Making Informed Choices On Incorporating Chemoprevention into carE (MiCHOICE, SWOG 1904): Design and methods of a cluster randomized controlled trial.

INTRODUCTION: Women with atypical hyperplasia (AH) or lobular carcinoma in situ (LCIS) have a significantly increased risk of breast cancer, which can be substantially reduced with antiestrogen therapy for chemoprevention. However, antiestrogen therapy for breast cancer risk reduction remains underutilized. Improving knowledge about breast cancer risk and chemoprevention among high-risk patients and their healthcare providers may enhance informed decision-making about this critical breast cancer risk reduction strategy. METHODS/DESIGN: We are conducting a cluster randomized controlled trial to evaluate the effectiveness and implementation of patient and provider decision support tools to improve informed choice about chemoprevention among women with AH or LCIS. We have cluster randomized 26 sites across the U.S. through the SWOG Cancer Research Network. A total of 415 patients and 200 healthcare providers are being recruited. They are assigned to standard educational materials alone or combined with the web-based decision support tools. Patient-reported and clinical outcomes are assessed at baseline, after a follow-up visit at 6 months, and yearly for 5 years. The primary outcome is chemoprevention informed choice after the follow-up visit. Secondary endpoints include other patient-reported outcomes, such as chemoprevention knowledge, decision conflict and regret, and self-reported chemoprevention usage. Barriers and facilitators to implementing decision support into clinic workflow are assessed through patient and provider interviews at baseline and mid-implementation. RESULTS/DISCUSSION: With this hybrid effectiveness/implementation study, we seek to evaluate if a multi-level intervention effectively promotes informed decision-making about chemoprevention and provide valuable insights on how the intervention is implemented in U.S. TRIAL REGISTRATION: NCT04496739.

Cause-specific mortality of white-tailed deer as influenced by military training activities in southwestern Oklahoma.

Radio-telemetry was used to monitor movements and mortality of 56 white-tailed deer (Odocoileus virginianus) in response to intensive military training activities on West Range (18,000 ha), Fort Sill Military Reservation, Oklahoma. Cause-specific mortality was determined for 22 radio-collared deer, including adults (greater than or equal to 2.0-yr-old), yearlings (0.6-1.9-yr-old), and fawns (less than or equal to 75-day-old age group) from 1987 to 1989. Winter home ranges were largely confined to a 14,411 ha impact area centrally located on West Range. The mean annual mortality rate was 0.50 for adults and yearlings combined. Fifty percent of all adult and yearling mortality was attributed to military training activities, 28% to hunting, 16% to collisions with automobiles, and 6% to unknown causes. The mean monthly mortality rate was 0.61 for neonatal fawns and predation accounted for three of four mortalities. All captured deer in the greater than or equal to 2.6-yr-old, 82% in the 1.6-yr-old, 10% in the 0.6-yr-old, and all deer in the less than 7-day-old age groups were seropositive for bluetongue virus (BTV). Our study strongly suggests that the consequences of military training activities should be considered in the management of white-tailed deer herds on military installations.