Core Elements of Shared Decision-making for Women Considering Breast Cancer Screening: Results of a Modified Delphi Survey

Abstract

BACKGROUND: The United States Preventive Services Task Force recommends individualized breast cancer screening for average-risk women before age 50, advised by risk assessment and shared decision-making (SDM). However, the foundational principles of this recommendation that would inform decision support tools for patients and primary care physicians at the point of care have not been codified. Determining the core elements of SDM for breast cancer screening as valued by patients and primary care providers (PCPs) is necessary for implementing effective SDM tools. The aim of this study is to affirm core elements of SDM in the context of clinical interactions, through a Delphi consensus process. METHODS: A Delphi was conducted with 30 participants (10 women aged 40-49, 10 PCPs, and 10 healthcare decision scientists), to codify core elements of breast cancer screening SDM. The criterion for establishing consensus was a threshold of 80% agreement. The Delphi concluded with an 83% response rate. RESULTS: Of 48 items fielded, 44 met the threshold on the high-importance end of the response scale and were accepted as core elements. Core elements across three thematic categories-information delivery and patient education, interpersonal clinician-patient communication, and framework of the decision-received panelists' support in nearly equal measure. Panelists unanimously agreed that SDM should include provision of clearly understandable information, including that of personal breast cancer risk factors, and benefits and harms of mammography screening, and that PCPs should convey they are listening, knowledgeable, and demonstrate cultural sensitivity. DISCUSSION: This research codifies the core elements of SDM for mammography in women 40-49, augmenting the evidence to inform discussions between patients and physicians. These core elements of SDM have the potential to operationalize SDM for breast cancer screening in an effort to improve public health outcomes.

Essential elements to “design for dissemination” within a research network—a modified Delphi study of the Community-Academic Aging Research Network (CAARN)

“…Lastly, the choice of a cut-off of 80% to determine consensus is arbitrary. In other studies, the cut-off has ranged from 70 to 80% [ 16 ], with a higher cut-off being favored for more homogeneous groups of panelists [ 33 ]. There were five items for which 70 to 79% of panelists deemed the item to be extremely or very important to CAARN’s success (Table 3 ), such as CRA having experience in establishing new partnerships, CRA providing input on the feasibility of the intervention and the packaging of materials for dissemination, and the Director being based at an academic organization.…”

Preliminary Evaluation of a Breast Cancer Screening Shared Decision-Making Aid Utilized Within the Primary Care Clinical Encounter

“…The Breast Cancer Screening Decision (BCSD) Core Components Checklist is derived from our previous work (26,27) and identifies 24 core components of breast cancer screening SDM that can be objectively observed from transcripts. A single coder (LD) evaluated transcripts to determine whether (“1”) or not (“0”) each component occurred within the clinical encounter.…”

Using Mixed Methods With Multiple Stakeholders to Inform Development of a Breast Cancer Screening Decision Aid for Women With Limited Health Literacy

“…We used the Delphi process to elicit feedback from content experts in successive rounds to build consensus on this complex topic. 12 – 14 Experts known to the study team from across the United States were invited to participate via email. Delphi panel sample sizes vary from <10 to 100+ depending on the research topic breadth and panelist expertise, heterogeneity, and availability.…”