Selective estrogen receptor modulators (SERMs) reduce breast cancer risk. 
Adoption of SERMs as prevention medication remains low. This is the first study 
to quantify social, cultural, and psychologic factors driving decision making 
regarding SERM use in women counseled on breast cancer prevention options. A 
survey study was conducted with women counseled by a health care provider (HCP) 
about SERMs. A statistical comparison of responses was performed between those 
who decided to use and those who decided not to use SERMs. Independent factors 
associated with the decision were determined using logistic regression. Of 1,023 
participants, 726 made a decision: 324 (44.6%) decided to take a SERM and 402 
(55.4%) decided not to. The most important factor for deciding on SERM use was 
the HCP recommendation. Other characteristics associated with the decision 
included attitudes and perceptions regarding medication intake, breast cancer 
worry, trust in HCP, family members with blood clots, and others' experiences 
with SERMs. The odds of SERM intake when HCP recommended were higher for 
participants with a positive attitude toward taking medications than for those 
with a negative attitude (Pinteraction = 0.01). This study highlights the 
importance of social and cultural aspects for SERM decision making, most 
importantly personal beliefs and experiences. HCPs' recommendations play a 
statistically significant role in decision making and are more likely to be 
followed if in line with patients' attitudes. Results indicate the need for 
developing interventions for HCPs that not only focus on the presentation of 
medical information but, equally as important, on addressing patients' beliefs 
and experiences. Cancer Prev Res; 10(11); 625-34. ©2017 AACRSee related 
editorial by Crew, p. 609.