Abstract P5-15-04: An intervention to help improve understanding of gene expression profiling tests in breast cancer: which is best, an information film or leaflet?

Background: Discussions between oncologists and patients about Gene Expression Profiling (GEP) risk of recurrence results can be challenging especially if scores are intermediate or close to the high or low risk of recurrence thresholds. Although many clinical teams provide patients with information leaflets, these often employ complex language written to meet regulatory guidelines rather than to educate effectively the end-user. We designed two 8-minute information films that were conversational in style with simple explanatory graphics. We then compared participants’ knowledge retention after reading leaflets explaining GEP tests and recurrence risks with that following their viewing of a film. Methods: Using a randomised factorial crossover design, at time-point one (T1) women aged 45-75 yrs without breast cancer, read either a leaflet about Oncotype DX or Prosigna testing or watched the corresponding information film. They could read or watch as many times as they liked and take notes. In structured interviews that were recorded, we asked 9 different questions to determine participants’ knowledge. Next day (T2) information in the opposite format was provided and knowledge was re-assessed. The maximum possible score was 18. Additional questions probed which modality participants had found the easiest to understand, their preferences for either the film or leaflet and reasons for these. Results: 120 women from different socio-educational groups took part, 60 of whom had Oncotype DX films and leaflets and 60 the Prosigna versions. Irrespective of the GEP test being described, their knowledge scores at T1 were significantly higher following viewing of the films compared with those after reading leaflets (mean difference 4.1 points; p<0.0001; 95% CI 3.2, 5.0). When participants read leaflets first and subsequently viewed films mean knowledge significantly increased (5.3 points, p<0.0001; 95% CI 4.4, 6.3). In contrast mean knowledge decreased by 2 points (p<0.01; 95% CI -3.1, -0.8) at T2 if the film was viewed first. Extraneous and sometimes irrelevant information already read in the leaflets had confused many participants. Overall clear preferences for the film were expressed (88/120; 73.3%); (leaflet = 28/120; 23.3%); 4/120; (3.3%) no preference. Primary reasons for this included the clarity, ease of understanding and the reassurance gained from the voice-overs in the films. Conclusion: Provision of complex information in a film format using simple graphics helped participants’ understanding of GEP test results more than reading information alone and was preferred significantly by the majority.