Erratum: Efficient Identification and Referral of<i> </i>Low-Income Women at High Risk for Hereditary Breast Cancer: A Practice-Based Approach

<i>Background:</i> Identification of low-income women with the rare but serious risk of hereditary cancer and their referral to appropriate services presents an important public health challenge. We report the results of formative research to reach thousands of women for efficient identification of those at high risk and expedient access to free genetic services. External validity is maximized by emphasizing intervention fit with the two end-user organizations who must connect to make this possible. This study phase informed the design of a subsequent randomized controlled trial. <i>Methods:</i> We conducted a randomized controlled pilot study (n = 38) to compare two intervention models for feasibility and impact. The main outcome was receipt of genetic counseling during a two-month intervention period. Model 1 was based on the usual outcall protocol of an academic hospital genetic risk program, and Model 2 drew on the screening and referral procedures of a statewide toll-free phone line through which large numbers of high-risk women can be identified. In Model 1, the risk program proactively calls patients to schedule genetic counseling; for Model 2, women are notified of their eligibility for counseling and make the call themselves. We also developed and pretested a family history screener for administration by phone to identify women appropriate for genetic counseling. <i>Results:</i> There was no statistically significant difference in receipt of genetic counseling between women randomized to Model 1 (3/18) compared with Model 2 (3/20) during the intervention period. However, when unresponsive women in Model 2 were called after 2 months, 7 more obtained counseling; 4 women from Model 1 were also counseled after the intervention. Thus, the intervention model that closely aligned with the risk program’s outcall to high-risk women was found to be feasible and brought more low-income women to free genetic counseling. Our screener was easy to administer by phone and appeared to identify high-risk callers effectively. The model and screener are now in use in the main trial to test the effectiveness of this screening and referral intervention. A validation analysis of the screener is also underway. <i>Conclusion:</i> Identification of intervention strategies and tools, and their systematic comparison for impact and efficiency in the context where they will ultimately be used are critical elements of practice-based research.

<i>背景：</i> 识别患有罕见但严重遗传性癌症风险的低收入女性，并将其转诊至合适的医疗服务机构，是一项重要的公共卫生挑战。本研究报道了形成性研究（formative research）的结果，旨在触达数千名女性，以高效识别高风险人群并使其快速获得免费遗传咨询（genetic counseling）服务。为最大化外部效度（external validity），本研究强调干预方案需适配两家终端用户组织——唯有通过这两家组织的联动，该干预才能得以落地。本研究阶段为后续的随机对照试验（randomized controlled trial）设计提供了依据。<i>方法：</i> 本研究开展了一项随机对照预试验（randomized controlled pilot study），样本量为38例（n=38），旨在比较两种干预模型的可行性与干预效果。主要结局指标为为期2个月的干预周期内接受遗传咨询的情况。模型1基于学术医院遗传风险项目的常规外呼流程：即遗传风险项目主动致电患者，为其预约遗传咨询；模型2则依托全州免费热线的筛查与转诊流程——通过该热线可识别大量高风险女性。在模型2中，女性会收到自身符合遗传咨询资格的通知，随后自行致电预约。此外，本研究还开发并完成了一份家族史筛查问卷（family history screener）的电话施测预测试，以筛选适合接受遗传咨询的女性。<i>结果：</i> 干预周期内，被随机分配至模型1的女性（3/18）与模型2的女性（3/20）在接受遗传咨询的比例上未呈现统计学显著差异。然而，在2个月后对模型2中无响应的女性进行外呼后，另有7人接受了遗传咨询；模型1中也有4名女性在干预周期结束后完成了咨询。综上，与遗传风险项目面向高风险女性的外呼流程高度契合的干预模型被证实具备可行性，且能吸引更多低收入女性使用免费的遗传咨询服务。本研究开发的筛查问卷操作简便，可通过电话高效施测，并能有效识别高风险来电者。目前该干预模型与筛查问卷已在主试验中应用，用于检验该筛查转诊干预的有效性，同时针对该筛查问卷的效度验证分析也正在进行中。<i>结论：</i> 识别干预策略与工具，并在其最终应用的场景中系统比较其干预效果与效率，是基于实践的研究的核心要素。

搜集汇总

背景与挑战

背景概述

该数据集是一项医学研究，探讨了如何高效识别和转诊低收入女性中遗传性乳腺癌高风险人群，采用基于实践的方法。研究包括一个随机对照试点，比较两种干预模型，发现与风险项目紧密相关的模型更可行，能促进更多女性接受免费遗传咨询。数据集聚焦公共卫生干预，旨在减少健康差异，关键词涉及BRCA、低收入和差异等。