Effects by educational attainment of a mammography screening patient decision aid for women aged 75 years and older

Abstract

BACKGROUND:To help inform screening decisions, a mammography screening decision aid (DA) for women aged 75 years and older was tested in a cluster randomized clinical trial of 546 women. DA use increased women's knowledge of the benefits and harms of mammography and lowered screening rates. In the current study, the objective was to examine whether participants' views of the DA and/or its effects differed by educational attainment. METHODS: A secondary analysis was conducted of 283 women who received the DA before a personal care provider (PCP) visit during the trial to examine the acceptability of the DA and its effects on knowledge of the benefits and harms of mammography, screening intentions, and receipt of screening by educational attainment. Adjusted analyses accounted for clustering by PCP. RESULTS: Of the 283 participants, 43% had a college education or less. Regardless of educational attainment, 87.2% found the DA helpful. Women with lower educational attainment were less likely to understand all of the DA's content (46.3% vs 67.5%; P < .001), had less knowledge of the benefits and harms of mammography (adjusted mean ± standard error knowledge score, 7.1 ± 0.3 vs 8.1 ± 0.3; P < .001), and were less likely to lower screening intentions (adjusted percentage, 11.4% vs 19.4%; P = .01). Receipt of screening did not differ by educational attainment. CONCLUSIONS: A mammography DA for women aged 75 years and older was helpful to women regardless of their educational attainment; however, those with a college degree or greater understood the DA and, possibly as a result, lowered their screening intentions. Future studies need to examine how to better support informed decision making around mammography screening in older women with lower educational attainment.

Primary Care Providers’ Perceptions of the Acceptability, Appropriateness, and Feasibility of a Mammography Decision Aid for Women Aged 75 and Older

“…14 Also, 84% of patients found the DA helpful regardless of their educational attainment and 97% with a high-school degree or less reported understanding most or all of the DA's information. 31 Notably, these patients are the very patients that PCPs in the current study see. However, the DA was designed for patients to read before a visit and not to support clinician counseling during a visit, which may explain these discrepancies.…”

Breast cancer screening motivation and behaviours of women aged over 75 years: a scoping review

“…Women were enthusiastic about screening based on an interest in taking care of themselves but rely on their providers for health care decisions. Overall, most women found the DA helpful and would recommend the use of the DA Cadet 2021 USA [ 47 ] 283 aged 75–89 Quantitative Secondary analysis Association between women’s educational attainment and their knowledge of the benefits and harms of mammography Decisional conflict, change in screening intention, discussions with PCP and receipt of screening 3 Regardless of educational attainment, 87.2% of the 283 women found the DA helpful. Women with lower educational attainment were less likely to understand all the DA’s content (46.3% vs 67.5%; P < .001), had less knowledge of the benefits and harms of mammography (adjusted mean ± standard error knowledge score, 7.1 ± 0.3 vs 8.1 ± 0.3; P < .001), and were less likely to lower screening intentions (adjusted percentage, 11.4% vs 19.4%; P = .01).…”

Breast Cancer Screening in the Geriatric Population: Challenges and Future Considerations

“…1) [28••]. A tool such as this can help physicians have a productive discussion about ongoing screening and has been demonstrated effective regardless of education level [29].…”

“…Patients tend to overestimate the benefit of screening studies and are enthusiastic to continue these tests [27,30]. A qualitative study out of NYC found that older women with a long history of screening mammography viewed the test as a necessary and routine part of their care [29,31]. A study of utilizing decision aids in a group of African American women in Philadelphia, most often cited that "getting a mammogram may help me feel good about myself and my health" [32].…”

“…A randomized control trial looking at the effect of a patient decision aid in women over 75 found that it was helpful in educating patients on the role of screening, and such an aid resulted in the de-escalation of screening [29]. Patients can be educated.…”