive breast cancer treatment because it can restore quality of life and body image, which are often impaired after mastectomy. However, many patients are not offered reconstruction, especially those who identify as Black or Hispanic/Latina. Many patients lack

knowledge about breast reconstruction risks, and their choices about reconstruction often misalign with their preferences. We have developed a breast reconstruction decision aid called BREASTChoice and demonstrated its efficacy and effectiveness in two randomized controlled trials. Patients and clinicians found

BREASTChoice highly usable but requested a version they could use on a mobile device and easily share with family and friends. Like most decision aids, BREASTChoice’s implementation has been limited to clinical settings and had limited uptake. For dissemination of decision support to be successful, it must make decision

support available how, when, and where people want to use it. Dissemination through social media within online communities could broaden the reach of BREASTChoice and other decision tools. Most Americans use social media (81%) and use the internet for health information (72%). Even most older adults (60%) use the

internet. Breast cancer survivors are especially engaged in social media and online communities. Our preliminary data suggest that breast cancer survivors would engage with BREASTChoice through social media. Guided by the Designing for Dissemination paradigm, and in partnership with 3 cancer survivor and two

clinician organizations, we propose to adapt BREASTChoice and disseminate it through social media within online communities. Aim 1. Adapt BREASTChoice for mobile use and online dissemination. Guided by the ADAPT-ITT model, we will conduct iterative phases of testing in breast cancer survivors (n=45), qualitative

interviews with topical experts (n=10), and website programming changes. Adaptations will be tracked using FRAME. Aim 2. Design and test social media messages for dissemination of BREASTChoice. Guided by Diffusion of Innovations Theory, we will engage key community partners regarding potential adoption and

readiness for change; assess the social media dissemination context, including digital opinion leaders and platforms; and develop and test social media messages. Aim 3. Disseminate BREASTChoice to breast cancer survivors by leveraging social media. Using the adapted tool and tested messages, we will roll out a social

media campaign over 12 months. We will test the campaign’s exposure, reach, and engagement with interrupted time series analysis, and BREASTChoice effectiveness (surgery choice, decision quality, decisional conflict, satisfaction with decisions) through a longitudinal user survey. Upon completion of these aims, we will

have overcome a major scientific gap, the limited adoption of decision aids, and have developed a widely applicable approach to disseminating decision aids outside of clinical contexts.