Mammography Decision Aid Reduces Decisional Conflict for Women in Their Forties Considering Screening

Abstract

Background: Clinical guidelines recommend a personalized approach to mammography screening for women in their forties; however, methods to do so are lacking. An evidence-based mammography screening decision aid was developed as an electronic mobile application and evaluated in a before-after study. Methods: The decision aid (Mammopad) included modules on breast cancer, mammography, risk assessment, and priority setting about screening. Women aged 40-49 years who were patients of rural primary care clinics, had no major risk factors for breast cancer, and no mammography during the previous year were invited to use the decision aid. Twenty women participated in pretesting of the decision aid and 75 additional women completed the before-after study. The primary outcome was decisional conflict measured before and after using Mammopad. Secondary outcomes included decision self-efficacy and intention to begin or continue mammography screening. Differences comparing measures before versus after use were determined using Wilcoxon signed rank tests. Results: After using Mammopad, women reported reduced decisional conflict based on mean Decisional Conflict Scale scores overall (46.33 versus 8.33; Z = -7.225; p < 0.001) and on all subscales ( p < 0.001). Women also reported increased mean Decision Self-Efficacy Scale scores (79.67 versus 95.73; Z = 6.816, p < 0.001). Although 19% of women changed their screening intentions, this was not statistically significant. Conclusions: Women reported less conflict about their decisions for mammography screening, and felt more confident to make decisions after using Mammopad. This approach may help guide women through the decision making process to determine personalized screening choices that are appropriate for them.

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

“…This outcome is notably different from those reported for the use of many decision aids, including a recently published randomized controlled trial comparing 4 print formats for presenting information about 3 low-value screening tests, including the PSA test 43 ; a recent evaluation of a decision aid for mammography for women in their forties that reported a significant decrease in decisional conflict, but no significant change in screening intentions 44 ; and the a Almost all Hispanic participants left the race options blank, as they did not identify with race as a construct.…”

Evaluation of risk communication in a mammography patient decision aid

“…Women in rural areas are less likely to have had a mammogram or to have an up-to-date mammogram [28]. Details of recruitment and participant flow into the parent study, including risk screening with the B-RST, were reported previously [5]. …”

“…Mammopad included three modules: a breast cancer informational module, a mammography informational module, and an interactive priority-setting module, which allowed users to prioritize harms and benefits of screening and identify questions and concerns to discuss with providers [5]. A summary report was presented to participants, and emailed to them, if requested.…”

“…The present study partnered with a project evaluating changes in decision quality measures reported by patients after using Mammopad, a mobile device-optimized PtDA designed for patients to use prior to a clinic visit, either at home, or in a waiting room [5]. Mammopad helps average-risk women in their forties understand and consider the costs and benefits of screening mammography options, clarify their values in relation to those options, and empower them to discuss screening mammography with clinicians.…”

A Systematic Literature Review of Shared Decision Making in Cancer Care (Preprint)

“…[19,[30][31][32][33][34] Hypothesized to facilitate SDM, DAs help clinicians share evidence-based information and clinical uncertainty with patients to improve the quality of decision making. [35] However, it is important to note that not all DA interventions promote SDM [36,37] and not all SDM interventions involve DAs. [9,14,38,39] Past research on SDM is limited by the lack of both qualitative and quantitative information on how clinicians implement SDM, their fidelity to the principles of SDM, and whether the "interpersonal and interdependent processes in which the health care provider and the patient relate to and influence each other" [1,2] (i.e., authentic bi-directionality of information exchange and influence) actually takes place.…”