Breast cancer: a randomized controlled trial assessing the effect of a decision aid on mammography screening uptake: study protocol

Abstract

IntroductionBreast cancer (BC) is the primary cancer among women. The World Health Organization recommends a bilateral screening mammogram every 2 years for women aged 50 to 74 years. However, it has been shown that there is an absence of information about the benefits and risks of screening. Shared medical decision-making is important to ensure patients are involved in the decision process. Decision aids can facilitative this decision-making process. This article presents a protocol to evaluate the effect of a decision aid on participation rates in the French organized BC screening program.Methods and analysisDesign and setting. The design is a 2 arm randomized controlled study, performed in the Pays de la Loire region (French West Coast). Randomization will be based on general medicine practices (Primary Care).ParticipantsWomen aged between 50 and 74 years, eligible for BC screening. In this region, there are 75000 women, and 2800 general practitioners eligible for recruitment.InterventionIn the « Decision aid for organized cancer screening » arm, the intervention will distribute invitation letters to eligible women combined with the provision of decision aid to these women and their general practitioners and an incentive to implement shared medical decision-making. In the « Standard organized cancer screening » arm, only the screening invitation will be sent to eligible women.Primary endpointBC screening participation rates will be assessed after an 18-month follow-up period.Statistical analysisIn this non-inferiority trial, the percentage of women who are up-to-date with their screening at 18 months after the intervention will be compared across arms using a generalized mixed linear model.DiscussionThe research team expect to demonstrate that providing a better explanation of the benefits and risks of BC screening is not at odds with screening participation. The study results should help policy makers thinking about implementing shared medical decision-making within the framework of organized BC screening programs in the future.Ethics and disseminationOn 6 December 2021, the protocol received a favorable opinion from the French Committee for the Protection of Persons (2021-A01583-38). This study is registered with ClinicalTrials.gov, number NCT05607849. (Version 1, November 7, 2022; https://www.clinicaltrials.gov/ct2/show/NCT05607849). The study findings will be used for publication in peer-reviewed scientific journals and presentations in scientific meetings.

Development and evaluation of a decision aid for women eligible for organized breast cancer screening according to international standards: A multi-method study

“…This final process involves women and health professionals evaluating the acceptability of the first version of the DA, assessing how women make their choices in real-life conditions when using the DA, and evaluating the implementation of shared decision-making with the attending physician. The results will be taken into account in the final DA version [ 49 ]. This will be valuable as some studies have described DA development, however few report evaluating a DA to assist patients to decide whether or not to participate in a screening program [ 6 , 50 ].…”

“…Nevertheless, it is challenging to measure the performance of a screening tool that provides patient-appropriate information via participation rates in organized screening. Lastly, the continuing DEDICACES research project will evaluate the impact of DAs on the participation rate of women in organized screening for breast cancer through a randomized controlled trial [ 49 ]. An ancillary study will assess the determinants of shared decision-making, in particular the level of knowledge and decisional conflict [ 49 ].…”

“…Lastly, the continuing DEDICACES research project will evaluate the impact of DAs on the participation rate of women in organized screening for breast cancer through a randomized controlled trial [ 49 ]. An ancillary study will assess the determinants of shared decision-making, in particular the level of knowledge and decisional conflict [ 49 ].…”