An Approach to Enhance Communication about Screening Mammography in Primary Care

Nekhlyudov, Larissa; Braddock, Clarence H.

doi:10.1089/jwh.2008.1184

Cited by 28 publications

(33 citation statements)

References 54 publications

(45 reference statements)

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“…22 Little research has focused on helping clinicians and patients overcome their biases as they present information about screening benefits, harms, and uncertainties and attempt to make informed and/or shared decisions. 23 The United States Preventive Services Task Force's (USPSTF) recommendation that women aged 40 to 49 years should make preference-based, individual decisions about mammography highlights the need for the development of effective, evidence-based approaches to help patients understand why seemingly counterintuitive recommendations might make sense. 24,25 The USPSTF recommendation against screening for prostate cancer with the prostate specific antigen (PSA) test 26 provides further impetus for such approaches.…”

Section: Introductionmentioning

confidence: 99%

Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions

et al. 2017

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PURPOSE We wanted to evaluate novel decision aids designed to help patients trust and accept the controversial, evidence-based, US Preventive Services Task Force recommendations about prostate cancer screening (from 2012) and mammography screening for women aged 40 to 49 years (from 2009). METHODSWe created recorded vignettes of physician-patient discussions about prostate cancer screening and mammography, accompanied by illustrative slides, based on principles derived from preceding qualitative work and behavioral science literature. We conducted a randomized crossover study with repeated measures with 27 men aged 50 to 74 years and 35 women aged 40 to 49 years. All participants saw a video intervention and a more traditional, paper-based decision aid intervention in random order. At entry and after seeing each intervention, they were surveyed about screening intentions, perceptions of benefits and harm, and decisional conflict.RESULTS Changes in screening intentions were analyzed without regard to order of intervention after an initial analyses showed no evidence of an order effect. At baseline, 69% of men and 86% of women reported wanting screening, with 31% and 6%, respectively, unsure. Mean change on a 3-point, yes, unsure, no scale was -0.93 (P = <.001) for men and -0.50 (P = <.001) for women after seeing the video interventions vs 0.0 and -0.06 (P = .75) after seeing the print interventions. At the study end, 33% of men and 49% of women wanted screening, and 11% and 20%, respectively, were unsure. CONCLUSIONS Our novel, persuasive video interventions significantly changed the screening intentions of substantial proportions of viewers. Our approach needs further testing but may provide a model for helping patients to consider and accept evidence-based, counterintuitive recommendations. 2017;15:48-55. https://doi.org/10.1370/afm.1996. Ann Fam Med INTRODUCTIONP atients face many medical decisions, and rarely is the evidence about the balance of benefits and harms so unequivocal that it can be assumed all patients would make the same choice if adequately informed. Evidence can be complicated and incomplete, and experts' recommendations may conflict. Even when there is an evidence-based recommendation for a specific medical decision, patients' values might lead to a different choice. Patients are exposed to social norms, media campaigns, and powerful anecdotes regarding testing.1,2 Furthermore, human decision making rarely fits the idealized model of a rational, informed process. 3,4 Order of presentation, loss-vs gain-based framing, anchor effects, and perceived norms can introduce biases, 5-10 and adding information can make decisions more difficult.11-14 Shortcuts (heuristics) used to simplify decisions often lead to suboptimal choices. 15,16 Thus, the ideal of the informed decision is difficult to achieve in practice. Charles et al note, "Patient preferences for information do not necesBarry G. Saver, MD 18 A Cochrane review of decision aids for treatment and screening decisions concluded there was...

