To address these issues, we developed the RealRisks decision aid (DA) for women to screen for HBOC eligibility and the Breast Cancer Risk Navigation Tool (BNAV) for their clinicians.46,47 Both tools were designed by our study team using participatory design methods and pilot tested among ethnically diverse women at high risk for breast cancer.36,48,49,50 This cluster randomized clinical trial compared the effectiveness of RealRisks and BNAV to patient education alone in promoting appropriate uptake of BRCA1/2 genetic counseling. The gene discussed is BRCA1; the disease is breast cancer.