Cultural and Linguistic Adaptation of a Breast Reconstruction Decision Tool

PROJECT SUMMARY/ABSTRACT Breast reconstruction is a critical component of breast cancer treatment because it restores quality of life and body image after mastectomy. It has become more common in the past 25 years, growing from 3 to 40% of mastectomy cases. However, Spanish-speaking Latina women who undergo mastectomy are the least likely to undergo reconstruction, meet with a reconstructive surgeon, or receive enough information about reconstruction. Those who do not have reconstruction experience the highest rates of dissatisfaction and regret about their decisions. Hispanic and Latino people are the largest minority population in the U.S. (19% of the population). Most (73%) primarily speak Spanish at home, and many (15%) feel uncomfortable with English. Persons diagnosed with cancer who primarily speak Spanish and identify as Latin American are less likely to receive guideline-concordant cancer treatments. Shared decision making and decision support can improve treatment decisions that are preference sensitive (the right choice depends on the person’s preferences). They result in higher patient knowledge and greater concordance between preferences and treatment. Unfortunately, most decision aids in the U.S. are in English and developed with few Latinx people. We have developed a decision aid for breast reconstruction called BREASTChoice, with proven efficacy and effectiveness in two randomized controlled trials. BREASTChoice was developed with extensive stakeholder engagement and includes a risk prediction model for personalized estimation of complication risk. Patients and clinicians are highly supportive of BREASTChoice and have asked for a Spanish language version that can be shared easily. Aim 1. Adapt BREASTChoice for Spanish-speaking Latina breast cancer survivors. We will interview Spanish-speaking Latina breast cancer survivors and other community-based key informants to culturally adapt and translate BREASTChoice. Our community partners, Living Beyond Breast Cancer and Latinas Contra Cancer, will help us identify participants. The adapted tool will be programmed as a mobile- friendly website. Aim 2. Assess usability and efficacy of the adapted BREASTChoice among Spanish-speaking Latina breast cancer survivors. We will conduct a pre-post evaluation among Spanish-speaking breast cancer survivors (N=50), who will use the tool and complete surveys before and after using it. Surveys will assess knowledge about breast reconstruction and the adapted tool’s usability. This study will result in the first culturally and linguistically relevant decision aid for breast reconstruction for Spanish speaking Latina breast cancer survivors. The decision aid’s format as a mobile friendly website will position it for wider dissemination and implementation because it will be portable and adaptable. The approach we use in this study will be widely applicable to other decision aids, so that decision support can reach Spanish-speaking Latinx populations.