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Section: Introductionmentioning

confidence: 99%

Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions

et al. 2017

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“…They are onerous, as is lack of structural capability in lower income residential areas. There are fewer primary care providers and mammography facilities, less preventive care, and the population often lacks transportation [6,[10][11][12][13][14][15][16][17][18][19][20]. Continuing efforts to reach lower income and African American populations include a community approach that reduces income, insurance, and other structural barriers with free or low-cost mammograms, and mobile units that schedule visits in medically underserved areas (MUAs) [6,8,19].…”

Section: Introductionmentioning

confidence: 99%

“…[12][13][14][15][16][17][18][19][20][21][22][23][24]. The role of health professionals in screening these populations is increasingly being acknowledged.…”

Section: Introductionmentioning

confidence: 99%

“…The role of health professionals in screening these populations is increasingly being acknowledged. They can be key figures in educating patients about the value of regular breast cancer screening [3,6,13]. Taken jointly with the fact that African American women are more likely to have a cancer subtype with high mortality, health professionals can, by encouraging regular screening, help reduce breast cancer mortality in this population [20,[22][23][24][25].…”

Section: Introductionmentioning

confidence: 99%

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Medical Barriers to Mammography Screening of African American Women in a High Cancer Mortality Area: Implications for Cancer Educators and Health Providers

2011

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African American women have a higher breast cancer mortality rate than whites even when cancer subtype is considered, are more likely to be diagnosed at a later stage, and are less likely to have mammography screening. Structural barriers limit screening but may be less important than clinical care and personal barriers among minority and lower income women. A random sample of 178 African American females aged >40 years from a high cancer risk area was surveyed to associate mammography screening with clinical, structural, and personal barriers. Clinical barriers including patient education and communication were significantly associated with lack of screening in previous 2 years. Personal barriers (lack of trust and knowledge) and structural barriers (lack of insurance, facilities, and providers) also reduced screening. Results reveal that medical practitioners should be more pro-active in reducing clinical barriers to mammography screening among lower income African American women. Improved patient physician communication, education about breast cancer to build knowledge and reduce fears, referral for mammography, and building trust are indicated.

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“…This framework strives to decrease the power divide between doctors and patients, which is achieved through a dynamic process in which both parties understand one another as equals and experts in their own fields (Briggs & Mantini-Briggs, 2009). The idea of a mutual exchange is central to this method, which involves shared decision-making between the patient and physician and the establishment of a common ground and trust (Nekhlyudov & Braddock, 2009). Shared decision-making allows for a relationship of "collaborative informed choice" (DiMatteo, 1994, p. 155), which instigates increased patient satisfaction, as patients tend to feel intelligent, valued, and empowered (e.g., Ellingson & Buzzanell, 1999;Street et al, 2009).…”

Section: Self-advocacymentioning

confidence: 99%

Risk, Activism, and Empowerment

Eid

Nahón-Serfaty

2015

International Journal of Civic Engagement and Social Change

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The prevalence of breast cancer in Venezuela is particularly alarming, which is attributed to healthcare inequalities, low health literacy, and lagging compliance with prevention methods (i.e., screening and mammography). While the right to health is acknowledged by the Venezuelan constitution, activism beyond governmental confines is required to increase women's breast cancer awareness and decrease mortality rates. Through the development of social support and strategic communicative methods enacted by healthcare providers, it may be possible to empower women with the tools necessary for breast cancer prevention. This paper discusses issues surrounding women's breast cancer, such as awareness of the disease and its risks, self-advocacy, and the roles of activists, healthcare providers, and society. Specifically, it describes a four-year action-oriented research project developed in Venezuela, which was a collaborative work among researchers, practitioners, NGOs, patients, journalists, and policymakers. The outcomes include higher levels of awareness and interest among community members and organizations to learn and seek more information about women's breast cancer, better understandings of the communicated messages, more media coverage and medical consultations, increasing positive patient treatments, expansion of networking of NGOs, as well as a widely supported declaration for a national response against breast cancer in Venezuela.

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An Approach to Enhance Communication about Screening Mammography in Primary Care

Cited by 28 publications

References 54 publications

Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions

Persuasive Interventions for Controversial Cancer Screening Recommendations: Testing a Novel Approach to Help Patients Make Evidence-Based Decisions

Medical Barriers to Mammography Screening of African American Women in a High Cancer Mortality Area: Implications for Cancer Educators and Health Providers

Risk, Activism, and Empowerment

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