LAUSR

Many discussions between physicians and their patients about the logic and rationale for different treatment recommendations are increasingly complex. The information required to aid educated decision-making requires careful balancing of the likely absolute benefits in terms of cure or preventing recurrence versus any treatment-related side effects. Few realise that medicine is an uncertain science where most facts are probabilities defined and refined by repeated hypothesis testing. In the context of life-threatening disease this can make communication with patients about risk and uncertainty challenging. Health literacy and numeracy skills in the general population are often poor, creating other communication difficulties; furthermore confusion increases when such conversations are set against a backdrop of fear and anxiety. Clinico-pathologic features traditionally help determine which women with early stage breast cancer are most likely to benefit from adjuvant chemotherapy, but many patients still believe that in life-threatening situations, more treatment must be better. Scores from gene expression profiling tests such as OncotypeDX®, EndoPredict® and Prosigna® may reduce some of the uncertainty and anxiety about omitting chemotherapy and increase the confidence of doctors helping patients with their decision-making.(1) However explaining high, intermediate and low risk test scores is not always straightforward especially when patients have widely varying personality and socio-educational characteristics. Both clinicians and their patients may also have a measurable intolerance to uncertainty that may contribute (irrespective of the recurrence score) to seemingly irrational decisions about treatment. This interactive session will incorporate materials from Talking About Risk in the context of Genomic Testing (TARGET), an evidence-based program (2) funded by the BCRF- This includes didactic presentations (PPT) exercises and video clips of doctors explaining risk scores from genomic tests. After attending the session participants should:- a) recognise how poor literacy and numeracy in general populations affects understanding about risk and decision-making b) understand how their own intolerance to uncertainty may ‘leak’ through into communication with patients and c) increase their repertoire of skills when explaining GEP scores to patients References 1. L Fallowfield, L Matthews, S May, V Jenkins, D Bloomfield. Psycho-oncology (2018) 27:4, 1264-1269 https://doi.org/10.1002/pon.4664 2. Fallowfield, L., Solis-Trapala, I., Starkings, R. et al. Breast Cancer Res Treat (2019) 177: 641. https://doi.org/10.1007/s10549-019-05316-7 Citation Format: L Fallowfield. Discussing risk & uncertainty with patients in the context of GEP testing [abstract]. In: Proceedings of the 2019 San Antonio Breast Cancer Symposium; 2019 Dec 10-14; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2020;80(4 Suppl):Abstract nr ES9-1.